“New Hope on the Horizon: Scientists Unlock Key to Slowing Progression of Diabetic Kidney Disease”
Scientists have identified the mechanism by which a commonly used blood pressure drug slows the progression of kidney damage caused by diabetes.
Researchers at the University of Bristol have discovered that spironolactone has a protective effect on the kidney’s blood vessels, which helps reduce the leakage of proteins into the urine.
Recent clinical trials have shown that spironolactone is an effective treatment for slowing the progression of diabetic kidney disease, but the drug can cause adverse side effects, including high levels of potassium in the blood – hyperkalemia – in patients.
The experts said their findings, published in the journal JCI Insight, could help scientists find new alternative treatments that don’t have adverse side effects.
It is believed that almost five million people in the UK have diabetes.
Diabetics are about four times more likely to need either dialysis or a kidney transplant.
An international team of scientists, including experts from Bristol Medical School, investigated how spironolactone prevents kidney damage.
They found that the drug had a protective effect by helping to maintain a gel-like layer on the surface of the blood vessels in the kidney known as the glycocalyx.
The team found that spironolactone reduced the activity of a group of enzymes called matrix metalloproteases and helped preserve the glycocalyx layer.
dr Matthew Butler, senior co-author of the study, Consulting Senior Lecturer and Clinical Scientist at the MRC at the University of Bristol and Honorary Advisor in Nephrology at the North Bristol NHS Trust (NBT), said: “This study is really exciting for us because it confirms this blocking Mineralocorticoid receptors with spironolactone maintain renal function by acting on the glycocalyx.
“Our next steps will be to investigate repurpose drugs that target matrix metalloprotease enzymes (MMPs) to see if they could be of benefit in patients with kidney disease and avoid the troublesome side effects associated with mineralocorticoid receptor blockers are.
“If we see the same level of protection when using these more specific drugs, patients will see significant benefits while avoiding the risks associated with high blood potassium levels.”
dr Faye Riley, Research Communications Manager at Diabetes UK, which funded the study, said: “Kidney damage is a common complication in people with diabetes.
“If it’s caught early enough, treatment can slow it down – but the options are limited once it’s advanced.”
“By piecing together exactly how an existing drug works to slow kidney damage, this early-stage research gives us insight into more effective ways to stop kidney damage and prevent kidney failure.”
“We look forward to further research to harness this potential and help people with diabetes live well and longer.”
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