Soluble Receptor for Advanced Glycation End Products: a new biomarker in diagnosis of' Diabetic Nephropathy
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Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria (>300 mg/d or >200 meg/min). The interaction of advanced glycation end products with their cellular receptor (RAGE) is implicated in the pathogenesis of diabetic vascular complications. RAGE has a circulating secretory receptor form, soluble RAGE (sRAGE), which, by neutralizing the action of advanced glycation end products, might exert a protective role against the development of cardiovascular disease. Objective: to study the serum levels of sRAGE in type 2 diabetic patients and to clarify the possible association with urinary albumin excretion as an early marker of microvascular damage. Patients and Methods: Eighty subjects divided into two groups; group I (patients group) included 60 type 2 diabetic patients. They were subdivided into 2 subgroups: twenty normo-albuminuric diabetic subgroup and forty micro-albuminuric diabetic subgroup. Group II (control group) included 20 apparently healthy individuals of matched age and sex. All cases were subjected for estimation of sRAGE by sandwich ELISA technique together with routine laboratory investigations including fasting blood glucose, s. creatinine, cholesterol, triglycerides, HDL-C, LDL-C, HbA1C and Microalbumin. Results: sRAGE was significantly lower in microalbuminuric diabetic than normoalbuminuric diabetic and control groups (p<0.05). There was a positive significant correlation between sRAGE and HDL-cholesterol and a negative significant correlation between sRAGE and creatinine, total cholesterol, triglycerides, LDL-cholesterol HbA IC and microalbutnin. Conclusion: The present study found that sRAGE blood levels are lower in diabetic patients who have renal complications, supporting the hypothesis that sRAGE, by limiting the interaction of AGE with cell membrane RAGE, can protect vessels against AGE toxicity. Thus, stimulation of sRAGE production should be considered as a potential therapeutic target in diabetes and AGE-related vascular disease.