D.N. is one of the major complications of D.M. Several pathogenic mechanisms have been
• proposed, such as the presence of glomerular hyperfilteration (and/or hyperperfusion), high activity
of protein kinase C, increased nonenzymatic glycosylation of proteins, hypercoagulability,
involvement of cytokines, growth factors, heriditary factors and several enzymes that degrade
ECM.
The four main types are aspartic, cysteine, serine proteinases and MMPs. Of these enzymes.
MMPs are thought to play an important role in the pathogenesis of D.N. In an attempt to clan& the
role of MMP-9 in DN among type 2 diabetics and its relation to microalbuminurea we select 25
patients with type 2 diabetes with no evidence of DN (no macro or microalbuminurea). (gp I) 40
patients with type 2 DM with evidence of DN (gp II) and 15 apparently healthy age and sex
matched subjects as a control group (gp HI). MMP-9 was significantly elevated in the gp II
(1085.55±191.18) than in gp 1(517.92±119.99) and gp ifi (192.28±79.32). Microalbuminurea was
significantly elevated also in gp 11 (63.03±14.53) than in gp I (17.12±3.93) and gp III (13.23±4.64).
Then: wa.s a positive correlation between MMP-9 and disease duration and serum creatinine level
amen"; patients in gp 1 Also there was a positive linear relationship between MMP-9 and
inicm.ilbuminurca among patients in gp II
So we conclude that NIMP-9 was significantly higher among patients with type 2 DM and
more significantly elesated among those with D.N. and Itnearly correlated with microalbuminurea.
We rccommend that elevated MMP-9 in Type 2 DM may early predict D.N. but further studies
were needed to localize the presence of MMP-9 in the diabetic human kidney and to determine the
unnary level of this powerful proteinase to clear cut its role in D.N and therapeutic inhibition of
this KIMP-9 may improve the outcome of D.N. |
