Heparins in diabetic microangiopathy: rationale and preliminary clinical results

It has been postulated, based upon epidemiological data, that genetic differences in the enzymes involved in the sulphation of glycosaminoglycan (GAG) side-chains of heparan sulphate (HS) proteoglycans are of crucial importance in the pathogenesis of diabetic nephropathy. An alteration in GAG metabolism is also believed to be responsible for the well-known co-occurrence of diabetic nephropathy and extrarenal micro- and macroangiopathy. In this article, recent in-vitro and in-vivo studies on the role of HS-GAG in the pathogenesis of diabetic nephropathy are discussed. Preliminary data suggest that HS-GAG treatment may be of benefit in patients with insulin-dependent diabetes mellitus, nephropathy and retinopathy. Results in patients with non-insulin-dependent diabetes mellitus are less convincing, although not completely negative.