Do adenosine receptors offer new therapeutic options for diabetic nephropathy?

Diabetes mellitus is currently considered to be an epidemic disease. Approximately a third of individuals with type 1 and type 2 diabetes develop persistent albuminuria, lose renal function, and are at increased risk of cardiovascular and other microvascular complications. Diabetic nephropathy (DN) is the primary cause of end stage renal disease throughout the world. Microvascular dysfunction in the glomerulus appears as an early pathogenic event in progression of this renal complication. In recent years, studies with animal knockout (KO) models have revealed that uncoupling of the vascular endothelial growth factor/nitric oxide (VEGF/NO) axis leads to the glomerular alterations that characterize diabetic nephropathy. Therefore, new therapeutic alternatives may usefully target VEGF overproduction or endothelial nitric oxide availability. Recent studies also demonstrate a role for adenosine receptors in glomerular physiology and VEGF production that looks promising for therapeutic intervention of the evolution of diabetic nephropathy. However further progress is required in order to understand the dynamics of local adenosine production, in particular the extracellular metabolism of adenine nucleotides by ectoenzymes and the role of nucleoside transporters on external adenosine accumulation in the glomerulus in the pathological state. So far there is no assay that is sufficiently sensitive and accurate for subclinical diagnoses of this renal disease, which is complicated and costly to patients with often devastating effects. Current studies using proteomics offer promising alternatives for the identification of new renal injury markers. It is hoped these will permit evaluation of new therapeutic tools for more opportune intervention of this disease.