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Effect of Oral carnosine supplementation on urinary TGF-β in diabetic nephropathy: a randomized controlled trial
Narongrit Siriwattanasit1, Bancha Satirapoj2, Ouppatham Supasyndh1
1Department of Medicine, Division of Nephrology, Phramongkutklao Hospital and College of Medicine, Bangkok, 10400, Thailand.
Background:
Activation of the transforming growth factor beta (TGF-β) pathway is a significant contributor to the pathogenesis of diabetic nephropathy. Carnosine is a dipeptide that can inhibit TGF-β synthesis. We tested the hypothesis that carnosine supplement added to standard therapy will result in reduced urinary TGF-β levels among patients with diabetic nephropathy.
Methods:
We randomly assigned 40 patients with diabetic nephropathy and albuminuria 30-299 mg/day to treatment with carnosine (2 g/day) or placebo for 12 weeks. Urinary TGF-β level was determined using ELISA, urine albumin was ascertained by immunonephelometric assay, and renal function and metabolic profiles were determined at baseline and during 12 weeks of active treatment. Primary outcome was decrease in urinary levels of TGF-β.
Results:
The 2 groups were comparable for baseline characteristics, blood pressure, urine albumin, urine TGF-β and renal function measurements. Urinary TGF-β significantly decreased with carnosine supplement (- 17.8% of the baseline values), whereas it tended to increase with placebo (+ 16.9% of the baseline values) (between-group difference P < 0.05). However, blood urea nitrogen, serum creatinine, glomerular filtration rate and other biochemical parameters remained unchanged during the study period including urinary albuminuria. Both groups were well tolerated with no serious side-effects.
Conclusions:
These data indicated an additional renoprotective effect of oral supplementation with carnosine to decrease urinary TGF-β level that serves as a marker of renal injury in diabetic nephropathy.
Trial Registration:
Thai Clinical Trials, TCTR20200724002 . Retrospectively Registered 24 July 2020.
Insights
Carnosine supplementation significantly reduced urinary transforming growth factor beta (TGF-β) levels in patients with diabetic nephropathy. This suggests carnosine offers a renoprotective effect, potentially aiding in managing kidney injury.
Area of Science:
- Nephrology
- Endocrinology
- Pharmacology
Background:
- Diabetic nephropathy pathogenesis involves the transforming growth factor beta (TGF-β) pathway.
- Carnosine, a dipeptide, has demonstrated inhibitory effects on TGF-β synthesis.
- Investigating carnosine's efficacy in reducing urinary TGF-β in diabetic nephropathy patients is crucial.
Purpose of the Study:
- To evaluate the effect of carnosine supplementation on urinary TGF-β levels in patients with diabetic nephropathy.
- To determine if carnosine, as an adjunct to standard therapy, can reduce markers of renal injury.
Main Methods:
- A randomized controlled trial involving 40 patients with diabetic nephropathy and albuminuria.
- Participants received either 2g/day of carnosine or a placebo for 12 weeks.
- Urinary TGF-β levels were measured using ELISA; urine albumin and renal function were assessed at baseline and during treatment.
Main Results:
- Urinary TGF-β levels significantly decreased by 17.8% in the carnosine group, while increasing by 16.9% in the placebo group (P < 0.05).
- No significant changes were observed in blood urea nitrogen, serum creatinine, glomerular filtration rate, or urinary albuminuria.
- Both treatments were well-tolerated with no serious adverse events.
Conclusions:
- Oral carnosine supplementation demonstrates an additional renoprotective effect in diabetic nephropathy.
- Carnosine effectively decreases urinary TGF-β levels, a key marker of renal injury.
- Further research may explore carnosine's long-term impact on diabetic nephropathy progression.
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