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Diabetes Publish Ahead of Print published online ahead of print February 19, 2008
DOI: 10.2337/db07-1726

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Original Research

Urinary Smad1 is a novel marker to predict later onset of mesangial matrix expansion in diabetic nephropathy

Akira Mima1, Hidenori Arai2, Takeshi Matsubara1, Hideharu Abe5, Kojiro Nagai6, Yukinori Tamura3, Kazuo Torikoshi1, Makoto Araki1, Hiroshi Kanamori1, Toshikazu Takahashi5, Tatsuya Tominaga5, Motokazu Matsuura5, Noriyuki Iehara1, Atsushi Fukatsu1, Toru Kita4, and Toshio Doi5

1Departments of Nephrology
2Geriatric Medicine
3Clinical Innovative Medicine, and
4Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
5Department of Clinical Biology and Medicine, Tokushima University Graduate School of Medicine, Tokushima 770-8503, Japan
6Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, U.S.A

Objective: We reported that Smad1 is a key transcriptional factor for mesangial matrix expansion in diabetic nephropathy. In this study, we examined whether urinary Smad1 in an early phase of diabetes can predict later development of glomerulosclerosis in diabetic nephropathy, and how an angiotensin II receptor blocker (ARB) can modulate structural changes and urinary markers.

Research design and Methods: Smad1 and albumin in the urine were examined 4 weeks after injection of streptozotocin in 48 rats or 6 weeks diabetes in db/db mice. Their renal pathology was analyzed after 20 weeks in rats or 12 weeks in mice. Among 48 diabetic rats 7 rats were treated with olmesartan for 20 weeks.

Results: Urinary Smad1 at 4 weeks of diabetic rats was nicely correlated with mesangial matrix expansion at 24 weeks (r=0.70, P<0.001), while albuminuria showed a weaker association (r=0.31, P=0.043). Olmesartan treatment significantly ameliorated glomerulosclerosis, and dramatically decreased urinary Smad1 (from 3.9±2.9 to 0.3±0.3 ng/mg creatinine, P < 0.05). In db/db mice, urinary Smad1 at 6 weeks was also significantly correlated with mesangial expansion at 18 weeks. In contrast, there was no change in urinary Smad1 in control diabetic rats or mice.

Conclusions: The increase of urinary Smad1 in an early stage of diabetes is correlated with later development of glomerulosclerosis in two rodent models. These data indicate that urinary Smad1 could be a novel predictor for later onset of morphological changes and can be used to monitor the effect of ARB in diabetic nephropathy.


Correspondence: harai{at}kuhp.kyoto-u.ac.jp


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H. Kato, H. Si, T. Hostetter, and K. Susztak
Smad1 as a Biomarker for Diabetic Nephropathy
Diabetes, June 1, 2008; 57(6): 1459 - 1460.
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