Glucose, glycation, and RAGE: Implications for amplification of cellular dysfunction in diabetic nephropathy

• Published in: Journal of the American Society of Nephrology Vol. 14; no. 5; pp. 1383 - 1395
• Main Authors: WENDT, Thoralf, TANJI, Nozomu, SCHMIDT, Ann Marie, GUO, Jiancheng, HUDSON, Barry I, BIERHAUS, Angelika, RAMASAMY, Ravichandran, ARNOLD, Bernd, NAWROTH, Peter P, SHI FANG YAN, D'AGATI, Vivette
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.05.2003
• Subjects: Animals; Biological and medical sciences; Blood Glucose - metabolism; Diabetic Nephropathies - metabolism; Glycation End Products, Advanced - metabolism; Humans; Kidneys; Medical sciences; Nephrology. Urinary tract diseases; Receptor for Advanced Glycation End Products; Receptors, Immunologic - metabolism; Urinary system involvement in other diseases. Miscellaneous; Endocrinopathy; Kidney disease; Human; Immunoglobulins; Urinary system disease; Ligand; Diabetes mellitus; Finished product; Terminal stage; Glucose; Homozygosity; Glycation; Nephropathy; Biological receptor
• DOI: 10.1097/01.ASN.0000065100.17349.CA
• ISSN: 1046-6673

Receptor for advanced glycation endproducts (RAGE) is a multi-ligand member of the immunoglobulin superfamily of cell surface molecules. Driven by rapid accumulation and expression of key ligands such as advanced glycation endproducts (AGE) and S100/calgranulins in diabetic tissues, upregulation and activation of RAGE magnifies cellular perturbation in tissues affected by hyperglycemia, such as the large blood vessels and the kidney. In the diabetic glomerulus, RAGE is expressed principally by glomerular visceral epithelial cells (podocytes). Blockade of RAGE in the hyperglycemic db/db mouse suppresses functional and structural alterations in the kidney, in the absence of alterations in blood glucose. Recent studies in homozygous RAGE null mice support a key role for RAGE in glomerular perturbation in diabetes. Importantly, beyond diabetes, studies in other settings of glomerulopathies support a critical RAGE-dependent pathway in podocytes linked to albuminuria, mesangial expansion, and glomerular sclerosis. A new paradigm is proposed in glomerular injury, and it is suggested that blockade of the RAGE axis may provide a novel means to prevent irreparable glomerular injury in diabetes and other sclerosing glomerulopathies.