Flavonoids on diabetic nephropathy: advances and therapeutic opportunities

• Published in: Chinese medicine Vol. 16; no. 1; pp. 1 - 74
• Main Authors: Hu, Qichao, Qu, Caiyan, Xiao, Xiaolin, Zhang, Wenwen, Jiang, Yinxiao, Wu, Zhao, Song, Dan, Peng, Xi, Ma, Xiao, Zhao, YanLing
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 07.08.2021; BioMed Central; BMC
• Subjects: Antioxidants; Autophagy; Baicalin; Bioflavonoids; Creatinine; Diabetes; Diabetes mellitus; Diabetic nephropathies; Diabetic nephropathy; Diabetics; Drug discovery; Drugs; Extracellular matrix; Flavones; Flavonoids; Free radicals; GA-binding protein; Genistein; Growth factors; Health aspects; Hesperidin; Hyperglycemia; Inflammation; Interleukin 1; Interleukin 6; Kaempferol; Kidney diseases; Kidney fibrosis; Kinases; Metabolic disorders; Natural products; Nephropathy; NF-κB protein; Oxidative stress; Pathogenesis; Phagocytosis; Podocyte autophagy; Public health; Quercetin; Review; Rutin; SIRT1 protein; Smad protein; Transforming growth factor-b1; Transforming growth factors; Tumor necrosis factor-α; Type 2 diabetes
• ISSN: 1749-8546; 1749-8546
• DOI: 10.1186/s13020-021-00485-4

With the advances in biomedical technologies, natural products have attracted substantial public attention in the area of drug discovery. Flavonoids are a class of active natural products with a wide range of pharmacological effects that are used for the treatment of several diseases, in particular chronic metabolic diseases. Diabetic nephropathy is a complication of diabetes with a particularly complicated pathological mechanism that affects at least 30% of diabetic patients and represents a great burden on public health. A large number of studies have shown that flavonoids can alleviate diabetic nephropathy. This review systematically summarizes the use of common flavonoids for the treatment of diabetic nephropathy. We found that flavonoids play a therapeutic role in diabetic nephropathy mainly by regulating oxidative stress and inflammation. Nrf-2/GSH, ROS production, HO-1, TGF-β1 and AGEs/RAGE are involved in the process of oxidative stress regulation. Quercetin, apigenin, baicalin, luteolin, hesperidin, genistein, proanthocyanidin and eriodictyol were found to be capable of alleviating oxidative stress related to the aforementioned factors. Regarding inflammatory responses, IL-1, IL-6β, TNF-α, SIRT1, NF-κB, and TGF-β1/smad are thought to be essential. Quercetin, kaempferol, myricetin, rutin, genistein, proanthocyanidin and eriodictyol were confirmed to influence the above targets. As a result, flavonoids promote podocyte autophagy and inhibit the overactivity of RAAS by suppressing the upstream oxidative stress and inflammatory pathways, ultimately alleviating DN. The above results indicate that flavonoids are promising drugs for the treatment of diabetic nephropathy. However, due to deficiencies in the effect of flavonoids on metabolic processes and their lack of structural stability in the body, further research is required to address these issues.