Biomedical subjects

M P Cohen

Publications and source records attributed to M P Cohen.

At least 19 recordsLinked to original sources

PubMed2001

Identification of calnexin as a binding protein for Amadori-modified glycated albumin.

Albumin modified by Amadori glucose adducts (glycated albumin) selectively binds to glomerular mesangial cells and triggers signal transduction processes that modulate cellular function. To identify glycated albumin binding proteins, we applied membrane extracts prepared from murine mesangial cells to a column of lysine-Sepharose followed by application to an affinity column of fructosyllysine-Sepharose. This procedure yielded an approximately 90 kDa polypeptide that immunoreacted with Amadori-modified but not carbohydrate-free albumin. MALDI mass fingerprinting matched 9 out of 25 peptides with calnexin, and amino acid analysis showed homology with this transmembrane calcium-binding protein of the calreticulin family. These results indicate that one of the mesangial cell receptors for glycated albumin is a calnexin-like protein.

Animals↗

PubMed2001

ERK mediates effects of glycated albumin in mesangial cells.

The alterations in glomerular cell biology induced by glycated albumin resemble those caused by high ambient glucose, but are operative in physiologic (5.5 mM) glucose concentration. Recently, high glucose has been shown to activate extracellular signal-related kinase (ERK) in mesangial cells, but whether the mitogen-activated protein kinase (MAPK) cascade participates in signal transduction triggered by glycated albumin is unknown. Using a specific inhibitor of MAPK/ERK kinase, we demonstrate for the first time that activation of ERK is required for the inhibition of cell growth and enhanced elaboration of extracellular matrix protein provoked by glycated albumin. These findings indicate that the MAPK/ERK pathway mediates biologic activities of this glycated protein.

Animals↗

PubMed2001

Glycated albumin stimulates TGF-beta 1 production and protein kinase C activity in glomerular endothelial cells.

BACKGROUND: The activation of protein kinase C (PKC) and transforming growth factor-beta (TGF-beta) in glomerular mesangial cells has been linked to mesangial matrix expansion in diabetic nephropathy. The role of these mediators in affecting the changes associated with diabetes in the biology of glomerular endothelial cells (GEnCs), which synthesize components of the glomerular basement membrane, is not known. We postulated that the PKC and TGF-beta systems promote the increased endothelial cell synthesis of glomerular basement membrane that is evoked by Amadori-modified glycated albumin, which is present in elevated concentrations in diabetes. METHODS: We examined the effects of PKC inhibition on collagen IV and TGF-beta1 production by mouse GEnCs incubated with glycated albumin and the influence of glycated albumin on PKC activity, TGF-beta 1 production, and proliferation by these cells. RESULTS: In physiologic (5.5 mmol/L) glucose concentrations, glycated albumin caused an increase in type IV collagen production that was totally prevented by a general PKC inhibitor GF 109203X (GFX), but only partly prevented by a neutralizing anti-TGF-beta antibody. Glycated albumin increased the steady-state level of TGF-beta 1 mRNA and stimulated the production of TGF-beta 1 protein, which was also prevented by the PKC inhibitor GFX. Of note, glycated albumin significantly stimulated PKC activity, as measured by the phosphorylation of a PKC-specific substrate. Cell proliferation, measured by [(3)H]-thymidine incorporation and cell counting, was decreased in the presence of glycated albumin. This effect was completely prevented by GFX and partially reversed by anti-TGF-beta antibody. Exogenous TGF-beta 1 inhibited cell proliferation to a degree similar to that of glycated albumin. CONCLUSIONS: PKC signaling and consequent TGF-beta 1 activation participate in the glycated albumin-induced stimulation of basement membrane collagen production by GEnC. By reducing the proliferative capacity, which is likely mediated by PKC and partly by TGF-beta, glycated albumin impedes the ability of the glomerular capillary endothelium to act as a first line of defense against deleterious circulating factors in the diabetic state.

Animals↗

PubMed2001

Increased urinary type IV collagen marks the development of glomerular pathology in diabetic d/db mice.

The diabetic db/db mouse exhibits increased albumin excretion soon after the onset of obesity and hyperglycemia, and later manifests glomerular mesangial matrix expansion resembling that found in human diabetic nephropathy. Since the glomerular lesion in this rodent model of type 2 diabetes is associated with renal overexpression of mRNA encoding type IV collagen, we postulated that changes in the urinary excretion of collagen IV may reflect developing glomerular pathology. To explore this hypothesis, we monitored urinary collagen IV (measured by immunoassay) in db/db mice during the course of evolution of nephropathy. At age 8 weeks, collagen IV excretion was not different in diabetic compared to nondiabetic animals despite marked albuminuria, but was significantly increased in db/db compared to db/m mice at age 12 and 16 weeks. Serum levels of collagen IV did not significantly differ between normal versus diabetic mice at any age. Glomerular morphometry revealed mesangial matrix expansion at age 12 weeks, coincident with the rise in collagen IV excretion, which became more marked at age 16 weeks in association with reduced creatinine clearance and elevated serum creatinine. The findings suggest that increased urinary type IV collagen is a better indicator than albuminuria of developing glomerular matrix accumulation that results in compromised renal filtration function.

Albuminuria↗

PubMed2001

Postoperative morbidity, mortality, costs, and long-term survival in severely obese patients undergoing orthotopic liver transplantation.

OBJECTIVE: Severely obese patients who undergo orthotopic liver transplantation are likely to have higher morbidity, mortality, costs, and a lower long-term survival. METHODS: This case-control study was done at a university hospital. One hundred twenty-one consecutive patients who underwent liver transplantation between 1994 and 1996 were studied. Severe obesity was defined as body mass index (BMI) more than 95th percentile (>32.3 for women and >31.1 for men), and moderate obesity was defined as BMI between 27.3 and 32.3 for women and 27.8 and 31.1 for men. The outcome measures were intraoperative complications, postoperative complications (wound infections, bile leak, vascular complications), length of hospital stay, costs of transplantation, and long-term survival RESULTS: The baseline characteristics, UNOS status, and cause of liver disease at the time of transplantation were similar in severely obese (n = 21, BMI = 37.4+/-4.8 kg/m2), obese (n = 36, BMI 28.7+/-0.9 kg/m2), and nonobese patients (n = 64, BMI 23.8+/-2.5 kg/m2). The intraoperative complications and transfusion requirements were similar in all three groups. The postoperative complications such as respiratory failure (p = 0.009) and systemic vascular complications (p = 0.04) were significantly higher in severely obese patients. The overall perioperative complication rate was 0.61 (39 of 64 patients) in nonobese patients, 0.77 (28 of 36 patients) in obese patients, and 1.43 (30 of 21 patients) in severely obese patients (p = 0.01). Infections were the leading cause of death in all groups accounting for 57-66% of deaths. The length of hospital stay was significantly higher in obese patients. The hospital costs of transplantation were higher ($30,000-$40,000) in severely obese patients than in nonobese patients. The long-term patient survival was similar between the groups (Kaplan-Meier analysis). CONCLUSIONS: Despite higher postoperative complications, severely obese patients have an acceptable long-term survival, which is comparable to nonobese patients. The cost of transplantation is higher among severely obese patients. There was no increased incidence of cardiovascular mortality among severely obese patients during the follow-up period.

Adult↗

PubMed2001

Increased collagen IV excretion in diabetes. A marker of compromised filtration function.

OBJECTIVE: Increased albumin excretion in diabetes is believed to be derived from hemodynamic and/or permeability abnormalities, whereas mesangial matrix expansion gives rise to the reduction in glomerular filtration surface and decline in renal function in diabetic nephropathy. We postulated that the overproduction of extracellular matrix proteins underlying glomerulosclerosis in diabetes might be associated with the excretion of increased amounts of type IV collagen in the urine. RESEARCH DESIGN AND METHODS: To explore this hypothesis, we measured the urinary excretion of (human) collagen IV by immunoassay in 65 patients with type 1 or type 2 diabetes and various degrees of albuminuria and examined its relationship to filtration function assessed by the reciprocal of the serum creatinine (RSC). RESULTS: Collagen IV excretion showed a significant (P < 0.001) inverse correlation (r = -0.62) with the RSC, and this correlation pertained regardless of whether albumin cxcretion was in the low (< or =< or = 100 microg/mg creatinine r = -0.73) or high (>100 microg/mg; r = -0.53) range. In contrast, albumin excretion showed insignificant correlation with either collagen IV excretion (r = 0.12) or with the RSC (r = -0.20). Urinary collagen IV was significantly higher (P < 0.05) in patients with an RSC value < or = 100 (28.3 +/- 2.4 ng/mg creatinine) than in patients with an RSC value > 100 (16.0 +/- 0.8 ng/mg creatinine). CONCLUSIONS: Because not all patients with microalbuminuria progress to declining renal function and some patients who develop nephropathy do not manifest albuminuria, the findings in this cross-sectional analysis suggest that measurement of urine collagen IV may be a useful noninvasive indicator to detect diabetic renal disease entering a phase of compromised renal function.

Adult↗

PubMed2001

Serum type IV collagen in diabetic patients at risk for nephropathy.

OBJECTIVE: Whereas increased urinary excretion of type IV collagen, which is believed to reflect renal overproduction of this extracellular matrix protein in early diabetic nephropathy, has been confirmed in several studies, examination of serum concentrations of this analyte has yielded conflicting results. We sought to clarify the relationship between early renal dysfunction in diabetes and circulating type IV collagen concentrations. RESEARCH DESIGN AND METHODS: We measured serum (human) collagen IV concentrations by immunoassay in 109 patients with type 1 or type 2 diabetes and various amounts of albuminuria extending from the normo- to the macroalbuminuric range, and we examined its relationship to albumin excretion and to serum creatinine levels. RESULTS: Serum collagen IV concentrations (mean +/- SEM) were not significantly different in normoalbuminuric (219 +/- 10 ng/ml), microalbuminuric (209 +/- 6 ng/ml), or macroalbuminuric (206 +/- 7 ng/ml) diabetic subjects or in nondiabetic normal volunteers (206 +/- 10 ng/ml). Collagen IV concentrations showed no significant correlation (P > 0.25) with albumin excretion (r = -0.001), HbA(1c) (r = 0.030), or serum creatinine (r = -0.161) and were unrelated to urinary excretion of collagen IV in the subset of subjects in whom these data were available. CONCLUSIONS: The results of this cross-sectional analysis discount the utility of measurement of the serum concentration of collagen IV as an indicator of early renal dysfunction in diabetes. Increased urine excretion of collagen IV without a significant change in the serum concentration is consistent with a renal origin of this analyte in early diabetic nephropathy.

Albuminuria↗

PubMed2000

Amadori-glycated albumin in diabetic nephropathy: pathophysiologic connections.

Amadori-glycated albumin in diabetic nephropathy: Pathophysiologic connections. Nonenzymatic glycation of proteins represents a major mechanism by which hyperglycemia leads to diabetic renal disease. Recent research has shown that Amadori-modified albumin, the principal glycated protein in plasma, elicits pathobiologic effects in cultured renal cells that are identical to those of high ambient glucose. When added to the incubation media of glomerular mesangial and endothelial cells, glycated albumin stimulates protein kinase C (PKC) activity, increases transforming growth factor-beta (TGF-beta) bioactivity, and induces gene overexpression and enhanced production of extracellular matrix proteins. These cellular events, whereby PKC-mediated TGF-beta activation leads to increased matrix expression, are inextricably linked, and they form the central tenets of a pathophysiologic connection between glycated proteins and diabetic nephropathy. In vivo studies further corroborate the role of glycated proteins in the pathogenesis of diabetic nephropathy. Reduction or neutralization of glycated albumin in the db/db mouse model of type 2 diabetes significantly ameliorates the proteinuria, renal insufficiency, mesangial expansion, and overexpression of matrix proteins. In human type 1 diabetes, the plasma-glycated albumin concentration is independently associated with the presence of nephropathy. Abrogating the biologic effects of increased glycated albumin has novel therapeutic potential in the management of renal complications in diabetes.

Animals↗

PubMed1999

Measuring glycated proteins: clinical and methodological aspects.

The recognition that nonenzymatic glycation, wherein free sugar condenses with certain reactive protein amino groups, is increased in hyperglycemic states has led to improved means for assessing diabetic control through the measurement of concentrations of glycated proteins in the circulation. This article reviews the chemistry, methods for measurement, and clinical relevance of circulating glycated proteins in the management of diabetes.

Animals↗

PubMed1999

Glycated albumin stimulation of PKC-beta activity is linked to increased collagen IV in mesangial cells.

Albumin modified by Amadori-glucose adducts induces coordinate increases in the expression of extracellular matrix proteins, transforming growth factor (TGF)-beta1, and the TGF-beta type II receptor in glomerular mesangial cells. Because activation of protein kinase C (PKC) accompanies the increased mesangial cell expression of matrix proteins and TGF-beta1 induced by high ambient glucose, we postulated that glycated albumin (GA) modulates PKC activity and that PKC participates in mediating the GA-induced stimulation of matrix production. To test this hypothesis, we examined the effects of PKC inhibitors on collagen type IV production by mouse or rat mesangial cells incubated with GA, and the influence of GA on PKC activity in these cells. Increased collagen type IV production evoked by GA in 5.5 and 25 mM glucose in mouse mesangial cells was prevented by both general (GF-109203X) and beta-specific (LY-379196) PKC inhibitors. Total PKC activity, measured by phosphorylation of a PKC-specific substrate, increased with time after exposure of rat mesangial cells to GA compared with the nonglycated, glucose-free counterpart. GA caused an increase in PKC-beta1 membrane-bound fraction and in total PKC activity in media containing physiological (5.5 mM) glucose concentrations in rat mesangial cells, confirming that the glucose-modified protein, and not a "hyperglycemic" milieu, was responsible. The findings indicate that Amadori-modified albumin stimulates mesangial cell PKC activity, and that activation of the PKC-beta isoform is linked to the stimulation of collagen type IV production.

Animals↗

PubMed1998

Glycated albumin stimulates fibronectin gene expression in glomerular mesangial cells: involvement of the transforming growth factor-beta system.

Albumin modified by Amadori glucose adducts, formed in increased amounts in diabetes, stimulates collagen IV production and gene expression in renal glomerular mesangial cells, and induces mesangial matrix accumulation accompanied by increased mRNA encoding alpha 1 (IV) collagen and fibronectin in diabetic animals. These effects contribute to the pathogenesis of diabetic nephropathy, and resemble biologic activities of the cytokine TGF-beta 1, which also has been causally implicated in diabetic renal disease. We postulated that Amadori-modified glycated albumin modulates TGF-beta 1 expression in mesangial cells, and that TGF-beta 1 participates in mediating the glycated albumin-induced increases in mesangial cell matrix production. To test this hypothesis, we measured mRNA encoding TGF-beta 1, the TGF-beta Type II receptor and fibronectin, a key matrix component of the TGF-beta 1 tissue response, after incubation of mesangial cells with glycated albumin. Steady state levels of the mRNAs encoding for these proteins were stimulated when mesangial cells were cultured in the presence of albumin containing Amadori glucose adducts compared with levels in cells cultured with the nonglycated, glucose-free counterpart. The glycated protein-induced changes in mRNA expression were observed with concentrations of glycated albumin encompassing those found in clinical specimens and in media containing physiologic (5.5 mM) glucose concentrations, indicating that they were due to the glucose-modified protein and not to a hyperglycemic milieu. Further, they were accompanied by increased translated fibronectin protein, which was prevented with TGF-beta neutralizing antibody, as was the glycated albumin-induced increase in fibronectin mRNA. The findings indicate that Amadori-modified glycated albumin stimulates mesangial cell TGF-beta 1 gene expression by mechanisms that are operative under normoglycemic conditions. These data provide the first link between elevated glycated serum albumin concentrations and increased TGF-beta 1 bioactivity in the pathogenesis of mesangial matrix accumulation in diabetes.

Animals↗

PubMed1997

Glycated albumin stimulates fibronectin and collagen IV production by glomerular endothelial cells under normoglycemic conditions.

Albumin modified by Amadori glucose adducts, formed in increased amounts in diabetes, stimulates the synthesis of matrix by renal glomerular mesangial cells and has been causally linked to the pathogenesis of diabetic nephropathy. However, the effect of glycated albumin on the biology of glomerular endothelial cells, which elaborate a basement membrane that undergoes thickening in diabetes, has not been investigated. We used well-characterized rat glomerular endothelial cells to examine the influence of glycated albumin on the synthesis of extracellular matrix proteins by these cells in culture. Concentrations of glycated albumin that are present in clinical specimens stimulate fibronectin and collagen IV production by glomerular endothelial cells, and this effect is operative under normoglycemic conditions. These results support the hypothesis that increased glycated albumin contributes to glomerular basement membrane thickening in diabetes.

Animals↗

PubMed1997

RAGE mRNA expression in the diabetic mouse kidney.

Receptors for advanced glycation end products (RAGE), which bind and internalize AGE-modified proteins formed from oxidation and other products of the nonenzymatic glycation reaction, have been mechanistically implicated in the development of the chronic complications of diabetes. In the present experiments, we sought evidence for the participation of RAGE in diabetic nephropathy by analysis of steady state levels of mRNA encoding RAGE in the renal cortex of a well-defined animal model (the db/db mouse) that develops renal pathology similar to that found in human diabetes. In these animals, increased AGE-product formation was confirmed by measurement of fluorescence in serum and renal cortex proteins. Renal involvement was confirmed by demonstration of increased urine albumin excretion and elevated serum creatinine concentrations relative to nondiabetic (db/m) littermate controls. Despite elevated concentrations of circulating and tissue AGE-modified proteins, the level of RAGE mRNA expression in renal cortex of diabetic mice did not significantly differ from that in nondiabetic littermate controls. The findings militate against changes in RAGE expression in the pathogenesis of renal abnormalities in this animal model.

Albuminuria↗

PubMed1996

Glycated albumin promotes a generalized vasculopathy in the db/db mouse.

Increased protein glycation has been mechanistically linked to accelerated vascular pathobiology in diabetes. Because glycated albumin induces biosynthetic abnormalities in cultured aortic endothelial cells that resemble those associated with macrovascular disease, we sought evidence that increased glycated albumin is operative in the genesis of diabetic vasculopathy in vivo. Plasma concentrations of fibronectin, a sensitive marker of endothelial cell damage, were increased two-fold in diabetic db/db mice compared with their nondiabetic db/m littermates. Treatment with monoclonal antibodies specifically reactive with albumin modified by Amadori glucose adducts normalized fibronectin in diabetic animals despite persistent hyperglycemia. These findings suggest that increased glycated albumin causally contributes to diabetic vasculopathy, and that blocking this influence ameliorates vascular damage.

Aging↗

PubMed1996

Prevention of decline in renal function in the diabetic db/db mouse.

We recently reported that when diabetic db/db mice, which develop glomerular pathology resembling that in human diabetes mellitus, are treated with monoclonal antibodies (A717) that neutralize the effects of excess glycated albumin, there is an amelioration of mesangial expansion, renal overexpression of mRNAs encoding for the extracellular matrix proteins collagen IV and fibronectin and proteinuria. These findings suggested that A717 might also retard the development of compromised renal function in this animal model. To examine this possibility, serum creatinine and blood urea nitrogen (BUN) were measured in diabetic db/db mice and their non-diabetic db/m littermates before and after an 8-week course of treatment with A717 or irrelevant murine immunoglobulin (MIg). Early in the course of diabetes, BUN and serum creatinine concentrations did not significantly differ from those in the db/m littermates, but were significantly increased after 10 weeks of sustained hyperglycaemia. Treatment of db/db mice with A717 prevented the rise in creatinine and attenuated the elevation in BUN. A717 also prevented the decrease in creatinine clearance observed in diabetic compared with non-diabetic animals (2.2 +/- 0.8 vs 4.1 +/- 0.3 vs 5.0 +/- 1.1 ml/h in db/db vs db/db-A717 vs db/m, respectively). MIg did not alter the change in renal function with time in db/db mice. Taken together with our previous results, the present findings indicate that the diabetic db/db mouse develops changes in renal function and structure that parallel the course of human diabetic nephropathy in nature and chronology and demonstrate, for the first time, that therapy directed against increased glycated albumin can prevent the decline in renal function in this rodent model of genetic diabetes.

Analysis of Variance↗

PubMed1996

The design and synthesis of substituted biphenyl libraries.

A novel scaffold system for the generation of diversity libraries has been designed which allows for rapid modification not only of functional groups, but their spatial arrangements as well. The biphenyl scaffold allows for display of three or four diverse functional groups in a wide variety of spatial arrangements depending on the substitution pattern selected. The libraries are generated by a combination of solution and solid-phase chemistries and are cleaved off the solid-support for screening.

Biphenyl Compounds↗

PubMed1996

Role of Amadori-modified nonenzymatically glycated serum proteins in the pathogenesis of diabetic nephropathy.

Accelerated nonenzymatic glycation in diabetes, resulting in Amadori-modified proteins and the later-developing advanced glycation end-products, has been mechanistically linked to the pathogenesis of diabetic nephropathy. Recent focus on putative AGE-induced pathophysiology has shifted attention from the possible role of Amadori-modified proteins in the development of diabetic complications. Ample experimental evidence has demonstrated that Amadori-modified serum proteins adversely affect renal glomerular capillary function, structure, and metabolism. Previous studies from the laboratories of this study's authors have shown that human serum containing diabetic concentrations of albumin modified by Amadori-glucose adducts inhibits the replication of murine mesangial cells in culture and stimulates the production and gene expression of type IV collagen. Monoclonal antibodies (A717) specific for Amadori-glycated albumin prevent these abnormalities. In other studies, it has also been shown that in vivo administration of A717 (Fab fragments) retards the progression of diabetic nephropathy in diabetic db/db mice. Neutralizing the effects of the elevated circulating glycated albumin concentration is associated with reduction in proteinuria and mesangial matrix expansion, and prevention of the overexpression of mRNA encoding type IV collagen and fibronectin in the renal cortex. The renoprotective effects of A717 are independent of any change in blood glucose concentrations. These studies implicate Amadori-modified glycated albumin in the pathogenesis of diabetic nephropathy. It is proposed in this study that abrogating the biologic effects of increased glycated albumin in diabetes has novel therapeutic potential in the management of diabetic renal complications.

Aging↗

PubMed1995

Albumin modified by Amadori glucose adducts activates mesangial cell type IV collagen gene transcription.

The direct relationship between elevated glucose concentrations and accelerated protein glycation has implicated increased glycation as a potential mechanistic link between hyperglycemia and the pathogenesis of diabetic nephropathy. Albumin modified by Amadori glucose adducts has been shown to stimulate collagen secretion by mesangial cells in vitro, and to contribute to the overproduction of glomerular mesangial matrix in vivo. To delineate mechanisms responsible for these effects, we examined the influence of glycated albumin on transcriptional activation of the alpha 1 (IV) collagen gene in renal glomerular mesangial cells. These experiments used a stably transfected reporter mesangial cell line that exhibits responses to media manipulations that are directionally parallel with those of non-transformed mesangial cells, and that expresses luciferase driven by 5'-flanking and first intron regions of the alpha 1 (IV) collagen gene. In these cells, purified glycated albumin stimulated collagen IV gene transcription, whereas glucose-free albumin did not. Further, glycated albumin induced a significant increase in mesangial cell collagen IV mRNA, assessed by Northern blot analysis and quantified by calculation of the ratio of collagen IV mRNA to 18S ribosomal RNA after densitometric scanning. The stimulation of collagen gene transcription and mRNA expression were both prevented by monoclonal antibodies known to specifically recognize Amadori-modified albumin. The findings indicate that glycated albumin promotes mesangial cell transcriptional activation and mRNA expression of the alpha 1 (IV) collagen gene and further implicate increased glycated albumin in diabetes in the pathogenesis of diabetic nephropathy.

Animals↗