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A potential pathological role of angiopoietins expression in glomeruli during progressive glomerulisclerosis related to podocyte injury.

A potential pathological role of angiopoietins (Ang) in glomeruli following podocyte injury-induced progressive glomerulosclerosis was explored. Eighty male Wistar rats were randomly allocated into sham operation group (Sham, n = 25), Uninephrectomy group (UPHT, n = 25) and Uninephrectomy+Daunorubicin group (DRB, n = 30). In DRB group, daunorubicin (5 mg/kg) was injected via tail vein on the 7th and 14th day after uninephrectomy. At week 1, 2, 4, 6 and 8 respectively following establishment of the animal model, 5 rats in Sham group and UPHT group, and 6 in DRB group were taken respectively for determining 24-h urinary protein excretion rate (24hUPER), blood urea nitrogen (BUN) and serum creatinine (Scr). The sections of kidneys were examined by an electric microscope, PAS staining, immunohistochemical staining and in situ hybridization histochemistry. The results showed that 24hUPER, BUN and Scr in DRB group were more than those in Sham group and UPHT group at the same time points, and there was a trend towards an increase on level of GSI in DRB group from week 2 to week 8. Electric microscopy revealed that podocyte injury presented in DRB group. The expression of Ang1 mRNA and protein in glomeruli of DRB group was decreased, while the expression of Ang2 protein in glomeruli of DRB group increased. Meanwhile, the expression of Ang1 mRNA had a negative correlation with the expression of Ang2 mRNA, and the expression of Ang1 protein had a positive correlation with the expression of Ang1 mRNA, and had a negative correlation with 24hUPER, BUN, Scr, glomerular sclerotic index (GSI), the expression of Ang2 protein and CoIV protein. The expression of Ang2 protein had a positive correlation with the expression of Ang2 mRNA, and had a positive correlation with 24hUPER, BUN, Scr, GSI, the expression of CoIV protein. It was concluded that podocyte injury might lead to an alteration in the expression of Ang1 and Ang2 within glomeruli. Ang2 may get rid of inhibition from Ang1 for downregulation of the Ang1 expression, which facilitate upregulation of the Ang2 expression in glomeruli to promote progressive glomerulosclerosis in the rats.

Angiopoietin-1↗

The renin-angiotensin system in glomerular podocytes: mediator of glomerulosclerosis and link to hypertensive nephropathy.

The renoprotective effects of pharmacologic inhibition of angiotensin II extend beyond the blood pressure-lowering effects alone, consistent with the observation that angiotensin II is produced locally within the kidney and mediates tissue injury through a series of nonhemodynamic effects. Podocytes are terminally differentiated epithelial cells that contribute to the filtration barrier of the kidney, but also safeguard against the development of glomerulosclerosis. Mounting evidence demonstrates that podocytes are not only a local source of angiotensin II production, but are also vulnerable to its deleterious effects, thus fueling the future development of glomerular scarring. In this review article, we explore the role of a local angiotensin system as a mediator of podocyte injury and discuss its potential link to hypertensive renal disease.

Angiotensin II↗

Screening and identification of substances that regulate nephrin gene expression using engineered reporter podocytes.

Downregulation of nephrin in podocytes leads to development of proteinuria in human and experimental kidney diseases. However, little is understood about pathophysiologic substances that regulate nephrin expression. In this report, we established conditionally immortalized reporter podocytes REPON for sensitive, continuous monitoring of nephrin gene expression. A murine podocyte cell line harboring a temperature-sensitive simian virus 40 large T antigen was stably transfected with a gene encoding secreted alkaline phosphatase (SEAP) under the control of the 5.4 or 8.3 kb nephrin gene promoter. The established reporter cells REPON5.4 and REPON8.3 were exposed to various pathophysiologic substances, and culture media were subjected to SEAP assay to identify regulators of nephrin gene expression. Among the bioactive substances tested, three physiological ligands of nuclear receptors including all-trans-retinoic acid, 1,25-dihydroxyvitamin D3, and dexamethasone significantly activated the nephrin gene promoter in a dose-dependent manner. These effects were observed in both REPON5.4 and REPON8.3 and were associated with upregulation of nephrin mRNA. The effects of these substances were synergistic, and the maximum effect was observed by combination of three agents. In contrast, inflammatory cytokines interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha as well as phorbol ester significantly downregulated the activity of the nephrin promoter as well as nephrin gene expression. These results elucidated the bidirectional regulation of nephrin by distinct pathophysiologic substances and may provide molecular bases for explaining how proteinuria is induced under pathologic situations and why some ligands for nuclear receptors have the anti-proteinuric potential.

Alkaline Phosphatase↗

Monoclonal antibody against rat podocyte-derived macrophagic cells reacts with crescent-forming cells in an experimental model.

The origin of crescent-forming cells in crescentic glomerulonephritis has not been clarified in spite of the application of monoclonal antibodies (mAbs) against glomerular epithelial cells or monocytes/macrophages. This study was undertaken to characterize the cellular composition of crescents using a new marker, mAb OS-3, produced against macrophagic cells derived from podocytes in normal rat glomerular culture. Monoclonal antibody OS-3 was confirmed to be reactive with some normal epithelial cells of Bowman's capsule. Female Wistar Kyoto rats were injected with rabbit antiglomerular basement membrane (GBM) serum and killed at 2 h, 1, 3, 7, 14 days and 2 months, respectively. The mAb OS-3-positive cells were segmentally observed in glomeruli at 3 days, increased at 14 days, but decreased at 2 months. These cells lacked reactivity with antipodocalyxin in double immunofluorescence (IF) staining. In immunoelectron microscopy of a glomerulus on day 3 and 7, however, reaction products were observed within cells located on the outer surface of the GBM, which were considered to be podocyte in terms of its localization. In conclusion, we have shown a possibility that damaged podocytes partly constitute crescent-forming cells with phenotypic changes, visualized by positive staining with mAb OS-3. We propose a novel concept of crescent formation, suggesting that crescents may be partly composed of phenotypically changed cells, which could not be detected by typical markers for glomerular epithelial cells or monocytes/macrophages.

Animals↗

Single and combination toxic metal exposures induce apoptosis in cultured murine podocytes exclusively via the extrinsic caspase 8 pathway.

Arsenite, cadmium, and mercury are among the most abundant toxic metals (TM) in the environment. Although the most common renal manifestation of TM toxicity is proximal tubular dysfunction, significant glomerular injury can also occur. We hypothesized that glomerular injury following TM exposure results from TM-induced apoptosis of podocytes. To test this hypothesis we examined the extent of apoptosis and the apoptotic pathways induced in cultured murine podocytes incubated for three days with arsenite, cadmium, or mercury, and with equimolar combinations of all three metals. Apoptosis was detected by DNA laddering, and the number of apoptotic nuclei determined by Tunel assay. Treatment for three days with each TM resulted in DNA laddering and induced a dose-dependent increase in apoptotic nuclei. In contrast, treatment with equimolar combinations of TM induced significantly fewer apoptotic nuclei than individual TM treatments. Apoptosis induced by each TM was associated with a significant (approximately 400%) increase in caspase 8 activity, but no change in caspase 9 activity, and Western analyses revealed a marked up-regulation of Fas (approximately 500%) and FADD (approximately 300%) with no change in expression of Bax, Bcl-2, or Bcl-xL. Similar to the apoptotic response, combinations of TM induced less caspase 8 activity and Fas/FADD expression than individual TM treatments. Collectively, these results demonstrate that (1) TM induced apoptosis in cultured murine podocytes via the extrinsic Fas-FADD caspase 8 pathway, rather than the mitochondrial apoptotic pathway, and (2) combination TM exposure induced less apoptosis than individual TM, indicating an antagonistic rather than an additive or synergistic toxicity.

Adaptor Proteins, Signal Transducing↗

Characterization of glucose uptake by cultured rat podocytes.

The nonmetabolizable glucose analogue [(3)H]-2-deoxy-D-glucose ((3)H-2DG) was used to study glucose transport in cultured rat podocytes. Intracellular accumulation of (3)H-2DG was linear up to 20 min and was inhibited by cytochalasin B (80% inhibition) and by phlorizin (20% inhibition). Pretreatment with insulin stimulated the (3)H-2DG uptake 1.5-fold. A Hill analysis of the rate of glucose transport yielded a V(max) value of approximately 10 mM and S(0.5)of 7.8 mM. The value h = 1.0 for a Hill coefficient confirmed that glucose uptake exhibited a Michaelis-Menten kinetics. Transporters GLUT2 and GLUT4 were expressed in over 90% podocytes. Of the GLUT2- and GLUT4-expressing cells, approximately one-fourth expressed the membrane-bound fraction. We conclude that cultured rat podocytes possess a differentiated glucose transport system consisting chiefly of facilitative GLUT2 and GLUT4 transporters. It seems likely that a sodium-dependent glucose cotransporter may also be present in these cells.

Animals↗

ERK-dependent signaling pathway and transcriptional factor Ets-1 regulate matrix metalloproteinase-9 production in transforming growth factor-beta1 stimulated glomerular podocytes.

The unregulated synthesis of glomerular basement membrane (GBM) components, extracelluar matrix (ECM) proteins, or the secretion of ECM-degradation enzymes, matrix metalloproteinases (MMPs), by podocytes under pathological conditions might be major factors in GBM damage. The present study examined the effects and the underlying molecular mechanism of transforming growth factor beta1 (TGFbeta1) on the production of gelatinase in cultured murine podocytes. Our results showed that TGFbeta1 is the most potent inducer of MMP-9 secretion in both a dose- and time-dependent manner, but has very little effect on MMP-2 secretion. TGFbeta1 upregulated MMP-9 mRNA levels, but did not affect the expression of matrix mettaloproteinases TIMP-1 mRNA. TGFbeta1 induced activation of both Smad2 and extracellular signal-regulated kinases (ERK1/2). However, blockade of Smad2 signaling pathway by Staurosporine did not affect the TGFbeta1-stimulated secretion of MMP-9, whereas inhibition of activation of ERK1/2 by PD98059 abolished TGFbeta1-stimulated secretion of MMP-9 and expression of MMP-9 mRNA. Protein levels of the transcriptional factor Ets-1 increased and were sustained for 12 h by TGFbeta1-stimulation. Our data also showed that blockage of ERK1/2 activation by PD98059 led to a reduction in the level of Ets-1 protein and to a consequent decrease in MMP-9 mRNA levels. These results demonstrate that TGFbeta1 can induce the production of MMP-9 in podocytes through the ERK1/2 MAPK pathway, and suggested that an increase in MMP-9 enzymatic activities may be involved in the damage of the GBM in response to inflammatory factors, ultimately leading to glomerulosclerosis.

Animals↗

Transactivation of the epidermal growth factor receptor by angiotensin II in glomerular podocytes.

BACKGROUND/AIMS: Activation of angiotensin II (ANG2) receptors stimulates extracellular signal-regulated kinases (ERKs) that, in some cell systems, are mediated by transactivating the epidermal growth factor (EGF) receptor (EGFR) through mechanisms involving matrix metalloprotease (MMP)-stimulated processing of heparin-binding EGF (HB-EGF) from its precursor. METHODS: The signaling pathways linked to ANG2-dependent ERK activation were determined in an immortalized mouse podocyte cell line by monitoring ANG2-stimulated phosphorylation of ERK1/2. RESULTS: ANG2 induced transient ERK phosphorylation that was maximal at 5 min and then rapidly dissipated. ANG2-dependent ERK activation was inhibited by: (1) the type-1 ANG2-selective antagonist losartan; (2) the type-2 ANG2-selective antagonist PD123319; (3) an inhibitor of MMP2/9; (4) the EGFR kinase inhibitor AG1478, and (5) the HB-EGF antagonists CRM197 and heparin. ANG2-dependent ERK activation was mediated by both protein kinase C (PKC)- and calcium-dependent mechanisms and was associated with tyrosine phosphorylation of EGFR. To determine if ANG2-dependent HB-EGF release could act in a paracrine fashion on adjacent cells, HEK293 cells were stably transfected with green fluorescent protein-tagged ERK2 (GFP-ERK2). In stably transfected HEK293 cells, EGF stimulated phosphorylation of endogenous ERK1/2 as well as GFP-ERK2. In contrast, ANG2 had no effect on ERK phosphorylation in stably transfected HEK293 cells. When podocytes were co-cultured with stably transfected HEK293 cells, however, treatment with ANG2 rapidly stimulated GFP-ERK2 phosphorylation. Both the MMP2/9 inhibitor and AG1478 attenuated ANG2-dependent phosphorylation of GFP-ERK2 in the co-culture system. CONCLUSIONS: These data indicate that ERK activation is induced by ANG2 in podocytes by mechanisms involving ANG2-dependent release of HB-EGF which, in turn, may act in an autocrine and paracrine fashion to stimulate ERK activity.

Angiotensin II↗

Direct effect of plasma permeability factors from patients with idiopatic FSGS on nephrin and podocin expression in human podocytes.

The presence of circulating plasma factors (PF) altering renal permeability to proteins has been previously described in patients with focal segmental glomerulosclerosis (FSGS). Since these patients show reduced nephrin and podocin expression at renal biopsy, we evaluated the effect of serum and PF from patients with FSGS on nephrin and podocin expression in human podocytes. We studied 7 sera from patients with steroid-resistant FSGS, 3 from patients with nephrotic syndrome caused by non-immune disease, and 6 from healthy subjects. PF was prepared from plasmapheresis eluates of 2 patients with post-transplant recurrence of FSGS. Purification procedure was based on protein A Sepharose chromatography and differential precipitation in ammonium sulphate. Nephrin and podocin expression was semi-quantitatively evaluated by immunofluorescence. We found that serum and PF from FSGS patients rapidly induced redistribution and loss of nephrin in podocytes. This effect was associated with cytoskeleton redistribution and inhibited by cytochalasin B and sodium azide. On the contrary, podocin expression was unchanged after incubation with serum and PF from FSGS patients for short periods, but markedly reduced at 24 h. Our results demonstrate that serum and PF from FSGS patients may directly affect nephrin and podocin in human podocytes, thus providing new insights into the mechanisms causing proteinuria in FSGS.

Adolescent↗

Immunoexpression of podocyte-associated proteins in acquired human glomerulopathies with nephrotic syndrome.

CD2AP, alpha-actinin-4 and podocalyxin are thought to play an important role in the structure and function of glomerular podocytes, therefore we intended to evaluate quantitatively, using computer image analysis system, the immunoexpression of these proteins in renal biopsy specimens in glomerulopathies presented with nephrotic syndrome: minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS) and nephropathy IgA (IgAN). As a control 10 biopsy specimens of the kidneys removed because of trauma were used. In normal kidneys CD2AP, alpha-actinin-4, and podocalyxin showed intense staining in podocytes along the capillary walls of the glomeruli. The intensity of immunoexpression of CD2AP and alpha-actinin-4 in renal tissue in patients with MCD, FSGS, and IgAN was similar to normal controls, but the distribution of these proteins was more granular in glomeruli of diseased kidney. The immunostaining of podocalyxin was weaker in podocytes in patients with FSGS as compared with normal glomeruli. The immunostaining of podocalyxin was not significantly altered in MCD and IgAN. The immunostaining of CD2AP and alpha-actinin-4 did not correlate with the intensity of proteinuria in patients with MCD, FSGS and IgAN, whilst in FSGS patients the significant correlation was found between the glomerular immunostaining of podocalyxin and proteinuria. In conclusion, revealed in our study diminished immunoexpression of podocalyxin and significant correlation with the level of proteinuria in FSGS patients suggests a possible role of this sialoprotein in the alteration of the glomerular filtration barrier in this disease.

Actinin↗

Podocyte-specific expression of cre recombinase in transgenic mice.

We report a transgenic mouse line that expresses Cre recombinase exclusively in podocytes. Twenty- four transgenic founders were generated in which Cre recombinase was placed under the regulation of a 2.5-kb fragment of the human NPHS2 promoter. Previously, this fragment was shown to drive beta-galactosidase (beta-gal) expression exclusively in podocytes of transgenic mice. For analysis, founder mice were bred with ROSA26 mice, a reporter line that expresses beta-gal in cells that undergo Cre recombination. Eight of 24 founder lines were found to express beta-gal exclusively in the kidney. Histological analysis of the kidneys showed that beta-gal expression was confined to podocytes. Cre recombination occurred during the capillary loop stage in glomerular development. No evidence for Cre recombination was detected in any of 14 other tissues examined.

Animals↗

Podocyte process effacement in vivo.

Foot process effacement is the most characteristic change in podocyte structure under a wide variety of human and experimental glomerulopathies with heavy proteinuria. It consists of simplification and even total disappearance of the interdigitating foot process pattern, resulting in the formation of a diffuse cytoplasmic sheet along the glomerular basement membrane. Although abundant evidence related to structural changes in podocyte foot processes has been reported, cellular or molecular mechanisms that occur within podocytes during the development of foot process effacement remain unclear. This review summarizes recent advances concerning structural and functional aspects of foot process effacement in vivo. Following a description of the general morphology of foot process effacement, the role of the cytoskeleton and its related proteins in the effacement are discussed. Finally, the relevance of foot process effacement in glomerular function is considered.

Animals↗

Deduction from Wilms' tumour that glomerular podocytes produce the basement membrane material bearing Goodpasture determinants.

Using an indirect immunoperoxidase technique, we tested frozen specimens from one Wilms' tumour composed of numerous glomeruloid bodies devoid of blood vessels, with monoclonal antibodies directed against vimentin, cytokeratin, CALLA/CD10, CD24, CR1/CD35, endothelium factor VIII, class I and II MHC molecules, laminin, fibronectin, and non-collagenic domain NC1 of type IV collagen. Two reagents against Goodpasture determinants were used: P1 monoclonal antibody and serum IgG (GP antibodies) from a biopsy-proven Goodpasture patient. Glomeruloid bodies comprised two cell types: a peripheral layer of parietal epithelial cells (cytokeratin and CD24-positive) and central cell clumps of podocytes (vimentin and CALLA-positive). The basal lamina surrounding the glomeruloid bodies contained laminin and NC1 domain of type IV collagen, while that present between the podocytes reacted strongly with laminin, and P1 and GP antibodies. Endothelium factor VIII was not detected within the glomeruloid bodies and CR1 molecules bound to the basement membrane material within them. These data favour the hypothesis that podocytes produce the basement membrane material which bears Goodpasture determinants recently identified as a novel chain, named the alpha 3 chain, of type IV collagen.

Anti-Glomerular Basement Membrane Disease↗

Sieve structure of slit diaphragms of podocytes and pore cells of gastropod molluscs.

The ultrastructure of the slit diaphragms between the pedicels of the podocytes of the prosobranch Viviparus viviparus and between the cytoplasmic tongues of the haemocyanin producing pore cells of the pulmonate Lymnaea stagnalis was investigated. In both cell types 2 diaphragms are present in the slits. They form a 3-dimensional sieve structure with holes of respectively 90 x 110 A (podocyte) and 200 x 220 A (pore cell). Injection experiments showed that the size of the holes of the pore cell sieve matches that of particles which can be ingested by theis cell type. The substructure of the sieves of the molluscs is compared to that of the 2-dimensional sieve of the podocytes of the mouse and the rat.

Animals↗

Cleared extrachromosomal domain (CED): a nuclear domain enriched in nuclear matrix filaments is a common structure in sturgeon podocytes.

The cell nucleus is divided into chromosome territories and the extrachromosomal domain. The latter includes several structural and functional compartments involved in RNA processing and transport. Morphological and cytochemical analyses of the cell nucleus in sturgeon podocytes revealed the existence of a previously uncharacterised nuclear compartment. It appears as a cleared nucleoplasmic area of variable size within the extrachromosomal domain. Conventional light and electron microscopy revealed that this compartment, here referred to as cleared extrachromosomal domain (CED), appears free of chromatin and RNA-containing organelles and is closely surrounded by heterochromatin masses. Cytochemical and immunogold electron microscope studies indicated that CEDs lack DNA, RNA and glycoconjugates. The ultrastructural examination of Lowicryl-embedded sections showed that CEDs are formed by a fibrillar network. In resinless preparations, this network appears as a dense mesh of crosslinked nuclear matrix filaments. The density of nuclear matrix filaments within the CED is remarkably higher than that observed in the rest of the nucleus. Our results indicate that the CED is a single, distinct extrachromosomal domain of the nuclear matrix of sturgeon podocytes. The absence in the CED of detectable DNA and RNA, as well as the lack of chromatin and RNA-containing structures, suggests that transcription and RNA processing do not occur in this novel nuclear compartment. The volume occupied by the CED may preserve the volume-to-cytoplasm ratio in the podocyte and contribute to modulate the spatial organisation and the volume occupied by the chromosomal territories.

Aging↗

Alterations in the distribution of plasma fibronectin and the ultrastructure of podocytes in the peripheral glomerular loops in nephrotic rats.

Glomerular distribution of rat plasma fibronectin was examined during the course of puromycin (PAN)- and daunomycin (DM)-induced nephrosis. In control animals, fibronectin was detected in the mesangial matrix and along the glomerular basement membrane (GBM), closely associated with the plasma membrane of glomerular cells. In peripheral loops, immunoprecipitates were preferentially distributed in the laminae rarae externa and interna. Fibronectin was densely precipitated in a glomerulosclerotic lesion induced by DM at 8 weeks after the injection. In peripheral loops, loss and reconstruction of epithelial foot processes occurred in PAN nephrosis but the change was accompanied by negligible perturbation of fibronectin distribution in the lamina rara externa. In contrast, a remarkable decrease of fibronectin was observed in DM nephrosis, unrelated to the presence or absence of foot processes. The decrease in immunoreactivity for fibronectin in the lamina rara externa seemed to have no association with podocyte attachment to or detachment from the GBM. Plasma fibronectin distributed in the lamina rara externa is not directly involved in the modification of podocyte configuration or podocyte attachment, although its spatial distribution may have some functional significance for preserving the ultrastructure of the GBM.

Animals↗

Glomerular basement membrane length to podocyte ratio in human nephronopenia: implications for focal segmental glomerulosclerosis.

BACKGROUND: This study aims to probe a possible mechanism for the development of focal segmental glomerulosclerosis (FSGS) in human nephronopenic states. METHODS: To this end, length (in microns) of the glomerular basement membrane (GBM) covered by the cytoplasm of a podocyte was determined in controls and various congenital and acquired forms of nephronopenia with and without FSGS. RESULTS: Results indicate that for all nephronopenic groups without FSGS, the respective lengths are not significantly different from those of controls. With the exception of long-surviving renal allografts with FSGS, each nephronopenic group with FSGS has a significantly longer length compared with its respective control group without FSGS. Although the corresponding length in long-surviving allografts with FSGS is longer than that in the transplant group without FSGS, the difference does not attain significance. Among all groups with FSGS, the respective GBM lengths are not significantly different among cases of congenital causes of nephronopenia, but are significantly longer than when nephronopenia is acquired, whereas the corresponding lengths among uninephrectomized and transplant groups are not significantly different from one another. CONCLUSION: These results support the hypothesis that in enlarging glomeruli of nephronopenia, the dominant reaction of podocytes is to undergo hypertrophy. The capacity for this is greater in podocytes of native kidneys than allografts, being most pronounced when the nephronopenia is congenital than if acquired, and being most constrained in allografts. This then imposes a limit to glomerular enlargement in nephronopenia beyond which denudation of segments of the enlarging/elongating glomerular capillaries occurs, when FSGS supervenes.

Adolescent↗

Angiotensin II receptor blocker attenuates overexpression of vascular endothelial growth factor in diabetic podocytes.

VEGF expressed in glomerular podocytes, is known to increase vascular permeability to macromolecules. Angiotensin II can stimulate the release of VEGF, and the protective effects of angiotensin II antagonist against diabetic glomerular injury suggest that the angiotensin II-induced VEGF is an important pathogenetic mechanism in the development of proteinuria during diabetic nephropathy although this mechanism is not fully understood. In this study, the changes of VEGF expression was examined in the experimental diabetic nephropathy to determine whether these changes were modified by renoprotective intervention by blockers of angiotensin II receptors. The streptozotocin- induced diabetic rats were treated with L-158,809, a blocker of angiotensin II receptors, for 12 weeks. Age-matched rats with L-158,809 served as controls. RT-PCR and immunohistochemistry were used to assess and quantify gene and protein expression of VEGF. A progressive increase in urinary protein excretion was observed in diabetic rats. Glomerular VEGF expression was significantly higher in diabetic rats than in the control groups, with a significant reduction in glomerular VEGF expression and proteinuria in L-158,809- treated diabetic rats. VEGF mRNA was also significantly higher in diabetic kidneys than in the control groups, with a significant reduction in VEGF mRNA in L-158,809-treated diabetic kidneys. These results demonstrates that VEGF expression is significantly increased in diabetic podocytes, and angiotensin II receptor antagonist attenuated these changes in VEGF expression and prevented the development of proteinuria in vivo. Attenuation of increased VEGF expression in podocytes could contribute to the renoprotective effects of angiotensin II receptor antagonists in diabetic nephropathy.

Angiotensin II↗