1.Cardiorenal Protection in Diabetic Kidney Disease
Jason F. LEE ; Ecaterina BERZAN ; Vikas S. SRIDHAR ; Ayodele ODUTAYO ; David Z.I. CHERNEY
Endocrinology and Metabolism 2021;36(2):256-269
Over the last 5 years there have been many new developments in the management of diabetic kidney disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT2) inhibitors were initially used for glycemic control, but more recent studies have now shown that their benefits extend to cardiovascular and kidney outcomes. The recent addition of data on the novel mineralocorticoid receptor antagonist (MRA) gives us another approach to further decrease the residual risk of diabetic kidney disease progression. In this review we describe the mechanism of action, key studies, and possible adverse effects related to these three classes of medications. The management of type 2 diabetes now includes an increasing number of medications for the management of comorbidities in a patient population at significant risk of cardiovascular disease and progression of chronic kidney disease. It is from this perspective that we seek to outline the rationale for the sequential and/or combined use of SGLT2 inhibitors, GLP-1 RA and MRAs in patients with type 2 diabetes for heart and kidney protection.
2.Cardiorenal Protection in Diabetic Kidney Disease
Jason F. LEE ; Ecaterina BERZAN ; Vikas S. SRIDHAR ; Ayodele ODUTAYO ; David Z.I. CHERNEY
Endocrinology and Metabolism 2021;36(2):256-269
Over the last 5 years there have been many new developments in the management of diabetic kidney disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT2) inhibitors were initially used for glycemic control, but more recent studies have now shown that their benefits extend to cardiovascular and kidney outcomes. The recent addition of data on the novel mineralocorticoid receptor antagonist (MRA) gives us another approach to further decrease the residual risk of diabetic kidney disease progression. In this review we describe the mechanism of action, key studies, and possible adverse effects related to these three classes of medications. The management of type 2 diabetes now includes an increasing number of medications for the management of comorbidities in a patient population at significant risk of cardiovascular disease and progression of chronic kidney disease. It is from this perspective that we seek to outline the rationale for the sequential and/or combined use of SGLT2 inhibitors, GLP-1 RA and MRAs in patients with type 2 diabetes for heart and kidney protection.
3.Vanishing Pancreatic Grafts.
Christopher PIVETTI ; In Chul HONG ; Chang H YOO ; Sun LEE ; Kenny KIM ; Gregory EMMANUEL ; Jason KIM ; Romy CHUNG ; Slawomir NIEWIADOMSKI ; Paul WOLF ; R F GITTES
Yonsei Medical Journal 2004;45(6):1169-1172
Comparison of pancreaticoduodenal transplants (PDT) and duct-ligated pancreas transplant (DLPT) were performed using syngeneic and allogeneic studies in rats. Both DLPT and PDT allogeneic grafts showed mild rejection. DLPT groups showed disorganized pathology and acini replaced by fat. Eventually, massive fibrosis was seen in the Islets of Langerhans, as well as rejection cellular infiltrates. In both PDT groups, normal histology was observed in the same period. Thus the effect of duct occlusion is highly detrimental for the grafts.
Animals
;
Graft Rejection/pathology
;
Ligation/adverse effects
;
Pancreas/*pathology
;
Pancreas Transplantation/*adverse effects
;
Pancreatic Ducts/surgery
;
Postoperative Period
;
Rats
;
Rats, Inbred Lew
;
Rats, Sprague-Dawley
;
Research Support, Non-U.S. Gov't
;
Transplantation, Homologous
;
Transplantation, Isogeneic
4.Gonadal Tumors Developed from Consecutively Transplanted Spleens Bearing Gonad Implants.
In Chul HONG ; Sun LEE ; Chang Hyun YOO ; Kenny K KIM ; Jason KIM ; Gregory EMMANUEL ; Slawomir NIEWIADOMSKI ; Paul WOLF ; Ruben F GITTES
Yonsei Medical Journal 2004;45(6):1136-1142
This study was conducted by consecutively transplanting spleens, which had gonads implanted previously. A total of 84 cases for infantile testicles and 106 cases for ovarian follicles were performed. In the case of ovarian implants, the results were determined by the total number of follicle implants. A modified spleen transplantation technique called double implantation of ovarian follicles was applied to increase the amount of the implants. In this technique, an extra spleen is implanted into the potential donor so that the ovarian follicles can be implanted to two different spleens, doubling the amount of implants. Through consecutive spleen transplantation, we observed the results beyond a typical rat's life span. In many of these cases, we found more aggressive forms of malignant tumor, seminoma and dysgerminoma. We present the results and discuss possible pathogenic mechanisms of tumor formation.
Animals
;
Animals, Newborn
;
Female
;
Male
;
Ovarian Neoplasms/*etiology
;
Ovary/*transplantation
;
Rats
;
Rats, Inbred Lew
;
Research Support, Non-U.S. Gov't
;
Spleen/*surgery/*transplantation
;
Testicular Neoplasms/*etiology/pathology
;
Testis/*transplantation
;
*Transplantation, Heterotopic