Natural antioxidants in the treatment and prevention of diabetic nephropathy; a potential approach that warrants clinical trials

Abstract

Diabetic nephropathy is the major cause of end-stage renal disease and effective and new therapeutic approaches are needed in diabetic nephropathy and chronic kidney diseases. Oxidative stress and inflammatory process are important factors contributing to kidney damage by increasing production of oxidants. KEAP1/Nrf2/ARE pathway regulates the transcription of many antioxidant genes and modulation of the pathway up regulates antioxidants. NFB controls the expression of genes involved in the inflammatory response. Natural substances have antioxidant and anti-inflammatory activities and have an impact on NFB and KEAP1/Nrf2/ARE pathways. The preclinical studies explored the effectiveness of whole herbs, plants or seeds and their active ingredients in established diabetic nephropathy. They ameliorate oxidative stress induced kidney damage, enhance antioxidant system, and decrease inflammatory process and fibrosis; most likely by activating KEAP1/Nrf2/ARE pathway and by deactivating NFB pathway. Whole natural products contain balanced antioxidants that might work synergistically to induce beneficial therapeutic outcome. In this context, more clinical studies involving whole plants or herbal products or mixtures of different herbs and plants and their active ingredients might change our strategies for the management of diabetic nephropathy. The natural products might be useful as preventive interventions and studies are required in this field.

Pulsed Electromagnetic Fields Alleviates Hepatic Oxidative Stress and Lipids Accumulation in db/db mice

“…Clinical studies have attempted to treat diabetic complications with synthetic antioxidant therapy. However, the effectiveness of these results were not as expected 8, 9 . In recent years, physical factor therapies improved oxidative stress have been proved 10-13 .…”

N6 -(2-hydroxyethyl)-adenosine from Cordyceps cicadae protects against diabetic kidney disease via alleviation of oxidative stress and inflammation

“…The incidence and prevalence of DKD and its impact on global public health have necessitated urgent attention in finding an alternative therapeutic option for preventing or treating DKD (Sheng et al, 2018). One of such strategies that has been employed in recent years is the use of natural products from medicinal plants and microbes (Al-Waili, Al-Waili, Al-Waili, & Salom, 2017;De Smet, 2002;Ríos, Francini, & Schinella, 2015). Hyperglycemia, which is a distinct feature of diabetes mellitus, is considered as the main driving force behind DKD (Olatunji, Chen, & Zhou, 2018;Sheng et al, 2018).…”

Diabetic Nephropathy an Obvious Complication in Long Term Type 1 Diabetes Mellitus: A Case Study

“…The effect of hyperglycemia and sudden weight loss is usually mediated through hemodynamic and multiple metabolic pathways in long term Type 1 diabetic patient [11,12]. Glucose homeostasis is accomplished through the coordinated actions of multiple vital organs, but mostly through equilibrium between the access of glucose into the circulation from the liver, and the uptake of glucose by skeletal muscle, adipose tissues and brain by the various glucose transporters [13].…”