Advanced glycation end products (AGEs) have been implicated in the pathogenesis of diabetic kidney disease. The actions of AGEs are mediated both through a non-receptor-mediated pathway and through specific receptors for AGE (RAGEs). To explore a specific role for RAGE in renal changes in type 2 diabetes, we examined the renal effects of a neutralizing murine RAGE antibody in db/db mice, a model of obese type 2 diabetes. One group of db/db mice was treated for 2 months with the RAGE antibody, and another db/db group was treated for the same period with an irrelevant IgG. Two groups of nondiabetic db/؉ mice were treated with either RAGE antibody or isotype-matched IgG for 2 months. Placebo-treated db/db mice showed a pronounced increase in kidney weight, glomerular volume, basement membrane thickness (BMT), total mesangial volume, urinary albumin excretion (UAE), and creatinine clearance compared with nondiabetic controls. In RAGE antibody-treated db/db mice, the increase in kidney weight, glomerular volume, mesangial volume, and UAE was reduced, whereas the increase in creatinine clearance and BMT was fully normalized. Notably, these effects in db/db mice were seen without impact on body weight, blood glucose, insulin levels, or food consumption. In conclusion, RAGE is an important pathogenetic factor in the renal changes in an animal model of type 2 diabetes. Diabetes 53: 166 -172, 2004 T he prevalence of type 2 diabetes is increasing worldwide. The development of diabetic nephropathy is seen in up to 30 -40% of all type 2 diabetic subjects followed by an increased morbidity and mortality. Furthermore, diabetic nephropathy is the most common cause of end-stage renal failure in the western world. Among the many potential pathogenic mechanisms responsible for the development of diabetic kidney disease (1,2), advanced glycation end products (AGEs) have been suggested to have measurable effects on the development of diabetic kidney changes as they appear in animal models of type 1 and type 2 diabetes (3-12). Recently, the receptor for AGEs (RAGE) has been proposed to play a key role in the development of diabetic renal changes in experimental type 1 diabetes (11). Accordingly, streptozotocin (STZ)-induced diabetic mice overexpressing RAGE showed a pronounced increase in renal damage compared with changes seen in nontransgenic diabetic animals (11). Furthermore, in a recent study, administration of soluble RAGE (sRAGE), a truncated form of RAGE, was shown to blunt the renal changes seen in a mouse model of type 2 diabetes (12).The aim of the present study was to explore the role of RAGE in the development of renal changes in type 2 diabetes. Accordingly, a specific neutralizing murine RAGE antibody (RAGE antibody) was administered for 2 months in db/db mice, a genetic model of type 2 diabetes characterized by obesity, sustained hyperglycemia, hyperinsulinemia, lack of ketonuria, and progressive renal kidney disease (11-17).
RESEARCH DESIGN AND METHODSAdult female db/db mice (C57BLKS/J-lepr db /lepr db ) and their...