Al-Dabet, M.M.* ; Shahzad, K.* ; Elwakiel, A.* ; Sulaj, A.* ; Kopf, S.* ; Bock, F.* ; Gadi, I.* ; Zimmermann, S.* ; Rana, R.* ; Krishnan, S.* ; Gupta, D.* ; Manoharan, J.* ; Fatima, S.* ; Nazir, S.* ; Schwab, C.* ; Baber, R.* ; Scholz, M.* ; Geffers, R.* ; Mertens, P.R.* ; Nawroth, P.P.* ; Griffin, J.H.* ; Keller, M. ; Dockendorff, C.* ; Kohli, S.* ; Isermann, B.*
     
    
        
Reversal of the renal hyperglycemic memory in diabetic kidney disease by targeting sustained tubular p21 expression.
    
    
        
    
    
        
        Nat. Commun. 13:5062 (2022)
    
    
    
      
      
	
	    A major obstacle in diabetes is the metabolic or hyperglycemic memory, which lacks specific therapies. Here we show that glucose-mediated changes in gene expression largely persist in diabetic kidney disease (DKD) despite reversing hyperglycemia. The senescence-associated cyclin-dependent kinase inhibitor p21 (Cdkn1a) was the top hit among genes persistently induced by hyperglycemia and was associated with induction of the p53-p21 pathway. Persistent p21 induction was confirmed in various animal models, human samples and in vitro models. Tubular and urinary p21-levels were associated with DKD severity and remained elevated despite improved blood glucose levels in humans. Mechanistically, sustained tubular p21 expression in DKD is linked to demethylation of its promoter and reduced DNMT1 expression. Two disease resolving agents, protease activated protein C (3K3A-aPC) and parmodulin-2, reversed sustained tubular p21 expression, tubular senescence, and DKD. Thus, p21-dependent tubular senescence is a pathway contributing to the hyperglycemic memory, which can be therapeutically targeted.
	
	
	    
	
       
      
	
	    
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        Article: Journal article
    
 
    
        Document type
        Scientific Article
    
 
    
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        Language
        english
    
 
    
        Publication Year
        2022
    
 
    
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        HGF-reported in Year
        2022
    
 
    
    
        ISSN (print) / ISBN
        2041-1723
    
 
    
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        2041-1723
    
 
    
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	    Volume: 13,  
	    Issue: 1,  
	    Pages: ,  
	    Article Number: 5062 
	    Supplement: ,  
	
    
 
    
        
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            Nature Publishing Group
        
 
        
            Publishing Place
            London
        
 
	
        
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        Reviewing status
        Peer reviewed
    
 
    
        Institute(s)
        Helmholtz Institute for Metabolism, Obesity and Vascular Research (HI-MAG)
    
 
    
        POF-Topic(s)
        30201 - Metabolic Health
    
 
    
        Research field(s)
        Helmholtz Diabetes Center
    
 
    
        PSP Element(s)
        G-506501-001
    
 
    
        Grants
        Deutsche Forschungsgemeinschaft (German Research Foundation)
    
 
    
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        Erfassungsdatum
        2022-11-15