Ameliorative impact of mycophenolate mofetil on diabetic kidney disease; a review on current knowledge

Abstract

Diabetic kidney disease as a common problem of diabetes can be the main cause of renal insufficiency in severe and untreated cases. Various aspects play a role in the progress of diabetic nephropathy, including gradual accumulation of AGEs (advanced glycation end-products), advancement in the pathway of polyol, oxidative stress, high filtration in glomeruli and increase in TGF-beta (transforming growth factor-beta) expression. Inflammatory process is known as a definite factor in the development of diabetic nephropathy. Increased molecules that cause inflammation comprise chemokines, cytokines, C-reactive protein (CRP), and adhesion molecules. Since pathogenesis of diabetic nephropathy basically is due to inflammatory procedure, therefore, the first therapeutic goal is to relieve inflammation. Numerous studies on animals have shown that anti-inflammatory effects of drugs are beneficial in treating nephropathy related to diabetes, but protective effects of these drugs have not been recognized in humans. Some substances involved in renal protective and anti-inflammatory in diabetic animals comprise; thiazolidinedione, statins, spironolactone, immunosuppressant, GLP-1 receptor agonist, angiotensin II receptor antagonist (ARB), cholecystokinin, and glucagon-like peptide-1. Mycophenolate mofetil (MMF) is a biologically inactive compound that belongs to a group of drugs that acts to suppress or restrain immune system. Therefore, mycophenolate, by weakening the immune system, prevents rejecting transplanted organ in the body. Here are some studies on the effect of MMF on inflammation as a significant factor in the development of diabetic problems.