No abstract

Abstract. The present study aimed to investigate the dynamics of clinical and laboratory parameters and serum Klotho protein level in patients with diabetic kidney disease using nephroprotective therapy combined with an inhibitor of the sodium-glucose cotransporter 2 (SGLT2) dapagliflozin. Methods. A total of 76 type 2 diabetic patients with diabetic nephropathy (DN) were examined in this prospective study. Control group - 20 healthy subjects. 53 patients received a standard course of treatment, which included metformin, renin-angiotensin-aldosterone system blockers and statins. In addition to standard therapy, 23 patients have been prescribed the SGLT2 inhibitor dapagliflozin 10 mg per day. The treatment follow-up period was six months. Klotho concentration was determined by an enzyme-linked immunosorbent assay. Results. The development of DN in type 2 diabetic patients was accompanied by a significant decrease in soluble Klotho protein in comparison with controls and patients without nephropathy. During follow-up, Klotho protein level was changed significantly in the group of DN patients with albuminuria. Standard therapy resulted in Klotho concentration increase by 14% compared to pre-treatment values; a more demonstrative increase in the Klotho level was found in the dapagliflozin group (almost 23%). Conclusions. SGLT2 inhibitor treatment resulted in a significant increase of pleiotropic serum protein Klotho in patients with type 2 diabetes and diabetic kidney disease.

Shortening of periodontal telomere length can be not only a factor of physiological aging, but also be a marker of the adverse effects of non‑alcoholic fatty liver disease (NAFLD). Objective —  to study the changes in periodontal status in patients with non‑alcoholic fatty liver disease. Materials and methods. 76 patients with non‑alcoholic fatty liver disease and 14 somatically healthy patients were selected. Questioning of patients, dental examination with determination of indexes, qPCR studies from scraping from the surface of the attached gum with disposable applicators were carried out. Results. Periodontal diseases in patients with NAFLD had an inflammatory nature of different clinical and morphological forms and were represented mainly by chronic generalized periodontitis. The length of telomeres was significantly shorter in patients with NAFLD compared with the respondents in the control group. A negative average strength relationship was found between telomere length and chronic generalized periodontitis (r = –0.590, p = 0.002), the presence of NAFLD (r = –0.506, p = 0.045), body mass index (r = –0.3068, p = 0.031), level of aspartate aminotransferase (r = –0.286, p = 0.017). Conclusions. Chronic inflammation and oxidative stress in the periodontal tissues in NAFLD contribute to premature cellular aging and shorten the telomere length of gingival epithelial cells. High body mass index is negatively correlated with telomere length, which also confirms premature cellular aging in patients with NAFLD.

Aim of the study was to determine the copeptin level in the blood serum of patients with type 2 diabetes mellitus (T2DM) depending on the kidney’s function and accounting for the Alu Ins/Del (rs4646994) polymorphism of the angiotensin-converting enzyme (ACE) gene. Materials and methods: 146 patients with T2DM complicated by diabetic nephropathy (DN) were examined. Patients were divided into 4 groups according to the chronic kidney disease stage. Control group – 30 healthy subjects. Serum levels of copeptin and insulin were determined by ELISA using appropriate kits in accordance with the manufacturers' instructions. Genotyping was performed using TagMan allelic discrimination assay. Results. Our study has shown that the development of DN in T2DM is accompanied by a significant increase of copeptin level in blood serum compared with the control group and with diabetic patients without signs of nephropathy. The highest copeptin levels were found in patients with albuminuria and impaired glomerular filtration rate. In patients with T2DM, a significant linear correlation founded between copeptin level and serum creatinine (r = 0.247, p < 0.03). We found more significant violations of glucose metabolism in DN patients with high serum levels of copeptin compared with patients with normal values of this factor. In particular significant increase in serum, copeptin was accompanied by an increase in the HOMA index and insulin level. In patients with T2DM – carriers of the homozygous I/I genotype were founded a reliable association with increasing copeptin levelы in blood serum, in contrast to D/D and I/D genotypes. Conclusions. The highest copeptin levels were founded in carriers of the homozygous I/I genotype of the Alu Ins/Del polymorphism of the ACE gene. An increase in the copeptin level has a certain genetic determinism, and its high level correlates with impaired glucose metabolism and the development of nephropathy in T2DM. Serum copeptin can be considered as a diagnostic marker of renal and metabolic lesions in T2DM. Keywords: diabetic nephropathy, copeptin, arginine-vasopressin system, diabetes mellitus, angiotensin-converting enzyme, ACE gene polymorphism.

The aim of this work was to study the features of the composition of the gut microbiota (GM) in patients with arterial hypertension (AH), which occurs against the background of abdominal obesity (AO). Materials and methods. The paper presents the data on examination of 70 patients with AH of 2–3 degrees (46 patients with AO and 24 patients without obesity – with normal body weight (NBW)). The control group included 20 apparently healthy individuals with NBW. The patients underwent detailed standard clinical, laboratory and instrumental examination. Determination of the quantitative composition of GM was carried out by the method of polymerase chain reaction with hybridization-fluorescence detection of results in real time using the test system “COLONOFLOR-16 (biocenosis)” (“ALFA-LAB”). In this work, a statistical analysis of the obtained data was carried out using standard methods and Microsoft Excel 17.0. Results. A significant change in the composition of GM were found in patients with AH, which proceeds against the background of AO, in comparison with apparently healthy individuals and with patients with AH without obesity (with NBW). In the group of AH patients with the presence of AO, significant decrease in the number of Lactobacillus spp., Bifidobacterium spp., Faecalibacterium prausnitzii and Аkkermansia muciniphila was found in comparison with apparently healthy individuals. The number of Faecalibacterium prausnitzii and Аkkermansia muciniphila in these patients was also significantly lower than in hypertensive patients with NBW. At the same time, the ratio of Bacteroides fragilis/Faecalibacterium prausnitzii was significantly higher than in the control group and the group of hypertensive patients without obesity – with NBW. Conclusions. The results of the study indicate a possible role for the deficiency of such representatives of GM as Lactobacillus spp., Bifidobacterium spp., Faecalibacterium prausnitzii and Аkkermansia muciniphila and an increase in the ratio of Bacteroides fragilis/Faecalibacterium prausnitzii in the pathogenesis of AH, which occurs against the background of AO.