Hypertensive renal injury is a primary etiology of end-stage renal disease, and satisfactory therapeutic strategies are urgently required. Cordyceps cicadae, a traditional Chinese herb, has potential renoprotective benefits and is widely used in the treatment of many kidney diseases. To investigate the mechanisms underlying the renoprotective effect of C. cicadae on hypertensive renal injury, we studied the effect of C. cicadae on tubular epithelial cells (TECs) in a spontaneously hypertensive rat (SHR) model and angiotensin II- (AngII-) cultured primary TECs. Our study showed that C. cicadae treatment could decrease 24-hour urine albumin, albumin-to-creatinine ratio (ACR), β2-MG level, and kidney injury molecule-1 (kim-1) level in SHR urine, alleviate interstitial fibrosis, and reduce α-smooth muscle actin (α-SMA) expression in SHR kidney. In primary TECs, medicated serum containing C. cicadae (CSM) might significantly reduce the AngII-induced production of kim-1 and neutrophil gelatinase-associated lipocalin (NGAL). Furthermore, C. cicadae treatment could decrease TEC apoptosis in SHRs as assessed by the terminal transferase-mediated biotin dUTP nick-end labeling (TUNEL) assay. CSM could inhibit caspase-3 activity and enhance cellular viability as measured by methyl thiazolyl tetrazolium in AngII-cultured TECs, suggesting that CSM might reduce the apoptosis level in TECs induced by AngII. We found that the SIRT1 expression level was markedly lowered, while the protein level of acetylated-p53 was elevated in the TECs of patients with hypertensive renal injury and SHRs. C. cicadae presented the effect of regulating the SIRT1/p53 pathway. Further SIRT1 inhibition with EX527 reversed the effect of C. cicadae on AngII-induced apoptosis. Taken together, our results indicate that C. cicadae offers a protective effect on TECs under hypertensive conditions, which may be related to its antiapoptotic effect through regulation of the SIRT1/p53 pathway.

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Objective. This study is aimed at investigating the efficacy of a very low-energy diet (VLED) in overweight and obese individuals with type 2 diabetes mellitus (T2DM). Methods. We thoroughly searched eight electronic resource databases of controlled studies concerning the efficacy and acceptability of intermittent or continuous VLEDs in patients with T2DM compared with other energy restriction interventions. Results. Eighteen studies (11 randomized and seven nonrandomized controlled trials) with 911 participants were included. The meta-analyses showed that compared with a low-energy diet (LED) and mild energy restriction (MER), VLED is superior in the reduction of body weight (mean difference (MD) MDLED=−2.77, 95% confidence interval (CI) CILED=−4.81 to−0.72, PLED=0.008; MDMER=−6.72, 95%CIMER=−10.05 to−3.39, PMER<0.0001), blood glucose (MDLED=−1.18, 95%CILED=−2.05 to−0.30, PLED=0.008; MDMER=−6.72, 95%CIMER=−10.05 to−3.39, PMER<0.0001), and triglyceride (TG) (MDLED=−0.35, 95%CILED=−0.58 to−0.12, PLED=0.002; MDMER=−0.55, 95%CIMER=−0.93 to−0.17, PMER=0.005) levels at the end of the intervention. After the follow-up (1–5 years), no obvious difference in weight loss (MD=−0.84, 95%CI=−3.01 to 1.32, P=0.45, I2=0%) and TG level (MD=−0.25, 95%CI=−0.55 to 0.06, P=0.12, I2=0%) between VLEDs and LEDs was evident, but VLED is more effective in glycemic control (MD=−1.43, 95%CI=−2.65 to−0.20, P=0.02). Compared to bariatric surgery, VLEDs offered comparable effects on weight loss (MD=2.51, 95%CI=−9.52 to 14.54, P=0.37), glycemic control (MD=0.37, 95%CI=−0.22 to 0.96, P=0.22), TG (MD=−0.3, 95%CI=−0.74 to 0.17, P=0.7), and insulin resistance improvement (MD=−1, 95%CI=−2.7 to 0.7, P=0.25). Conclusion. Dietary intervention through VLEDs is an effective therapy for rapid weight loss, glycemic control, and improved lipid metabolism in overweight and obese individuals with T2DM. Thus, VLEDs should be encouraged in overweight and obese individuals with T2DM who urgently need weight loss and are unsuitable or unwilling to undergo surgery. As all outcome indicators have low or extremely low quality after GRADE evaluation, further clinical trials that focus on the remission effect of VLEDs on T2DM are needed.