Exp Clin Endocrinol Diabetes 2004; 112(3): 135-141
DOI: 10.1055/s-2004-817822
Article

J. A. Barth Verlag in Georg Thieme Verlag Stuttgart · New York

A 63bp Deletion in the Promoter of RAGE Correlates with a Decreased Risk for Nephropathy in Patients with Type 2 Diabetes

G. Rudofsky1  Jr. , B. Isermann1 , T. Schilling1 , S. Schiekofer1 , M. Andrassy1 , J. G. Schneider1 , M. Morcos1 , P. M. Humpert1 , A. A. R. Sayed1 , S. Witte2 , W. Renn3 , M. Pfohl4 , A. Hamann1 , V. Nosikov5 , E. Schleicher3 , H.-U. Häring3 , G. Rudofsky6  sen. , E. Ritz1 , P. P. Nawroth1 , A. Bierhaus1
  • 1Department of Medicine I, Otto-Meyerhof-Zentrum and Department of Nephrology, University of Heidelberg, Germany
  • 2Department of Medical Biometry, University of Heidelberg, Germany
  • 3Department of Medicine IV, University Tübingen, Germany
  • 4Medizinische Klinik I, Bethesda Kliniken zu Duisburg, Duisburg, Germany
  • 5Department of Molecular Diagnostics and Genome Fingerprinting, National Research Center “GosNIIgenetics”, Moscow, Russia
  • 6Department of Angiology, University of Essen, Germany
Further Information

Publication History

Received: April 7, 2003 First decision: May 23, 2003

Accepted: July 14, 2003

Publication Date:
30 March 2004 (online)

Abstract

Several polymorphisms have been identified in the RAGE-promoter region that might modulate the outcome of disease. Here we analyse the association of a 63bp deletion (delta63) spanning from bp - 407 to bp - 345 with diabetic nephropathy.

The deletion was determined using the polymerase chain reaction (PCR) in a cross-sectional study with 1087 patients with type 1 diabetes (n = 559) and type 2 diabetes (n = 528). 475 patients with osteoporosis served as disease independent control.

The prevalence of the heterozygous genotype did not significantly differ between the three groups (type 1: 2.15 %, type 2: 2.27 %, controls: 1.47 %), indicating that heterozygous delta63 is not related to the manifestation of diabetes. Homozygous carriers were not identified in this study. The heterozygous delta63 genotype, was associated with a reduced prevalence of diabetic nephropathy in patients with type 2 diabetes (OR = 0.06; 95 % CI: [0.05, 0.07]), but not in patients with type 1 (OR = 1.49; 95 % CI: [1.14, 1.94]).

We conclude, that patients with type 2 diabetes and the 63bp deletion in the promoter of RAGE seem to be protected from diabetic nephropathy. The observed difference between type 1 and type 2 diabetes might point to diverse pathomechanisms of nephropathy in both types of diabetes.

References

  • 1 Abel M, Ritthaler U, Zhang Y, Deng Y, Schmidt A M, Greten J, Sernau T, Wahl P, Andrassy K, Ritz E, Waldherr R, Stern D M, Nawroth P P. Expression of receptors for advanced glycosylated end products in renal disease.  Nephrol Dial Transplant. 1995;  10 1662-1667
  • 2 Aiello L P, Wong J S. Role of vascular endothelial growth factor in diabetic vascular complications.  Kidney Int. 2000;  58 (Suppl 77) S113-119
  • 3 Beisswenger P J, Makita Z, Curphey T J, Moore L L, Jean S, Brinck-Johnsen T, Bucala R, Vlassara H. Formation of immunochemical advanced glycosylation end products preceedes and correlates with early manifestions of renal and retinal disease in diabetes.  Diabetes. 1995;  44 824-829
  • 4 Bierhaus A, Kasper M, Arnold B, Nawroth P P. Deletion von RAGE bedingt in RAGE -/- Mäusen einen proinflammatorischen Phänotyp.  Diabet Stoffw. 2003;  12 80
  • 5 Bierhaus A, Ritz E, Nawroth P P. Expression of receptors for advanced glycation end-products in occlusive vascular and renal disease.  Nephrol Dial Transplant. 1996;  11 (Suppl 5) 87-90
  • 6 Brownlee M, Cerami A, Vlassara H. Advanced glycosylation end products in tissue and the biochemical basis of diabetic complications.  N Engl J Med. 1988;  318 1315-1321
  • 7 Festa A, D'Agostino R, Howard G, Mykkanen L, Tracy R P, Haffner S M. Inflammation and microalbuminuria in nondiabetic and type 2 diabetic subjects: The Insulin Resistance Atherosclerosis Study.  Kidney Int. 2000;  58 1703-1710
  • 8 Fogarty D G, Hanna L S, Wantman M, Warram J H, Krolewski A S, Rich S S. Segregation analysis of urinary albumin excretion in families with type 2 diabetes.  Diabetes. 2000;  49 1057-1063
  • 9 Hofmann M A, Drury S, Fu C, Wu Q, Taguchi A, Lu Y, Avila C, Kambham N, Slattery T, Beach D, McClary J, Nagashima M, Morser J, Bierhaus A, Neurath M, Nawroth P, Stern D, Schmidt A M. RAGE mediates a novel proinflammatory axis. The cell surface receptor for S100/calgranulin polypeptides.  Cell. 1999;  97 889-901
  • 10 Hofmann M A, Drury S, Hudson B I, Gleason M R, Qu W, Lu Y, Lalla E, Chitnis S, Monteiro J, Stickland M H, Bucciarelli L G, Moser B, Moxley G, Itescu S, Grant P J, Gregersen P K, Stern D M, Schmidt A M. RAGE and arthritis: the G82S polymorphism amplifies the inflammatory response.  Genes Immun. 2002;  3 123-135
  • 11 Holla L I, Kahkova K, Fassmann A, Buckova D, Halabala T, Znojil V, Vanek J. Diatribution of the receptor for advanced glycation end products gene polymorphisms in patients with chronic periodontitis: a preliminary study.  J Peridontol. 2001;  72 1742-1746
  • 12 Horie K, Miyata T, Maeda K, Miyata S, Sugiyama S, Sakai H, van Ypersele de Strihou C, Monnier V M, Witztum J L, Kurokawa K. Immunhistochemical colocalization of glycoxidant products and lipid peroxidation products in diabetic renal glomerular lesions: implication for glycooxidative stress in the pathogenesis of diabetic nephropathy.  J Clin Invest. 1997;  100 2995-3004
  • 13 Hudson B I, Stickland M H, Futers T S, Grant P J. Effects of novel polymorphisms in the RAGE gene on transcriptional regulation and their association with diabetic retinopathy.  Diabetes. 2001;  50 1505-1511
  • 14 Hudson B I, Stickland M H, Grant P J. Identification of polymorphisms in the receptor for advanced glycation end products (RAGE) gene: prevalence in type 2 diabetes and ethnic groups.  Diabetes. 1998;  47 1155-1157
  • 15 Isermann B, Schmidt S, Bierhaus A, Schiekofer S, Borcea V, Ziegler R, Nawroth P P, Ritz E. (CA)(n) dinucleotide repeat polymorphism at the 5′-end of the aldose reductase gene is not associated with microangiopathy in Caucasians with long-term diabetes mellitus 1.  Nephrol Dial Transplant. 2000;  15 918-920
  • 16 Kankova K, Beranek M, Hajek D, Vlkova E. Polymorphisms 1704 G/T, 2184 A/G, and 2245 G/A in the RAGE gene are not associated with diabetic retinopathy in NIDDM: pilot study.  Retina. 2002;  22 119-121
  • 17 Kankova K, Marova I, Zahejsky J, Muzik J, Stejskalova A, Znojil V, Vacha J. Polymorphisms 1704 G/T and 2184 A/G in the RAGE gene are associated with antioxidant status.  Metabolism. 2001 a;  50 1152-1160
  • 18 Kankova K, Vasku A, Hajek D, Zahejsky J, Vasku V. Association of G82S polymorphism in the RAGE gene with skin complications in type 2 diabetes.  Diabetes Care. 1999;  22 1745
  • 19 Kankova K, Zahejsky J V, Marova I I, Muzik J, Kuhrova V V, Blazkova M, Znojil V, Beranek M, Vacha J V. Polymorphisms in the RAGE gene influence susceptibility to diabetes-associated microvascular dermatoses in NIDDM.  J Diabetes Complications. 2001 b;  15 185-192
  • 20 Kislinger T, Fu C, Huber B, Qu W, Taguchi A, Du Yan S, Hofmann M, Yan S F, Pischetsrieder M, Stern D, Schmidt A M. N(epsilon)-(carboxymethyl)lysine adducts of proteins are ligands for receptor for advanced glycation end products that activate cell signaling pathways and modulate gene expression.  J Biol Chem. 1999;  274 31740-31749
  • 21 Landin-Olsson M. Latent autoimmune diabetes in adults.  Ann NY Acad Sci. 2002;  958 112-116
  • 22 Lawrence T, Gilroy D W, Colville-Nash P R, Willoughby D A. Possible new role for NF-kappaB in the resolution of inflammation.  Nat Med. 2001;  7 1291-1297
  • 23 Liu L, Xiang K. RAGE Gly82Ser polymorphism in diabetic microangiopathy.  Diabetes Care. 1999;  22 646
  • 24 Makita Z, Bucala R, Rayfield E A, Yang Z, Skolnik E, Friedman E A, Cerami A, Vlassara H. Advanced glycosylation endproducts in patients with diabetic nephropathy.  N Engl J Med. 1991;  325 836-842
  • 25 Makita Z, Yanagisawa K, Kuwajima S, Yoshioka N, Atsumi T, Hasunuma Y, Koike T. Advanced glycation endproducts and diabetic nephropathy.  J Diabetes Complications. 1995;  9 265-268
  • 26 McCance D R, Dyer D G, Dunn J A, Bailic K E, Thorpe S R, Baynes J W, Lyons T J. Maillard reaction products and their relation to complications in insulin-dependent diabetes mellitus.  J Clin Invest. 1993;  91 2470-2478
  • 27 Neeper M, Schmidt A M, Brett J, Yan S D, Wang F, Pan Y C, Elliston K, Stern D, Shaw A. Cloning and expression of a cell surface receptor for advanced glycosylation endproducts of proteins.  J Biol Chem. 1992;  267 14998-15004
  • 28 Nishino T, Horii Y, Shiiki H, Yamamoto H, Makita Z, Bucala R, Dohi K. Immunohistochemical detection of advanced glycosylation end products within the vascular lesions and glomeruli in diabetic nephropathy.  Hum Pathol. 1995;  26 308-313
  • 29 O'Rahilly S, Wainscoat J S, Turner R C. Type 2 (insulin-dependent) diabetes mellitus. New genetics for old night mares.  Diabetologia. 1988;  31 407-414
  • 30 Orita M, Iwahana H, Kanagawa H, Hayashi K, Sekiya T. Detection of polymorphisms of human DNA by gel electrophoresis as single-strand conformation polymorphisms.  Proc Natl Acad Sci USA. 1989;  86 2766-2770
  • 31 Park L, Raman K G, Lee K J, Lu Y, Ferran L J, Chow W S, Stern D, Schmidt A M. Suppression of accelerated diabetic atherosclerosis by the soluble receptor for advanced glycation endproducts.  Nat Med. 1998;  4 1025-1031
  • 32 Pettersson-Fernholm K, Forsblom C, Hudson B I, Perola M, Grant P J, Groop P. The functional - 374 T/A RAGE gene polymorphism is associated with proteinuria and cardiovascular disease in type 1 diabetic patients.  Diabetes. 2003;  52 891-894
  • 33 Pickup J C, Crook M A. Is type II diabetes mellitus a disease of the innate immune system?.  Diabetologia. 1998;  41 1241-1248
  • 34 Poirier O, Nicaud V, Vionnet N, Raoux S, Tarnow L, Vlassara H, Parving H H, Cambien F. Polymorphism screening of four genes encoding advanced glycation endproduct putative receptors. Association study with nephropathy in type 1 diabetic patients.  Diabetes. 2001;  50 1214-1218
  • 35 Prevost G, Fajardy I, Fontaine P, Danze P M, Besmond C. Human RAGE GLY82SER dimorphism and HLA class II DRB1-DQA1-DQB1 haplotypes in type 1 diabetes.  Eur J Immunogenet. 1999;  26 343-348
  • 36 Schenk S, Schraml P, Bendik I, Ludwig C U. A novel polymorphism in the promotor of the RAGE gene is associated with non-small cell lung cancer.  Lung cancer. 2001;  32 7-12
  • 37 Schmidt A M, Hofmann M, Taguchi A, Yan S D, Stern D M. RAGE: a multiligand receptor contributing to the cellular response in diabetic vasculopathy and inflammation.  Sem Thromb Hemost. 2000 a;  26 485-494
  • 38 Schmidt A M, Hori O, Brett J, Yan S D, Wautier J L, Stern D. Cellular receptors for advanced glycation end products. Implications for induction of oxidant stress and cellular dysfunction in the pathogenesis of vascular lesions.  Arterioscler Thromb. 1994;  14 1521-1528
  • 39 Schmidt A M, Yan S D, Wautier J L, Stern D. Activation of receptor for advanced glycation end products. A mechanism for chronic vascular dysfunction in diabetic vasculopathy and atherosclerosis.  Circ Res. 1999;  84 489-497
  • 40 Schmidt A M, Yan S D, Stern D M. The dark side of glucose.  Nature Med. 1995;  1 1002-1004
  • 41 Schmidt A M, Yan S D, Yan S F, Stern D M. The biology of the receptor for advanced glycation end products and its ligands.  Biochim Biophys Acta. 2000;  1498 99-111
  • 42 Seaquist E R, Goetz F C, Rich S, Barbosa J. Familial clustering of diabetic kidney disease: evidence for genetic susceptibility to diabetic nephropathy.  N Engl J Med. 1989;  320 1161-1165
  • 43 Stern D M, Yan S D, Yan S F, Schmidt A M. Receptor for advanced glycation endproducts (RAGE) and the complications of diabetes.  Aging Res Rev. 2002;  1 1-15
  • 44 Tanji N, Markowitz G S, Fu C, Kislinger T, Taguchi A, Pischetsrieder M, Stern D, Schmidt A M, D'Agati V D. Expression of advanced glycation end products and their cellular receptor RAGE in diabetic nephropathy and nondiabetic renal disease.  J Am Soc Nephrol. 2000;  11 1656-1666
  • 45 Thomsen G, Robinsin W P, Kuhner M K, Joe S, MacDonald M J, Gottschall J L, Barbosa J, Rich S S, Bertrams J, Baur M P. Genetic heterogeneity, modes of inheritance and risk estimates for a join study of Caucasians with insulin-dependent diabetes mellitus.  Am J Hum Genet. 1988;  43 799-816
  • 46 Thornalley P J. Cell activation by glycated proteins. AGE receptors, receptor recognition factors and functional classification of AGEs.  Cell Mol Biol. 1998;  44 1013-1023
  • 47 Vasku V V, Kankova K, Vasku A, Muzik J, Izakovicova Holla L, Semradova V V, Vacha J. Gene polymorphisms (G82 S, 1704 G/T, 2184 A/G and 2245 G/A) of the receptor of advanced glycation end products (RAGE) in plaque psoriasis.  Arch Dermatol Res. 2002;  294 127-130
  • 48 Vlassara H. Advanced glycation in diabetic renal and vascular disease.  Kidney Int. 1995;  48 (Suppl 51) 43-44
  • 49 Vlassara H, Striker L J, Teichberg S, Fuh H, Li Y M, Steffes M. Advanced glycosylation endproducts induce glomerular sclerosis and albuminuria in normal rats.  Proc Nat Acad Sci. 1994;  91 11704-11708
  • 50 Wautier J L, Guillausseau P J. Advanced glycation end products, their receptors and diabetic angiopathy.  Diabetes Metab. 2001;  27 535-542
  • 51 Wautier J L, Guillausseau P J. Diabetes, advanced glycation endproducts and vascular disease.  Vascular Medicine. 1998;  3 131-137
  • 52 Wautier J L, Zoukourian C, Chappey O, Wautier M P, Guillausseau P J, Cao R, Hori O, Stern D, Schmidt A M. Receptor-mediated endothelial cell dysfunction in diabetic vasculopathy: soluble receptor for advanced glycation end products blocks hyperpermeability in diabetic rats.  J Clin Invest. 1996;  97 238-243
  • 53 Wendt T M, Tanji N, Guo J, Kislinger T R, Qu W, Lu Y, Bucciarelli L G, Rong L L, Moser B, Markowitz G S, Stein G, Bierhaus A, Lieliensiek B, Arnold B, Nawroth P P, D'Agati V D, Stern D M, Schmidt A M. RAGE drives the development of glomerulosclerosis and implicates early podocyte activation in the pathogenesis of diabetic nephropathy.  Am J Pathol. 2003;  162 1123-1137
  • 54 Yamamoto Y, Kato I, Doi T, Yonekura H, Ohashi S, Takeuchi M, Watanabe T, Yamagishi S, Sakurai S, Takasawa S, Okamoto H, Yamamoto H. Development and prevention of advanced diabetic nephropathy in RAGE overexpressing mice.  J Clin Invest. 2001;  108 261-268
  • 55 Yan S D, Chen X, Fu J, Chen M, Zhu H, Roher A, Slattery T, Zhao L, Nagahima M, Morser J, Migheli A, Nawroth P P, Stern D, Schmidt A M. RAGE and amyloid-β-peptide neurotoxicity in Alzheimer's disease.  Nature. 1996;  382 685-691
  • 56 Zimmet P, Turner R, McCarty D, Rowley M, Mackay I. Crucial points at diagnosis. Type 2 diabetes or slow type 1 diabetes.  Diabetes care. 1999;  22 (Suppl 2) B59-64

PhD Angelika Bierhaus

Department of Medicine I, University of Heidelberg

Im Neuenheimer Feld 350

69120 Heidelberg

Germany

Phone: + 496221564752

Fax: + 49 62 21 56 47 54

Email: angelika_bierhaus@med.uni-heidelberg.de

    >