TY  - JOUR
A1  - von Websky, Karoline
A1  - Reichetzeder, Christoph
A1  - Hocher, Berthold
T1  - Physiology and pathophysiology of incretins in the kidney
JF  - Current opinion in nephrology and hypertension : reviews of all advances, evaluations of key references, comprehensive listing of papers
N2  - Purpose of reviewIncretin-based therapy with glucagon-like peptide-1 receptor (GLP-1R) agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors is considered a promising therapeutic option for type 2 diabetes mellitus. Cumulative evidence, mainly from preclinical animal studies, reveals that incretin-based therapies also may elicit beneficial effects on kidney function. This review gives an overview of the physiology, pathophysiology, and pharmacology of the renal incretin system.Recent findingsActivation of GLP-1R in the kidney leads to diuretic and natriuretic effects, possibly through direct actions on renal tubular cells and sodium transporters. Moreover, there is evidence that incretin-based therapy reduces albuminuria, glomerulosclerosis, oxidative stress, and fibrosis in the kidney, partially through GLP-1R-independent pathways. Molecular mechanisms by which incretins exert their renal effects are understood incompletely, thus further studies are needed.SummaryThe GLP-1R and DPP-4 are expressed in the kidney in various species. The kidney plays an important role in the excretion of incretin metabolites and most GLP-1R agonists and DPP-4 inhibitors, thus special attention is required when applying incretin-based therapy in renal impairment. Preclinical observations suggest direct renoprotective effects of incretin-based therapies in the setting of hypertension and other disorders of sodium retention, as well as in diabetic and nondiabetic nephropathy. Clinical studies are needed in order to confirm translational relevance from preclinical findings for treatment options of renal diseases.
KW  - DDP-4 inhibition
KW  - diabetes
KW  - diabetic nephropathy
KW  - GLP-1 receptor
KW  - hypertension
KW  - incretins
KW  - kidney
KW  - renal impairment
Y1  - 2014
U6  - https://doi.org/10.1097/01.mnh.0000437542.77175.a0
SN  - 1062-4821
SN  - 1473-6543
VL  - 23
IS  - 1
SP  - 54
EP  - 60
PB  - Lippincott Williams & Wilkins
CY  - Philadelphia
ER  - 
TY  - JOUR
A1  - Hocher, Berthold
A1  - Reichetzeder, Christoph
A1  - Alter, Markus L.
T1  - Renal and cardiac effects of DPP-4 inhibitors - from preclinical development to clinical research
JF  - Kidney & blood pressure research : official organ of the Gesellschaft für Nephrologie
N2  - Inhibitors of type 4 dipeptidyl peptidase (DDP-4) were developed and approved for the oral treatment of type 2 diabetes. Its mode of action is to inhibit the degradation of incretins, such as type 1 glucagon like peptide (GLP-1), and GIP. GLP-1 stimulates glucose-dependent insulin secretion from pancreatic beta-cells and suppresses glucagon release from alpha-cells, thereby improving glucose control. Besides its action on the pancreas type 1 glucagon like peptide has direct effects on the heart, vessels and kidney mainly via the type 1 glucagon like peptide receptor (GLP-1R). Moreover, there are substrates of DPP-4 beyond incretins that have proven renal and cardiovascular effects such as BNP/ANP, NPY, PYY or SDF-1 alpha. Preclinical evidence suggests that DPP-4 inhibitors may be effective in acute and chronic renal failure as well as in cardiac diseases like myocardial infarction and heart failure. Interestingly, large cardiovascular meta-analyses of combined Phase II/III clinical trials with DPP-4 inhibitors point all in the same direction: a potential reduction of cardiovascular events in patients treated with these agents. A pooled analysis of pivotal Phase III, placebo-controlled, registration studies of linagliptin further showed a significant reduction of urinary albumin excretion after 24 weeks of treatment. The observation suggests direct renoprotective effects of DPP-4 inhibition that may go beyond its glucose-lowering potential. Type 4 dipeptidyl peptidase inhibitors have been shown to be very well tolerated in general, but for those excreted via the kidney dose adjustments according to renal function are needed to avoid side effects. In conclusion, the direct cardiac and renal effects seen in preclinical studies as well as meta-analysis of clinical trials may offer additional potentials - beyond improvement of glycemic control - for this newer class of drugs, such as acute kidney failure, chronic kidney failure as well as acute myocardial infarction and heart failure.
KW  - DDP-4 inhibition
KW  - Diabetes
KW  - GLP-1
KW  - Cardiovascular effects
KW  - Myocardial infarction
KW  - Kidney
KW  - Diabetic nephropathy
KW  - Acute renal failure
Y1  - 2012
U6  - https://doi.org/10.1159/000339028
SN  - 1420-4096
VL  - 36
IS  - 1
SP  - 65
EP  - 84
PB  - Karger
CY  - Basel
ER  -