Epigenetics and epigenomics in diabetic kidney disease and metabolic memory

Nat Rev Nephrol. 2019 Jun;15(6):327-345. doi: 10.1038/s41581-019-0135-6.

Abstract

The development and progression of diabetic kidney disease (DKD), a highly prevalent complication of diabetes mellitus, are influenced by both genetic and environmental factors. DKD is an important contributor to the morbidity of patients with diabetes mellitus, indicating a clear need for an improved understanding of disease aetiology to inform the development of more efficacious treatments. DKD is characterized by an accumulation of extracellular matrix, hypertrophy and fibrosis in kidney glomerular and tubular cells. Increasing evidence shows that genes associated with these features of DKD are regulated not only by classical signalling pathways but also by epigenetic mechanisms involving chromatin histone modifications, DNA methylation and non-coding RNAs. These mechanisms can respond to changes in the environment and, importantly, might mediate the persistent long-term expression of DKD-related genes and phenotypes induced by prior glycaemic exposure despite subsequent glycaemic control, a phenomenon called metabolic memory. Detection of epigenetic events during the early stages of DKD could be valuable for timely diagnosis and prompt treatment to prevent progression to end-stage renal disease. Identification of epigenetic signatures of DKD via epigenome-wide association studies might also inform precision medicine approaches. Here, we highlight the emerging role of epigenetics and epigenomics in DKD and the translational potential of candidate epigenetic factors and non-coding RNAs as biomarkers and drug targets for DKD.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Blood Glucose / metabolism*
  • DNA Methylation / genetics
  • Diabetes Mellitus / drug therapy
  • Diabetes Mellitus / metabolism*
  • Diabetic Nephropathies / drug therapy
  • Diabetic Nephropathies / genetics*
  • Diabetic Nephropathies / metabolism
  • Disease Progression
  • Epigenesis, Genetic / genetics*
  • Epigenomics
  • Gene-Environment Interaction
  • Histone Code / genetics
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Kidney Failure, Chronic / genetics
  • Kidney Failure, Chronic / metabolism
  • Molecular Targeted Therapy
  • Precision Medicine
  • RNA, Untranslated / genetics
  • Renal Insufficiency, Chronic / drug therapy
  • Renal Insufficiency, Chronic / genetics*
  • Renal Insufficiency, Chronic / metabolism

Substances

  • Blood Glucose
  • Hypoglycemic Agents
  • RNA, Untranslated