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. 2025 Jan 21;110(2):e239-e248.
doi: 10.1210/clinem/dgae266.

Plasma Proteomics of Diabetic Kidney Disease Among Asians With Younger-Onset Type 2 Diabetes

Resham Lal Gurung  1   2 , Huili Zheng  1 , Hiromi Wai Ling Koh  3 , Yiamunaa M  1 , Jian-Jun Liu  1 , Sylvia Liu  1 , Clara Chan  1 , Keven Ang  1 , Clara Si Hua Tan  1 , Radoslaw Mikolaj Sobota  3 , Tavintharan Subramaniam  1 , Chee Fang Sum  1 , Su Chi Lim  1   3   4   5   6
Affiliations

Plasma Proteomics of Diabetic Kidney Disease Among Asians With Younger-Onset Type 2 Diabetes

Resham Lal Gurung et al. J Clin Endocrinol Metab. .

Abstract

Context: Patients with younger onset of type 2 diabetes (YT2D) have increased risk for kidney failure compared to those with late onset. However, the mechanism of diabetic kidney disease (DKD) progression in this high-risk group is poorly understood.

Objective: This work aimed to identify novel biomarkers and potential causal proteins associated with DKD progression in patients with YT2D.

Methods: Among YT2D (T2D onset age <40 years), 144 DKD progressors (cases) were matched for T2D onset age, sex, and ethnicity with 292 nonprogressors (controls) and divided into discovery and validation sets. DKD progression was defined as decline of estimated glomerular filtration rate (eGFR) of 3 mL/min/1.73 m2 or greater or 40% decline in eGFR from baseline. A total of 1472 plasma proteins were measured through a multiplex immunoassay that uses a proximity extension assay technology. Multivariable logistic regression was used to identify proteins associated with DKD progression. Mendelian randomization (MR) was used to evaluate causal relationship between plasma proteins and DKD progression.

Results: Forty-two plasma proteins were associated with DKD progression, independent of traditional cardiorenal risk factors, baseline eGFR, and urine albumin-to-creatinine ratio. The proteins identified were related to inflammatory and remodeling biological processes. Our findings suggest angiogenin as one of the top signals (odds ratio = 5.29; 95% CI, 2.39-11.73; P = 4.03 × 10-5). Furthermore, genetically determined plasma angiogenin level was associated with increased odds of DKD progression.

Conclusion: Large-scale proteomic analysis identified novel proteomic biomarkers for DKD progression in YT2D. Genetic evidence suggest a causal role of plasma angiogenin in DKD progression.

Keywords: diabetes kidney disease; proteomics; younger onset of type 2 diabetes.

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Figures

Figure 1.
Figure 1.
Flowchart of participant selection for observational analysis.
Figure 2.
Figure 2.
Association between protein and diabetic kidney disease progression among patients in the A, discovery and B, validation sets. The 69 and 42 proteins lying above the dotted line were associated with diabetic kidney disease at 10% false discovery rate in the A, discovery set and 5% nominal type 1 error rate in the B, validation set.
See this image and copyright information in PMC

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