title: Emerging role of thiamine therapy for prevention and treatment of early-stage diabetic nephropathy.
abstract: Thiamine supplementation may prevent and reverse early-stage diabetic nephropathy. This probably occurs by correcting diabetes-linked increased clearance of thiamine, maintaining activity and expression of thiamine pyrophosphate-dependent enzymes that help counter the adverse effects of high glucose concentrations-particularly transketolase. Evidence from experimental and clinical studies suggests that metabolism and clearance of thiamine is disturbed in diabetes leading to tissue-specific thiamine deficiency in the kidney and other sites of development of vascular complications. Thiamine supplementation prevented the development of early-stage nephropathy in diabetic rats and reversed increased urinary albumin excretion in patients with type 2 diabetes and microalbuminuria in two recent clinical trials. The thiamine monophosphate prodrug, Benfotiamine, whilst preventing early-stage development of diabetic nephropathy experimentally, has failed to produce similar clinical effect. The probable explanations for this are discussed. Further definitive trials for prevention of progression of early-stage diabetic nephropathy by thiamine are now required.
authors.affiliation: Clinical Sciences Research Institute, Warwick Medical School, University of Warwick, University Hospital, Coventry, UK. N.Rabbani@warwick.ac.uk
authors.forename: N
authors.initials: N
authors.lastname: Rabbani
authors.forename: P J
authors.initials: PJ
authors.lastname: Thornalley
mesh_terms: D000419:Albuminuria / Q000150:complications / Q000517:prevention & control; D000818:Animals; D003921:Diabetes Mellitus, Experimental / Q000150:complications / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000517:prevention & control; D019587:Dietary Supplements; D006801:Humans; D051381:Rats; D013831:Thiamine / Q000493:pharmacokinetics / Q000627:therapeutic use*
chemical_list: D013831:Thiamine