title: High levels of AGE-LDL, and of IgG antibodies reacting with MDA-lysine epitopes expressed by oxLDL and MDA-LDL in circulating immune complexes predict macroalbuminuria in patients with type 2 diabetes.
abstract: BACKGROUND
  Circulating immune complexes (IC) containing modified forms of LDL (mLDL) are strongly pro-inflammatory and when present in high levels are associated with the development of diabetic complications.
  
  
  OBJECTIVE
  We investigated whether levels of oxidized LDL (oxLDL), malondialdehyde-LDL (MDA-LDL) and advanced glycation end products-LDL (AGE-LDL) as well as IgG and IgM antibodies reacting with MDA-lysine epitopes expressed by oxLDL and MDA-LDL isolated from circulating IC were associated with progression to macroalbuminuria in type 2 diabetes (VADT cohort).
  
  
  METHODS
  Levels of mLDL in IC were measured in 905 patients, a median of two years after entry into the study. Participants were followed for an average of 3.7years for renal outcomes. Generalized logistic regression models were used to quantify the association of increased levels of biomarkers and development of abnormal albuminuria. Normal, persistent micro- (ACR ≥30), incident micro- (ACR ≥30) and incident macroalbuminuria (ACR ≥300) were the outcomes of interest.
  
  
  CONCLUSIONS
  Patients with macro (n=78) or non-persistent microalbuminuria (n=81) at baseline were excluded. Odds ratios for endpoints in relation to high versus low (defined using a median split) biomarker levels are found in Fig. 1. Our study demonstrates that high levels of AGE-LDL as well as of IgG antibodies (but not IgM antibodies) reacting with MDA-LDL lysine epitopes in circulating IC predict the development of macroalbuminuria in patients with type 2 diabetes. These data support the pathogenic role of modified LDL IgG antibodies but not the protective role of modified LDL IgM antibodies.
authors: Department of Medicine and Laboratory Services, Medical University of South Carolina and Ralph H. Johnson VA Medical Center, Charleston, SC. Electronic address: virellam@musc.edu.
authors: Maria F
authors: MF
authors: Lopes-Virella
authors: Department of Public Health Services, Medical University of South Carolina, Charleston, SC.
authors: Kelly J
authors: KJ
authors: Hunt
authors: Department of Public Health Services, Medical University of South Carolina, Charleston, SC.
authors: Nathaniel L
authors: NL
authors: Baker
authors: Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC.
authors: Gabriel
authors: G
authors: Virella
mesh_terms: D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D000936:Antigen-Antibody Complex / Q000032:analysis*; D001323:Autoantibodies / Q000032:analysis*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000276:immunology; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology*; D018450:Disease Progression; D000939:Epitopes; D005260:Female; D005500:Follow-Up Studies; D017127:Glycation End Products, Advanced / Q000097:blood*; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D015994:Incidence; D008077:Lipoproteins, LDL / Q000037:antagonists & inhibitors / Q000097:blood; D008297:Male; D008315:Malondialdehyde / Q000037:antagonists & inhibitors / Q000097:blood; D008875:Middle Aged; D011237:Predictive Value of Tests; D051437:Renal Insufficiency / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D013022:South Carolina / Q000453:epidemiology
chemical_list: D000936:Antigen-Antibody Complex; D001323:Autoantibodies; D015415:Biomarkers; D000939:Epitopes; D017127:Glycation End Products, Advanced; D007074:Immunoglobulin G; D008077:Lipoproteins, LDL; C099252:oxidized low density lipoprotein; D008315:Malondialdehyde
keywords: AGE- LDL; Albuminuria; MDA-LDL; Modified LDL antibodies; Modified LDL immune complexes; Nephropathy