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Том 18 №4 2016 год - Нефрология и диализ

Нефротический синдром: роль ангиопоэтинов в патогенезе


Ермоленко В.М. Филатова Н.Н.

Аннотация: Сосудистые эндотелиальные факторы роста, обеспечивающие ангио- и васкулогенез, играют важнейшую роль в физиологии и патологии человека. Влияя на функции эндотелия, ангиопоэтины способствуют образованию первичных кровеносных сосудов у эмбриона, а у взрослых способствуют заживлению ран, улучшают коллатеральную циркуляцию при инфаркте миокарда, ускоряя реабилитацию пациентов. В то же время ангиопоэтины индуцируют целый ряд неблагоприятных эффектов: развитие диабетической ретинопатии, макулярной дегенерации сетчатки, ускоряют рост и метастазирование злокачественных опухолей. В обзоре приводятся данные о роли агиопоэтинов (VEGF-A и ANGPTL4) в патогенезе основных проявлений нефротического синдрома - протеинурии, отеков, дислипидемии. Установлено, что экспрессия гипосиализированной формы ANGPTL4 в подоцитах способна вызывать развитие нефротического синдрома и гипертриглицеридемии у больных диабетической нефропатией и гломерулонефритом с минимальными изменениями. Однако на фоне продолжающихся потерь белка с мочой повышается экспрессия ANGPTL4 в сердце, печени, мышцах, уменьшающая протеинурию, но одновременно усугубляющая гипертриглицеридемию. В то же время мутантные формы ANGPTL4 индуцируют ремиссию нефротического синдрома, не ухудшая липидный профиль. Назначение больным N-ацетил-D-маннозамина способно трансформировать гипосиализированный ANGPTL4 в нормальный и существенно снижать протеинурию и предупреждать рецидивы нефротического синдрома.

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Ключевые слова: нефротический синдром, сосудистые эндотелиальные факторы роста, ангиопоэтины, nephrotic syndrome, vascular endothelial growth factor, angiopoietins

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