Agarwal R (2006) Anti-inflammatory effects of short-term pioglitazone therapy in men with advanced diabetic nephropathy. Am J Physiol Renal Physiol 290: F600–F605

The THIAZOLIDINEDIONE pioglitazone can reduce inflammation in patients with chronic kidney disease secondary to type 2 diabetes mellitus, according to the results of a prospective, single-center trial. The researcher proposes that, through its anti-inflammatory effects, the drug could lessen the high risk of cardiovascular events in this population.

Men with advanced diabetic nephropathy were randomized to receive pioglitazone (n = 21) or the SULPHONYLUREA glipizide (n = 19) for 16 weeks. Levels of biomarkers of inflammation, such as white blood cell count, plasma C-reactive protein and plasma INTERLEUKIN 6 (IL-6), as well of as plasma MATRIX METALLOPROTEINASE 9—an indicator of atherosclerotic plaque stabilization—were significantly reduced after treatment with pioglitazone (P <0.05 for all). The 1,125 cells/µl reduction in white blood cell count and 58% decrease in IL-6 level in the pioglitazone group were significant even when compared with changes in these inflammation biomarkers in the glipizide group (P = 0.009 and P = 0.001, respectively). Levels of plasma TUMOR NECROSIS FACTOR α and markers of oxidative stress (plasma MALONDIALDEHYDE, plasma and urine albumin carbonyl and total protein carbonyl) did not change in response to either therapy.

Pioglitazone is a synthetic PEROXISOME PROLIFERATIVE ACTIVATED RECEPTOR γ agonist that inhibits the expression of proinflammatory genes and reduces monocyte production of inflammatory markers such as IL-6. Subject to confirmation in large trials, pioglitazone could be used together with angiotensin-receptor blockers, statins and aspirin, to reduce cardiovascular event risk in patients with diabetic nephropathy.