Glicación de proteínas como elemento esencial en las complicaciones crónicas de la diabetes mellitus
Keywords:
Diabetes mellitus, complicacionesAbstract
La hiperglicemia es considerada en la actualidad como un factor causal clave en el desarrollo de las complicaciones vasculares diabéticas, pudiendo producir sus efectos nocivos por múltiples vías. Esto ha sido confirmado por el estudio Diabetes Control and Complication Trial de 1993, para la microangiopatía en el caso de la diabetes tipo 1 y corroborado por el United Kingdom Prospective Diabetes Study publicado a fines de 1998 para el caso de la diabetes tipo 2. En esta revisión se resumen las evidencias actuales en apoyo del rol de la hiperglicemia en las complicaciones vasculares del paciente con diabetes mellitus. Se profundiza en uno de los mecanismos bioquímicos protagónicos en esta enfermedad: la glicación o glicosilación noenzimática y se hace énfasis en la acción deletérea directa de la glucosa y otros monosacáridos sobre las proteínas así como la evidencia obtenida en estudios en animales y en ensayos clínicos de fase III, en apoyo de que la aminoguanidina, un inhibidor de la glicación, que retarda la aparición y modifica el curso de estas complicaciones. Se describe como los AGEs se unen a los receptores correspondientes y desencadenan una serie de mecanismos que conllevan al trastorno de la coagulación, a la aterogénesis y a los cambios de la membrana basal glomerular, produciéndose como consecuencia la proteinuria, la esclerosis y la expansión mesangial características de la etapa final de la enfermedad renal diabética. Un estricto control de las cifras de glicemia en la actualidad y el uso de fármacos antagonistas de la formación de los compuestos AGEs permitirán una mejor profilaxis de las complicaciones vasculares en esta enfermedad.
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