Importance of Identifying Novel Biomarkers of Microvascular Damage in Type 1 Diabetes
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LEADING ARTICLE
Importance of Identifying Novel Biomarkers of Microvascular Damage in Type 1 Diabetes M. Loredana Marcovecchio1
© Springer Nature Switzerland AG 2020
Abstract Microvascular complications of type 1 diabetes, which primarily include diabetic kidney disease, retinopathy, and neuropathy, are characterized by damage to the microvasculature of the kidney, retina, and neurons. The pathogenesis of these complications is multifactorial, and several pathways are implicated. These complications are often silent during their early stages, and once symptoms develop, there might be little to be done to cure them. Thus, there is a strong need for novel biomarkers to identify individuals at risk of microvascular complications at an early stage and guide the implementation of new therapeutic options for preventing their development and progression. Recent advancements in proteomics, metabolomics, and other ‘omics’ have led to the identification of several potential biomarkers of microvascular complications. However, biomarker discovery has met several challenges and, up to now, there are no new biomarkers that have been implemented into clinical practice. This highlights the need for further work in this area to move towards better diagnostic and prognostic approaches.
Key Points
1 Introduction
Early detection of microvascular complications is of paramount importance and new biomarkers are required to achieve that goal.
Mortality rates in individuals with type 1 diabetes (T1D) still exceed that of the background population by three- to fourfold [1–3], even though over the last decades there have been key advancements in the management of this condition. The burden associated with T1D is largely due to the associated micro- and macro-vascular complications, which develop in a high percentage of patients after a variable diabetes duration [4, 5]. Prevention of vascular complications relies on the ability to identify high-risk individuals at an early stage when tissue damage may be more responsive to interventions and reversible [4–6]. Many of the biomarkers currently in use do not allow for early diagnosis of vascular damage, thus highlighting the need for novel biomarkers reflecting earlier stages of the development of vascular complications, to identify subjects at risk and implement additional preventive strategies. Recent advancements in proteomics, metabolomics, and other ‘omics’ and the integration of these different approaches continue to unveil new potential biomarkers in several fields, including T1D vascular complications [7, 8]. This review provides an overview of biomarkers of microvascular damage, specifically in the context of T1D. The focus of the review is on the value of biomarkers of vascular complications and the challenges related to their development and implementation into clinical practice.
New ‘omics’-based biomarkers are promising, and they could be included in a multi-biomarker approach together with traditional markers of complications to support early diagnosis and management of m
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