Functional Connections Between Insulin and Neurotrophin-3 in Hemodialysis Patients with Type 2 Diabetes.

The bidirectional transfer of biological information between insulin and neurotrophin-3 (NT-3) in hemodialysis patients (end-stage renal disease-ESRD) with type 2 diabetes mellitus (T2DM) is extremely poorly studied. Why was NT-3 chosen? Because, of all the nerve growth factors, this one also exhibits specific actions at the nephron level. The authors of this manuscript also conducted the first study on the serum behavior of NT-3 in this category of patients. Even though the results have already been published, the way in which an endocrine compound (insulin) interacts at the renal level with a growth factor with predominantly autocrine and paracrine action (NT-3), under both normal and pathological conditions, has not been thoroughly studied. This paper will address the following topics: 1. that insulin synthesis and release involve the same molecules that also exert important actions at the renal level; 2. involvement of insulin deficiency/resistance in the development of diabetic nephropathy and end-stage renal disease vs. kidney influences on serum glucose and insulin levels; 3. actions of NT-3 under normal conditions vs. diabetes mellitus; 4. aspects highlighted by personal studies performed on hemodialysis patients with T2DM. Taking an original approach, the functional link between insulin and NT-3 in hemodialysis patients, especially those with T2DM, will be presented. Finally, new therapeutic possibilities and directions for patient monitoring will be proposed, as well as topics for further research.