Aradhana Mohan, Aditya Upadhyay, Madan M Godbole, Eesh Bhatia and Swasti Tiwari
Objective: Previously, we reported presence of Wilms’ tumor 1 (WT1) in urinary exosomes in ~50% diabetic (T1D) population without proteinuria as oppose to 100% in T1D population with proteinuria. Here, we investigated if T1D subjects with detectable WT1 in urinary exosomes (UE) progress to proteinuria faster in a 2 year follow-up study. Method: 52 T1D subjects without proteinuria (age < 60 years) were enrolled. Urine and blood samples were collected for analysis. WT1 immunoblotting was performed on UE isolated by ultracentifugation of urine samples. Urine microalbumin, serum creatinine and glycated haemoglobin (HbA1c) were analyzed. Results: WT1 protein was detected in UE of 28 out of 52 T1D subjects. The data from followed patients, at the end of two years of follow up, revealed that 4 subjects (out of total 19) progressed to proteinuria with urine microalbumin >20 μg/min in WT1-positive group as oppose to none in WT1 negative group. Moreover, binary logistic regression analysis revealed a significant relation of WT1 presence in UE with increase in urine microalbumin >5 μg/min as indicated by significant Odds ratio of 9.9 (95% CI of 92.686, p=0.04). Both groups had statistically similar diabetes duration, age, % HbA1c and estimated GFR at the baseline. Conclusion: Thus, presence of WT-1 in urinary exosomes could potentially predict risk of developing proteinuria in type 1 diabetic patients.