Clinical and Pharmacological Basis for the Use of Drugs Inhibiting of the RAAS in Patients with Diabetic Neuropathy

Diabetes mellitus (DM) is the most common cause of diabetic neuropathy (DN) comprises a heterogeneous group of disorders that can cause neuronal dysfunction throughout the human body. The incidence of diabetes and its complications is increasing to staggering proportions. In 2014 the WHO estimated an overall prevalence of 422 million (8, 5%). The incidence of diabetic neuropathy approaches 50% in most diabetic populations; there is no treatment, and its consequences in the form of foot ulceration and amputation. The recent studies suggest that the renin angiotensin aldosterone system (RAAS) plays a vital role in regulating glucose metabolism and blood pressure. In the same time the metabolic abnormalities associated with diabetes lead to activation RAAS, which might promote the formation of reactive oxygen species to lead the endothelial and neuronal dysfunctions. Furthermore, TNFα is part of the response of the organism to hypertension and is originally described as one of the central mediators of inflammation trough the activation of transcription factor NFκB an important factor in the control of cell proliferation, differentiation, and apoptosis. Methodology & Theoretical Orientation: The study is going on in parallel groups. The patients (enrolled on randomized principle) with DPN will be investigated. The enrolled subjects was divided into two main groups: group I with Type I and Type II DM, complicated by DPN to take Aliskiren and group II with the same pathology, proceeding with the treatment without Aliskiren but given Telmisartan, for certainty of Aliskiren efficacy. At the start of the trial and on completion of the six week period TNFα level and C-peptide will be determined. Findings: Telmisartan has less TNFα modulatory effects then Aliskiren, Namely, the symptoms of neuropathy a well as blood TNFα level and C-peptide level are not changed significantly. Conclusion & Significance: TNFα is involved in DPN pathogenesis formation and clinical manifestation. Aliskiren ameliorates symptoms in DPN patients by modulatory impact on TNFα, so we have results for clinical and pharmacological analysis of Aliskiren application in DPN. The involvements of RAAS system in developments of DNP needs further research study.