We have recently published that tubular epithelial cells affect the podocyte epigenome though
nicotinic acid metabolism in
diabetic nephropathy (DN), and we have named this relationship "proximal tubule-podocyte communication". In this review, we describe this novel mechanism in the early stage of DN, focusing on the function of renal tubular
Sirt1 and Sirt1-related
nicotinic acid metabolism. Mainly, we discuss the following three findings. First, we described the details of proximal tubule-podocyte communication. Second, we explained how
Sirt1 regulates
albuminuria via epigenetic mechanisms. This means that repeated high
glucose stress triggers the initial changes in proximal tubules, which lead to the epigenetically irreversible glomerular damages. However, proximal tubular
Sirt1 overexpression can rescue these changes. Our previous data indicated that the decrease in
Sirt1 expression in proximal tubules caused the reduction in glomerular
Sirt1 and the subsequent increase in glomerular
Claudin-1. It seemed plausible that some humoral mediator is released from proximal tubules, migrates to podocytes and glomeruli, and affects
Sirt1 expression in podocytes. Third, we mentioned a mediator connecting this communication,
nicotinamide mononucleotide (NMN). We suggest the potential of
Sirt1 or NMN as not only a therapeutic target but also as a prognostic marker of very early stage DN.