Diabetic Nephropathy (DN) is a major complication in patients with type 1 or type 2 diabetes
and represents the leading cause of end-stage renal disease. Novel therapeutic approaches are
warranted. In view of a polymorphism in the carnosinase 1 gene CNDP1, resulting in reduced
carnosine degradation activity and a significant DN risk reduction, carnosine (β-alanyl-L-histidine)
has gained attention as a potential therapeutic target. Carnosine has anti-inflammatory, antioxidant,
anti-glycation and reactive carbonyl quenching properties. In diabetic rodents, carnosine supplementation
consistently improved renal histology and function and in most studies, also glucose metabolism.
Even though plasma half-life of carnosine in humans is short, first intervention studies in (pre-)
diabetic patients yielded promising results. The precise molecular mechanisms of carnosine mediated
protective action, however, are still incompletely understood. This review highlights the recent
knowledge on the role of the carnosine metabolism in DN.