van Aanhold CCL, Dijkstra KL, Bos M, et al. - Experts aspired to explore whether reduced glomerular endothelial thrombomodulin is correlated with glomerular macrophage infiltration in diabetic nephropathy (DN). Thrombomodulin expression was investigated in human kidney samples to examine the possibility of targeting thrombomodulin in patients with DN. The sample consisted of 90 diabetic patients with histologically confirmed DN (62%) and 55 diabetic patients with no evidence of DN (38%), as well as 37 renal autopsy samples from non-diabetic controls without renal pathology. Glomerular thrombomodulin reduction in diabetes is likely to act as an early proinflammatory step in DN pathogenesis. Under diabetic conditions, the thrombomodulin protein can be cleaved, leading to a compensatory increase in transcription. The restoration of glomerular thrombomodulin can be due to the nephroprotective effects of endothelin A receptor antagonists in diabetic patients.