1
|
Gong H, Ren Y, Li Z, Zha P, Bista R, Li Y, Chen D, Gao Y, Chen L, Ran X, Wang C. Clinical characteristics and risk factors of lower extremity amputation in the diabetic inpatients with foot ulcers. Front Endocrinol (Lausanne) 2023; 14:1144806. [PMID: 37065766 PMCID: PMC10102466 DOI: 10.3389/fendo.2023.1144806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVES To analyze clinical characteristics of the diabetic inpatients with foot ulcers and explore the risk factors of lower extremity amputation (LEA) in West China Hospital of Sichuan University. METHODS A retrospective analysis was performed based on the clinical data of the patients with diabetic foot ulcer (DFU) hospitalized in West China Hospital of Sichuan University from January 1, 2012 to December 31, 2020. The DFU patients were divided into three groups: non-amputation, minor amputation, and major amputation groups. The ordinal logistic regression analysis was used to identify the risk factors for LEA. RESULTS 992 diabetic patients (622 males and 370 females) with DFU were hospitalized in the Diabetic Foot Care Center of Sichuan University. Among them, 72 (7.3%) (55 minor amputations and 17 major amputations) cases experienced amputation, and 21(2.1%) refused amputation. Excluding the patients who refused amputation, the mean age and duration of diabetes of and HbA1c the 971 patients with DFU, were 65.1 ± 12.3 years old, 11.1 ± 7.6 years, and 8.6 ± 2.3% respectively. The patients in the major amputation group were older and had longer course of diabetes for a longer period of time than those in the non-amputation and minor amputation groups. Compared with the non-amputation patients (55.1%), more patients with amputation (minor amputation (63.5%) and major amputation (88.2%)) suffered from peripheral arterial disease (P=0.019). The amputated patients had statistically lower hemoglobin, serum albumin and ankle brachial index (ABI), but higher white blood cell, platelet counts, fibrinogen and C-reactive protein levels. The patients with amputation had a higher incidence of osteomyelitis (P = 0.006), foot gangrene (P < 0.001), and a history of prior amputations (P < 0.001) than those without amputation. Furthermore, a history of prior amputation (odds ratio 10.194; 95% CI, 2.646-39.279; P=0.001), foot gangrene (odds ratio 6.466; 95% CI, 1.576-26.539; P=0.010) and ABI (odds ratio 0.791; 95% CI, 0.639-0.980; P = 0.032) were significantly associated with LEAs. CONCLUSIONS The DFU inpatients with amputation were older with long duration of diabetes, poorly glycemic control, malnutrition, PAD, severe foot ulcers with infection. A history of prior amputation, foot gangrene and a low ABI level were the independent predictors of LEA. Multidisciplinary intervention for DFU is essential to avoid amputation of the diabetic patients with foot ulcer.
Collapse
Affiliation(s)
- Hongping Gong
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- International Medical Center Ward, Department of General Practice, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Ren
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenyi Li
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Panpan Zha
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Raju Bista
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Li
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dawei Chen
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yun Gao
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lihong Chen
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chun Wang
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Chun Wang, ,
| |
Collapse
|
2
|
Oxidative Stress and Inflammatory Biomarkers in Patients with Diabetic Foot. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121866. [PMID: 36557068 PMCID: PMC9785583 DOI: 10.3390/medicina58121866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Diabetic foot (DF) development is driven by complex interactions of hyperglycemia, inflammation, and oxidative stress (OS). We aimed to investigate OS and inflammatory biomarkers in patients with DF and their potential to improve early diagnosis and management of DF. Materials and Methods: The prooxidant−antioxidant balance (PAB), superoxide dismutase (SOD), total oxidative status (TOS), total sulfhydryl groups (SHG), routine biochemical parameters, and complete blood count were determined in 42 patients with type-2 DM, of which 23 patients had DF, while 19 patients were without DF complications. The neutrophils-to-lymphocyte ratio (NLR) was evaluated as a biomarker of inflammation. Results: Patients with DF had significantly higher (p < 0.05) PAB levels (170 ± 33.9 U/L) compared to those without DF complications (142 ± 31.3 U/L). In addition, patients with DF had significantly reduced SOD activities (p < 0.01). NLR values were significantly higher in the DF group (median: 2.8; interquartile range: 2.0−4.3) than in the group without DF (median: 1.4; interquartile range: 1.4−2.1; p < 0.01). A positive correlation was found between the PAB and NLR index (r = 0.449; p < 0.05). The diagnostic accuracy of both PAB (AUC = 0.741; p < 0.01) and NLR (AUC = 0.760; p < 0.01) was estimated as acceptable. Conclusions: In conclusion, the development of DF is associated with enhanced OS and inflammation processes. PAB and NLR could be useful non-invasive biomarkers of DF development.
Collapse
|
3
|
Huang Y, Kyriakides TR. The role of extracellular matrix in the pathophysiology of diabetic wounds. Matrix Biol Plus 2020; 6-7:100037. [PMID: 33543031 PMCID: PMC7852307 DOI: 10.1016/j.mbplus.2020.100037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/29/2022] Open
Abstract
Impaired healing leading to the formation of ulcerated wounds is a critical concern in patients with diabetes. Abnormalities in extracellular matrix (ECM) production and remodeling contribute to tissue dysfunction and delayed healing. Specifically, diabetes-induced changes in the expression and/or activity of structural proteins, ECM-modifying enzymes, proteoglycans, and matricellular proteins have been reported. In this review, we provide a summary of the key ECM molecules and associated changes in skin and diabetic wounds. Such information should allow for new insights in the understanding of impaired wound healing and lead to the development of ECM-based therapeutic strategies.
Collapse
Affiliation(s)
- Yaqing Huang
- Vascular Biology and Therapeutics Program, Yale University, New Haven, CT 06519, USA.,Department of Pathology, Yale University, New Haven, CT 06519, USA
| | - Themis R Kyriakides
- Vascular Biology and Therapeutics Program, Yale University, New Haven, CT 06519, USA.,Department of Pathology, Yale University, New Haven, CT 06519, USA.,Department of Biomedical Engineering, Yale University, New Haven, CT 06519, USA
| |
Collapse
|
4
|
Shahvali S, Shahesmaeili A, Sanjari M, Karami-Mohajeri S. The correlation between blood oxidative stress and sialic acid content in diabetic patients with nephropathy, hypertension, and hyperlipidemia. Diabetol Int 2019; 11:19-26. [PMID: 31950000 DOI: 10.1007/s13340-019-00395-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/23/2019] [Indexed: 12/23/2022]
Abstract
This clinical study was designed to find out the correlation between oxidative stress and sialic acid (SA) content of plasma and RBCs in patients with type 2 diabetes. We evaluated SA concentration and oxidative stress biomarkers in healthy subjects and diabetic patients with and without complications in a cross-sectional survey. Significant changes in oxidative stress biomarkers and RBC-SA were revealed in the diabetic patients compared to those in the healthy group. Plasma SA significantly increased with an increase in lipid peroxidation of RBCs (LPO-RBC) (P < 0.001) in the diabetic patients without complication. RBC-SA significantly decreased with an elevation in LPO-RBC (P < 0.001) in all the diabetic patients and those with nephropathy. There was no significant correlation between plasma and RBC-SA and other oxidative stress biomarkers in the diabetic subjects. In multiple logistic regression analysis, RBC-SA was independently related to LPO-RBC in all the diabetic patients and those with nephropathy. We conclude that the induction of LPO-RBC in diabetic patients and those with nephropathy may influence the SA decomposition of RBC membrane, thereby altering its functions and transporter activities. Therefore, LPO-RBC and SA levels in RBCs can be used for prediction of diabetic nephropathy, and further studies to evaluate other factors contributing to desialylation of RBC membrane are justified.
Collapse
Affiliation(s)
- Sedigheh Shahvali
- 1Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.,2Pharmaceutics Research Center, Institute of Neuropharmacology, Faculty of Pharmacy, Kerman University of Medical Sciences, Haft Bagh-e-Alavi Highway, 7616911319 Kerman, Iran
| | - Armita Shahesmaeili
- 3Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mojgan Sanjari
- 1Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayyeh Karami-Mohajeri
- 2Pharmaceutics Research Center, Institute of Neuropharmacology, Faculty of Pharmacy, Kerman University of Medical Sciences, Haft Bagh-e-Alavi Highway, 7616911319 Kerman, Iran
| |
Collapse
|
5
|
Korkmaz P, Koçak H, Onbaşı K, Biçici P, Özmen A, Uyar C, Özatağ DM. The Role of Serum Procalcitonin, Interleukin-6, and Fibrinogen Levels in Differential Diagnosis of Diabetic Foot Ulcer Infection. J Diabetes Res 2018; 2018:7104352. [PMID: 29675434 PMCID: PMC5841040 DOI: 10.1155/2018/7104352] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/13/2017] [Indexed: 12/15/2022] Open
Abstract
AIMS We aimed to evaluate the roles of interleukin-6 (IL-6), PCT, and fibrinogen levels in the differential diagnosis of the patients with infected diabetic foot ulcer (IDFU) and noninfected diabetic foot ulcer (NIDFU) and to compare those with C-reactive protein (CRP), white blood cell (WBC), and erythrocyte sedimentation rate (ESR). METHODS Patients over 18 years with a diagnosis of type 2 diabetes mellitus and DFU who were followed up in our hospital between 1 January 2016 and 1 January 2017 were included in the study. In addition to this patient group, patients with diabetes but without DFU were determined as the control group. RESULTS Thirty-eight patients with IDFU, 38 patients with NIDFU, and 43 patients as the control group were included in the study. Fifty-six point three percent of the patients who participated in the study were males, and the mean age was 61.07 ± 11.04 years. WBC, ESR, CRP, IL-6, and fibrinogen levels of the cases with IDFU were determined to be significantly higher compared to the cases in NIDFU (p < 0.01). The area under the ROC curve (AUROC) value was highest for CRP (0.998; p < 0.001), and the best cut-off value for CRP was 28 m/L. The best cut-off values for fibrinogen, IL-6, ESR, and WBC were 480 mg/dL, 105.8 pg/mL, 31 mm/h, and 11.6 (103 μ/L), respectively. CONCLUSION Serum PCT levels were not found to be effective in the discrimination of IDFU and NIDFU. Serum IL-6 and fibrinogen levels seem to be two promising inflammatory markers in the discrimination of IDFU.
Collapse
Affiliation(s)
- Pınar Korkmaz
- Department of Clinical Microbiology and Infectious Diseases, Dumlupınar University Faculty of Medicine, 43020 Kutahya, Turkey
| | - Havva Koçak
- Department of Biochemistry, Dumlupınar University Faculty of Medicine, Kutahya, Turkey
| | - Kevser Onbaşı
- Department of Endocrinology and Metabolism, Dumlupınar University Faculty of Medicine, Kutahya, Turkey
| | - Polat Biçici
- Department of Plastic Surgery, Kütahya Dumlupınar Training and Research Hospital, Kutahya, Turkey
| | - Ahmet Özmen
- Department of Clinical Microbiology and Infectious Diseases, Kütahya Dumlupınar Training and Research Hospital, Kutahya, Turkey
| | - Cemile Uyar
- Department of Clinical Microbiology and Infectious Diseases, Kütahya Dumlupınar Training and Research Hospital, Kutahya, Turkey
| | - Duru Mıstanoğlu Özatağ
- Department of Clinical Microbiology and Infectious Diseases, Dumlupınar University Faculty of Medicine, 43020 Kutahya, Turkey
| |
Collapse
|
6
|
Ojalvo AG, Acosta JB, Marí YM, Mayola MF, Pérez CV, Gutiérrez WS, Marichal II, Seijas EÁ, Kautzman AM, Pacheco AE, Armstrong DG. Healing enhancement of diabetic wounds by locally infiltrated epidermal growth factor is associated with systemic oxidative stress reduction. Int Wound J 2017; 14:214-225. [PMID: 27002919 PMCID: PMC7949965 DOI: 10.1111/iwj.12592] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/24/2016] [Indexed: 12/23/2022] Open
Abstract
The diabetic foot ulcer (DFU) is the leading cause of lower extremity amputation worldwide and is directly associated with comorbidity, disability and mortality. Oxidative stress mechanisms have been implicated in the pathogenesis of these wounds. Intra-lesional infiltration of epidermal growth factor has emerged as a potential therapeutic alternative to allow for physiological benefit while avoiding the proteolytic environment at the centre of the wound. The aim of this study was to characterise the response of patients with DFUs to epidermal growth factor treatment in terms of redox status markers. Experimental groups included patients with DFUs before and 3-4 weeks after starting treatment with epidermal growth factor; compensated and non-compensated diabetic patients without ulcers; and age-matched non-diabetic subjects. Evaluations comprised serum levels of oxidative stress and antioxidant reserve markers. Patients with DFUs exhibited the most disheveled biochemical profile, with elevated oxidative stress and low antioxidant reserves, with respect to non-ulcerated diabetic patients and to non-diabetic subjects. Epidermal growth factor intra-lesional administration was associated with a significant recovery of oxidative stress and antioxidant reserve markers. Altogether, our results indicate that epidermal growth factor intra-ulcer therapy contributes to restore systemic redox balance in patients with DFUs.
Collapse
Affiliation(s)
- Ariana García Ojalvo
- Wound Healing and Cytoprotection Group, Department of Pharmaceuticals, Biomedical Research DirectionCenter for Genetic Engineering and BiotechnologyHavanaCuba
| | - Jorge Berlanga Acosta
- Wound Healing and Cytoprotection Group, Department of Pharmaceuticals, Biomedical Research DirectionCenter for Genetic Engineering and BiotechnologyHavanaCuba
| | - Yssel Mendoza Marí
- Wound Healing and Cytoprotection Group, Department of Pharmaceuticals, Biomedical Research DirectionCenter for Genetic Engineering and BiotechnologyHavanaCuba
| | - Maday Fernández Mayola
- Wound Healing and Cytoprotection Group, Department of Pharmaceuticals, Biomedical Research DirectionCenter for Genetic Engineering and BiotechnologyHavanaCuba
| | - Calixto Valdés Pérez
- Diabetic Foot Ulcer Service, National Institute of Angiology and Vascular SurgerySalvador Allende HospitalHavanaCuba
| | - William Savigne Gutiérrez
- Diabetic Foot Ulcer Service, National Institute of Angiology and Vascular SurgerySalvador Allende HospitalHavanaCuba
| | | | | | - Alicia Molina Kautzman
- Wound Healing and Cytoprotection Group, Department of Pharmaceuticals, Biomedical Research DirectionCenter for Genetic Engineering and BiotechnologyHavanaCuba
| | - Angélica Estrada Pacheco
- Wound Healing and Cytoprotection Group, Department of Pharmaceuticals, Biomedical Research DirectionCenter for Genetic Engineering and BiotechnologyHavanaCuba
| | - David G. Armstrong
- Southern Arizona Limb Salvage Alliance (SALSA), Department of SurgeryUniversity of Arizona College of MedicineTucsonAZUSA
| |
Collapse
|
7
|
Li XH, Guan LY, Lin HY, Wang SH, Cao YQ, Jiang XY, Wang YB. Fibrinogen: A Marker in Predicting Diabetic Foot Ulcer Severity. J Diabetes Res 2016; 2016:2358321. [PMID: 28044140 PMCID: PMC5156809 DOI: 10.1155/2016/2358321] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/10/2016] [Indexed: 11/17/2022] Open
Abstract
Aims. To examine whether fibrinogen levels are a valuable biomarker for assessing disease severity and monitoring disease progression in patients with diabetic foot ulcer (DFU). Methods. A retrospective study was designed to examine the utility of fibrinogen in estimating disease severity in patients with DFU admitted to our hospital between January 2015 and January 2016. In total, 152 patients with DFU were enrolled in the study group, and 52 age and gender matched people with diabetes but no DFU were included as the control group. DFU severity was assessed using Wagner criteria. Results. Patients with DFU were divided into 2 subgroups based on the Wagner criteria. Mean fibrinogen values were significantly higher in patients with DFU grade ≧ 3 compared to those with DFU grades 1-2 (5.23 ± 1.37 g/L versus 3.61 ± 1.04 g/L). Using ROC statistic, a cut-off value of 5.13 g/L indicated the possible amputation with a sensitivity of 81.8% and a specificity of 78.9% (positive predictive value [PPV] 78.6%, negative predictive value [89.0%]). Fibrinogen values were found to be correlated with CRP levels, neutrophil, and WBC count. Conclusions. Fibrinogen levels might be a valuable tool for assessing the disease severity and monitoring the disease progression in patients with DFU.
Collapse
Affiliation(s)
- X. H. Li
- Health Management Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - L. Y. Guan
- Health Management Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - H. Y. Lin
- Health Management Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - S. H. Wang
- Health Management Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Y. Q. Cao
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - X. Y. Jiang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Y. B. Wang
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
- *Y. B. Wang:
| |
Collapse
|
8
|
Al-Nimer MS, Al-Ani FS, Ali FS. Role of nitrosative and oxidative stress in neuropathy in patients with type 2 diabetes mellitus. J Neurosci Rural Pract 2012; 3:41-4. [PMID: 22346190 PMCID: PMC3271613 DOI: 10.4103/0976-3147.91932] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Evidences of oxidative and/or nitrosative stress in type 2 diabetes mellitus were demonstrated in experimental and human studies. This study is aimed to assess the serum peroxynitrite and oxidized lipoproteins in patients with type 2 diabetes mellitus presented with clinical and laboratory evidences of peripheral neuropathy. MATERIALS AND METHODS Eighty four patients with type 2 diabetes mellitus (51 of them had neuropathy) and 31 apparent healthy subjects were studied in the unit of neurophysiology at the University Hospital of Medical College, Al-Nahrin University in Baghdad, Iraq. Neuropathy total symptom score (NTSS), neuropathy impairment score in the lower leg (NIS-LL), and nerve conduction velocity of sensory (ulnar and sural) and motor (ulnar and common peroneal) nerves were used to assess the neuropathy. Fasting venous blood was obtained from each participant for the determination of serum glucose and oxidized lipoproteins. RESULTS The electrophysiology study revealed significant decrease in conduction velocity of ulnar (sensory and motor components), sural, and common peroneal nerves in diabetic neuropathy compared to diabetics without neuropathy and healthy subjects. Significant high level of serum peroxynitrite was found in diabetic patients with or without neuropathy compared with non-diabetics. The changes in serum-oxidized lipoproteins in patients with diabetics with or without neuropathy were non-significantly differed from healthy subjects. Neither nitrosative stress nor oxidative stress indices correlated with the variables that are related to the neuropathy. CONCLUSION It concludes that evidence of nitrosative and to less extent the oxidative stress is associated with neuropathy in type 2 diabetes mellitus and their indices not correlated with variables related to neuropathy.
Collapse
Affiliation(s)
- Marwan S Al-Nimer
- Department of Pharmacology, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | | | | |
Collapse
|
9
|
Cellular dysfunction in diabetes as maladaptive response to mitochondrial oxidative stress. EXPERIMENTAL DIABETES RESEARCH 2012; 2012:696215. [PMID: 22253615 PMCID: PMC3255456 DOI: 10.1155/2012/696215] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 09/27/2011] [Indexed: 12/20/2022]
Abstract
Oxidative stress has been implicated in diabetes long-term complications. In this paper, we summarize the growing evidence suggesting that hyperglycemia-induced overproduction of superoxide by mitochondrial electron transport chain triggers a maladaptive response by affecting several metabolic and signaling pathways involved in the pathophysiology of cellular dysfunction and diabetic complications. In particular, it is our goal to describe physiological mechanisms underlying the mitochondrial free radical production and regulation to explain the oxidative stress derived from a high intracellular glucose concentration and the resulting maladaptive response that leads to a cellular dysfunction and pathological state. Finally, we outline potential therapies for diabetes focused to the prevention of mitochondrial oxidative damage.
Collapse
|
10
|
Mesa MG, Duarte HÁ, Carretero JH, Fors López MM, Vilas MM. De Marco Formula effectiveness as an adjunctive therapy to prevent infected ischemic diabetic foot amputation and reduce plasma fibrinogen. J Tissue Viability 2011; 20:67-72. [DOI: 10.1016/j.jtv.2010.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 12/02/2010] [Accepted: 12/06/2010] [Indexed: 11/16/2022]
|
11
|
Breusing N, Grune T, Andrisic L, Atalay M, Bartosz G, Biasi F, Borovic S, Bravo L, Casals I, Casillas R, Dinischiotu A, Drzewinska J, Faber H, Fauzi NM, Gajewska A, Gambini J, Gradinaru D, Kokkola T, Lojek A, Luczaj W, Margina D, Mascia C, Mateos R, Meinitzer A, Mitjavila MT, Mrakovcic L, Munteanu MC, Podborska M, Poli G, Sicinska P, Skrzydlewska E, Vina J, Wiswedel I, Zarkovic N, Zelzer S, Spickett CM. An inter-laboratory validation of methods of lipid peroxidation measurement in UVA-treated human plasma samples. Free Radic Res 2010; 44:1203-15. [PMID: 20836662 DOI: 10.3109/10715762.2010.499907] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Lipid peroxidation products like malondialdehyde, 4-hydroxynonenal and F(2)-isoprostanes are widely used as markers of oxidative stress in vitro and in vivo. This study reports the results of a multi-laboratory validation study by COST Action B35 to assess inter-laboratory and intra-laboratory variation in the measurement of lipid peroxidation. Human plasma samples were exposed to UVA irradiation at different doses (0, 15 J, 20 J), encoded and shipped to 15 laboratories, where analyses of malondialdehyde, 4-hydroxynonenal and isoprostanes were conducted. The results demonstrate a low within-day-variation and a good correlation of results observed on two different days. However, high coefficients of variation were observed between the laboratories. Malondialdehyde determined by HPLC was found to be the most sensitive and reproducible lipid peroxidation product in plasma upon UVA treatment. It is concluded that measurement of malondialdehyde by HPLC has good analytical validity for inter-laboratory studies on lipid peroxidation in human EDTA-plasma samples, although it is acknowledged that this may not translate to biological validity.
Collapse
Affiliation(s)
- Nicolle Breusing
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Weigelt C, Rose B, Poschen U, Ziegler D, Friese G, Kempf K, Koenig W, Martin S, Herder C. Immune mediators in patients with acute diabetic foot syndrome. Diabetes Care 2009; 32:1491-6. [PMID: 19509015 PMCID: PMC2713614 DOI: 10.2337/dc08-2318] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Subclinical inflammation is an important risk factor for type 2 diabetes and diabetes complications. However, data on the association between inflammation and acute diabetic foot syndrome are scarce. The aim of this study was to compare systemic immune mediators in diabetic patients with and without an ulcer and to identify modulating factors. RESEARCH DESIGN AND METHODS Circulating levels of acute-phase proteins, cytokines, and chemokines were measured in diabetic patients with an ulcer (n = 170) and without an ulcer (n = 140). Of the patients, 88% had type 2 diabetes. RESULTS Patients with an acute foot ulcer had higher levels of C-reactive protein (CRP), fibrinogen, interleukin (IL)-6, macrophage migration inhibitory factor, macrophage inflammatory protein-1alpha, and interferon-gamma-inducible protein-10 as well as lower levels of RANTES (regulated on activation normal T-cell expressed and secreted) (all P < 0.01). No differences were found for IL-8, IL-18, and monocyte chemoattractant protein-1. Most of these associations persisted after adjustment for demographic and anthropometric data, metabolic confounders, and diabetes complications. In multivariate models, size of ulcer according to the University of Texas classification but not the grade of infection was independently associated with three markers of subclinical inflammation (CRP, IL-6, and fibrinogen). CONCLUSIONS We demonstrate in our cross-sectional study that acute foot ulcers and their severity are associated with a marked upregulation of acute-phase proteins, cytokines, and chemokines independently of the concomitant infection. Further studies should investigate whether an activation of the immune system precedes the development of foot ulcer and whether anti-inflammatory therapies might be effective.
Collapse
Affiliation(s)
- Christian Weigelt
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|