Circulating Neutrophil Extracellular Traps in Type 2 Diabetes Mellitus Patients With Suppurative and Necrotic Complications

Abstract

Aim of the study. Neutrophil extracellular traps (NETs) have been reported to participate in many pathological processes, which points at NET concentration in blood as an important indicator of the body condition. When studying NETs, their blood concentration is usually evaluated indirectly, which has a number of shortcomings. We aimed to measure directly the amount of NETs as integral structures, using blood smears as a most suitable tool for clinical practice, and to carry out measurements of NET levels in blood of type 2 diabetes mellitus (T2DM) patients with necrotic suppurative complications to elucidate the usefulness of this assay. Materials and methods of the research. NETs were quantified by counting in standardized blood smears stained with Romanovsky dyes. Results. The mean level of circulating NETs in the blood of patients was higher than that in healthy subjects. Blood NET concentration in healthy persons and patients with high levels of NETs increased as glycated hemoglobin (HbA1c) concentration increased in the blood. In other patients, NET concentration decreased as HbAlc increased. Elevated NET levels and a direct correlation between NETs and HbAlc were observed in patients with phlegmon, large-area infected wound, lower leg gangrene, suppurative mediastinitis. In other patients, the prevailing lesions were infected wounds, abscesses, finger gangrene. Conclusion. This pilot study demonstrated the usefulness of measurement (using blood smear) of circulating NET concentration in the blood as a clinical parameter that would help to estimate patient’s condition, to predict the duration of post-surgical wound healing and the probability of complications in the form of thrombosis in T2DM.

Effect of Vitamin D3 in combination with Omega‐3 Polyunsaturated Fatty Acids on NETosis in Type 2 Diabetes Mellitus Patients

“…T2DM complicated by purulent necrotizing ulcers on the lower limbs is characterized by a long progressive course, which is associated with the development of vascular pathology and chronic nonhealing wounds with chronic inflammation. We have previously shown that the blood of mostly severe patients has high concentrations of NETs [12,13].…”

“…It has been indeed repeatedly observed that excessive NET formation is linked to the development of autoimmune, cardiovascular, and endocrine diseases, including diabetes mellitus. In particular, our data have shown that in type 2 diabetes mellitus (T2DM) patients with purulent necrotizing lesions of the lower extremities, a more severe clinical course is associated with a higher blood NET level [12,13]. NETosis promotes microthrombosis as well as causes delayed wound healing [9,14,15], which could have a negative effect on the healing process in T2DM patients.…”