Endothelial and platelet markers in diabetes mellitus type 2

Abstract

Diabetes mellitus (DM) is an extremely common disorder which carries a risk of vascular impairment. DM type 2 (DM2) can be characterized by the dysfunction of haemostasis manifesting by stimulated coagulation process, disorder of platelet function and decreased fibrinolytic activity. These all are the reasons why DM2 is the most common acquired thrombophilia. Endothelial dysfunction along with platelet hyperactivity are unquestionably involved in the hyperactivation of platelets and clotting factors in DM. As a natural consequence of continuous investigation, many markers of endothelial dysfunction and diabetic thrombocytopathy have been identified and considered for implementation in clinical practice. Endothelial function can be assessed by the evaluation of endothelial markers, circulating molecules synthesised in various amounts by the endothelium. These markers precede the signs of evident microangiopathy. Platelets have an ethiopathogenic relation to the microangiopathy in DM. Their increased activity was confirmed in both types of DM. Predictors of endothelial and platelet disorder could improve the screening of individuals at increased risk, thus leading to the early diagnosis, appropriate treatment, as well as to the effective prevention of the complications of DM2. In the article we deal with the mechanisms involved in the pathogenesis of endothelial and platelet functional abnormalities, endothelial and platelet markers of DM2 considered for implementation in clinical practice and possibilities of their detection.

Comment on Salomon et al. Gestational Diabetes Mellitus Is Associated With Changes in the Concentration and Bioactivity of Placenta-Derived Exosomes in Maternal Circulation Across Gestation. Diabetes 2016;65:598–609

“…Elevated MPs have also been reported in patients with diabetes. Endothelial dysfunction along with platelet hyperactivity is known to play a key role in the pathogenesis of diabetes (5). Thus increased endothelial and platelet MPs could be a marker of diabetes-associated endothelial dysfunction and hyperactivation of platelets, which in turn may help detect patients at risk for uteroplacental thrombosis or any adverse effects on implantation or in maternal-fetal vascular exchange.…”

Association of Mean Platelet Volume and Platelet Distribution Width with Hba1c

“…Hence, increased MPV and PDW might be linked with increased thrombotic potential [7]. Platelets are a central element of the athero-thrombotic process due to their prothrombotic and proinflamatory function [8,9,10]. The association of increased MPV, PDW and decreased platelet count with disease related to endothelial dysfunction such as metabolic syndrome diabetes, coronary artery disease (CAD) and malignancy which has been shown in many studies [11][12][13][14][15].…”

“…Oxidative stress, inflammation) and insulin resistance [16][17][18][19]. In diabetic thrombocytopathy, many biomarkers have been considered for the implementation in clinical practice [20]. Most parameter of platelet activity measurement is time consuming, expensive & required high sample volume [21].…”

The relationship of systemic markers of renal function and vascular function with retinal blood vessel responses

“…This is counter to the link between vascular, renal and glycaemic indices and venous responses that were evident only in the first flicker cycle, when vessels were relatively unstimulated. We also note that soluble E selectin and endothelial microparticles, both known to be increased in diabetes [47, 53, 54, 65], were not linked to any ocular or retinal vessel index.…”

“…A further development in ocular pathology is the recognition of the value of retinal vessel responses to flickering light in diabetes and cardiovascular disease [14–16, 41–43]. A potential pathophysiological process to explain these abnormal retinal vessel responses is endothelial dysfunction [11–13, 17, 18, 44–46], known to be present in diabetes [47–49]. However, the kidney can also be a target organ in diabetes, and may also be linked to endothelial dysfunction [50–52].…”