Serum Fibroblast Growth Factor 21 Levels Are Correlated with the Severity of Diabetic Retinopathy

Abstract

The aim of the study was to assess serum fibroblast growth factor 21 (FGF21) concentrations in Chinese type 2 diabetic patients with and without retinopathy and to assess the association between FGF21 and the severity of retinopathy. 117 diabetic patients were compared with 68 healthy controls. Fasting blood glucose, serum total cholesterol, serum triglycerides, serum insulin, and serum FGF21 levels were estimated. FGF21 concentrations in the patients were significantly higher than those in control. In the patient group there was a significant positive correlation between FGF21, insulin level, and homeostasis model assessment index. Serum FGF21 concentrations in patients with proliferative diabetic retinopathy or nonproliferative diabetic retinopathy were significantly higher than those in patients without diabetic retinopathy. When the presence of diabetes was defined as the final variable in the conditional logistic regression model with the FGF21 concentration as the continuous variable, FGF21 was significantly involved in the model. This study shows that the increase in serum concentration of FGF21 was associated with the severity of diabetic retinopathy and suggests that FGF21 may play a role in the pathogenesis of diabetic retinopathy and its degree.

Relationship of fibroblast growth factor 21 with baseline and new on-study microvascular disease in the Fenofibrate Intervention and Event Lowering in Diabetes study

“…We extended this finding by showing a significant association of FGF21 levels are expressed as median (IQR) and were log e -transformed before analysis a For the analysis of new on-study microvascular disease (except two-step progression of ETDRS grade), patients with the specific type of microvascular disease at baseline were excluded b Serial retinal photography was performed in a substudy of patients at baseline, 2 years, 5 years and at study close p values were estimated by t test baseline FGF21 levels with new on-study total microvascular disease among individuals free of any disease at baseline. There is only one other study in the literature that has investigated the relationship of FGF21 levels with retinopathy, a cross-sectional study of 117 Chinese patients with type 2 diabetes reporting that serum FGF21 levels were associated with the severity of diabetic retinopathy [14]. However, in our present study with a larger sample size and 5 year follow-up, we did not observe any significant association of plasma FGF21 levels with baseline or new on-study retinopathy.…”

“…As all the patients in the FIELD study had type 2 diabetes at baseline, the findings from this study may not be generalisable to healthy people or other people at high risk but without diabetes. This is particularly important because patients with type 2 diabetes have been reported to have elevated FGF21 levels [2,7,14]. Further studies in different clinical settings, or with different participant characteristics, are merited to confirm our findings from the FIELD study.…”

“…Recently, we have reported that higher FGF21 levels at baseline predict a higher risk of total cardiovascular disease (CVD) events in patients with type 2 diabetes taking part in the FIELD study [12]. Previous studies have demonstrated an association between higher circulating FGF21 levels and diabetic nephropathy and retinopathy [13,14]. However, these studies are limited by their cross-sectional design and there are no reports on the association of FGF21 levels with other microvascular diseases, such as neuropathy and amputation, in patients with type 2 diabetes.…”

FGF21 Administration Suppresses Retinal and Choroidal Neovascularization in Mice

“…FGF21 prevents renal lipid accumulation, and attenuates renal dysfunction in type 1 diabetic mice (Zhang et al, 2013). In type 2 diabetes, serum FGF21 levels are higher in patients with retinopathy versus no retinopathy (Esteghamati et al, 2016; Lin et al, 2014). FGF21 treatment decreases body weight and improves the lipid profile (decreases triglycerides and increases HDL cholesterol levels) in type 2 diabetes patients, non-human primates and in obese rodents (Bernardo et al, 2015; Gaich et al, 2013; Schlein et al, 2016; Talukdar et al, 2016) suggesting that FGF21 might play a beneficial role in diabetes and diabetic complications, such as diabetic retinopathy.…”

Biomarkers in Diabetic Retinopathy

“…In a cross-sectional study, FGF-21 levels in the circulation have been independently associated with the severity of diabetic retinopathy in type 2 diabetes patients [243]. In the FIELD study, baseline FGF-21 levels were also associated with microvascular complications at baseline.…”