The Levels of the Circulating Cellular Adhesion Molecules ICAM-1, VCAM-1 and Endothelin-1 and the Flow-mediated Vasodilatation Values in Patients with Type 1 Diabetes Mellitus with Early-stage Diabetic Retinopathy

Abstract

Objective Endothelial dysfunction plays an important role in the development of diabetic retinopathy. The aim of this study was to evaluate endothelial dysfunction using different approaches in patients with type 1 diabete mellitus with early stages of diabetic retinopathy. For this purpose, we investigated the serum levels of cellular adhesion molecules, including intercellular adhesion molecule (ICAM-1), vascular cell adhesion molecule (VCAM-1) and endothelin-1 (ET-1), which have emerged as specific markers of endothelial dysfunction, and measured the flow-mediated dilatation (FMD), a noninvasive technique used to evaluate endothelial dysfunction. Methods The study group included 59 patients with type 1 diabetes mellitus (DM) and 30 age-matched healthy control subjects. The diabetic patients were divided into two groups according to the ophthalmoscopic findings: Group 1, composed of type 1 diabetic patients having no signs of diabetic retinopathy (DRP), and Group 2, composed of type 1 diabetic patients having findings of the early stages of nonproliferative diabetic retinopathy (NPDR). Results The serum levels of ET-1 (fmol/mL), ICAM-1 (ng/mL) and VCAM-1 (ng/mL) were 8.52±0.699 vs. 478.39±46.22 vs. 728.64±35.081 in the patients without retinopathy, 8.91±1.354 vs. 451.79±48.262 vs. 863.59±62.37 in the diabetic patients with NPDR and 10.73±1.04 vs. 608.15±74.92 vs. 872.95±57.63 in the control group. There were no significant differences in the serum levels of the three molecules between the groups. The FMD values were 6.51±0.46% in the diabetic patients without retinopathy, 6.66±0.29% in the diabetic patients with NPDR and 6.68±0.51% in the control group. No significant differences were found between the groups. Conclusion The early stages of diabetic retinopathy cannot be considered in the evaluation of systemic markers of endothelial dysfunction.

Vascular Cell Adhesion Molecule 1, Intercellular Adhesion Molecule 1, and Cluster of Differentiation 146 Levels in Patients with Type 2 Diabetes with Complications

“…In a study of patients with T2DM, the sICAM-1 and sVCAM-1 concentrations were found to be higher in the study group. However, plasma sVCAM-1, but not sICAM-1, was independently associated with DKD, suggesting that sICAM-1 and sVCAM-1 may play different roles in the different stages of the same disease [19]. …”

“…Increased levels of ICAM-1 have been reported in the diabetic retina in the early stages of retinopathy, suggesting that ICAM-1 mediates the adhesion and transendothelial migration of circulating leukocytes through the retinal vessel walls, one of the earliest pathological changes observed in the course of the development of DR [19]. Further research has found plasma CD146 levels to be elevated at the early stage of diabetic complications [20].…”

Relationship of systemic endothelial function and peripheral arterial stiffness with diabetic retinopathy

“…The study found that the presence of retinopathy was not significantly associated with FMD responses. Similarly, Ugurlu et al 9 analysed FMD responses in patients with type 1 diabetes. Subjects with diabetes and no DR, diabetes and early DR and normal controls were compared, with no differences found in any of the markers of endothelial dysfunction.…”

“…FMD measurement is however operator dependent and may be affected by measurement-induced changes in systemic haemodynamics. Studies using FMD have thus far identified inconsistent relationships between DR and endothelial dysfunction, with some reporting reduced FMD in DR,1 6–8 and others reporting no relationship 3 9…”

Does inflammation play a role in development of necrobiosis lipoidica?

“…The results of the studies in the group of diabetic patients with controlled disease revealed that its level was comparable to the control group and our results are in line with this observation. According to Ugurlu et al [23] endothelin serum concentration cannot be used to assess local imbalance of angiogenesis.…”