Aim: Diabetic foot is a devastating complication of diabetes mellitus. Many factors such as neuropathy, vascular injury and infection contribute in the development of diabetic foot. Programmed cell death is a pathway that causes a tendency for the development of atherosclerosis. Whereas Fas/Fas ligand pathway induces apoptosis, osteoprotegerin (OPG) causes calcification in vascular area and also effects apoptotic pathway. In the present study, we aimed to investigate the role of Fas/Fas ligand and OPG in the pathogenesis of diabetic foot.
Materials and methods: Thirty-eight patients with type-2 diabetes and diabetic foot, 25 patients with type-2 diabetes but without diabetic foot and 25 healthy control subjects were enrolled in the study. Diabetic foot lesions are scored according to Wagner classification. Soluble Fas, Fas ligand and OPG levels were measured in serum samples by ELISA method.
Results: OPG, sFas and sFas ligand levels were found significantly higher in diabetic foot group than the patients without diabetic foot, and controls (P<0.05, P<0.001, P<0.001 respectively). Patients with advanced diabetic foot lesions (Wagner stage 45) had higher sFas and sFas ligand levels (P<0.01, P<0.01 respectively). Although OPG levels were also higher in this group, the difference did not reach any statistical significance. In diabetic foot group, OPG was correlated with sFas ligand (P<0.01, r=0.52), sFas (P<0.05, r=0.42), CRP levels (P<0.05, r=0.41) and leukocyte count (P<0.05, r=0.33), and Fas levels were correlated with CRP levels (P<0.01, r=0.46) ve leukocyte count (P<0.01, r=0.46).
Discussion: In this study, we assessed that the apoptotic pathway in the development of diabetic foot increases by means of the Fas/Fas ligand, and that the OPG levels are associated with the apoptosis in diabetic foot. We consider that the development of new effective treatment strategies against apoptosis will play an important role in the future management of diabetic foot lesions.
25 - 29 Apr 2009
European Society of Endocrinology