High levels of soluble thrombomodulin may be a marker of arterial disease and peripheral ischemia in Egyptian patients with diabetes mellitus

Background Thrombomodulin is an endothelial cell membrane protein acting as a cofactor for the activation of plasma protein C. It was found that soluble forms of thrombomodulin (sTM) exist in plasma and is considered a marker of endothelial dysfunction. Materials and methods The study included 160 individuals: 40 healthy controls and 120 diabetic patients (40 patients with type 1 diabetes and 80 patients with type 2 diabetes). sTM concentrations were measured by an enzyme-linked immunosorbent assay-based assay employing monoclonal antithrombomodulin antibodies. Results The diabetic patients had highly significantly increased plasma sTM concentrations compared with the control group (P < 0.001). Type 2 diabetic patients with peripheral limb ischemia showed a highly significant increase in plasma sTM levels when compared with type 2 or type 1 diabetic patients without ischemia (P < 0.001). sTM concentrations were positively correlated with age, duration of diabetes, and urinary albumin concentration, with highly significant P value (P < 0.001). A cutoff value of greater than 9500 ng/ml of sTM was found to be of 96.9% diagnostic accuracy in differentiating type 2 diabetic patients with and without peripheral limb ischemia. Conclusion We recommend including sTM in the follow-up panel of diabetic patients because of its potential ability to predict the risk for ischemic manifestations.