Key result
In female patients with type 2 diabetes and peripheral vascular disease, plasma adrenomedullin levels were significantly elevated compared to healthy controls (5.66 vs 2.96 pmol/ml, p=0.001).
Cross-Sectional (n=90)
No
Absolute Event Rate: 5.66% vs 2.96%
p-value: p=0.001
In type 2 diabetic patients with peripheral vascular disease, elevated adrenomedullin and decreased b-FGF correlate with reduced peripheral blood flow and increased endothelial dysfunction markers.
Hypothesis-generating for AM/b-FGF as PVD markers in diabetes; prospective validation required before clinical consideration.
BACKGROUND: Progressive micro-vascular vaso-degeneration is the major factor in progression of diabetic complications. Adrenomedullin (AM) and basic-Fibroblast growth factor (b-FGF) are strongly correlated with angiogenesis in vascular diseases. This study aims to provide base line data regarding the vascular effects and correlation of AM, and b-FGF with the peripheral blood flow in diabetic patients with peripheral vascular disease (PVD), and their effect on endothelial dysfunction markers. Ninety age- and sex matched females were enrolled in the study: 30 were controls, 30 had diabetes without complications (group II) and 30 had diabetes with PVD (group III) diagnosed by ankle/ brachial index (A/BI). Plasma levels of AM, b-FGF, intercellular adhesion molecule -1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) were measured by indirect enzyme immunoassay (ELISA). RESULTS: There was a significant increase in plasma AM, VCAM-1and ICAM-1, while a significant decrease in plasma b-FGF in diabetic patients with PVD (p < 0.05). A positive correlation was observed between plasma AM, b-FGF and A/BI and a negative correlation with VCAM -1 and ICAM in diabetic PVD. AM was not a predictor, while b-FG, VCAM-1 and ICAM-1 could be predictors for peripheral blood flow in diabetic PVD. CONCLUSION: This study elucidates for the first time that AM and b-FGF are correlated and have a direct impact on the peripheral blood flow, the rise of AM in diabetic PVD may be a consecutive and compensatory vasculo-protective effect as its angiogenic and anti-inflammatory properties act to relief the endothelial insult. Down expression of b-FGF may be a predisposing factor for micro-vascular derangement. It is not clear if the rise of AM and the decline of b- FGF levels may be consequences or predisposing factors for VCAM-1 and ICAM-1 elevation as these endothelial dysfunction biomarkers could reduce peripheral blood flow and vascular integrity. It is optimistic to believe that drug intervention through AM and b-FGF administration together with reversing the endothelial inflammatory process by targeting VCAM and ICAM could reduce the prevalence of diabetic vascular complications, reduce the risk of cerebrovascular and cardiovascular morbidity in diabetes through normalizing vascular endothelium function and peripheral blood flow.
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Alrouq et al. (2014) conducted a cross-sectional in Type 2 diabetes with peripheral vascular disease (n=90). Peripheral vascular disease in type 2 diabetes vs. Healthy controls and uncomplicated type 2 diabetes was evaluated on Plasma Adrenomedullin (AM) level (pmol/ml) (p=0.001). In female patients with type 2 diabetes and peripheral vascular disease, plasma adrenomedullin levels were significantly elevated compared to healthy controls (5.66 vs 2.96 pmol/ml, p=0.001).
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