Abstract
BackgroundCirculating angiopoietin-like 2 (ANGPTL2) protein levels are known to be significantly increased in numerous chronic inflammatory diseases and are associated with the diagnosis and/or prognosis of cardiovascular diseases, diabetes, chronic kidney disease, and various types of cancers. However, no data regarding the relationship between ANGPTL2 and diabetic foot ulcers (DFUs) are available. Here, we explored the potential link between ANGPTL2 and DFUs.MethodsA total of 68 participants with type 2 diabetes mellitus (T2DM) were recruited, including 28 patients with DFU and 40 diabetic patients without DFUs. The clinical characteristics of T2DM patients with and without DFUs were compared. Serum concentrations of ANGPTL2 and VEGF were measured using enzyme-linked immunosorbent assay (ELISA) kits. The correlations between ANGPTL2 and clinical variables were analyzed. Multiple linear regression and logistic regression models were constructed to test the associations between ANGPTL2 and the severity and presence of DFUs.ResultsSerum levels of ANGPTL2 were higher in patients with DFUs than those in diabetic controls. Serum ANGPTL2 levels were higher in the advanced stages of DFUs. Spearman correlation analysis revealed strong positive associations of ANGPTL2 with CRP, VEGF and ESR in all subjects. In addition, serum ANGPTL2 was still positively correlated with DFUs stage after adjusting the risk factors. After adjusting for age, sex, HbA1C and duration of diabetes, ANGPTL2 was found to be independently associated with the presence of DFUs.ConclusionsCirculating ANGPTL2 levels are an independent risk factor for DFUs. This suggests that ANGPTL2 may play important roles in the development of DFUs, a possibility that needs to investigated in prospective studies.
Highlights
Circulating angiopoietin-like 2 (ANGPTL2) protein levels are known to be significantly increased in numerous chronic inflammatory diseases and are associated with the diagnosis and/or prognosis of cardiovascular diseases, diabetes, chronic kidney disease, and various types of cancers
Serum ANGPTL2 levels were increased in the presence of and advanced stage of Diabetic foot ulcers (DFU) Patients with DFU exhibited elevated ANGPTL2 levels when compared to subjects with Type 2 diabetes mellitus (T2DM) only (T2DM vs. DFU: 4.221 ± 1.301 vs. 6.561 ± 2.335 μg/L, p < 0.0001) (Fig. 1)
Serum ANGPTL2 levels were enhanced in patients with DFUs at higher stages (5.494 ± 0.7346 vs. 6.165 ± 2.071, 6.084 ± 1.402, 11.3 ± 2.843, p = 0.0004, Fig. 2). These results show that serum ANGPTL2 levels increased in the presence of and advanced stage of DFUs
Summary
Circulating angiopoietin-like 2 (ANGPTL2) protein levels are known to be significantly increased in numerous chronic inflammatory diseases and are associated with the diagnosis and/or prognosis of cardiovascular diseases, diabetes, chronic kidney disease, and various types of cancers. No data regarding the relationship between ANGPTL2 and diabetic foot ulcers (DFUs) are available. We explored the potential link between ANGPTL2 and DFUs. Type 2 diabetes mellitus (T2DM), a chronic inflammatory disease, is widely considered to be a major health issue globally. Circulating ANGPTL2 level has been shown to be associated with various chronic inflammatory diseases, including T2DM [12], with significantly higher serum levels present in these diseases. The serum ANGPTL2 concentration was reported to be independently associated with death and major adverse cardiovascular events in patients with T2DM [13]. El-Lebedy D. et al further confirmed that serum ANGPTL2 is an independent risk biomarker for cardiovascular disease in T2DM patients [14]. The present study aimed to explore the association between ANGPTL2 and DFUs
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