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Abstract
BackgroundThe Steno hypothesis states that changes in basement membrane anionic charge leads to diabetic microvascular complications. In diabetic nephropathy, loss of basement membrane glycosaminoglycans and the association between glomerular basement membrane heparan sulphate and proteinuria has been documented. A correlation between erythrocyte surface and the glomerular capillary wall charges has also been observed.The aim of this study is to evaluate the relationship between retinopathy and erythrocyte anionic charge and urinary glycosaminoglycan excretion in type 2 diabetic patients.Methods49 subjects (58 ± 7 yrs, M/F 27/22) with type 2 diabetes with proliferative retinopathy (n = 13), nonproliferative retinopathy (n = 13) and without retinopathy (n = 23) were included in the study. 38 healthy subjects were selected as control group (57 ± 5 yrs, M/F 19/19). Erythrocyte anionic charge (EAC) was determined by the binding of the cationic dye, alcian blue. Urinary glycosaminoglycan and microalbumin excretion were measured.ResultsEAC was significantly decreased in diabetic patients with retinopathy (255 ± 30 ng alcian blue/106 RBC, 312 ± 30 ng alcian blue/106 RBC for diabetic and control groups respectively, p < 0.001). We did not observe an association between urinary GAG and microalbumin excretion and diabetic retinopathy. EAC is found to be negatively corralated with microalbuminuria in all groups.ConclusionsWe conclude that type 2 diabetic patients with low erythrocyte anionic charge are associated with diabetic retinopathy. Reduction of negative charge of basement membranes may indicate general changes in microvasculature rather than retinopathy. More prospective and large studies needs to clarify the role of glycosaminoglycans on progression of retinopathy in type 2 diabetic patients.
Highlights
The Steno hypothesis states that changes in basement membrane anionic charge leads to diabetic microvascular complications
Erythrocyte anionic charge (EAC) was significantly decreased in diabetic patients with retinopathy (255 ± 30 ng alcian blue/106 RBC, 312 ± 30 ng alcian blue/106 RBC for diabetic and control groups respectively, p < 0.001)
EAC is found to be negatively corralated with microalbuminuria in all groups
Summary
The Steno hypothesis states that changes in basement membrane anionic charge leads to diabetic microvascular complications. The aim of this study is to evaluate the relationship between retinopathy and erythrocyte anionic charge and urinary glycosaminoglycan excretion in type 2 diabetic patients. Diabetic retinopathy is the leading cause of blindness in diabetic adults [1,2]. Diabetic patients with evidence of nephropathy are characterized by a 5 to 10 times higher incidence of proliferative retinopathy [5]. Albuminuria is associated with kidney disease but, is a strong predictor of cardiovascular disease and proliferative retinopathy, suggesting it reflects a generalized vascular disease [6]. The coincidence of generalized vascular dysfunction, albuminuria, mesangial expansion, proliferative retinopathy and accelerated development of atherosclerosis suggests a common cause of abnormalities in susceptible diabetic patients
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