Fas-mediated apoptosis and peripheral polyneuropathy in type 2 diabetes mellitus

Mowaffak M Abd Elhameed,Noha A Elsawy,Magdy H Zekry Mgalaa,Marwa R Abd Elfadeel,Reham A Abo Elwafa,Sarah S El-Tawab

doi:10.4103/err.err_37_19

Mowaffak M Abd Elhameed, Noha A Elsawy + Show 4 more

Open Access

https://doi.org/10.4103/err.err_37_19

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Abstract

ObjectiveTo evaluate the role of soluble Fas (sFas) and soluble Fas ligand (sFasL) in the pathogenesis of distal symmetrical polyneuropathy (DSPN) in patients with type 2 diabetes mellitus, and to analyze the relationship between these apoptotic markers with clinical parameters and electrophysiologic profile of DSPN, as well as with different diabetic factors among those patients.Patients and methodsThe study included 60 Egyptians with type 2 diabetes mellitus. All patients were evaluated clinically for DSPN by using Michigan Neuropathy Screening Instrument. Electrophysiological diagnosis of DSPN was based on the criteria suggested by the European Standardized Telematic tool to Evaluate Electrodiagnostic Methods group. Diabetic patients were divided into two groups according to the electrophysiological findings: group A included patients with DSPN (N=42), and group B included patients without DSPN (N=18). The severity of DSPN among group A patients was assessed clinically using Toronto Clinical Neuropathy Score and electrophysiologically by the severity score proposed by Hidasi and colleagues. The study also included 30 healthy volunteers as a control group. Serum levels of sFas and sFasL were assessed in all the studied groups.ResultsSerum level of sFas was significantly elevated in diabetic patients with DSPN compared with diabetics without DSPN and nondiabetic control (P=0.029 and 0.000). Receiver operating characteristic (ROC) curve analysis detected that sFas was statistically significant in discriminating between diabetic patients with DSPN from those patients without DSPN with an accuracy of 66%. The cutoff point that has the highest sensitivity (61%) and specificity (62%) was 33.3 ng/ml. Serum level of sFas showed a positive significant correlation with the electrophysiological severity of DSPN (P=0.020). Serum level of sFasL did not show statistically significant difference between all the studied groups.ConclusionFas-mediated apoptosis has an important role in the development of diabetic DSPN and is correlated with its electrophysiological severity.

Highlights

Diabetes mellitus (DM) is a public disease with rapidly increasing rates worldwide [1]
Diabetic patients with Distal symmetrical polyneuropathy (DSPN) had statistically significant longer diabetes duration, and higher HbA1c level than those without DSPN. These results run in accordance with many of the DSPN prevalence studies carried out across the world, in which poor glycemic control and longer duration of diabetes were identified as risk factors for Diabetic peripheral neuropathy (DPN) [22,23,24]
This study revealed a significant increase in the mean value of soluble Fas (sFas) serum level in diabetic patients with DSPN compared with diabetic patients without DSPN (P=0.028) and control group (P=0.000)

Summary

Introduction

Diabetes mellitus (DM) is a public disease with rapidly increasing rates worldwide [1]. The prevalence of type 2 DM is ∼90% of people with diabetes around the world [2]. It is estimated that by the year 2030, Egypt will have at least 8.6 million adults with diabetes [3]. Diabetic peripheral neuropathy (DPN) is the most prevalent and troublesome complication in patients with DM [4,5]. Distal symmetrical polyneuropathy (DSPN) is the commonest, accounting for 75% of diabetic neuropathy [6]. Despite the advances in methods to control blood glucose level, the development of DPN is probably neither preventable nor controllable [7]

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