Utility of Tetrahydrobiopterin Pathway in the Assessment of Diabetic Foot Ulcer: Significant and Complex Interrelations

Objectives. Tetrahydrobiopterin (BH4) pathway that included generation of neopterin (Neop), biopterin (Biop), and nitric oxide (NO) is altered in type 2 diabetes (T2D). The aim of this study was to assess the biomarkers of BH4 pathway in noninfected DFUs and to relate these levels to the variables o...

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Main Authors: Marwan Al-Nimer, Rawa Ratha, Taha Mahwi
Format: Article
Language:English
Published: Hindawi Limited 2019-01-01
Series:Journal of Diabetes Research
Online Access:http://dx.doi.org/10.1155/2019/3426878
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spelling doaj-677202314bb24d4aa5bff9db73c406d82020-11-25T02:16:51ZengHindawi LimitedJournal of Diabetes Research2314-67452314-67532019-01-01201910.1155/2019/34268783426878Utility of Tetrahydrobiopterin Pathway in the Assessment of Diabetic Foot Ulcer: Significant and Complex InterrelationsMarwan Al-Nimer0Rawa Ratha1Taha Mahwi2Department of Pharmacology and Toxicology, Hawler Medical University, Erbil, IraqDepartment of Pharmacology and Toxicology, College of Pharmacy, University of Sulaimani, Sulaimani, IraqDepartment of Medicine, College of Medicine, University of Sulaimani, Sulaimani, IraqObjectives. Tetrahydrobiopterin (BH4) pathway that included generation of neopterin (Neop), biopterin (Biop), and nitric oxide (NO) is altered in type 2 diabetes (T2D). The aim of this study was to assess the biomarkers of BH4 pathway in noninfected DFUs and to relate these levels to the variables of diabetes as well as to the hematological indices. Methods. We performed a cross-sectional investigating study in a Kurdish people including 30 healthy subjects (group I), 66 T2D patients (group II), and 57 DFUs patients (group III). Hematological indices including red cell distribution width (RDW), mean platelet volume (MPV), and platelet distribution width (PDW) were determined by Coulter hematological analysis. Serum BH4 markers including NO, Neop, and Biop were determined by using an enzyme-linked immunosorbent assay (ELISA) technology. The relationship between BH4 markers with glycemic and hematological indices was assessed by Spearman’s correlation and multivariable regression analysis. Results. Neop was significantly increased while PDW was significantly decreased in group III compared with group II patients. Nitric oxide was found to be inversely correlated with age (r=−0.382), duration of diabetes (r=−0.264), mean arterial blood pressure (r=−0.532), body mass index (r=−0.321), RDW (r=−0.322), and PDW (r=−0.284) in group III patients. Circulating Neop and Biop significantly correlated with RDW and erythrocyte sedimentation rate. Multivariable regression analysis revealed that serum Neop predicted the DFUs in 92.5% of group III patients. Conclusion. Tetrahydrobiopterin biomarkers are predictors of DFUs and the significant correlation of neopterin with red distribution width and erythrocyte sedimentation rate indicating the role of neopterin in the vascular and inflammation concerns of noninfected DFUs.http://dx.doi.org/10.1155/2019/3426878
collection DOAJ
language English
format Article
sources DOAJ
author Marwan Al-Nimer
Rawa Ratha
Taha Mahwi
spellingShingle Marwan Al-Nimer
Rawa Ratha
Taha Mahwi
Utility of Tetrahydrobiopterin Pathway in the Assessment of Diabetic Foot Ulcer: Significant and Complex Interrelations
Journal of Diabetes Research
author_facet Marwan Al-Nimer
Rawa Ratha
Taha Mahwi
author_sort Marwan Al-Nimer
title Utility of Tetrahydrobiopterin Pathway in the Assessment of Diabetic Foot Ulcer: Significant and Complex Interrelations
title_short Utility of Tetrahydrobiopterin Pathway in the Assessment of Diabetic Foot Ulcer: Significant and Complex Interrelations
title_full Utility of Tetrahydrobiopterin Pathway in the Assessment of Diabetic Foot Ulcer: Significant and Complex Interrelations
title_fullStr Utility of Tetrahydrobiopterin Pathway in the Assessment of Diabetic Foot Ulcer: Significant and Complex Interrelations
title_full_unstemmed Utility of Tetrahydrobiopterin Pathway in the Assessment of Diabetic Foot Ulcer: Significant and Complex Interrelations
title_sort utility of tetrahydrobiopterin pathway in the assessment of diabetic foot ulcer: significant and complex interrelations
publisher Hindawi Limited
series Journal of Diabetes Research
issn 2314-6745
2314-6753
publishDate 2019-01-01
description Objectives. Tetrahydrobiopterin (BH4) pathway that included generation of neopterin (Neop), biopterin (Biop), and nitric oxide (NO) is altered in type 2 diabetes (T2D). The aim of this study was to assess the biomarkers of BH4 pathway in noninfected DFUs and to relate these levels to the variables of diabetes as well as to the hematological indices. Methods. We performed a cross-sectional investigating study in a Kurdish people including 30 healthy subjects (group I), 66 T2D patients (group II), and 57 DFUs patients (group III). Hematological indices including red cell distribution width (RDW), mean platelet volume (MPV), and platelet distribution width (PDW) were determined by Coulter hematological analysis. Serum BH4 markers including NO, Neop, and Biop were determined by using an enzyme-linked immunosorbent assay (ELISA) technology. The relationship between BH4 markers with glycemic and hematological indices was assessed by Spearman’s correlation and multivariable regression analysis. Results. Neop was significantly increased while PDW was significantly decreased in group III compared with group II patients. Nitric oxide was found to be inversely correlated with age (r=−0.382), duration of diabetes (r=−0.264), mean arterial blood pressure (r=−0.532), body mass index (r=−0.321), RDW (r=−0.322), and PDW (r=−0.284) in group III patients. Circulating Neop and Biop significantly correlated with RDW and erythrocyte sedimentation rate. Multivariable regression analysis revealed that serum Neop predicted the DFUs in 92.5% of group III patients. Conclusion. Tetrahydrobiopterin biomarkers are predictors of DFUs and the significant correlation of neopterin with red distribution width and erythrocyte sedimentation rate indicating the role of neopterin in the vascular and inflammation concerns of noninfected DFUs.
url http://dx.doi.org/10.1155/2019/3426878
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