Biomedical Engineering Reference
In-Depth Information
ADHESION MOLECULES AND OTHER TYPES OF
DIABETES MELLITUS
Type 1 diabetes is an autoimmune disease characterized by absolute insulin
dei ciency. Hyperglycemia and its associated metabolic dysfunctions including
endothelial damage could af ect both macro- and microvasculature, leading to the
development and progression of complications in patients with type 1 diabetes.
Increased levels of soluble forms of various cell adhesion molecules, such as
ICAM-1, VCAM-1, and ELAM-1 (endothelial leukocyte adhesion molecule 1),
have been associated with type 1 diabetic patients with microangiopathy (Nowak
et al.
2008). First, circulating levels of ICAM-1 appeared to be consistently
associated with the presence or progression of retinopathy in patients with type
1 diabetes (Blann and Lip 1998). h e association between ICAM-1 and type 1
diabetes has been supported by the i ndings from
in vitro
and
in vivo
data showing
that ICAM-1 may regulate immune activation and inl ammatory response (Blann
and Lip 1998). Second, some but not all studies have reported elevated levels of
E-selectin in patients with type 1 diabetes with microangiopathy. Due to sparse
data, it remains controversial whether E-selectin is a reliable marker for type 1
diabetes with or without complications. h ird, inferences from available studies
regarding the link of soluble VCAM-1 to type 1 diabetes were hindered by their
small sample sizes and inconsistent results. Finally, it is worth mentioning that
endothelial damage may be involved in the pathogenesis of type 1 diabetes, but
prospective data are lacking.
Gestational diabetes mellitus (GDM) was dei ned as glucose intolerance with
onset or i rst recognition during pregnancy (Buchanan and Xiang 2005). Most
women who developed GDM had underlying insulin resistance to which the
insulin resistance of pregnancy was partly additive (Buchanan and Xiang 2005).
h ere is no evidence suggesting that the formation of placental vascular bed causes
alterations in endothelial function as rel ected by the shedding of soluble adhesion
molecules into maternal circulation during normal pregnancy (Chaiworapongsa
et al.
2002). However, there is some evidence indicating a more signii cant rise
in circulating levels of endothelial cell adhesion molecules in pregnant women
with GDM as compared with healthy pregnant women. For instance, E-selectin
and VCAM-1 levels have been observed to be signii cantly higher in pregnant
women with GDM than in normal pregnant controls in some but not all studies
(Kautzky-Willer
et al.
1997, Lawrence
et al.
2002, Telejko
et al.
2009). Some studies
have reported that levels of ICAM-1 and VCAM-1 among GDM women were
similar to those in healthy pregnant women, although these endothelial markers
were slightly lower in healthy pregnant women than in GDM women (Kautzky-
Willer
et al.
1997). Overall, i ndings from sparse and inclusive data indicated that
endothelial dysfunction as rel ected by persistent elevation of circulating adhesion
molecules may be useful in predicting the risk of GDM and subsequent risk of
