University of Alexandria, Egypt
Title: Serum Glycoprotein (YKL-40) and high sensitivity C-reactive protein in type 2 diabetic patients in relation to cardiovascular complications
Hoda EL-Attar has completed her MBBS in 11/1979, MS in Chemical Pathology 4/1987 ,MD in Chemical Pathology in 4/2001. She worked as an assistant Professor in Chemical Pathology from 28/8/2006 .Now She is working as a professor in Chemical Pathology since 30/8/2011 in Alexandria University Egypt. She is a member of the European Society of Cardiology (ESC): Working Group on Atherosclerosis and Vascular Biology. She has published 27 papers.
Objective: YKL-40 may be of pathogenic importance in the low-grade inflammation that precedes the development of cardiovascular disease in Type 2 DM. Introduction: The YKL-40 belongs to the family 18 of glycosyl hydrolases comprising chitinases from various species, but YKL-40 is without any enzymatic properties. YKL-40 mRNA and protein expression are associated with cell proliferation, differentiation and tissue morphogenesis . It is stored in the specific granules of neutrophil granulocytes and released from fully activated cells. YKL-40 induces the maturation of monocytes to macrophages, and is secreted by macrophages during late stages of differentiation and by activated macrophages .The glycoprotein YKL-40 is overexpressed in many inflammatory conditions. Diabetes mellitus (DM) is a powerful and independent risk factor for cardiovascular disease .YKL-40 is a marker of inflammation and endothelial dysfunction. It is closely related to both the early and late phases in the development of atherosclerosis. Aim: The study serum YKL-40 in Type 2 diabetic patients in relation to cardiovascular complications. Subjects and Methods :80 subjects were divided into 3 groups:GROUP 1 :16 apparently healthy volunteers ,GROUP 2 :16 patients suffering from Type 2 DM without clinically evident cardiovascular complications and GROUP 3 : 48 patients suffering from Type 2 DM with cardiovascular complications .In Group:3 ,IHD was found in all patients , stroke in 8.3% and PAD in 4.16% .Subjects with acute or chronic inflammation, autoimmune disease or malignancy were excluded. ECG ,CIMT,Fundus examination ,Laboratory investigations( Complete urine analysis ,Urinary albumin , creatinine and calculation of urinary albumin to creatinine ratio,Fasting and postprandial glucose ,Glycated hemoglobin ,Creatinine and uric acid, ALT,Total cholesterol, HDL-C, TG and calculation of LDL-C, eGFR , hsCRP and YKL-40)were done to all subjects. Results and Conclusion: hsCRP levels were significantly elevated in the diabetic group with cardiovascular complications when compared to the diabetic group without cardiovascular complications (p=.024) The inflammatory glycoprotein YKL-40 was significantly higher in patients with type 2 diabetes mellitus than controls(p=.017 ) and cardiovascular complications(p<0.001) contributed to its greater elevation. YKL-40 was positively correlated with several cardiovascular risk factors such as triglycerides, systolic blood pressure and mean blood pressure in the group of diabetic patients without cardiovascular complications. In the group of diabetic patients with cardiovascular complications YKL-40 showed positive correlation with duration of diabetes mellitus and urinary albumin to creatinine ratio denoting that longer duration of inflammation leads to increased YKL-40 levels with subsequent generalized vascular damage reflected by albuminuria. By drawing receiver operating characteristic (ROC) curve between diabetic patients without and with cardiovascular complications the AUC for hsCRP was( 0.676, p=.036) and for YKL-40 was( 0.743, p=0.004). YKL-40 had a better specificity and positive predictive value than hsCRP in discriminating between diabetic patients without cardiovascular complications from those with cardiovascular complications. Key words: YKL40, type 2 diabetes, atherosclerosis, cardiovascular complications.