Endothelial Perturbation in Children and Adolescents With Type 1 Diabetes
Association with markers of the inflammatory reaction
- Mario Romano, MD1,
- Mariapina Pomilio, MD2,
- Sergio Vigneri, MD3,
- Angela Falco, MD4,
- Pierluigi Lelli Chiesa, MD5,
- Francesco Chiarelli, MD2 and
- Giovanni Davì, MD4
- 1Department of Human Pathology, University of Messina, Messina
- 2Department of Medicine and Aging, Division of Pediatrics, University of Chieti, Chieti
- 3Department of Medicine, University of Palermo, Palermo
- 4Department of Medicine and Aging, Division of Hematology, University of Chieti, Chieti
- 5the Department of Medicine and Aging, Division of Pediatric Surgery, University of Chieti, Chieti, Italy
Abstract
OBJECTIVE—The progression of diabetic angiopathy is, in most cases, unpredictable. The aim of this study was to investigate early events that could influence the development of diabetic angiopathy.
RESEARCH DESIGN AND METHODS—Circulating levels of von Willebrand factor (vWF) and tissue-plasminogen activator (tPA), defining endothelial perturbation, were measured in 40 young patients with type 1 diabetes. Patients were divided into two groups according to the duration of diabetes (group A, <1 year; group B, >1 year) and compared with a control group of age- and sex-matched healthy individuals. Prothrombin fragment 1 and 2 (F1+2), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) levels were also determined as markers of a prothrombotic state and inflammatory response. A total of 16 of the 20 children in group A were re-examined after 12 months.
RESULTS—Compared with either normal subjects or patients in group B, children in group A showed increased levels of vWF, tPA, F1+2, TNF-α, and CRP. Significant direct correlations between TNF-α or CRP and either vWF, tPA, or F1+2 were observed. Endothelial perturbation was shown in 70% of group A and 20% of group B. After 1 year, 16 of the 20 patients in group A showed a significant reduction in vWF, tPA, F1+2, TNF-α, and CRP levels, whereas endothelial perturbation was reversed in 5 of these patients.
CONCLUSIONS—Endothelial perturbation represents an early and, in some cases, reversible event in the chronology of type 1 diabetes in children. A correlation might exist between the initial inflammatory reaction and the appearance of endothelial perturbation.
- CRP, C-reactive protein
- ELISA, enzyme-linked immunosorbent assay
- F1+2, prothrombin fragment 1 and 2
- ICA-IgG, anti-islet cell antibodies
- IL-1β, interleukin-1β
- IL-6, interleukin-6
- TNF-α, tumor necrosis factor-α
- tPA, tissue-plasminogen activator
- vWF, von Willebrand factor
Footnotes
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Address correspondence and reprint requests to Giovanni Davì, MD, Cattedra di Ematologia, Università di Chieti, Via dei Vestini 31, 66013 Chieti, Italy. E-mail: gdavi{at}unich.it.
Received for publication 11 January 2001 and accepted in revised form 31 May 2001.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
