Abstract
Angiopoietin-2 (Ang-2) has been reported to be involved in the development of type 2 diabetes (T2D) and accelerates micro and macro vascular complication. The current study aimed to investigate serum Ang-2 levels in Saudi patients with type 2 diabetes and its complications. In this observational cross-sectional study, serum was collected from 329 T2D subjects aged 34–79 years. All subjects were evaluated for fasting blood glucose (FBG), HbA1c, lipid profile, and kidney profile. Serum concentration of Ang-2 was assayed by ELISA-based method. Mean serum Ang-2 level was significantly higher in female T2D subjects (2881 ± 1550 pg/ml) compared with male T2D subjects (2450 ± 1477 pg/ml). The mean serum Ang-2 levels in female T2D subjects significantly increased with increase in their age and BMI, while mean serum Ang-2 levels did not significantly increase among the male with their age and BMI. A significantly higher level of Ang-2 was found in patients with diabetic complications like neuropathy (3293 ± 1728 pg/ml), retinopathy (2986 ± 1645 pg/ml), and vascular complications (3152 ± 1571 pg/ml). The study has established comprehensive Ang-2 levels in various subsets of adults with diabetes. While interpreting Ang-2 levels, the differences in age and sex need to be taken into account. Diabetic patients with higher Ang-2 levels should be monitored closely and level of serum Ang-2 should be served as a marker to identify patients at high risk of diabetic complications.
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References
International Diabetes Federation. 7th Diabetes Atlas, 2015. http://www.diabetesatlas.org/resources/2015-atlas.html. Accessed 12 April 2017.
Fowler MJ. Microvascular and macrovascular complications of diabetes. Clinical diabetes. 2008;26:77–82.
Carmeliet P. Angiogenesis in health and disease. Nat Med. 2003;9:653–60.
Carmeliet P. Angiogenesis in life, disease and medicine. Nature. 2005;438:932–6.
Lee KW, Lip GY, Blann AD. Plasma angiopoietin-1, angiopoietin-2, angiopoietin receptor tie-2, and vascular endothelial growth factor levels in acute coronary syndromes. Circulation. 2004;110:2355–60.
Eklund L, Olsen BR. Tie receptors and their angiopoietin ligands are context-dependent regulators of vascular remodeling. Exp Cell Res. 2006;312:630–41.
Yancopoulos GD, Davis S, Gale NW, Rudge JS. Vascular-specific growth factors and blood vessel formation. Nature. 2000;407:242–8.
Al-Rubeaan K, Siddiqui K, Al-Ghonaim MA, Youssef AM, Al-Sharqawi AH, AlNaqeb D. Assessment of the diagnostic value of different biomarkers in relation to various stages of diabetic nephropathy in type 2 diabetic patients. Sci Rep. 2017;7(1):2684.
Abu El-Asrar AM, Mohammad G, Allegaert E, Ahmad A, Siddiquei MM, Alam K, et al. Opdenakker GMatrix metalloproteinase-14 is a biomarker of angiogenic activity in proliferative diabetic retinopathy. Mol Vis. 2018;24:394–406. eCollection 2018
Fawzy MS, Abu AlSel BT. Assessment of vitamin D-binding protein and early prediction of nephropathy in type 2 Saudi diabetic patients. J Diabetes Res. 2018;2018:8517929. https://doi.org/10.1155/2018/8517929. eCollection 2018
Maric-Bilkan C. Sex differences in micro-and macro-vascular complications of diabetes mellitus. Clin Sci. 2017;131:833–46.
American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care. 2015;38:S8–S16.
Early Treatment of Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic colour fundus photographs — an extension of the modified Airlie House classification. ETDRS report number 10. Ophthalmology. 1991;98:786–806.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.
Li L, ZHeng-Qing Y, Juan-Yu H, Jian-Yong X, Fan L, Guang-Chun Z, et al. Association between interleukin-19 and angiopoietin-2 with vascular complications in type 2 diabetes. J Diabetes Investig. 2016;7:895–900.
Alissa EM, Bahjri SM, Al-Ama N, Ahmed WH, Ferns GA. High cardiovascular risk in young Saudi males: cardiovascular risk factors, diet and inflammatory markers. Clin Chim Acta. 2006;365:288–96.
Thomas M, Augustin HG. The role of the Angiopoietins in vascular morphogenesis. Angiogenesis. 2009;12:125–37.
Maisonpierre PC, Suri C, Jones PF, Bartunkova S, Wiegand SJ, Radziejewski C, et al. Angiopoietin-2, a natural antagonist for Tie2 that disrupts in vivo angiogenesis. Science. 1997;277:55–60.
Silha JV, Krsek M, Sucharda P, Murphy LJ. Angiogenic factors are elevated in overweight and obese individuals. Int J Obes. 2005;29:1308–14.
Lieb W, Zachariah JP, Xanthakis V, Safa R, Chen MH, Sullivan LM, et al. Clinical and genetic correlates of circulating Angiopoietin-2 and soluble Tie-2 in the community. CircCardiovasc Genet. 2010;3:300–6.
Khalil RA. Sex hormones as potential modulators of vascular function in hypertension. Hypertension. 2005;46:249–54.
Ardelt AA, McCullough LD, Korach KS, Wang MM, Munzenmaier DH, Hurn PD. Estradiol regulates angiopoietin-1 mRNA expression through estrogen receptor-alpha in a rodent experimental stroke model. Stroke. 2005;36:337–41.
Albrecht ED, Babischkin JS, Lidor Y, Anderson LD, Udoff LC, Pepe GJ. Effect of estrogen on angiogenesis in co-cultures of human endometrial cells and microvascular endothelial cells. Hum Reprod. 2003;18:2039–47.
Ye F, Florian M, Magder SA, Sabah NA. Hussain. Regulation of angiopoietin and Tie-2 receptor expression in nonreproductive tissues by estrogen. Steroids. 2002;67:305–10.
Tahergorabi Z, Khazaei M. The relationship between inflammatory markers, angiogenesis, and obesity. ARYA Atheroscler. 2013;9:247–53.
Murdoch C, Muthana M, Lewis CE. Hypoxia regulates macrophage functions in inflammation. J Immunol. 2005;175:6257–63.
Eder K, Baffy N, Falus A, Fulop AK. The major inflammatory mediator interleukin-6 and obesity. Inflamm Res. 2009;58:727–36.
Tuo QH, Zeng H, Stinnett A, Yu H, Aschner JL, Liao DF, et al. Critical role of angiopoietins/Tie-2 in hyperglycemic exacerbation of myocardial infarction and impaired angiogenesis. Am J Physiol Heart Circ Physiol. 2008;294:H2547–57.
Musaiger AO. Overweight and obesity in eastern mediterranean region: prevalence and possible causes. J Obes. 2011;2011:1–17.
Memish ZA, Bcheraoui CE, Tuffaha M, Robinson M, Daoud F, Jaber S, et al. Obesity and associated factors — Kingdom of Saudi Arabia, 2013. Prev Chronic Dis. 2014;11:140236.
Al-Malki JS, Al-Jaser MH, WarsyA S. Overweight and obesity in Saudi females of childbearing age. Int J Obes. 2003;27:134–9.
Tabata M, Kadomatsu T, Fukuhara S, Miyata K, Ito Y, Endo M, et al. Angiopoietin-like protein 2 promotes chronic adipose tissue inflammation and obesity-related systemic insulin resistance. Cell Metab. 2009;10:178–88.
Pugliese G, Pricci F, Romeo G, Pugliese F, Mene P, Giannini S, et al. Upregulation of mesangial growth factor and extracellular matrix synthesis by advanced glycation end products via a receptor-mediated mechanism. Diabetes. 1997;46:1881–7.
Giacco F, Brownlee M. Oxidative stress and diabetic complications. Circ Res. 2010;107:1058–70.
Loukovaara S, Robciuc A, Holopainen JH, Lehti K, Pessi T, Liinamaa J, et al. Ang-2 upregulation correlates with increased levels of MMP-9, VEGF, EPO and TGFb1 in diabetic eyes undergoing vitrectomy. ActaOphthalmol. 2013;91:531–9.
Sivak JM, Fini ME. MMPs in the eye: emerging roles for matrix metalloproteinases in ocular physiology. Prig Retin Eye Res. 2002;21:1–14.
Suri C, Jones PF, Patan S, Bartunkova S, Maisonpierre PC, Davis S, et al. Requisite role of angiopoietin-1, a ligand for the TIE2 receptor, during embryonic angiogenesis. Cell. 1996;87:1171–80.
Saharinen P, Bry M, Alitalo K. How do angiopoietins Tie in with vascular endothelial growth factors? CurrOpinHematol. 2010;17:198–205.
Abu El-Asrar AM, Missotten L, Geboes K. Expression of hypoxia-inducible factor-1alpha and the protein products of its target genes in diabetic fibrovascularepiretinal membranes. Br J Ophthalmol. 2007;91:822–6.
Fiedler U, Augustin HG. Angiopoietins: a link between angiogenesis and inflammation. Trends Immunol. 2006;27:552–8.
Chong AY, Caine GJ, Freestone B, Blann AD, Lip GY. Plasma angiopoietin-1, angiopoietin-2, and angiopoietin receptor tie-2 levels in congestive heart failure. J Am CollCardiol. 2004;43:423–8.
Lim HS, Blann AD, Chong AY, Freestone B, Lip GY. Plasma vascular endothelial growth factor, angiopoietin-1, and angiopoietin-2 in diabetes: implications for cardiovascular risk and effects of multifactorial intervention. Diabetes Care. 2004;27:2918–24.
Lim HS, Lip GY, Blann AD. Angiopoietin-1 and angiopoietin-2 in diabetes mellitus: relationship to VEGF, glycaemic control, endothelial damage/dysfunction and atherosclerosis. Atherosclerosis. 2005;180:113–8.
Rasul S, Reiter MH, Ilhan A, Lampichler K, Wagner L, Kautzky-Willer A. Circulating angiopoietin-2 and soluble Tie-2 in type 2 diabetes mellitus: a cross-sectional study. Cardiovasc Diabetol. 2011;10:55.
Woolf AS, Gnudi L, Long DA. Roles of angiopoietins in kidney development and disease. J Am Soc Nephrol. 2009;20:239–44.
Chang FC, Lai TS, Chiang CK, Chen YM, Wu MS, Chu TS, Wu KD, Lin SL. Angiopoietin-2 is associated with albuminuria and microinflammation in chronic kidney disease. PloS one. 2013;8(3):e54668.
Chen S, Li H, Zhang C, Li Z, Wang Q, Guo J, Luo C, Wang Y. Urinary angiopoietin-2 is associated with albuminuria in patients with type 2 diabetes mellitus. International journal of endocrinology. 2015;2015 https://doi.org/10.1155/2015/163120.
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The authors would like to acknowledge the members of the research unit, at University Diabetes Center, for patient recruitment.
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KS conceived and designed the study. KS, SSJ, and SSN conducted the research, provided the research materials, and collected and organized the data. SSN analyzed and interpreted the data. KS wrote the initial and final draft of the article. All of the authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the College of Medicine, King Saud University and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Siddiqui, K., Joy, S.S. & Nawaz, S.S. Serum Angiopoietin-2 levels as a marker in type 2 diabetes mellitus complications. Int J Diabetes Dev Ctries 39, 387–393 (2019). https://doi.org/10.1007/s13410-018-0679-1
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DOI: https://doi.org/10.1007/s13410-018-0679-1