Increased serum levels of hepatocyte growth factor [HGF] in type 2 diabetes mellitus associated with ischemic heart disease is a good predictor biochemical marker for diagnosis of coronary atherosclerosis

Atherosclerotic cardiovascular complications are the major causes of morbidity and mortality in type 2 diabetes mellitus. Injury of endothelial cells has been postulated as the initial trigger of progression of atherosclerosis in diabetes mellitus. It has been hypothesized that HGF might contribute to the protection or repair of vascular endothelial cells. Therefore, this study was designed to find out how much type 2 diabetes with and without ischemic heart disease affect the level of HGF and to find out any relationship between the change in serum HGF and development of coronary atherosclerosis. HGF levels were measured by ELIZA in the serum of 16 healthy volunteers and 44 type 2 diabetic subjects.13 of them had ischemic heart disease with coronary atherosclerosis, other 15 had ischemic heart disease with normal coronary angiogram while the remaining 16 diabetic subjects has no ischemic heart disease and without any complications. IN addition to, ultrasonographic measurements of the combined thickness of the common carotid intima and media [CCA-IMT] was done to all subjects to examine early vessel wall changes in atherosclerosis. Serum HGF levels were statistically significantly decreased and the mean CCA-IMT were significantly increased in uncomplicated diabetic subgroup [group II] compared to controls [P<0.05] on the other hand, we found that serum HGF levels were statistically significantly increased and the mean CCA-IMT were significantly increased in other two diabetic subgroups [diabetics with ischemic heart disease] [group III and IV] compared to controls [P < 0.05, P<0.01] respectively. Also, we found that serum HGF levels and the mean CCA-IMT were statistically significantly increased in diabetics with ischemic heart disease and with coronary atherosclerosis compared to diabetic with ischemic heart disease and with normal coronary angiogram [P<0.05]. Clycozylated haemoglobin [HbAIC] was significantly increased in diabetic subgroups compared to controls [P<0.05, P<0.05 and P<0.01] respectively. And in diabetics with coronary atherosclerosis compared to those without [P<0.05]. HDL-C was significantly decreased in diabetic with ischemic heart disease and with coronary atherosclerosis compared to those without [P<0.05]. Significant negative correlation were obtained between serum HGF and each of HbA1c [r=-0.614, P<0.01] and CCA-IMT [r=-0.66, P<0.01] in uncomplicated diabetics and significant positive correlation between serum HGF and each of HbA1c [r=+0.62, P<0.01] and CCA-IMT [r+0.68, P<0.01] in diabetics with ischemic heart disease with and without coronary atherosclerosis. At the same time, we found significant positive correlation between CCA-IMT and each of age of diabetics [r=+0.43, P<0.05], duration of diabetes [r+0.41, P<0.05] and HbA1c [r=+0.71, p<0.01] in all diabetic subgroups. We can conclude that serum HGF decreased in uncomplicated diabetics and increased in diabetic with ischemic heart disease especially those with coronary atherosclerosis. increased serum HGF may be involved in the pathogenesis of atherosclerosis in type 2 diabetes and can be used as a useful test for predicting these atherosclerotic lesions. Treatment strategies to decrease HGF in type 2 diabetics complicated with atherosclerotic vascular disease by the use of growth modulating factors may prove to be useful to prevent and slow the progression of atherosclerosis in type 2 diabetes mellitus

Nitric oxide levels in patients with chronic renal failure before and after treatment with haemodialysis and renal transplantation

Nitric oxide [NO], an extensively studied endothelium - derived relaxing factor, seems to be a very potent regulator of intrarenal hemodynamics. Rats with chronic renal failure have a low nitric oxide [NO] production and a diminished NO excretion.The supplementation of L-arginine has an inhibitory effect on the progression of renal insufficiency. The Present study was designed to determine whether chronic renal failure patients have a low NO production. Plasma and urine nitrate [N03] and nitrite [N02] stable metabolites of NO, were measured in 50 patients with chronic renal failure. The 50 chronic renal failure patients were divided into five groups; group 1, mild renal failure [Creatinine clearance> 60 ml / min / 1.73 m[2]]; group 2, moderate renal failure [Creatinine Clearance> 30 < 60 ml / min. / 1.73 m[2]] and group 3, severe renal failure [Creatinine Clearance < 30 ml / min. / 1.73. m[2]], group 4, severe renal failure under hemodialysis, group 5, transplanted group. Each group was 10 patients. The study included also 10 healthy subjects matched for age, gender, body mass index and diet served as controls. Results showed that the daily urinary NO excretion was significantly lower in patients with moderate and severe renal failure as compared with those with mild renal failure and normal controls [P < 0.01]. At the same time the daily urinary NO excretion was not statistically significant in transplanted group when compared with those of controls [P > 0.05], but was statistically significant in severe CRF patients under haemodialysis when compared with controls [P < 0.01]. Plasma NO was significantly elevated in chronic renal failure patients as compared with normal controls [P < 0.05]. But increase in plasma NO in transplanted group was statistically not significant when compared with controls [P > 0.05]. The 24 - hour urinary NO excretion was correlated with creatinine clearance in chronic renal failure patients [P < 0.05 and P < 0.01] respectively, in different groups, but not correlated with 24 hour urinary protein [P> 0.05]. Plasma NO in renal failure patients was not correlated with creatinine clearance or 24 hour urinary protein [P > 0.05]. In conclusion, we found that chronic renal failure is a state of NO deficiency. Treatment stategies to increase NO production [L-arginine supplementation or other NO compounds] may prove to be useful in maintaining the renal function and slow the progression of renal disease