Tumor necrosis factor alpha, interleukin-10 and nitric oxide in patients with type 1 diabetes mellitus and their association with glycemic control and some complications of the disease

Abstract EN

Type-1 diabetes mellitus is a disease that results from autoimmune destruction of insulin producing B-cells.

The autoimmune response against B-cells is believed to result from a disorder of immune regulation.

According to this concept tumor necrosis factor alpha (TNF-a), interleukin-10 (IL-10), nitric oxide (NO), urinary albumin excretion rate (UAER) and HbAIc in addition to serum glucose, kidney and liver Junction tests as well as lipogram were studied in sixty eight type-1 diabetic patients.

Twelve healthy subjects were included as a control group According to disease duration patients were classified into three groups: group J (30 cases) patients with disease duration less than 5 years, group II (22 cases) patients with disease duration 5-10 years and group III (16 cases) patients with disease duration> 10 years.

Also patients were classified according to UAER into 3 groups: group A (30 cases) normoalbuminuric patients UAER<20 pg/min.

group B (35 cases) microalbuminuric patients UAER 20-200pg/min.

group C (3 cases) macroalbuminuric patients UAER>200 pg/min.According to HbAIc levels.patients were classified into controlled group (HbAcK 6%) 20 patients and uncontrolled group(HbAlc> 6 %)48 patients.

In whole patients group mean values of HbAIc, TNF-a and UAER showed significant elevations compared to controls (P<0.001,0.001 and 0.05 respectively), while IL-10 revealed significant reduction.

(P<0.001): NO mean value showed statistically insignificant elevation.

Mean values of HbAIc in groups I, II, III, A, B revealed significant elevations compared to controls (P<0.001 for all) also in group III versus group I (P<0.05) and in group B versus A (P<0.05).

TNF-a showed significant elevation in groups 1, II, III in comparison with controls (P<0.001 for all).

While mean value of IL-10 showed significant reduction in groups I, III compared to controls (P<0.01, P<0.001 respectively) also in group III versus group I, II (P<0.01 for both).

NO and UAER showed significant elevations in group HI compared to controls (P<0.05 andP<0.01 respectively).

NO levels showed significant elevation in groups I&III compared to group 11 (P<0.05 for both).

UAER in group III revealed significant elevation versus groups I and II (P<0.01, P<0.001 respectively).

In normoalbuminuric and microalbuminuric groups (A, B) TNF-a showed significant elevation compared to controls (P<0.001 for both).

IL-10 mean value showed significant reduction in groups A & B compared to controls (P<0.001 for both).

NO levels revealed no significant differences.

In uncontrolled group, level of IL 10 was significantly low,while UAER was significantly high(p<0,05 for both).

TNF-a and NO showed no signifigant difference between controlled and uncontrolled groups.

Positive correlations were found between TNF-a and serum glucose and HbAIc, also negative correlations were found between IL-10 and serum glucose, HBAIc, cholesterol, triglycerides and LDL-c.

NO showed positive correlation with UAER level.

From this study we concluded that increased TNF-a (proinflammatory cytokine ofThl ) and decreased IL-10 levels (type 2 cytokine of Th2) may play a role in the pathogenesis of type-1 diabetes mellitus.

TNF-a and IL-10 may be a predictor of glycemic control.

Increased NO level may play a role in the pathogenesis and complications of diabetes.