Toll like receptor 4 (TLR4) expression on peripheral blood mononuclear cells (PBMCs) among patients with Graves disease.

Graves disease (GD) is a multifactorial disease due to multiple environmental and genetic factors as well as immune malfunction. Human Toll-like receptors (TLRs) play a key role in activating innate and adaptive immune cells. Their role in modulating immunity also interferes with the mechanisms that maintain tolerance in the host. Thus, expression or activation of TLRs can contribute to the loss of tolerance by a lot of mechanisms. In order to confirm the importance of TLR4 in the pathogenesis of GD, this study intended to measure TLR4 expression on peripheral blood mononuclear cells in GD patients before and after control of disease with Carbimazole as compared to a group of normal controls. We conducted a case-control study on 36 patients with newly diagnosed Graves disease and 36 individuals as the control group. Patients were recruited from the endocrinology outpatient clinic, Ain-Shams University Hospitals and were followed up till achieving the euthyroid state (for a minimum period of 6 months). In GD patients at baseline, the mean monocyte percentage was 4.46%, and the mean TLR4 on monocytes 90.91%. After achieving euthyroid state, the mean monocyte was 6.16%, and the mean TLR4 on monocytes 72.30%. In the control group, the mean monocyte was 3.88%, and the mean TLR4 on monocytes 66.30%. Results indicated significant differences in expression of TLR4 between GD patients before treatment, after achieving euthyroid state and in the control group (p< 0.0001). In conclusion, the present study showed a higher expression of TLR4 on monocytes among newly diagnosed GD patients in comparison to normal individuals. TLR4 expression on monocytes decreased significantly among GD patients after treatment.

Role of Inflammatory Markers in Elderly Type 2 Diabetic Patients with Mild Cognitive Impairment.

BACKGROUND: Type 2 diabetes (T2DM) is a risk factor for Alzheimer's disease and mild cognitive impairment. The etiology of cognitive impairment in people with T2DM is uncertain but, chronic hyperglycemia, cerebral micro vascular disease, severe hypoglycemia, and increased prevalence of macro vascular disease are implicated. OBJECTIVES: To determine the serum levels of soluble vascular adhesion molecule (sVCAM-1) and highly sensitive C-reactive protein (hs-CRP) in elderly type 2 diabetics with mild cognitive impairment (MCI). METHODS: Our study was conducted on 90 elderly subjects (aged 60 years old or more). They were divided into Group І, 30 patients with T2DM and mild cognitive impairment, group ІІ, 30 patients with T2DM without cognitive impairment and group III, 30 healthy subjects as a control group. They were subjected to history taking, full clinical examination, anthropometric measurement, the Addenbrooke's Cognitive Examination III (ACE---III 2012), Fasting plasma glucose, 2 hours plasma glucose, HbA1c, lipid profile, protein/creatinine ratio, serum sVCAM-1 and hs-CRP. RESULTS: Serum levels of sVCAM-1 in diabetic elderly patients with MCI were significantly higher (946.7 ± 162.01 ng/ml) than diabetic elderly patients without cognitive impairment (479.06 ± 65.27 ng/ml) and control (263.7 ± 72.05 ng/ml) with (P=0.002). Serum levels of Hs-CRP in diabetic elderly patients with MCI were significantly higher than as diabetic elderly patients without cognitive impairment and control with (P=0.005). CONCLUSION: Elderly diabetic patients with mild cognitive impairment have higher levels of soluble adhesion molecules and markers of low-grade systemic inflammation than other groups.

Urinary neutrophil gelatinase-associated lipocalin in type 2 diabetes: Relation to nephropathy and retinopathy.

BACKGROUND: Diabetes mellitus is the leading cause of end stage renal disease worldwide. Early identification of diabetic nephropathy even before appearance of microalbuminuria is a challenge for early prevention of occurrence and progression of this complication. Neutrophil gelatinase-associated lipocalin is a small protein that belongs to the lipocalin protein. Urinary neutrophil gelatinase-associated lipocalin is a promising early marker in different renal problems. AIM OF THE WORK: To measure urinary neutrophil gelatinase-associated lipocalin in type 2 diabetic patients and to assess its role as an early marker for diagnosis of diabetic nephropathy and diabetic retinopathy. PATIENT AND METHODS: The current study included 60 subjects with type 2 diabetes and 20 healthy control subjects. Diabetic subjects were divided into 3 groups according to urinary albumin creatinine ratio; 20 normoalbuminuric patients, 20 micro-albuminuric patients and 20 macroalbuminuric patients. They were subjected to history taking, full clinical examination, fundus examination, anthropometric measurement, urinary neutrophil gelatinase-associated lipocalin and urinary albumin creatinine ratio. RESULTS: Urinary neutrophil gelatinase-associated lipocalin was higher in all diabetic groups than in the control group, with no difference in between diabetic groups. The difference was of great value when comparing normoalbuminuric group with control as albumin creatinine ratio was not different while the urinary neutrophil gelatinase-associated lipocalin was statistically significant (5.94 ±â€¯1.85 ng/dl vs 1.96 ±â€¯0.65, p < 0.001). No correlation was found with retinopathy. CONCLUSION: Urinary neutrophil gelatinase-associated lipocalin is a sensitive marker for early detection of diabetic nephropathy even in normoalbuminuric patients denoting early tubular damage before microalbuminuria. It is not correlated with retinopathy.