Number of circulating pro‐angiogenic cells, growth factor and anti‐oxidative gene profiles might be altered in type 2 diabetes with and without diabetic foot syndrome

Abstract Aims/Introduction Type 2 diabetes is often complicated by diabetic foot syndrome ( DFS ). We analyzed the circulating stem cells, growth factor and anti‐oxidant gene expression profiles in type 2 diabetes patients without or with different forms of DFS . Materials and Methods Healthy volunteers ( n = 13) and type 2 diabetes patients: (i) without DFS ( n = 10); or with (ii) Charcot osteoneuropathy ( n = 10); (iii) non‐infected ( n = 17); (iv) infected ( n = 11); and (v) healed ulceration were examined ( n = 12). Peripheral blood endothelial progenitor cells ( EPC ), mesenchymal stem cells ( MSC ), hematopoietic stem cells ( HSC ) and very small embryonic‐like ( VSEL ) cells were phenotyped using flow cytometry. Plasma cytokine concentrations and gene expressions in blood cells were measured by L uminex and quantitative real‐time polymerase chain reaction assays, respectively. Results Patients with non‐complicated type 2 diabetes showed reduced HMOX 1 expression, accompanied by HMOX 2 upregulation, and had less circulating EPC , MSC or HSC than healthy subjects. In contrast, VSEL cells were elevated in the type 2 diabetes group. However, subjects with DFS , even with healed ulceration, had fewer VSEL cells, more CD 45‐ CD 29 + CD 90 + MSC , and upregulated HMOX 1 when compared with the type 2 diabetes group. Patients with C harcot osteopathy had lowered plasma fibroblast growth factor‐2. Elevated plasma tumor necrosis factor‐α and decreased catalase expression was found in all diabetic patients. Conclusions Patients with type 2 diabetes and different forms of DFS have an altered number of circulating stem cells. Type 2 diabetes might also be associated with a changed plasma growth factor and anti‐oxidant gene expression profile. Altogether, these factors could contribute to the pathogenesis of different forms of DFS .