Innate immune Activity in Patients with Type 1 Diabetes Mellitus and the Effect of the Anti-Oxidant Coenzyme Q10 on Inflammatory Activity

Abstract

SUMMARY AND CONCLUSION M ajor long-term complications in patients with diabetes are related to oxidative stress, caused by the hyperglycaemia characteristic for diabetes mellitus. As an anti-oxidant, CoQ10 has neutralizing effects on ROS, but appears to affect different aspects of the innate immune system independently of its radical scavenging properties. In the present study, we aimed to assess Natural Killer cells in children and adolescents with type 1 diabetes mellitus; as a component of the innate immune system and their implication in the pathogenesis of diabetes and it’s long term complications, and the influence of CoQ10 supplementation on subset distribution and activation markers of peripheral natural killer cells. This case control study was conducted on 30 children and adolescents with type 1 diabetes mellitus recruited from the regular attendants of the Diabetes Clinic, Children's Hospital, Ain Shams University (diabetic patients group). They were compared to 30 age and sex matched healthy individuals serving as a control group. Following the diabetic patients group was done for 12 weeks from the beginning of February 2015 to the end of April 2015. Patients received CoQ10 30 mg trice daily for 12 weeks and were followed up for lymphocytes %, NK cell % and CD314%. Patients compliance to the drug use was followed up with regular phone calls and during their monthly visit to the diabetic clinic. The diabetic patients were 13 (43.30%) males and 17 (56.70%) females, their ages ranged between (6-16) years with a mean of 12.07 years±3.03 compared to the control group which were represented by 15 males and 15 females with a mean age of 11.21 years±3.06. From the course of this study we found that the following parameters were different in diabetic patients after intake of coenzyme Q than both the control group and diabetics before coenzyme Q with a significant value: • Peripheral blood lymphocyte % • Peripheral blood lymphocyte NK cells % The diabetic patients group was also classified as follows: 1- Infected and non-infected groups; infected were defined as those with positive CRP or one or more attacks of infection last year severe enough to require hospital admission. The infected patients were 12, 7 males (58.3%) and 5 females (41.7%). 18 patients were non-infected, 6 males (33.3%) and 12females (66.7%). 2- Controlled and non-controlled groups; controlled were defined as those with HbA1C <7.5 and uncontrolled group are those with HbA1C >/= 7.5. The controlled patients were 7, 1 males (14.3%) and 6 females (85.7%). 23 patients were uncontrolled, 12 males (52.2%) and 11females (47.8%). 3- Complicated and non complicated groups; complicated were defined as those with history, clinical examination or laboratory data suggestive of retinopathy, nephropathy or neuropathy (one or more of the three).The complicated patients were 22, 7 males (31.8%) and 15 females (68.2%). 8 patients were uncomplicated, 6 males (75%) and 2 females (25%). Comparatively, analysis of the Receiver Operating Characteristic (ROC) curve done between infected and non-infected diabetic patients showed cut off level of NK cells at > 14.9% has sensitivity=70.0 %, specificity=88.24%, positive predictive value = 77.8%, negative predictive values=83.3 %. Our results showed significant statistical decrease in lymphocyte % and increase in NK cell% in diabetic patients subgroups after the 12 weeks period of Coenzyme Q use, with no statistical difference in CD314%. On comparing between the controlled and uncontrolled diabetic groups there was found to be significant statistical increase as regard lymphocytes% with no significant difference found when comparing NK cells % and CD314%.