Antimicrobial Peptide 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 Human Beta Defensin 2 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. Our study was a case control study being conducted on children and adolescents on regular follow up at Diabetes Clinic, Children's Hospital, Ain-Shams University. It included 30 patients with type 1 diabetes mellitus (Patients Group). The diabetic patients were 13 males (43.30%) and 17 females (56.70%) their ages ranged between (6-16) years with a mean of 12.07±3.03 years. They were assessed twice before and after taking of 30 mg trice daily of co-enzyme Q10 for 12 weeks orally from the beginning of February 2015 to the end of April 2015. They were compared to 30 age and sex matched healthy individuals serving as a control group. It was represented by 15 males and 15 females with a mean age of 11.21±3.06 years. From the course of this study we found that HβD-2 level was decreased in type 1 diabetic ptients compared to control group as well as after intake of Co enzyme Q for 12 weeks. 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. There was 7 males (58.3%) and 5 females (41.7%). 18 patients were non-infected; 6 males (33.3%) and 12 females (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.About 1 male (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. Comparatively, analysis of the Receiver Operating Characteristic (ROC) that the best cut off value of HβD-2 % between the complicated and non-complicated diabetic patients was > 60% with sensitivity of 31.82 %, specificity of 100 %, PPV = 100 % and NPV = 34.8 %. The following parameters had a positive predictor relation with increased infection: - Disease duration. - CRP. Our results showed significant statistical decrease in HβD-2 % in all diabetic patients subgroups after the 12 weeks period of Coenzyme Q use. In conclusion, this study has showed a significant decrease HβD-2 % level after the use of coenzyme Q in cases of long standing diabetes thus improving the overall performance of their innate immunity. These results may suggest the use of coenzyme Q as a useful supplement for diabetics as an antioxidant improving the overall immune system performance and hence reducing the risk of infections.