title: Elevation of von Willebrand factor in plasma in diabetic patients with neuropathic foot ulceration.
abstract: OBJECTIVE
  The present study examines the relationship between markers of endothelial dysfunction and diabetic neuropathy or consequent neuropathic foot ulceration in patients with Type 2 diabetes mellitus.
  
  
  METHODS
  We studied 65 Type 2 diabetic patients including 25 diabetic patients without neuropathy, 27 with neuropathy but no history of foot ulceration, and 13 with neuropathic ulceration. Plasma concentrations of von Willebrand factor (vWF) and soluble thrombomodulin (TM), measures of endothelial dysfunction, were determined by enzyme immunoassays. We performed various tests quantifying aspects of diabetic neuropathy including vibration perception threshold (VPT; for sensory neuropathy), coefficient of variation of R-R intervals (CVR-R; for cardiac autonomic neuropathy), and cold-induced vasodilation in the great toe for peripheral sympathetic neuropathy.
  
  
  RESULTS
  CVR-R and cold-induced vasodilation were significantly diminished in patients with neuropathic foot ulceration compared with patients with neuropathy but no history of foot ulceration. Plasma vWF concentrations were positively correlated with VPT and cold-induced vasodilation test, and were inversely correlated with CVR-R. Multivariate analysis disclosed that VPT and percentage vasodilation were independent factors for plasma vWF. Plasma vWF was significantly elevated in patients with foot ulceration compared with patients without neuropathy or those with neuropathy but not foot ulceration. However, plasma TM concentrations did not differ between the three groups.
  
  
  CONCLUSIONS
  Diabetic patients with neuropathic foot ulceration had severe impairment of cardiac autonomic and peripheral sympathetic nerves. Elevation of vWF in plasma was associated with neuropathic foot ulceration, linking endothelial dysfunction to foot ulceration.
authors.affiliation: Department of Medicine, Koshigaya Hospital, Dokkyo University School of Medicine, Koshigaya, Saitama, Japan. yaso@dokkyomed.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Aso
authors.forename: Y
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: K
authors.initials: K
authors.lastname: Tayama
authors.forename: T
authors.initials: T
authors.lastname: Inukai
authors.forename: Y
authors.initials: Y
authors.lastname: Takemura
mesh_terms: D001341:Autonomic Nervous System / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000097:blood* / Q000503:physiopathology; D005260:Female; D016523:Foot Ulcer / Q000097:blood* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010523:Peripheral Nervous System Diseases / Q000097:blood; D012044:Regression Analysis; D012881:Skin Temperature; D018180:Thrombomodulin / Q000097:blood; D014664:Vasodilation; D014732:Vibration; D014841:von Willebrand Factor / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D018180:Thrombomodulin; D014841:von Willebrand Factor