title: Imbalanced low-grade inflammation and endothelial activation in patients with type 2 diabetes mellitus and erectile dysfunction.
abstract: BACKGROUND
  Erectile dysfunction (ED) is highly prevalent among type 2 diabetes mellitus patients (T2DM). Although a link among systemic inflammation, endothelial dysfunction, and ED is described in clinical situations mainly related with coronary heart disease (CHD) risk, evidences of this link in T2DM patients are rather limited.
  
  
  OBJECTIVE
  To evaluate the association between endothelial dysfunction and balance of pro-/anti-inflammatory mediators with ED presence and severity in T2DM.
  
  
  METHODS
  We conducted a cross-sectional study of 190 T2DM patients without symptomatic CHD, 150 out of them with ED and 40 without ED. Serum levels of E-selectin, intercellular adhesion molecule-1, tumor necrosis factor-α (TNF-α), and interleukin (IL)-10 were measured using specific enzyme-linked immunosorbent assays (ELISAs). ED presence and severity were tested by the five-item version of the International Index of Erectile Function questionnaire.
  
  
  METHODS
  Differences in circulating levels of endothelial dysfunction (ICAM-1, E-selectin) and inflammatory/anti-inflammatory (TNF-α, IL-10, TNF-α : IL-10 ratio) markers between T2DM patients with and without ED, and assessment of biomarkers ED predictive value while adjusting for other known ED risk factors.
  
  
  RESULTS
  Patients with ED were older and had longer duration of diabetes than patients without ED. E-selectin serum levels were significantly increased, while IL-10 were lower in patients with ED; because TNF-α levels tend to be higher, TNF-α : IL-10 ratio was more elevated in ED patients. No significant differences of ICAM-1 levels were observed between study groups. Endothelial activation markers and TNF-α, as well as diabetes duration, were negatively correlated with erectile function. On multivariate analysis including age, duration of diabetes, insulin treatment, hypertension, insulin resistance, fair-to-poor glycemic control, and metabolic syndrome, increments in E-selectin levels and TNF-α : IL-10 ratio predicted independently ED presence, while IL-10 increases were associated with lower risk of ED in T2DM patients.
  
  
  CONCLUSIONS
  ED in T2DM patients without symptomatic CHD is associated with systemic endothelial dysfunction and a predominant, imbalanced low-grade inflammatory response.
authors.affiliation: Department of Immunology, National Institute of Endocrinology, La Habana, Cuba. mjarana@infomed.sld.cu
authors.forename: Manuel de J
authors.initials: Mde J
authors.lastname: Araña Rosaínz
authors.forename: Miriam Ojeda
authors.initials: MO
authors.lastname: Ojeda
authors.forename: Janet Rodriguez
authors.initials: JR
authors.lastname: Acosta
authors.forename: Lizet Castelo
authors.initials: LC
authors.lastname: Elías-Calles
authors.forename: Neraldo Orlandi
authors.initials: NO
authors.lastname: González
authors.forename: Omaida Torres
authors.initials: OT
authors.lastname: Herrera
authors.forename: Caridad T
authors.initials: CT
authors.lastname: García Álvarez
authors.forename: Elvira Maciquez
authors.initials: EM
authors.lastname: Rodríguez
authors.forename: Mario Estevez
authors.initials: ME
authors.lastname: Báez
authors.forename: Eduardo Álvarez
authors.initials: EÁ
authors.lastname: Seijas
authors.forename: Ramiro Fragas
authors.initials: RF
authors.lastname: Valdés
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000276:immunology*; D019040:E-Selectin / Q000097:blood; D004730:Endothelium, Vascular / Q000276:immunology*; D007172:Erectile Dysfunction / Q000097:blood / Q000276:immunology*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000276:immunology; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D016753:Interleukin-10 / Q000097:blood; D008297:Male; D008875:Middle Aged; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D014652:Vascular Diseases / Q000097:blood / Q000276:immunology*
chemical_list: D019040:E-Selectin; D014409:Tumor Necrosis Factor-alpha; D018799:Intercellular Adhesion Molecule-1; D016753:Interleukin-10