Angiopoietin-like protein-4 and Follistatin-like 1 protein levels and Angiopoietin-like protein-4 gene polymorphism in patients with diabetic foot

Angiopoietin-like protein-4 (ANGPTL-4) is an angiopoietin-like protein that plays an important role in wound healing, lipid and glucose metabolism. Follistatin-like 1 (FSTL1) is a cardiokin with effects on angiogenesis and inflammation. The aim of this study was to evaluate the relationship between ANGPTL-4 and FSTL1 levels and rs4076317 and rs1044250 single nucleotide polymorphisms (SNP) in the ANGPTL-4 gene in Type 2 diabetic patients with diabetic foot. Sixty patients with type 2 diabetes mellitus with diabetic foot (Group 1), 70 patients with type 2 diabetes mellitus without diabetic foot (Group 2) and 53 healthy subjects (Group 3) were included in this study. SNP analysis was performed using Sanger method. The mean ANGPTL-4 was 12.32 ± 5.58 ng/mL in group 1, 9.49 ± 2.88 ng/mL in group 2, 8.33 ± 3.15 ng/mL in group 3, and the difference was significant (p <0.001). The mean ANGPTL-4 was significantly higher in diabetic patients with proliferative retinopathy, peripheral sensory neuropathy, nephropathy, hypertension, coronary artery disease, and peripheral arterial disease than those without. There was no difference between the groups in terms of the distribution of both SNP genotypes. The prevalence of hypertension was significantly higher in diabetic patients with rs1044250 CT genotype than CC/TT (p <0.001). The FSTL1 level was 972.22 (799.83-1695.45) pg/mL in group 1, 843.54 (680.02-1099.67) pg/mL in groups 2 and 3, and the difference was significant (p = 0.003). Rs1044250 and rs4076317 SNPs in the ANGPTL-4 gene did not constitute a molecular risk for diabetic foot. In this study, it was shown that ANGPTL-4 levels could be used as a biomarker to show complications in diabetic patients.