Soluble Receptor for Glycation End-products Concentration Increases Following the Treatment of Severe Diabetic Ketoacidosis
William H. Hoffman1, Takaki Ishikawa2, James Blum3, Naoto Tani2, Tomoya Ikeda2, Carol M. Artlett41Augusta University, Medical College of Georgia, Department of Pediatrics, Georgia, USA2Osaka City University Faculty of Medicine, Department of Legal Medicine, Abeno Osaka, Japan
3University of North Carolina-Wilmington, Department of Mathematics and Statistics, North Carolina, USA
4Drexel University College of Medicine, Department of Microbiology and Immunology, Pennsylvania, USA
Objective: To determine the time relationships of soluble receptor for glycation end-products (sRAGE), [a decoy of the advanced glycation end-products (AGE)-RAGE axis] and D-lactate, (a metabolite of methylglyoxal) in the inflammatory response to diabetic ketoacidosis (DKA).
Methods: Sixteen children and adolescents with type 1 diabetes (T1D) had blood samples obtained, 6-12 hours into treatment, at three weeks and three months post start of treatment. sRAGE and D-lactate concentrations at three months were considered baseline. Expression of RAGE was investigated in the myocardium of a newly diagnosed and untreated young person with fatal T1D/DKA.
Results: sRAGE 6-12 hours after the start of treatment was 39% lower than the values at two weeks (p=0.0036) and at three months (p=0.0023) post treatment. D-lactate was higher during treatment than at three weeks (p=0.04) and at three months (p=0.035).
Conclusion: sRAGE concentration was decreased during treatment, compared to concentrations at two weeks and three months after treatment. The increased D-lactate during treatment was in keeping with the known increase in dicarbonyls at this time. The finding of RAGE expression in a young myocardium prior to DKA treatment suggested cardiovascular inflammation pre-treatment and at a young age.
Manuscript Language: English
