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Abstract Diabetes mellitus (DM) is a multisystem disease with both biochemical and anatomical/structural consequences. It is a chronic disease of carbohydrate, fat, and protein metabolism caused by the lack of insulin, which results from the marked and progressive inability of the pancreas to secrete insulin because of autoimmune destruction of the beta cells. Diabetes is a group of chronic diseases characterized by hyperglycemia. chronic hyperglycemia injures the human body in many different ways. One of the chief injuries arising from hyperglycemia is injury to vasculature, which is classified as either small vascular injury (microvascular disease) or injury to the large blood vessels of the body (macrovascular disease). Oxidized LDL has been implicated as a major factor in the atherosclerotic process in humans and in animal models because of its biological effects on endothelial cells, macrophages and smooth muscle cells. A number of studies suggest the Ox-LDL is a more potent pro-atherosclerotic motivator than the native unmodified LDL. Ox-LDL has been observed to be increased in diabetic patients and this may contribute to the increased atherogenesis in diabetes, regardless of normal lipid levels. Endothelium exposed to Ox-LDL develops alterations such as early signs of injury in the form of apoptosis. The oxidized low density lipoprotein (Ox-LDL) levels have been regarded as one of the independent determinants of intima media thickness (IMT) of the common carotid artery, a surrogate marker of atherosclerosis. Ox-LDL induces foam cell formation from macrophages that plays a key role in early atherogenesis. Oxidation of LDL occurs primarily in the vessels wall, thus activating many inflammatory and atherogenic reactions. Inflammatory mediators may be pathogenic by inducing vascular endothelial dysfunction. Leukocyte recruitment and adhesion to vascular endothelium, mediated by cell adhesion molecules such as intercellular adhesion molecule-1 (ICAM-1), play an important role in the development of atherosclerosis. In several studies have shown that circulating ICAM-1 may serve as a molecular marker for atherosclerosis and development of CHD. In vitro studies show that Ox-LDL induces dose dependent expression of ICAM-1 on endothelial cells and stimulates ICAM-1-dependent adhesion of monocytes. The aim of this study was to assess the level of oxidized low density lipoprotein (Ox-LDL) in children and adolescents with type 1 diabetes milletus, Investigate the association of the marker level with the occurrence and severity of both microvascular and macro-vascular complications, and Investigate the relation between intracellular adhesion molecules and Ox-LDL in IDDM. This study was carried out on 90 subjects (38 male and 52 female). They included 60 type 1 diabetic patients; 26 (43.3%) males and 34 (56.7%) females compared to 30 ageand sex-matched healthy subjects served as controls. The control group consisted of 12 (40%) males and 18 (60%)females. The mean age of patients was 14.58 ± 1.87 years while that of controls was 14.27 ± 1.89 years. All patients and controls were subjected to history taking, thorough clinical examination and laboratory investigations including blood glucose, glycated haemoglobin, lipid profile, and Urinary albumin excretion. Oxidized LDL using ELISA technique. Imaging study: CIMT was done for all the subjects included in the study by ultrasound. The study revealed the following results: 1. 18 patients out of 30 had nephropathy in the form of microalbuminuria (60%), 7 patients had neuropathy (23.33%), and 5 patients had retinopathy (16.67%), while 4 patients had both nephropathy and neuropathy (13.3%), and 3 patients had both nephropathy and retinopathy (10%). 2. There was a statistically significant difference between diabetic patients (complicated and non complicated) and controls regarding systolic and diastolic blood pressure (p< 0.05) 3. Complicated diabetics had statistically significantly high systolic and diastolic blood pressure and insulin dose compared to non- complicated diabetics 4. Complicated diabetic patients were elder and had lower height and BMI than non complicated group. Disease duration was statistically significant longer in complicated patients compared to non-complicated patients (p<0.001)Diabetic patients (complicated and non complicated) showed significantly higher mean blood glucose, Triglycerides, total cholesterol, low density lipoprotein, oxidized LDL, ICAM1, compared to controls (p<0.001). In addition, HDL level were significantly lower in patients compared to controls (p=0.049). 6. Complicated diabetics had significantly high RBS, HbA1c, urinary albumin, TG, TC, Ox-LDL, ICAM1 and low density lipoprotein compared to non complicated patients. 7. Oxidized LDL has been highly significant in diabetic group (complicated and non complicated) compared to control one. 8. Oxidized LDL was statistically significant high in diabetic patients with complications (95.32 ± 31.13) than diabetic patients without complications (64.33 ± 22.56). 9. Oxidized LDL is significantly higher in diabetic patients with nephropathy and is higher in diabetics Neuropathy and Retinopathy although there values didn’t reach statistically significant levels. 10. Statistically significant correlation between oxidized LDL and LDL and HbA1c. 11. Intercellular adhesion molecule1 was statistically significant in diabetics (complicated and non complicated) compared to controls, as well as ICAM1 statistically significant in complicated group compared to non complicated group 12. Carotid intima media thickness was statistically significant in diabetics (complicated and non complicated) compared to controls, whereas no significant difference between complicated group and non complicated group 13. A Positive significant correlation between ICAM1 and HbA1c, CIMT and urinary Alb and negative correlation with HDL in uncomplicated diabetics. 14. A positive significant correlation between ICAM1 and HbA1c, CIMT and urinary Alb and negative significant correlation with HDL in complicated diabetics. 15. A positive significant difference between ICAM1 and disease duration in both groups. While insulin dose is significant in non complicated group only. 16. Carotid intima media thickness was found to have a positive statistically significant correlation with laboratory variables in diabetic group without complication except HDL a non statistically significant negative correlation. 17. Carotid intima media thickness was found to have a positive correlation with laboratory variables in diabetic group with complication except HDL a negative correlation, and statistically significant correlations with HbA1c, ICAM1, TG, TC, LDL, OX LDL and Urin Alb. Further longitudinal studies are needed to detect the correlation between Ox-LDL and ICAM1 and cardiovascular risk factors in T1DM children and adolescents. |