Gremlin-1 and Wagner Classification: Potential Biomarker for Amputation in Diabetic Foot Patients

Area of Science:

• Endocrinology
• Vascular Surgery
• Diabetology

Background:

• Diabetic foot (DF) is a severe complication of diabetes mellitus, characterized by high rates of morbidity and mortality.
• Neuropathy and ischemia are primary drivers of DF development and progression.
• Identifying reliable prognostic markers for DF is crucial for timely intervention and limb salvage.

Purpose of the Study:

• To investigate the association between serum Gremlin-1 levels and diabetic foot disease severity, stratified by the Wagner classification.
• To assess the potential of Gremlin-1 as a predictive biomarker for lower extremity amputation in diabetic patients.
• To explore correlations between Gremlin-1 levels and key metabolic parameters in diabetic foot patients.

Main Methods:

• A cohort of 85 patients with diabetic foot ulcers or at high risk for DF was studied.
• Serum Gremlin-1 levels were quantified using the Enzyme-Linked Immunosorbent Assay (ELISA) method.
• Disease severity was assessed using the Wagner classification; laboratory data and patient complications were reviewed.

Main Results:

• Serum Gremlin-1 levels showed a significant decrease with advancing Wagner stages of diabetic foot disease (p=0.05).
• Patients undergoing amputation exhibited significantly lower serum Gremlin-1 levels (p<0.05).
• Gremlin-1 demonstrated 67% sensitivity and 46% specificity in predicting amputation at a 2.47 ng/ml cut-off; positive correlations were observed with total cholesterol, LDL, and fasting glucose.

Conclusions:

• Serum Gremlin-1 levels are inversely correlated with diabetic foot disease severity and are significantly reduced in patients requiring amputation.
• Gremlin-1 may serve as a valuable prognostic biomarker for predicting the need for amputation in diabetic foot patients.
• The precise role and mechanism of Gremlin-1 in DF pathogenesis warrant further investigation.