Tgf-ß1 expression in contractured achilles tendon among diabetic foot patients: A semi-quantitative study

Abstract

Background. Increased plantar pressure when walking is among the pathogenesis of diabetic foot ulceration. Contractured Achilles tendon will biomechanically results in increased plantar pressure. In this study, we summarize the correlation between increased transforming growth factor β1 (TGF-β1) expression and the development of Achilles tendon contracture in diabetic foot patients. Methods. Thirty diabetic foot patients with indication for surgery were enrolled to this study and divided to two groups. Case group consisted of patients presenting Achilles tendon contracture, in contrary with control group. During surgery, the specimens of Achilles tendon were taken and analysed semi-quantitatively by immunohistochemical (IHC) examination. Achilles contracture as a dependent variable was concluded fromphysical examination, and later by histological findings. Results. IHC revealed that the positive TGF-β1 expressions were found in all case and control group cases, respectively. There were different results between both groups regarding the expression strength, specifically 2/15 vs 8/15 for + 3 result, 10/15 vs 6/15 for + 2 result, and 3/15 vs 1/15 for + 1 result. Linear regression analysis showed significant result (p < 0.05) of age and TGF-β1 expressions as the determinants of Achilles tendon contracture, while the results for sex, body mass index (BMI), and HbA1c were insignificant. Conclusions. Chronic hyperglycemia was thought to be one of the etiology of Achilles tendon contracture through the cascade involving the advanced glycation end products (AGEs) accumulation. However, these results suggested that the HbA1c level is not a sole determinant, and TGF-β1 should be considered as a contributing factor for Achilles tendon contracture during the development of diabetic foot ulcerations.