Investigation of new biomarkers that can be used for the diagnosis of asymptomatic diabetic peripheral artery disease (PAD): Serum netrin-1 levels can be a potential biomarker for the diagnosis of PAD

Diabetic peripheral arterial disease (PAD) is strongly associated with cardiovascular and cerebrovascular diseases, contributing to a high risk of mortality and morbidity. Diagnostic tests that can predict the development of diabetic PAD in the asymptomatic period are inadequate, and new potential biomarkers are needed. This study was conducted to investigate the diagnostic values of serum netrin-1, endothelin-1, oxidative stress parameters, and L-arginine/methylarginine derivatives for diabetic asymptomatic PAD. Three hundred and eighty-six type-2 diabetes mellitus patients who were clinically asymptomatic for PAD were screened for PAD by ankle-brachial index (ABI) measurement. At the same time, forty patients with PAD were included in the study group, and forty-one patients without PAD were included in the control group. Ready-to-use commercial kits were used to measure serum netrin-1, endothelin-1, and oxidative stress markers. Serum netrin-1 median values were found to be significantly higher in the group with diabetic PAD than in the group without (OR [CI 95%]: 1.434 [1.136-1.964], p: 0.036). While a significant positive correlation relationship was detected between total oxidative status and netrin-1 and LDL, a negative significant correlation relationship was detected between ADMA and eGFR. No significant difference was detected between the groups regarding serum endothelin-1, oxidative stress parameters, and L-arginine/methylarginine derivatives. As a result, this study showed that serum netrin-1 levels are high in asymptomatic diabetic PAD patients and can be a possible biomarker in the detection of asymptomatic PAD.