Osteoprotegerin, RANKL, ADMA, and Fetuin-A serum levels in children with type I diabetes mellitus

Chrysis D, Efthymiadou A, Mermigka A, Kritikou D, Spiliotis BE. Osteoprotegerin, RANKL, ADMA, and Fetuin-A serum levels in children with type I diabetes mellitus. Pediatric Diabetes 2017: 18: 277-282. Introduction: Patients with type I diabetes mellitus (T1DM) have increased incidence of atherosclerosis and cardiovascular disease. Although these complications are unusual in children with T1DM, prevention, and early intervention could decrease morbidity and mortality. Osteoprotegerin (OPG), asymmetric dimethylarginine (ADMA), and Fetuin-A have been associated with increased cardiovascular risk (CVR). Increased OPG and ADMA, and decreased or increased Fetuin-A serum levels have been associated with increased CVR. Aim: Because patients with T1DM have higher CVR we investigated OPG, ADMA, and Fetuin-A, in children with T1DM. Methods: We determined the serum levels of OPG, receptor activator of nuclear factor-kappa B ligand (RANKL), ADMA, and Fetuin-A by enzyme-linked immunosorbent assay (ELISA) in 56 children with T1DM aged 12.1 +/- 3.4 yr and in 46 normal control children, (C) aged 11.3 +/- 3.0 yr. Results: Serum OPG levels were significantly increased in patients with T1DM (3.352 +/- 0.73 pmol/L) compared with C (2.75 +/- 0.67 pmol/L, p<0.0001) but RANKL did not change. ADMA was significantly decreased in T1DM compared with C (0.68 +/- 0.13 mu mol/L versus 0.82 +/- 0.18 mu mol/L, p<0.0001). Fetuin-A was similar in T1DM (0.551 +/- 0.13 g/L) and C (0.540 +/- 0.11 g/L) subjects. OPG was positively associated with glycosylated hemoglobin A1c (p<0.001) and negatively associated with BMI (p<0.01). ADMA and Fetuin-A were not associated with A1c and ADMA was only negatively associated with age (p<0.05). Conclusion: OPG is increased, ADMA is decreased, but RANKL and Fetuin-A are unchanged in T1DM children. Whereas increased OPG has been firmly related to increased CVR, more studies, especially longitudinal studies, are needed to delineate the role and clinical significance of decreased ADMA and if Fetuin-A has any role in T1DM.