| Summary: | Reham Hammad,1 Asmaa A Elmadbouly,1 Inass Hassan Ahmad,2 Shaymaa A Mohammed,1 Nehal Farouk,3 Zahraa Futooh,4 Mohamed Omar Alfy,5 Sarah Abozaid,1 Eman F Mohamed,6 Fatma M Kotb,6 Alzahra Abdelbadea,7 Nora Seliem,7 Ahmed Elshafei,8 Alya Mashaal9 1Clinical Pathology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 2Endocrinology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 3Vascular Surgery Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 4General Surgery Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 5General Surgery Department, Al Zahraa University Hospital, Al-Azhar University, Cairo, Egypt; 6Internal Medicine Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 7Biochemistry Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 8Biochemistry and Molecular Biology Department, Faculty of Pharmacy for Boys, Al-Azhar University, Cairo, Egypt; 9Immunology, Zoology & Entomology Department, Faculty of Science for Girls, Al-Azhar University, Cairo, EgyptCorrespondence: Asmaa A Elmadbouly Tel +20 1011504476Email asmaaelmadbouly@azhar.edu.egBackground: The link between immune system and type 2 diabetes mellitus (T2DM) pathogenesis attracted attention to demonstrate the role of immune cells and their secreted cytokines in T2DM development and its subsequent foot complications.Objective: To investigate the relation between T Natural killer cell (TNK) %, Interleukin 4 (IL4) and Interferon gamma (IFN-γ) and diabetic foot infection (DFI) development in patients with diabetic foot ulcer (DFU).Patients and Methods: Ninety patients with diabetes were included in this work, divided as T2DM group (n=30), DFU group (n=30), and DFI group (n=30). TNK% was detected using flow cytometry. Serum IL4 and IFN-γ were measured by ELISA. Diabetes biochemical parameters were also analyzed.Results: Significant decrease was detected in TNK% and IFN-γ in DFI group compared to other 2 groups (P< 0.001). Significant decrease was detected in serum levels of IL4 in DFI group compared to T2DM group (P=0.006). IFN-γ/IL4 was significantly decreased in DFI compared to DFU group (P=0.020). There was a significant correlation of TNK% with both IL4 and IFN-γ (r=0.385, P< 0.001; r=0.534, P< 0.001, respectively). Significant negative correlation of TNK% with HbA1c and LDL was revealed (r=− 0.631, P< 0.001; and r=− 0.261, P=0.013, respectively), while a positive correlation was seen with HDL (r=0.287, P=0.006). A significant negative correlation of IL4 with HbA1c was found (r=− 0.514, P< 0.001;. As for IFN-γ, a significant negative correlation with HbA1c and LDL was detected (r=− 0.369, P< 0.001; r=− 0.229, P=0.030). TNK % and IFN-γ level showed negative correlations with disease duration/year (r=− 0.546, P< 0.001; r=− 0.338, P=0.001,respectively).Conclusion: Decline in TNK frequency has essential role in T2DM pathogenesis and subsequent foot complications. Downregulation of TNK% and IFN-γ level have potential roles in predicting infection of diabetic ulcer and are correlated with disease duration.Keywords: diabetic foot ulcer, diabetic foot infection, natural killer cell, interferon gamma, interleukin 4
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