IMMUNOREGULATORY IMBALANCE AND FUNCTIONAL STATE OF THE HEART IN THE PATIENTS WITH DIABETES MELLITUS TYPE 2

Diabetes mellitus type 2 is one of the most important non-infectious diseases in the modern world,being an important risk factor of cardiovascular disorders. Changes in left ventricular myocardial diastolicfunction are observed in diabetic patients independently from other comorbidities. Etiology of the heart failureduring diabetes mellitus type 2 is multifactorial, exhibiting cellular, molecular and metabolic aspects. However,its pathophysiological mechanisms are not completely understood. The aim of this study was to evaluatenumbers of inflammatory T lymphocytes, i.e., T helper type 1 (Th1) and T helper type 17 (Th17) cells, andFoxP3+T regulatory lymphocytes, depending on the functional state of the heart assessed by two-dimensionalechocardiography in patients with arterial hypertension and diabetes mellitus type 2. A total of twenty-fivepatients with a combination of arterial hypertension and diabetes mellitus type 2, and 14 patients with arterialhypertension without carbohydrate disturbances were recruited to a cross-ectional case-control study. All thepatients underwent echocardiography with transthoracic access at the M-mode, B-mode and Doppler modeof imaging. We evaluated numbers of Th1 and Th17 lymphocytes by intracellular production of IL-17 andIFNγ by CD4+ lymphocytes, respectively. The numbers of FoxP3+T regulatory lymphocytes were estimatedby expression of CD25 and FoxP3 transcription factor. A flow cytometry approach was used in both cases. Werevealed some correlations between the numbers of Th17 lymphocytes, FoxP3+T regulatory lymphocytes andfunctional parameters of myocardium in patients with diabetes mellitus type 2, which were absent in patients without carbohydrate impairments. The numbers of FoxP3+T egulatory lymphocytes, Treg/Th17 lymphocyteratio, and mean fluorescence intensity of IL-17 for Th17 cells was lower in patients with diabetes mellitus anddiastolic dysfunction compared to the patients with diabetes free of diastolic dysfunction. Association of diastolicdysfunction with diabetes mellitus type 2 was accompanied by increase of IFNγ+Th1 lymphocyte numbers andconcentrations of IL-10, IFNγ and TNFα in serum as compared to the patients with diastolic dysfunctionin the absence of carbohydrate metabolism disturbances. The diabetic patients with diastolic dysfunctionwere characterized by hyperinsulinemia, hyperglycemia, higher index of insulin resistance, increase of waistcircumference and visceral adiposity index when compared to the