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BioMed Research International
Volume 2013 (2013), Article ID 719570, 4 pages
http://dx.doi.org/10.1155/2013/719570
Research Article

Low Circulating Protein C Levels Are Associated with Lower Leg Ulcers in Patients with Diabetes

1Department of Dermatology, The University of Sydney, St Leonards, NSW 2065, Australia
2Sutton Arthritis Research Laboratory, Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, The University of Sydney, St Leonards, NSW 2065, Australia
3Department of Endocrinology, The University of Sydney, St Leonards, NSW 2065, Australia
4Department of Haematology, Kolling Institute of Medical Research, Royal North Shore Hospital, The University of Sydney, St Leonards, NSW 2065, Australia
5Raymond Purves Research Laboratories, Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, The University of Sydney, St Leonards, NSW 2065, Australia

Received 3 August 2012; Accepted 5 December 2012

Academic Editor: Jorge Berlanga Acosta

Copyright © 2013 K. Whitmont et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Activated protein C (APC) promotes angiogenesis and reepithelialisation and accelerates healing of diabetic ulcers. The aim of this study was to determine the relationship between the incidence of lower leg ulcers and plasma levels of APC's precursor, protein C (PC), in diabetic patients. Patients with diabetes who had a lower leg ulcer(s) for >6 months ( ) were compared with age-, type of diabetes-, and sex-matched subjects with diabetes but without an ulcer ( , controls). Total PC was assessed using a routine PC colorimetric assay. There was a significantly ( ) lower level of plasma PC in patients with ulcers (103.3 ± 22.7, mean ± SD) compared with control ( ) subjects, when corrected for age and matched for gender and type of diabetes. Ulcer type (neuropathic, ischaemic, or mixed) was not a significant covariate for plasma PC levels ( ). There was no correlation between PC levels and gender, type of diabetes, , or C-reactive protein in either group. In summary, decreased circulating PC levels are associated with, and may predispose to, lower leg ulceration in patients with diabetes.