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Abstract
Background: Systemic inflammation plays a role in the pathogenesis of Diabetes Mellitus (DM) complications via innate immune receptors. Toll-like receptors (TLRs) are the key immune receptors that mediate the inflammatory response in DM. Aim of the study: to evaluate the association of TLR2 and TLR9 gene polymorphism in patients with type 2 DM and diabetic foot. Patients and methods: the study included three groups, group I: 30 patients of type 2 DM with diabetic foot, group II: 30 patients of type 2 DM without diabetic foot and group III: 30 normal individuals as control subjects. TLR2 (1350 T/C, rs3804100) and TLR9 (1237 T/C, rs5743836) genotyping were performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique for all the groups. Results: The frequency of TLR9-1237 T/C polymorphic genotypes in group I (DM with diabetic foot) was 73.3 % for the heteromutant genotype (TC) and 6.7 % for the homomutant (CC). There was statistical significant difference in the distribution of TLR9-1237 T/C genotypes between group I (DM with diabetic foot) and group II (DM without diabetic foot) with p-value < 0.001 as well as between group I (DM patients with diabetic foot) and group III (control) with p-value < 0.05. Calculated risk estimation revealed that TLR9-1237 polymorphism (TC & CC) conferred almost twenty times increased risk of diabetic foot (odds ratio (OR) = 20, 95 %, confidence interval (CI) = 5.38-74.30). As for TLR2-1350 T/C, the frequency of the heteromutant genotype (TC) was 3.3 % with no homomutant genotype (CC) in diabetic patients with diabetic foot. There was no statistical difference in the distribution of TLR2-1350T/C genotypes between the three groups. Conclusion: The study revealed that TLR9-1237 T/C polymorphism may be considered as a molecular risk for diabetic foot among patients with type 2 diabetes