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Invited Critique
May 1, 2008

Increased Antiangiogenic Protein Expression in the Skeletal Muscle of Diabetic Swine and Patients—Invited Critique

Arch Surg. 2008;143(5):470. doi:10.1001/archsurg.143.5.470

The diabetic foot ulcer continues to be a devastating problem as brought home vividly in December 2007 when a close friend required an above-knee amputation to control sepsis that began in a foot ulcer. Progress has been made in recent years with distal bypasses and improved stents for large-vessel revascularization as well as by the recognition of the importance of neuropathy, focusing attention on protecting weight-bearing surfaces. But, the problem of microvascular disease has been resistant to progress. Two basic angiogenic defects are the focus of recent research. The defects are of the yin and yang variety. The antiangiogenic defect described by Sodha and colleagues is the increased expression of the antiangiogenic peptides angiostatin and endostatin. It is disappointing that the difference between the healthy patients and the diabetic patients was less than 2-fold. Nonetheless, this phenomenon suggests therapeutic strategies and is definitely promising.