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Biomarker Insights into Diabetic Foot Ulcers: Evaluating Pentraxin-3 and Netrin-1 for Diagnosis and Clinical Associations

Pankila Yadav, Palani Selvam Mohanraj, Akash Bansal, Shailendra Dwivedi and 3 more

The International Journal of Lower Extremity Wounds | Sep 7, 2026

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Elevated serum Netrin-1 levels and their positive association with glycemic indices suggest a potential role for Netrin-1 in diabetic foot ulceration, whereas PTX-3 showed no significant associations.

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AimTo measure serum levels of Pentraxin-3 (PTX-3) and Netrin-1 in diabetic patients with and without foot ulcers and determine how these levels relate to clinical features, glycemic control, and ulcer status.MethodsIn this cross-sectional study, 80 patients were divided into three groups: infected diabetic foot ulcer (IDFU, n = 27), non-infected diabetic foot ulcer (NIDFU, n = 27), and diabetes control (n = 26). Biochemical, demographic, and clinical data were gathered. PTX-3 and Netrin-1 levels in serum were measured using ELISA. ANOVA, regression, and correlation analyses were used to assess biomarker relationships and group comparisons.ResultsAcross all groups, there was a significant increase in fasting blood glucose, HbA1c, and diabetes duration. There was no significant difference in PTX-3 levels. Netrin-1 levels were linked with HbA1c (r = 0.37) and fasting blood glucose (r = 0.41) and were higher in both ulcer groups (p < 0.001). While PTX3 performed poorly (AUC = 0.518-0.576), Netrin-1 exhibited good diagnostic accuracy for differentiating IDFU and NIDFU from DM (AUC = 0.891 and 0.855, respectively). Netrin-1 did not, however, distinguish infected from non-infected ulcers (AUC = 0.510).ConclusionElevated serum Netrin-1 levels and their positive association with glycemic indices suggest a potential role for Netrin-1 in diabetic foot ulceration, whereas PTX-3 showed no significant associations.

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Pankila Yadav

first | All India Institute of Medical Sciences | ORCID 0009-0004-0203-1473

Palani Selvam Mohanraj

middle | All India Institute of Medical Sciences | ORCID 0000-0002-0943-8709

Akash Bansal

middle | All India Institute of Medical Sciences | ORCID 0000-0002-9574-9326

Shailendra Dwivedi

middle | All India Institute of Medical Sciences | ORCID 0000-0003-2781-1009

Ravi Gupta

middle | All India Institute of Medical Sciences

Kanishka Kumar

middle | All India Institute of Medical Sciences

Aroop Mohanty

last | All India Institute of Medical Sciences

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BibTeX

@article{Yadav2026Biomarker,
  title = {Biomarker Insights into Diabetic Foot Ulcers: Evaluating Pentraxin-3 and Netrin-1 for Diagnosis and Clinical Associations},
  author = {Pankila Yadav and Palani Selvam Mohanraj and Akash Bansal and Shailendra Dwivedi and Ravi Gupta and Kanishka Kumar and Aroop Mohanty},
  journal = {The International Journal of Lower Extremity Wounds},
  year = {2026},
  doi = {10.1177/15347346261484298},
  url = {https://doi.org/10.1177/15347346261484298}
}

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