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Circulating Progenitor Cells Predict Microvascular Outcomes in Type 2 Patients

A low CD34+ count also diminished the protective effects of ACE inhibitors/ARBs on microalbuminuria progression…

Low circulating progenitor cells have been shown to predict future cardiovascular events and mortality in patients with CKD and low levels in diabetic patients may indicate microvascular complications.

Diabetes lowers the levels of circulating and endothelial progenitor cells, which promote vascular repair and correlate with cardiovascular outcomes. The Division of Metabolic Diseases at the University of Padova tested the hypothesis that low CPC and EPC levels predict microvascular complications in patients with type 2 diabetes.

This pseudo-prospective study consisted of a cohort of type 2 diabetic patients of both genders aged between 30-80 years who were available for a baseline CPC/EPC. Those with acute disease, cancer, cirrhosis, uremia, pregnancy and/or experienced surgery, trauma or a cardiovascular event within the previous three months were excluded. Out of 257 total patients with a baseline CPC/EPC received, 187 met inclusion/exclusion criteria.

Patients were followed for a mean time of 3.9 years. The mean age was 63 and 67% were males. The average duration study patients had diabetes was 10 years and their HbA1c indicated fair glycemic control overall.

Results showed that CPCs were lower in patients with retinopathy or neuropathy as compared to those without. CPCs were also lower in patients with asymptomatic atherosclerosis. This study showed that reduced levels of progenitor cells predicted worsening of microangiopathy in patients with type 2 diabetes over 3.9 years.

New onset or progression of microalbuminuria, CKD, retinopathy and neuropathy occurred in 70 patients, 9.5% per year. The CD34+ phenotype was significant in predictive ability and is significantly associated with nephropathy, retinopathy and microangiopathy. It was also found that reduction in CD34+ CPC removed the protective effects of ACE inhibitors/ARBs on nephropathy and worsening from micro- to macroalbuminuria.

This data along with previous studies showing a correlation with cardiovascular events indicate that CPCs and EPCs can be used as biomarkers for complications in patients with diabetes. Variability of follow-up time among patients was a limitation of this study and future studies may consider looking at a more even number of males to females. Overall, this study supports the importance of looking at CPCs and EPCs to predict complications and that targeted therapy to increase these levels may prove beneficial in the diabetes population.

Practice Pearls:

  • A low CD34+ count diminished the protective effects of ACE inhibitors/ARBs on microalbuminuria progression.
  • CPCs and EPCs can be used to predict progression of microalbuminuria, retinopathy and microangiopathy in diabetic patients.
  • Targeted therapy to increase these progenitor cell levels may prove beneficial in slowing diabetic micro and macroangiopathy.

Rigato, M. “Circulating Progenitor Cell Count Predicts Microvascular Outcomes in Type 2 Diabetic Patients.” Journal of Clinical Endocrinology and Metabolism. Web 10 May 2015.