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G. Tremolada, R. Lattanzio, G. Zerbini, A. Ramoni, V. Asnaghi, G. Mazzolari, M.R. Pastore, R. Brancato; Correlation Between Glycated Hemoglobin (HbA1c) and Number of Endothelial Progenitor Cells (EPCs) Colony–Forming Units (CFUs) in Patients With Type 1 Diabetes and Proliferative Diabetic Retinopathy (PDR) . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3840.
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To find out a correlation between HbA1c and number of EPCs CFUs in patients with type 1 diabetes and PDR in order to clarify if blood glucose control could be considered a modulating factor in the stimulation of the recruitmet of EPCs from bone marrow.
We isolated EPCs from whole blood of 11 type 1 diabetic patients with PDR, 12 diabetic patients without retinopathy despite similar age , gender distribution and duration of diabetes and 11 age– and gender– matched healthy controls. Peripheral blood monocyte cells (PBMCs) were isolated and seeded in petri dishes previously coated with endothelial cell attachment factor (ECAF, Sigma, St. Louis MO, USA). Cells were cultured in M199 medium supplemented with 20% fetal bovine serum. Forty–eight hours after seeding supernatant was removed, PBMCs were spinned and re–seeded (1 x 106 per well) in 24–wells plates. Seven days after seeding, the experiment was stopped and colonies–forming units of EPCs were counted in a minimum of ten wells for each patient. The glicometabolic control was also assesed in diabetic patients through HbA1c evaluation. The correlation of EPCs CFUs and HbA1c was performed by linear regression analysis.
The number of EPCs colony–forming units per 1 x 106 PBMCs was increased in patients with proliferative retinopathy (15.4± 1.7 number of colonies±SE) when compared to patients without retinopathy (1.6± 0.7, p=0.0001). Non–diabetic controls showed an intermediate number of EPCs counts (9.5± 2.4).In diabetic patients without retinopathy there was an inverse correlation between number of colony–forming units and glycated hemoglobin (p < 0.05). No correlation between these two parameters was found in patients with proliferative retinopathy .
The inverse correlation between the number of EPCs CFUs and HbA1c in uncomplicated diabetes suggests that blood glucose controls the activity of EPCs. On the other hand this correlation was totally lost in patients with PDR suggesting a role of the ischemic retina and other still unknown factors in the mobilization of EPCs from bone marrow. This aspect remains to be clarified by further studies.
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