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Simon Brunner, Florian Hoellerl, Katharina E. Schmid-Kubista, Florian Zeiler, Guntram Schernthaner, Susanne Binder, Gerit-Holger Schernthaner; Circulating Angiopoietic Cells and Diabetic Retinopathy in Type 2 Diabetes Mellitus, with or without Macrovascular Disease. Invest. Ophthalmol. Vis. Sci. 2011;52(7):4655-4662. doi: 10.1167/iovs.10-6520.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate different types of circulating angiopoietic cells, such as vasculogenic circulating progenitor cells (CPCs), endothelial progenitor cells (EPCs), and mature EPCs (matEPCs) in patients with type 2 diabetes mellitus (T2DM), with or without diabetic retinopathy (DR) and with or without macrovascular disease (MVD).
One hundred twenty-six patients with T2DM—66 with MVD and 60 without MVD—were enrolled in a case–control study. MVD comprised coronary heart disease, peripheral arterial disease, stroke, or various combinations of those conditions. By a modified Early Treatment of Diabetic Retinopathy Study (ETDRS) classification, 55 patients were classified without DR (CO), 19 with mild nonproliferative DR (mNPDR), 16 with moderate-severe NPDR (msNPDR), 19 with early proliferative diabetic retinopathy (ePDR), and 17 with high-risk PDR (hrPDR). CPCs (CD34/CD133), EPCs (CD34/CD133/CD30), and matEPCs (CD34/CD133/CD309/CD31) were enumerated by flow cytometry.
Patients with MVD CPCs, EPCs, and matEPCs showed a significant, stepwise decline with advancing stages of retinopathy. In contrast, in the patients without MVD, EPCs and matEPCs reached up to 56% of CPCs and 37% of EPCs. On the other hand, the percentage of EPCs and matEPCs was reduced to 5% of CPCs and EPCs each in MVD patients. Thus, the percentage of EPCs and matEPCs in comparison with that of CPCs and EPCs represented an 11- and 7-fold difference.
The circulating angiopoietic CPCs, EPCs, and matEPCs in T2DM patients with DR had a different regulations, with increasing relative differences occurring in proliferative DR, apparently depending on the macrovascular comorbidities. Patients with MVD showed a strong retinopathy-stage–dependent depletion of all angiopoietic cells.
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