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Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Time-dependent dynamic mobilization of circulating progenitor cells during percutaneous coronary intervention in
Insights
Diabetic patients undergoing percutaneous coronary intervention (PCI) show a transient decrease in circulating progenitor cells (CPCs). This early dip suggests CPCs are used at injury sites, potentially explaining poorer outcomes in diabetics.
Area of Science:
- Cardiovascular Research
- Stem Cell Biology
- Diabetology
Background:
- Circulating progenitor cell (CPC) and endothelial progenitor cell (EPC) function is impaired in diabetic patients.
- This impairment may contribute to adverse outcomes in diabetics undergoing percutaneous coronary intervention (PCI).
Purpose of the Study:
- To investigate the dynamic changes in CPCs in diabetic patients following elective PCI.
Main Methods:
- Blood samples were collected from 8 diabetic patients with stable coronary artery disease at baseline and 1, 4, and 24 hours post-PCI.
- Fluorescence activated cell sorting (FACS) quantified CD34+ and CD34+/KDR+ cells.
- Exclusion criteria included recent acute coronary syndrome.
Main Results:
- A decrease in CPCs from baseline was observed in 7 out of 8 patients post-PCI.
- Maximal reductions in CD34+ and CD34+/KDR+ cells were 47.8% and 53.3% at 1 and 4 hours, respectively.
- CPCs returned to baseline by 24 hours without subsequent elevation; one patient with myocardial injury showed increased CPCs.
Conclusions:
- A transient decrease in circulating progenitors occurs early after PCI, suggesting cellular incorporation at sites of vascular injury.
- The lack of CPC elevation post-PCI in diabetics may correlate with their poorer clinical outcomes.
- Myocardial injury appears to trigger increased progenitor mobilization, counteracting the acute reduction in circulating levels.
Background:
Circulating progenitor cells (CPC) especially endothelial progenitor cell (EPC) levels and functions are attenuated in diabetic patients. This may explain the poorer outcome of diabetics undergoing percutaneous coronary intervention (PCI). We aim to study the dynamic changes of these cells in these patients.
Methods:
Blood of 8 diabetics with stable coronary artery disease who underwent elective PCI, were obtained at baseline, 1, 4 and 24 h after PCI. Fluorescence activated cell sorting (FACS) analysis was performed to quantitate CD34+ and CD34+/ KDR+ cells. Patients with recent acute coronary syndrome were excluded.
Results:
After PCI, decreases in CPC from baseline were detected in 7 out of the 8 patients. In these 7 patients, mean CD34+ and CD34+/KDR+ cells were 182+/-99/1 x 10(5) and 18+/-16/1 x 10(5) cells respectively. Maximal decrease of CD34+ and CD34+/KDR+ cells were 47.8% and 53.3% at 1 h and 4 h respectively. At 24 h, CPC levels returned to baseline but were not elevated. The only patient with raised cardiac enzymes has instead, 2 to 3 fold increase in CPCs at 1 and 4 h.
Conclusions:
We found a transient dip in circulating progenitors early during PCI. This suggests incorporation of the cells into the sites of vascular denudation. The absence of subsequent CPC elevation post-PCI in diabetes may be associated with known poorer outcome of these patients. With myocardial injury, more progenitors may be mobilized from the bone marrow into the circulation and abolish the hyperacute reduction in circulating levels.
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