Endothelial function and endothelial progenitor cells in systemic lupus erythematosus
Anselm Mak1,2, Jerry Kok Yen Chan3,4,5
1Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. mdcam@nus.edu.sg.
Insights
Systemic lupus erythematosus (SLE) patients face high cardiovascular disease (CVD) mortality due to factors beyond traditional risks. Endothelial dysfunction and reduced endothelial progenitor cells (EPCs) in SLE contribute to this, but standardized assessments are needed for prognostic use.
Area of Science:
- Cardiovascular disease research
- Rheumatology
- Vascular biology
Background:
- Traditional cardiovascular disease (CVD) risk factors do not fully explain the elevated CVD mortality in systemic lupus erythematosus (SLE) patients.
- Endothelial dysfunction, an early stage of atherosclerosis, is a key area of investigation for CVD risk in SLE.
- Endothelial progenitor cells (EPCs) are vital for vascular repair and function but are reduced in number and impaired in function in SLE patients.
Purpose of the Study:
- To review the factors contributing to CVD in SLE.
- To focus on the evaluation and alterations of endothelial function and EPCs in SLE.
- To discuss the potential and limitations of using endothelial function and EPCs as prognostic markers for CVD in SLE.
Main Methods:
- Literature review of studies on CVD risk factors in SLE.
- Analysis of current methods for assessing endothelial function and EPCs.
- Examination of quantitative and functional changes in EPCs in SLE patients.
Main Results:
- Endothelial dysfunction is prevalent in SLE and contributes to CVD risk.
- EPCs are quantitatively and functionally deficient in SLE patients.
- Challenges exist in standardizing assessments of endothelial function and EPCs.
Conclusions:
- Endothelial dysfunction and altered EPCs are significant contributors to CVD in SLE.
- Standardized methods are required to translate endothelial function and EPC assessments into reliable prognostic markers for CVD in SLE.
- Further research is needed to overcome limitations in the current prognostication potential of these markers.
Abstract:
The observations that traditional cardiovascular disease (CVD) risk factors fail to fully account for the excessive cardiovascular mortality in patients with systemic lupus erythematosus (SLE) compared with the general population have prompted in-depth investigations of non-traditional, SLE-related risk factors that contribute to cardiovascular complications in patients with SLE. Of the various perturbations of vascular physiology, endothelial dysfunction, which is believed to occur in the earliest step of atherosclerosis, has been extensively investigated for its contribution to CVD risk in SLE. Endothelial progenitor cells (EPCs), which play a crucial part in vascular repair, neovascularization and maintenance of endothelial function, are quantitatively and functionally reduced in patients with SLE. Yet, the lack of a unified definition of EPCs, standardization of the quantity and functional assessment of EPCs as well as endothelial function measurement pose challenges to the translation of endothelial function measurements and EPC levels into prognostic markers for CVD in patients with SLE. This Review discusses factors that contribute to CVD in SLE, with particular focus on how endothelial function and EPCs are evaluated currently, and how EPCs are quantitatively and functionally altered in patients with SLE. Potential strategies for the use of endothelial function measurements and EPC quantification as prognostic markers of CVD in patients with SLE, and the limitations of their prognostication potential, are also discussed.
