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Comprehensive assessment of endothelial dysfunction before cellular therapy: EASIX, local imaging, and systemic
Laura Simons1, Lina Alasfar1,2, Muath Qadoura1
1Department of Internal Medicine V, Hematology, Oncology, and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany.
Blood Vessels, Thrombosis & Hemostasis
|December 3, 2025
Summary
Endothelial dysfunction is a challenge after cellular therapies. The endothelial activation and stress index (EASIX) marker shows promise for assessing risk and guiding monitoring in patients receiving these treatments.
Area of Science:
- Cardiovascular Biology
- Immunology
- Oncology
Background:
- Endothelial dysfunction is a significant contributor to mortality following cellular therapies.
- Clinical assessment of endothelial dysfunction in these patients is currently challenging.
- Multimodal assessment of endothelial function is needed to understand its impact on outcomes.
Purpose of the Study:
- To evaluate a comprehensive endothelial profile in patients undergoing cellular therapy.
- To determine correlations between endothelial markers and clinical outcomes.
- To identify reliable markers for endothelial risk stratification.
Main Methods:
- Prospective observational study of 169 patients undergoing allogeneic stem cell transplantation or CAR T-cell therapy and 102 healthy controls.
- Assessed endothelial activation and stress index (EASIX), glycocalyx thickness (GlycoCheck), digital perfusion (Tivita), serum markers (angiopoietin-2, CD141, etc.), and platelet aggregation.
- Correlated endothelial markers with clinical outcomes including sepsis and nonrelapse mortality.
Main Results:
- Significant intercorrelations were observed among EASIX, perfused boundary region (PBR), tissue perfusion, and serum markers.
- Elevated EASIX, angiopoietin-2, impaired PBR, and reduced digital perfusion were associated with early sepsis.
- EASIX independently predicted nonrelapse mortality.
Conclusions:
- Endothelial responses to systemic insult are heterogeneous, necessitating multimodal assessment.
- EASIX is a simple, routinely available marker that can stratify endothelial risk.
- EASIX can guide monitoring for patients undergoing cellular therapy.
