title: Circulating angiopoietic cells and diabetic retinopathy in type 2 diabetes mellitus, with or without macrovascular disease.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Ophthalmology, Rudolf Foundation Clinic, Vienna, Austria. simon.brunner@wienkav.at
authors.forename: Simon
authors.initials: S
authors.lastname: Brunner
authors.forename: Florian
authors.initials: F
authors.lastname: Hoellerl
authors.forename: Katharina E
authors.initials: KE
authors.lastname: Schmid-Kubista
authors.forename: Florian
authors.initials: F
authors.lastname: Zeiler
authors.forename: Guntram
authors.initials: G
authors.lastname: Schernthaner
authors.forename: Susanne
authors.initials: S
authors.lastname: Binder
authors.forename: Gerit-Holger
authors.initials: GH
authors.lastname: Schernthaner
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002452:Cell Count; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000473:pathology*; D003930:Diabetic Retinopathy / Q000188:drug therapy / Q000473:pathology*; D042783:Endothelial Cells / Q000166:cytology*; D005434:Flow Cytometry; D005451:Fluorescein Angiography; D006412:Hematopoietic Stem Cells / Q000166:cytology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D012907:Smoking / Q000473:pathology
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin