title: Endothelial progenitor cells in primary aldosteronism: a biomarker of severity for aldosterone vasculopathy and prognosis.
abstract: BACKGROUND
  Primary aldosteronism (PA) is associated with a higher incidence of cardiovascular events, probably through mineralocorticoid receptor (MR)-dependent endothelial cell dysfunction, in comparison with essential hypertension (EH).
  
  
  OBJECTIVE
  Our objective was to investigate the number and function of endothelial progenitor cells (EPC) in PA and the relationship with arterial stiffness and disease progression.
  
  
  METHODS
  We conducted a prospective study of the change of EPC number and outcome of PA patients after treatment at a tertiary medical center.
  
  
  METHODS
  Changes in arterial stiffness and EPC number after treatment and the curability of hypertension were assessed.
  
  
  METHODS
  A total of 113 PA patients (87 patients diagnosed with aldosterone-producing adenoma, 26 with idiopathic hyperaldosteronism) and 55 patients with EH participated.
  
  
  RESULTS
  PA patients had higher arterial stiffness than EH patients (P = 0.006), with a lower numbers of circulating EPC and endothelial colony-forming units (P < 0.05). The differences were ameliorated at 6 months after unilateral adrenalectomy or treatment with spironolactone. Expression of MR was identified in the EPC. The number of circulating EPC was inversely correlated with the plasma aldosterone concentration (P = 0.021), arterial stiffness (P = 0.029) and serum high-sensitivity C-reactive protein (P = 0.03). High-dose aldosterone (10(-5) and 10(-6) m) attenuated EPC proliferation and angiogenesis in vitro. Among the 45 patients who underwent unilateral adrenalectomy, 32 (71%) were cured of hypertension. The preoperative number of EPC [log(EPC number percent) >-3.6] predicted the curability of hypertension after adrenalectomy (P = 0.003).
  
  
  CONCLUSIONS
  The relative deficiency of EPC in PA patients may contribute to aldosterone vasculopathy, which can be reversed by adrenalectomy and spironolactone. High aldosterone levels attenuated EPC proliferation and angiogenesis. Circulating EPC number may be a valuable biomarker to identify PA patients with a high incidence of arterial stiffness and to predict postoperative residual hypertension of aldosterone-producing adenoma.
authors.affiliation: Department of Internal Medicine, Taipei Veterans General Hospital and Cardiovascular Research Center, National Yang-Ming University, Taipei 100, Taiwan.
authors.forename: Vin-Cent
authors.initials: VC
authors.lastname: Wu
authors.forename: Shyh-Chyi
authors.initials: SC
authors.lastname: Lo
authors.forename: Yuh-Lien
authors.initials: YL
authors.lastname: Chen
authors.forename: Po-Hsun
authors.initials: PH
authors.lastname: Huang
authors.forename: Chia-Ti
authors.initials: CT
authors.lastname: Tsai
authors.forename: Chan-Jung
authors.initials: CJ
authors.lastname: Liang
authors.forename: Chin-Chi
authors.initials: CC
authors.lastname: Kuo
authors.forename: Yih-Shing
authors.initials: YS
authors.lastname: Kuo
authors.forename: Bai-Chin
authors.initials: BC
authors.lastname: Lee
authors.forename: En-Ling
authors.initials: EL
authors.lastname: Wu
authors.forename: Yen-Hung
authors.initials: YH
authors.lastname: Lin
authors.forename: Yun-Yu
authors.initials: YY
authors.lastname: Sun
authors.forename: Shuei-Liong
authors.initials: SL
authors.lastname: Lin
authors.forename: Jaw-Wen
authors.initials: JW
authors.lastname: Chen
authors.forename: Shing-Jong
authors.initials: SJ
authors.lastname: Lin
authors.forename: Kwan-Dun
authors.initials: KD
authors.lastname: Wu
mesh_terms: D000236:Adenoma / Q000378:metabolism; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000096:biosynthesis; D017209:Apoptosis / Q000502:physiology; D001158:Arteries / Q000473:pathology; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism; D002452:Cell Count; D049109:Cell Proliferation; D016922:Cellular Senescence / Q000502:physiology; D018450:Disease Progression; D042783:Endothelial Cells / Q000502:physiology*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000473:pathology*; D006973:Hypertension / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D017382:Reactive Oxygen Species / Q000378:metabolism; D012039:Regional Blood Flow / Q000502:physiology; D013234:Stem Cells / Q000502:physiology*; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology / Q000473:pathology*
chemical_list: D015415:Biomarkers; D017382:Reactive Oxygen Species; D000450:Aldosterone; D002097:C-Reactive Protein