title: Impact of depression on circulating endothelial progenitor cells in patients with acute coronary syndromes: a pilot study.
abstract: OBJECTIVE
  Depression has been identified as a risk factor for an adverse prognosis and reduced survival in patients with acute coronary syndrome (ACS). The number of endothelial progenitor cells (EPCs) is an independent predictor of clinical outcomes in patients with ACS. The aim of this study was to evaluate the impact of depression on EPC levels in patients with ACS.
  
  
  METHODS
  Out of 74 ACS patients [23 non-ST-segment elevation myocardial infarction (NSTEMI), 48 STEMI], 36 had a diagnosis of major depressive episode (MDE) according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) criteria at the time of the inclusion in the study. Control groups were as follows: 15 healthy individuals and 18 patients with current MDE without a history of cardiovascular diseases. EPCs were defined as CD34CD133KDR and evaluated by flow cytometry. All patients underwent standardized cardiological and psychopathological evaluations. Parametric and nonparametric statistical tests were performed wherever appropriate.
  
  
  RESULTS
  ACS patients with MDE showed a significant decrease in circulating EPC number compared with ACS patients without MDE (P < 0.001). The ACS study population was then subdivided into STEMI and NSTEMI groups, and within each group patients with MDE again showed a significant decrease in circulating CD34CD133KDR EPCs compared with others (P <0.001).
  
  
  CONCLUSIONS
  We showed that ACS patients with MDE have a reduced number of circulating CD34CD133KDR cells compared with ACS patients without MDE, suggesting that the presence of MDE reduces the response of bone marrow to acute ischemic events. Considering the reparative role of EPCs in ACS patients, we propose that patients with MDE might be protected less than patients without MDE.
authors.affiliation: aDepartment of Surgical, Medical and Molecular Pathology and Critic Area bDepartment of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa cUnit of Cardiology, Ospedale S. Andrea, La Spezia dCardio-Respiratory Department, Ospedale Campo di Marte, Lucca eUnit of Cardiology, USL5 Sarzana (SP), Italy *Rossella Di Stefano and Francesca Felice contributed equally to the writing of this article.
authors.forename: Rossella
authors.initials: R
authors.lastname: Di Stefano
authors.forename: Francesca
authors.initials: F
authors.lastname: Felice
authors.forename: Stefano
authors.initials: S
authors.lastname: Pini
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Mazzotta
authors.forename: Francesco M
authors.initials: FM
authors.lastname: Bovenzi
authors.forename: Daniele
authors.initials: D
authors.lastname: Bertoli
authors.forename: Marianna
authors.initials: M
authors.lastname: Abelli
authors.forename: Lucia
authors.initials: L
authors.lastname: Borelli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Cardini
authors.forename: Lisa
authors.initials: L
authors.lastname: Lari
authors.forename: Camilla
authors.initials: C
authors.lastname: Gesi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Muccignat
authors.forename: Claudia
authors.initials: C
authors.lastname: Oligeri
authors.forename: Paola
authors.initials: P
authors.lastname: Michi
authors.forename: Alberto
authors.initials: A
authors.lastname: Balbarini
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000453:epidemiology / Q000523:psychology; D000328:Adult; D000368:Aged; D002452:Cell Count; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000097:blood* / Q000453:epidemiology; D042783:Endothelial Cells / Q000473:pathology*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D013234:Stem Cells / Q000473:pathology*