title: Effects of circulating endothelial progenitor cells, serum vascular endothelial growth factor and hypogammaglobulinemia in Perthes disease.
abstract: OBJECTIVE
  The aim of this study was to investigate Legg-Calvé-Perthes disease (PD) pathogenesis by comparing absolute circulating endothelial progenitor cell (EPC) counts, serum levels of vascular endothelial growth factor-A (VEGF-A) and immunoglobulins between PD patients and controls.
  
  
  METHODS
  The study included 28 PD cases (mean age: 8 ± 3.8) and 25 healthy age-matched control subjects. EPC, serum VEGF-A and immunoglobulin levels were measured in peripheral blood samples. Comparisons and correlation analysis were performed.
  
  
  RESULTS
  In the PD group, 17 subjects were in the fragmentation stage and 11 in the healing stage. Four patients had bilateral disease and 14 had hypogammaglobulinemia. Median EPC count of the PD group was 80 and was significantly higher than those of the control group (p=0.011). No significant difference was determined in serum VEGF-A levels (p=0.354). EPC count were inversely correlated with serum IgG levels of the PD group (r=0.403, p=0.03). Absolute EPC count was also significantly higher in the fragmentation stage than in the healing stage and were also greater in bilaterally affected than in unilaterally affected patients. Circulating EPC count was correlated to the serum VEGF-A levels in patients with fragmentation stage of PD (r=0.605, p=0.01) and in those with hypogammaglobulinemia (r=0.599, p=0.001).
  
  
  CONCLUSIONS
  High EPC count at the fragmentation stage of PD and relatively higher counts in bilateral disease suggest that EPC may be a valuable marker in the diagnosis and follow-up of PD. Additional studies are needed to explain the strong correlation between EPC and serum VEGF-A level in the fragmentation stage and in the presence of hypogammaglobulinemia.
authors: Department of Orthopedics and Traumatology, Ahi Evran Training and Research Hospital, Ahi Evran University, Kırşehir, Turkey. hicabi.sezgin@hotmail.com.
authors: Hicabi
authors: H
authors: Sezgin
authors: Department of Orthopedics and Traumatology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey.
authors: Birol
authors: B
authors: Gülman
authors: Department of Orthopedics and Traumatology, Sabuncuoğlu Şerefeddin Training and Research Hospital, Amasya University, Amasya, Turkey.
authors: Alper
authors: A
authors: Çıraklı
authors: Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey.
authors: Abdülkerim
authors: A
authors: Bedir
authors: Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey.
authors: Dilek
authors: D
authors: Usta
authors: Department of Orthopedics and Traumatology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey.
authors: Sina
authors: S
authors: Coşkun
authors: Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey.
authors: Alişan
authors: A
authors: Yıldıran
mesh_terms: D000361:Agammaglobulinemia / Q000175:diagnosis* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D066026:Endothelial Progenitor Cells / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000097:blood* / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D011237:Predictive Value of Tests; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*
chemical_list: D015415:Biomarkers; D042461:Vascular Endothelial Growth Factor A