Decreased numbers of endothelial progenitor cells in patients in the early stages of systemic sclerosis

Introduction: Microangiopathy and endothelial dysfunction are present in the early stages of systemic sclerosis (SSc). Defective vasculogenesis mediated by bone marrow-derived endothelial progenitor cells (EPCs) might be involved in the vascular abnormalities found in SSc. Objectives: To evaluate the circulating EPC levels and EPC subtypes via flow cytometry and early outgrowth colony-forming units (CPUs) in patients with SSc compared to healthy subjects. Methods: Thirty-nine female SSc patients (30 in the early stages of SSc) and 44 age-matched healthy women were included. Peripheral blood EPCs were quantified using flow cytometry and by counting the early outgrowth CFUs. Results: The EPCs quantified with flow cytometry and the CPU numbers were significantly lower in SSc patients than in control subjects (155.1 +/- 95.1 vs. 241.3 +/- 1842 EPC/10(6) lymphomononuclear cells, p = 0.011; 15.4 +/- 8.6 vs. 23.5 +/- 10.9 CFU, p<0.001; respectively), as well as in the group of patients in the early stages of SSc compared to the controls. Patients with digital ulcers had significantly higher CFU counts than those without ulcers (p = 0.013). Among patients with the scleroderma pattern on nailfold capillaroscopy, patients with the late pattern had significantly lower EPC levels than those with the early and active patterns (p = 0.046). There were no significant correlations of EPCs or CFU levels with RP duration. Conclusions: The present study revealed decreased EPCs in SSc patients, including those with early disease onset. These findings suggest that defective vasculogenesis occurs in the early phases of the disease. Therefore, EPCs might be an important therapeutic target for the prevention of vascular complications in SSc patients. (C) 2015 Elsevier Inc. All rights reserved.