The impact of endothelial progenitor cells on restenosis after percutaneous angioplasty of hemodialysis vascular access

Chih-Cheng Wu; Po-Hsun Huang; Chao-Lun Lai; Hsin-Bang Leu; Jaw-Wen Chen; Shing-Jong Lin

doi:10.1371/journal.pone.0101058

The impact of endothelial progenitor cells on restenosis after percutaneous angioplasty of hemodialysis vascular access

PLoS One. 2014 Jun 25;9(6):e101058. doi: 10.1371/journal.pone.0101058. eCollection 2014.

Authors

Chih-Cheng Wu¹, Po-Hsun Huang², Chao-Lun Lai³, Hsin-Bang Leu⁴, Jaw-Wen Chen⁵, Shing-Jong Lin⁶

Affiliations

¹ Cardiovascular center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan; School of Medicine, National Taiwan University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
² Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
³ Cardiovascular center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan; School of Medicine, National Taiwan University, Taipei, Taiwan.
⁴ Cardiovascular center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
⁵ Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Institute and Department of Pharmacology, National Yang-Ming University, Taipei, Taiwan.
⁶ Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.

Abstract

Objective: We prospectively investigate the relation between baseline circulating endothelial progenitor cells and the subsequent development of restenosis after angioplasty of hemodialysis vascular access.

Background: Effect of angioplasty for hemodialysis vascular access is greatly attenuated by early and frequent restenosis. Circulating endothelial progenitor cells (EPCs) play a key role in vascular repair but are deficient in hemodialysis patients.

Method: After excluding 14 patients due to arterial stenosis, central vein stenosis, and failed angioplasty, 130 patients undergoing angioplasty for dysfunctional vascular access were prospectively enrolled. Flow cytometry with quantification of EPC markers (defined as CD34+, CD34+KDR+, CD34+KDR+CD133+) in peripheral blood immediately before angioplasty procedures was used to assess circulating EPC numbers. Patients were followed clinically for up to one year after angioplasty.

Results: During the one-year follow-up, 95 patients (73%) received interventions for recurrent access dysfunction. Patients in the lower tertile of CD34+KDR+ cell count had the highest restenosis rates (46%) at three month (early restenosis), compared with patients in the medium and upper tertiles of CD34+KDR+ cell count (27% and 12% respectively, p = 0.002). Patients in the lower tertile of CD34+KDR+ cell count received more re-interventions during one year. Patients with early restenosis had impaired EPC adhesive function and increased senescence and apoptosis. In multivariate analysis, the CD34+KDR+ and CD34+KDR+CD133+ cell counts were independent predictors of target-lesion early restenosis.

Conclusion: Our results suggest that the deficiency of circulating EPCs is associated with early and frequent restenosis after angioplasty of hemodialysis vascular access.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Angioplasty*
Cell Proliferation
Cells, Cultured
Endothelial Progenitor Cells / cytology*
Endothelial Progenitor Cells / metabolism
Female
Flow Cytometry
Graft Occlusion, Vascular / pathology*
Humans
Male
Middle Aged
Prospective Studies
Renal Dialysis*
Vascular Access Devices*

Grants and funding

This study was supported by grants from the National Taiwan University Hospital, Hsinchu Branch (HCH100-4, HCH101-13), and the UST-UCSD International Centre of Excellence in Advanced Bio-engineering NSC-100-2911-I-009-101-A2. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.