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Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Research article

Early Endothelial Progenitor Cells (eEPCs) in systemic sclerosis (SSc) - dynamics of cellular regeneration and mesenchymal transdifferentiation

Authors: S. Patschan, D. Tampe, C. Müller, C. Seitz, C. Herink, G. A. Müller, E. Zeisberg, M. Zeisberg, E. Henze, D. Patschan

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

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Abstract

Background

Patients with systemic sclerosis (SSc) are endagered by tissue fibrosis and by microvasculopathy, with the latter caused by endothelial cell expansion/proliferation. SSc-associated fibrosis potentially results from mesenchymal transdifferentiation of endothelial cells. Early Endothelial Progenitor Cells (eEPCs) act proangiogenic under diverse conditions. Aim of the study was to analyze eEPC regeneration and mesenchymal transdifferentiation in patients with limited and diffuse SSs (lSSc and dSSc).

Methods

Patients with both, lSSc and dSSc were included into the study. The following parameters were evaluated: eEPC numbers and regeneration, concentrations of vasomodulatory mediators, mesenchymal properties of blood-derived eEPC. Serum samples of healthy subjects and SS patients were used for stimulation of cultured human eEPC, subsequently followed by analysis of mesenchymal cell characteristics and mobility.

Results

Twenty-nine patients were included into the study. Regenerative activity of blood-derived eEPCs did not differ between Controls and patients. Circulating eEPC were significantly lower in all patients with SSc, and in limited and diffuse SSc (lSSc/dSSc). Serum concentrations of promesenchymal TGF-b was elevated in all patients with SSc. Cultured mononuclear cells from SS patients displayed higher abundances of CD31 and of CD31 and aSMA combined. Finally, serum from SSc patients inhibited migration of cultured eEPCs and the cells showed lower sensitivity towards the endothelin antagonist Bosentan.

Conclusions

The eEPC system, which represents an essential element of the endogenous vascular repair machinery is affected in SSc. The increased appearance of mesenchymal properties in eEPC may indicate that alterations of the cells potentially contribute to the accumulation of connective tissue and to vascular malfunction.
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Literature
1.
go back to reference Goldblatt F, O’Neill SG. Clinical aspects of autoimmune rheumatic diseases. Lancet Lond Engl. 2013;382:797–808.CrossRef Goldblatt F, O’Neill SG. Clinical aspects of autoimmune rheumatic diseases. Lancet Lond Engl. 2013;382:797–808.CrossRef
2.
go back to reference Matucci-Cerinic M, Kahaleh B, Wigley FM. Review: evidence that systemic sclerosis is a vascular disease. Arthritis Rheum. 2013;65:1953–62.CrossRefPubMed Matucci-Cerinic M, Kahaleh B, Wigley FM. Review: evidence that systemic sclerosis is a vascular disease. Arthritis Rheum. 2013;65:1953–62.CrossRefPubMed
3.
go back to reference Mowat A. Connective tissue diseases. Clin Haematol. 1972;1:573–94.PubMed Mowat A. Connective tissue diseases. Clin Haematol. 1972;1:573–94.PubMed
5.
go back to reference Asahara T, Murohara T, Sullivan A, Silver M, van der Zee R, Li T, et al. Isolation of putative progenitor endothelial cells for angiogenesis. Science. 1997;275:964–7.CrossRefPubMed Asahara T, Murohara T, Sullivan A, Silver M, van der Zee R, Li T, et al. Isolation of putative progenitor endothelial cells for angiogenesis. Science. 1997;275:964–7.CrossRefPubMed
6.
go back to reference Case J, Mead LE, Bessler WK, Prater D, White HA, Saadatzadeh MR, et al. Human CD34 + AC133 + VEGFR-2+ cells are not endothelial progenitor cells but distinct, primitive hematopoietic progenitors. Exp Hematol. 2007;35:1109–18.CrossRefPubMed Case J, Mead LE, Bessler WK, Prater D, White HA, Saadatzadeh MR, et al. Human CD34 + AC133 + VEGFR-2+ cells are not endothelial progenitor cells but distinct, primitive hematopoietic progenitors. Exp Hematol. 2007;35:1109–18.CrossRefPubMed
7.
go back to reference Yoder MC, Mead LE, Prater D, Krier TR, Mroueh KN, Li F, et al. Redefining endothelial progenitor cells via clonal analysis and hematopoietic stem/progenitor cell principals. Blood. 2007;109:1801–9.CrossRefPubMedPubMedCentral Yoder MC, Mead LE, Prater D, Krier TR, Mroueh KN, Li F, et al. Redefining endothelial progenitor cells via clonal analysis and hematopoietic stem/progenitor cell principals. Blood. 2007;109:1801–9.CrossRefPubMedPubMedCentral
8.
go back to reference Basile DP, Yoder MC. Renal endothelial dysfunction in acute kidney ischemia reperfusion injury. Cardiovasc Hematol Disord Drug Targets. 2014;14:3–14.CrossRefPubMedPubMedCentral Basile DP, Yoder MC. Renal endothelial dysfunction in acute kidney ischemia reperfusion injury. Cardiovasc Hematol Disord Drug Targets. 2014;14:3–14.CrossRefPubMedPubMedCentral
9.
go back to reference Chen J, Chen J, Chen S, Zhang C, Zhang L, Xiao X, et al. Transfusion of CXCR4-primed endothelial progenitor cells reduces cerebral ischemic damage and promotes repair in db/db diabetic mice. PLoS One. 2012;7, e50105.CrossRefPubMedPubMedCentral Chen J, Chen J, Chen S, Zhang C, Zhang L, Xiao X, et al. Transfusion of CXCR4-primed endothelial progenitor cells reduces cerebral ischemic damage and promotes repair in db/db diabetic mice. PLoS One. 2012;7, e50105.CrossRefPubMedPubMedCentral
10.
go back to reference Martí-Fàbregas J, Crespo J, Delgado-Mederos R, Martínez-Ramírez S, Peña E, Marín R, et al. Endothelial progenitor cells in acute ischemic stroke. Brain Behav. 2013;3:649–55.CrossRefPubMedPubMedCentral Martí-Fàbregas J, Crespo J, Delgado-Mederos R, Martínez-Ramírez S, Peña E, Marín R, et al. Endothelial progenitor cells in acute ischemic stroke. Brain Behav. 2013;3:649–55.CrossRefPubMedPubMedCentral
11.
go back to reference Patschan S, Patschan D, Henze E, Blaschke S, Wessels JT, Müller G-A. Impairment and differential expression of PR3 and MPO on peripheral myelomonocytic cells with endothelial properties in granulomatosis with polyangiitis. Int J Nephrol. 2012;2012:715049–12.CrossRef Patschan S, Patschan D, Henze E, Blaschke S, Wessels JT, Müller G-A. Impairment and differential expression of PR3 and MPO on peripheral myelomonocytic cells with endothelial properties in granulomatosis with polyangiitis. Int J Nephrol. 2012;2012:715049–12.CrossRef
12.
go back to reference Zhao YH, Yuan B, Chen J, Feng DH, Zhao B, Qin C, et al. Endothelial progenitor cells: therapeutic perspective for ischemic stroke. CNS Neurosci Ther. 2013;19:67–75.CrossRefPubMed Zhao YH, Yuan B, Chen J, Feng DH, Zhao B, Qin C, et al. Endothelial progenitor cells: therapeutic perspective for ischemic stroke. CNS Neurosci Ther. 2013;19:67–75.CrossRefPubMed
13.
go back to reference Patschan SA, Patschan D, Temme J, Korsten P, Wessels JT, Koziolek M, et al. Endothelial progenitor cells (EPC) in sepsis with acute renal dysfunction (ARD). Crit Care Lond Engl. 2011;15:R94.CrossRef Patschan SA, Patschan D, Temme J, Korsten P, Wessels JT, Koziolek M, et al. Endothelial progenitor cells (EPC) in sepsis with acute renal dysfunction (ARD). Crit Care Lond Engl. 2011;15:R94.CrossRef
14.
go back to reference Allanore Y, Batteux F, Avouac J, Assous N, Weill B, Kahan A. Levels of circulating endothelial progenitor cells in systemic sclerosis. Clin Exp Rheumatol. 2007;25:60–6.PubMed Allanore Y, Batteux F, Avouac J, Assous N, Weill B, Kahan A. Levels of circulating endothelial progenitor cells in systemic sclerosis. Clin Exp Rheumatol. 2007;25:60–6.PubMed
15.
go back to reference Del Papa N, Quirici N, Soligo D, Scavullo C, Cortiana M, Borsotti C, et al. Bone marrow endothelial progenitors are defective in systemic sclerosis. Arthritis Rheum. 2006;54:2605–15.CrossRefPubMed Del Papa N, Quirici N, Soligo D, Scavullo C, Cortiana M, Borsotti C, et al. Bone marrow endothelial progenitors are defective in systemic sclerosis. Arthritis Rheum. 2006;54:2605–15.CrossRefPubMed
16.
go back to reference Distler JHW, Allanore Y, Avouac J, Giacomelli R, Guiducci S, Moritz F, et al. EULAR scleroderma trials and research group statement and recommendations on endothelial precursor cells. Ann Rheum Dis. 2009;68:163–8.CrossRefPubMed Distler JHW, Allanore Y, Avouac J, Giacomelli R, Guiducci S, Moritz F, et al. EULAR scleroderma trials and research group statement and recommendations on endothelial precursor cells. Ann Rheum Dis. 2009;68:163–8.CrossRefPubMed
17.
go back to reference Fadini GP, Losordo D, Dimmeler S. Critical reevaluation of endothelial progenitor cell phenotypes for therapeutic and diagnostic use. Circ Res. 2012;110:624–37.CrossRefPubMedPubMedCentral Fadini GP, Losordo D, Dimmeler S. Critical reevaluation of endothelial progenitor cell phenotypes for therapeutic and diagnostic use. Circ Res. 2012;110:624–37.CrossRefPubMedPubMedCentral
18.
go back to reference Patschan D, Patschan S, Henze E, Wessels JT, Koziolek M, Müller GA. LDL lipid apheresis rapidly increases peripheral endothelial progenitor cell competence. J Clin Apheresis. 2009;24:180–5.CrossRefPubMed Patschan D, Patschan S, Henze E, Wessels JT, Koziolek M, Müller GA. LDL lipid apheresis rapidly increases peripheral endothelial progenitor cell competence. J Clin Apheresis. 2009;24:180–5.CrossRefPubMed
19.
go back to reference Patschan S, Patschan D, Potulski M, Henze E, Scholze J, Müller G-A. Endothelial progenitor cells in systemic lupus erythematosus. J Nephrol. 2013;26:1065–72.CrossRefPubMed Patschan S, Patschan D, Potulski M, Henze E, Scholze J, Müller G-A. Endothelial progenitor cells in systemic lupus erythematosus. J Nephrol. 2013;26:1065–72.CrossRefPubMed
20.
go back to reference van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum. 2013;65:2737–47.CrossRefPubMedPubMedCentral van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum. 2013;65:2737–47.CrossRefPubMedPubMedCentral
21.
go back to reference LeRoy EC, Medsger TA. Criteria for the classification of early systemic sclerosis. J Rheumatol. 2001;28:1573–6.PubMed LeRoy EC, Medsger TA. Criteria for the classification of early systemic sclerosis. J Rheumatol. 2001;28:1573–6.PubMed
22.
go back to reference Patschan S, Nemirovsky K, Henze E, Scholze J, Müller GA, Patschan D. Tocilizumab increases EPC regeneration in rheumatoid arthritis. Scand J Rheumatol. 2014;43:528–30.CrossRefPubMed Patschan S, Nemirovsky K, Henze E, Scholze J, Müller GA, Patschan D. Tocilizumab increases EPC regeneration in rheumatoid arthritis. Scand J Rheumatol. 2014;43:528–30.CrossRefPubMed
23.
go back to reference Xavier S, Vasko R, Matsumoto K, Zullo JA, Chen R, Maizel J, et al. Curtailing endothelial TGF-β signaling is sufficient to reduce endothelial-mesenchymal transition and fibrosis in CKD. J Am Soc Nephrol JASN. 2015;26:817–29.CrossRefPubMed Xavier S, Vasko R, Matsumoto K, Zullo JA, Chen R, Maizel J, et al. Curtailing endothelial TGF-β signaling is sufficient to reduce endothelial-mesenchymal transition and fibrosis in CKD. J Am Soc Nephrol JASN. 2015;26:817–29.CrossRefPubMed
24.
go back to reference Zeisberg M, Hanai J, Sugimoto H, Mammoto T, Charytan D, Strutz F, et al. BMP-7 counteracts TGF-beta1-induced epithelial-to-mesenchymal transition and reverses chronic renal injury. Nat Med. 2003;9:964–8.CrossRefPubMed Zeisberg M, Hanai J, Sugimoto H, Mammoto T, Charytan D, Strutz F, et al. BMP-7 counteracts TGF-beta1-induced epithelial-to-mesenchymal transition and reverses chronic renal injury. Nat Med. 2003;9:964–8.CrossRefPubMed
25.
go back to reference Jimenez SA. Role of endothelial to mesenchymal transition in the pathogenesis of the vascular alterations in systemic sclerosis. ISRN Rheumatol. 2013;2013:835948.CrossRefPubMedPubMedCentral Jimenez SA. Role of endothelial to mesenchymal transition in the pathogenesis of the vascular alterations in systemic sclerosis. ISRN Rheumatol. 2013;2013:835948.CrossRefPubMedPubMedCentral
26.
go back to reference Abraham D, Distler O. How does endothelial cell injury start? The role of endothelin in systemic sclerosis. Arthritis Res Ther. 2007;9 Suppl 2:S2.CrossRefPubMed Abraham D, Distler O. How does endothelial cell injury start? The role of endothelin in systemic sclerosis. Arthritis Res Ther. 2007;9 Suppl 2:S2.CrossRefPubMed
27.
go back to reference Kahaleh B. Vascular disease in scleroderma: mechanisms of vascular injury. Rheum Dis Clin North Am. 2008;34:57–71. vi.CrossRefPubMed Kahaleh B. Vascular disease in scleroderma: mechanisms of vascular injury. Rheum Dis Clin North Am. 2008;34:57–71. vi.CrossRefPubMed
28.
go back to reference Müller-Ladner U, Distler O, Ibba-Manneschi L, Neumann E, Gay S. Mechanisms of vascular damage in systemic sclerosis. Autoimmunity. 2009;42:587–95.CrossRefPubMed Müller-Ladner U, Distler O, Ibba-Manneschi L, Neumann E, Gay S. Mechanisms of vascular damage in systemic sclerosis. Autoimmunity. 2009;42:587–95.CrossRefPubMed
29.
go back to reference Neidhart M, Kuchen S, Distler O, Brühlmann P, Michel BA, Gay RE, et al. Increased serum levels of antibodies against human cytomegalovirus and prevalence of autoantibodies in systemic sclerosis. Arthritis Rheum. 1999;42:389–92.CrossRefPubMed Neidhart M, Kuchen S, Distler O, Brühlmann P, Michel BA, Gay RE, et al. Increased serum levels of antibodies against human cytomegalovirus and prevalence of autoantibodies in systemic sclerosis. Arthritis Rheum. 1999;42:389–92.CrossRefPubMed
30.
go back to reference Pandey JP, LeRoy EC. Human cytomegalovirus and the vasculopathies of autoimmune diseases (especially scleroderma), allograft rejection, and coronary restenosis. Arthritis Rheum. 1998;41:10–5.CrossRefPubMed Pandey JP, LeRoy EC. Human cytomegalovirus and the vasculopathies of autoimmune diseases (especially scleroderma), allograft rejection, and coronary restenosis. Arthritis Rheum. 1998;41:10–5.CrossRefPubMed
31.
go back to reference Renaudineau Y, Grunebaum E, Krause I, Praprotnik S, Revelen R, Youinou P, et al. Anti-endothelial cell antibodies (AECA) in systemic sclerosis--increased sensitivity using different endothelial cell substrates and association with other autoantibodies. Autoimmunity. 2001;33:171–9.CrossRefPubMed Renaudineau Y, Grunebaum E, Krause I, Praprotnik S, Revelen R, Youinou P, et al. Anti-endothelial cell antibodies (AECA) in systemic sclerosis--increased sensitivity using different endothelial cell substrates and association with other autoantibodies. Autoimmunity. 2001;33:171–9.CrossRefPubMed
32.
go back to reference Trojanowska M. Cellular and molecular aspects of vascular dysfunction in systemic sclerosis. Nat Rev Rheumatol. 2010;6:453–60.CrossRefPubMed Trojanowska M. Cellular and molecular aspects of vascular dysfunction in systemic sclerosis. Nat Rev Rheumatol. 2010;6:453–60.CrossRefPubMed
33.
go back to reference O´Riordan E, Mendelev N, Patschan S, Patschan D, Eskander J, Cohen-Gould L, et al. Chronic NOS inhibition actuates endothelial-mesenchymal transformation. Am J Physiol Heart Circ Physiol. 2007;292:H285–94.CrossRef O´Riordan E, Mendelev N, Patschan S, Patschan D, Eskander J, Cohen-Gould L, et al. Chronic NOS inhibition actuates endothelial-mesenchymal transformation. Am J Physiol Heart Circ Physiol. 2007;292:H285–94.CrossRef
34.
go back to reference Zeisberg EM, Tarnavski O, Zeisberg M, Dorfman AL, McMullen JR, Gustafsson E, et al. Endothelial-to-mesenchymal transition contributes to cardiac fibrosis. Nat Med. 2007;13:952–61.CrossRefPubMed Zeisberg EM, Tarnavski O, Zeisberg M, Dorfman AL, McMullen JR, Gustafsson E, et al. Endothelial-to-mesenchymal transition contributes to cardiac fibrosis. Nat Med. 2007;13:952–61.CrossRefPubMed
35.
go back to reference Zeisberg EM, Potenta SE, Sugimoto H, Zeisberg M, Kalluri R. Fibroblasts in kidney fibrosis emerge via endothelial-to-mesenchymal transition. J Am Soc Nephrol JASN. 2008;19:2282–7.CrossRefPubMed Zeisberg EM, Potenta SE, Sugimoto H, Zeisberg M, Kalluri R. Fibroblasts in kidney fibrosis emerge via endothelial-to-mesenchymal transition. J Am Soc Nephrol JASN. 2008;19:2282–7.CrossRefPubMed
36.
go back to reference Guiducci S, Manetti M, Romano E, Mazzanti B, Ceccarelli C, Dal Pozzo S, et al. Bone marrow-derived mesenchymal stem cells from early diffuse systemic sclerosis exhibit a paracrine machinery and stimulate angiogenesis in vitro. Ann Rheum Dis. 2011;70:2011–21.CrossRefPubMed Guiducci S, Manetti M, Romano E, Mazzanti B, Ceccarelli C, Dal Pozzo S, et al. Bone marrow-derived mesenchymal stem cells from early diffuse systemic sclerosis exhibit a paracrine machinery and stimulate angiogenesis in vitro. Ann Rheum Dis. 2011;70:2011–21.CrossRefPubMed
37.
go back to reference Stoelting S, Trefzer T, Kisro J, Steinke A, Wagner T, Peters SO. Low-dose oral metronomic chemotherapy prevents mobilization of endothelial progenitor cells into the blood of cancer patients. Vivo Athens Greece. 2008;22:831–6. Stoelting S, Trefzer T, Kisro J, Steinke A, Wagner T, Peters SO. Low-dose oral metronomic chemotherapy prevents mobilization of endothelial progenitor cells into the blood of cancer patients. Vivo Athens Greece. 2008;22:831–6.
38.
go back to reference Cutolo M, Ruaro B, Pizzorni C, Ravera F, Smith V, Zampogna G, et al. Longterm treatment with endothelin receptor antagonist bosentan and iloprost improves fingertip blood perfusion in systemic sclerosis. J Rheumatol. 2014;41:881–6.CrossRefPubMed Cutolo M, Ruaro B, Pizzorni C, Ravera F, Smith V, Zampogna G, et al. Longterm treatment with endothelin receptor antagonist bosentan and iloprost improves fingertip blood perfusion in systemic sclerosis. J Rheumatol. 2014;41:881–6.CrossRefPubMed
39.
go back to reference Parisi S, Bruzzone M, Centanaro Di Vittorio C, Laganà A, Peroni CL, Fusaro E. Efficacy of bosentan in the treatment of Raynaud’s phenomenon in patients with systemic sclerosis never treated with prostanoids. Reumatismo. 2013;65:286–91.CrossRef Parisi S, Bruzzone M, Centanaro Di Vittorio C, Laganà A, Peroni CL, Fusaro E. Efficacy of bosentan in the treatment of Raynaud’s phenomenon in patients with systemic sclerosis never treated with prostanoids. Reumatismo. 2013;65:286–91.CrossRef
40.
go back to reference Kill A, Tabeling C, Undeutsch R, Kühl AA, Günther J, Radic M, et al. Autoantibodies to angiotensin and endothelin receptors in systemic sclerosis induce cellular and systemic events associated with disease pathogenesis. Arthritis Res Ther. 2014;16:R29.CrossRefPubMedPubMedCentral Kill A, Tabeling C, Undeutsch R, Kühl AA, Günther J, Radic M, et al. Autoantibodies to angiotensin and endothelin receptors in systemic sclerosis induce cellular and systemic events associated with disease pathogenesis. Arthritis Res Ther. 2014;16:R29.CrossRefPubMedPubMedCentral
Metadata
Title
Early Endothelial Progenitor Cells (eEPCs) in systemic sclerosis (SSc) - dynamics of cellular regeneration and mesenchymal transdifferentiation
Authors
S. Patschan
D. Tampe
C. Müller
C. Seitz
C. Herink
G. A. Müller
E. Zeisberg
M. Zeisberg
E. Henze
D. Patschan
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-1197-2

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