Circulating Progenitor Cell Count Predicts Microvascular Outcomes in Type 2 Diabetic Patients

J Clin Endocrinol Metab. 2015 Jul;100(7):2666-72. doi: 10.1210/jc.2015-1687. Epub 2015 May 5.


Context: Diabetes reduces the levels of circulating progenitor cells (CPCs) and endothelial progenitor cells (EPCs), which promote vascular repair and are inversely correlated with cardiovascular risk.

Objective: The objective of the study was to test whether CPC/EPC levels predict onset/progression of microangiopathy in a cohort of type 2 diabetic (T2D) patients.

Design: This was a pseudoprospective study with a 3.9-year follow-up.

Setting: The study was conducted at a tertial referral diabetes outpatient clinic.

Patients: A total of 187 T2D patients having a baseline determination of CPCs/EPCs participated in the study.

Intervention: Baseline data on demographics, anthropometrics, concomitant risk factors, diabetic complications, and medications were collected.

Main outcome measure: Onset or progression of microangiopathy was assessed at follow-up compared with baseline.

Results: New onset or progression of microalbuminuria, chronic kidney disease, retinopathy, and neuropathy occurred in 70 patients (9.5%/y). After controlling the false discovery rate, baseline CD34(+) CPCs and EPCs were significantly lower in patients with onset/progression of microalbuminuria and any microangiopathy. Patients with baseline CD34(+) CPC or CD133(+)/kinase insert domain-containing receptor(+)/EPC levels below the median were more likely to experience worsening microangiopathy than those with high cell levels. Independently from confounders, including age, sex, glycated hemoglobin, and diabetes duration, CD34(+) cells predicted onset/progression of microalbuminuria, retinopathy, and any microangiopathy in false discovery rate-adjusted analyses. A low CD34(+) cell count limited the beneficial effects of renin-angiotensin system blockers on microalbuminuria progression.

Conclusions: Levels of circulating (endothelial) progenitor cells predict microvascular outcomes in T2D. Together with previous studies showing an association with cardiovascular events, these data indicate that CPCs/EPCs represent biomarkers of the global complication burden in diabetes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Cells / pathology*
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / diagnosis*
  • Diabetes Mellitus, Type 2 / pathology
  • Diabetic Angiopathies / blood
  • Diabetic Angiopathies / diagnosis*
  • Disease Progression
  • Endothelial Progenitor Cells / pathology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prognosis