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Rheumatology Advance Access published online on June 9, 2009
Rheumatology, doi:10.1093/rheumatology/kep130
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Reduced number of endothelial progenitor cells is predictive of early relapse in anti-neutrophil cytoplasmic antibody-associated vasculitis

Jakub Závada1,2, Lindy Kideryová3, Robert Pytlík3, Zdenka Hrusková1 and Vladimír Tesar1

1Department of Nephrology, Charles University in Prague, First Faculty of Medicine and General Teaching Hospital,2Institute of Rheumatology and 3First Department of Internal Medicine and Haematooncology, Charles University in Prague, First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic.

Correspondence to: Jakub Závada, Institute of Rheumatology, Na Slupi 4, 128 50, Praha 2, Czech Republic. E-mail: zavada{at}revma.cz


  Abstract

Objectives. ANCA-associated vasculitis (AAV) is an inflammatory disorder of small- to medium-sized vessels with relapsing/remitting progression. Microvascular endothelial injury is a major feature of AAV. Circulating endothelial progenitor cells (EPCs) may provide an endogenous repair mechanism to counteract ongoing endothelial damage. We hypothesized that decreased capacity for endothelial regeneration paralleled by low EPC numbers could increase the risk of relapse in patients with AAV.

Methods. The number of circulating EPCs was determined by a colony-forming assay in a cohort of 41 patients with AAV. The patients were stratified into three subgroups according to the initial EPC count (low, medium and high) and prospectively followed. The primary goal was to determine the association between baseline EPC level and the time to the first relapse of the disease.

Results. A total of 19 (46%) patients relapsed during the study period. The cumulative relapse-free survival increased stepwise across three increasing baseline levels of EPCs (P = 0.013). EPC levels were not predictive of progression of renal disease, number of organs involved or death from any cause.

Conclusion. Low numbers of EPCs are associated with increased propensity for early relapse of AAV.

KEY WORDS: Vasculitis, Anti-neutrophil cytoplasmic antibody, Relapse, Outcome, Endothelial progenitor cell, Endothelium, Pauci-immune glomerulonephritis, Wegener's granulomatosis

Submitted 12 January 2009; Accepted 21 April 2009


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