EPCs IN ISCHEMIC, VENOUS AND DIABETIC ULCERS

Recent studies largely demonstrated the important role of bone marrow-derived Endothelial Progenitor Cells (EPCs) in wound healing. An impairment of EPCs release, functionality or homing has been observed in conditions of impaired healing, such as diabetes. Moreover a group of chemokines (SDF1, VEGF and IGF-1) is known to be both involved in wound healing and to control both release, homing and functionality of EPCs. An altered pattern of these substances is supposed to contribute to impaired healing. We present the preliminary results of a study on EPCs number and functionality, related to plasmatic and local growth factors levels, in patients with ischemic, venous or diabetic ulcers, compared with a control group of patients with acute lesions. Functionality was evaluated as CFU potential in standard in vitro conditions. Compared to control subjects (n=4, 133.526.1 cells/mL), plasmatic EPCs show an expected decreased level in diabetic (n=5, 83.369.1 cells/mL) but noteworthy ischemic ulcer patients displayed a lower value of circulating cells than venous ulcers ones (n=5, 92.251.3 and n=6, 245.2176.6 cells/mL respectively). A similar pattern was observed for circulating progenitor cells (CD341/CD331). EPCs functionality tended to be higher in diabetic and venous ulcers patients, and approached control levels in ischemic ulcers patients. In all groups VEGF in the ulcer site was significantly higher than plasmatic level (in accordance to literature) although a diabetic subjects were featured by a comprehensive lower level of VEFG. Higher systemic levels of IGF-1 than in ulcers were detected in diabetic and venous ulcers patients, while an inverted ratio was found in ischemic ulcers patients. No apparent difference in was found for SDF1 levels.