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Int J Sports Med 2007; 28(5): 368-373
DOI: 10.1055/s-2006-924363
Physiology & Biochemistry

© Georg Thieme Verlag KG Stuttgart · New York

Exercise Capacity and Circulating Endothelial Progenitor Cells in Hemodialysis Patients

F. Manfredini1 , G. M. Rigolin2 , A. M. Malagoni1 , S. Soffritti3 , B. Boari4 , F. Conconi1 , G. L. Castoldi2 , L. Catizone3 , P. Zamboni5 , R. Manfredini4
  • 1Center for Biomedical Studies Applied to Sport, Vascular Diseases Center, University of Ferrara, Italy
  • 2Section of Hematology, University of Ferrara, Italy
  • 3Department of Nephrology, St. Anna Hospital, Ferrara, Italy
  • 4Section of Internal Medicine, Gerontology and Geriatrics, Vascular Diseases Center, University of Ferrara, Italy
  • 5Section of General Surgery, Vascular Diseases Center, University of Ferrara, Italy
Further Information

Publication History

Accepted after revision: May 20, 2006

Publication Date:
06 October 2006 (online)

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Abstract

Mobilization of circulating endothelial progenitor cells (EPCs) is increased after acute exercise and training. This study aims to evaluate whether, in a low performance population, EPC levels may be related to exercise capacity in steady state conditions. Study population consisted of sixteen hemodialysis patients. The distance walked in the 6-minute walking test (6 MWD) and the maximal speed attained in an incremental treadmill test were used to assess the exercise capacity. Physical functioning was measured by the scale on the SF36 questionnaire. Quantification of peripheral blood CD34(+) cells and enumeration of EPCs, assessed as CD34(+) cells coexpressing AC 133 and vascular endothelial growth factor receptor-2, were performed. Hemoglobin concentration, white blood cells, high-sensitivity C-reactive protein, total cholesterol, and triglycerides were measured. Statistical analysis examined the relationship between blood progenitors cells versus performance parameters, laboratory parameters, age, body mass index, hemodialysis duration, and erythropoietin therapy. Univariate analysis revealed a significant association between percentage values of EPC and performance parameters only: 6 MWD (r = 0.720; p = 0.0017), maximal treadmill speed (r = 0.721; p = 0.0016), and physical functioning score (r = 0.506; p = 0.0453). A similar statistical association between EPC absolute values and performance parameters was found. No correlation between CD34+ and any parameter under study was observed. Multivariate analysis indicated 6 MWD as the most significant independent factor associated with EPC level. EPC percentage value was significantly lower (p = 0.0087) in the worse (6 MWD < 300 m, n = 8) than in the better performing group (6 MWD > 300 m, n = 8). In a group of renal patients, mobilization of EPCs was related to the degree of exercise capacity, suggesting a possible connection with the cardiovascular risk in low performance populations limited by chronic diseases.

Key words

Cardiovascular risk - kidney failure - chronic - stem cells - tests

References

  • 1 Aicher A, Zeiher A M, Dimmeler S. Mobilizing endothelial progenitor cells.  Hypertension. 2005;  45 321-325
    CrossrefPubMedSearch in Google Scholar
  • 2 Barnett D, Granger V, Kraan J, Whitby L, Reilly J T, Papa S, Gratama J W. Reduction of intra- and inter-laboratory variation in CD34+ stem cell enumeration using stable test material, standard protocols and targeted training.  Br J Haematol. 2000;  108 784-792
    CrossrefPubMedSearch in Google Scholar
  • 3 Cahalin L P, Mathier M A, Semigran M J, Dec G W, DiSalvo T G. The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure.  Chest. 1996;  110 325-332
    CrossrefPubMedSearch in Google Scholar
  • 4 Choi J H, Kim K L, Huh W, Kim B, Byun J, Suh W, Sung J, Jeon E S, Oh H Y, Kim D K. Decreased number and impaired angiogenic function of endothelial progenitor cells in patients with chronic renal failure.  Arterioscler Thromb Vasc Biol. 2004;  24 1246-1252
    PubMedSearch in Google Scholar
  • 5 Collins A J. Cardiovascular mortality in end-stage renal disease.  Am J Med Sci. 2003;  325 163-167
    CrossrefPubMedSearch in Google Scholar
  • 6 Enright P L. The six-minute walk test.  Respir Care. 2003;  48 783-785
    PubMedSearch in Google Scholar
  • 7 Fadini G P, Miorin M, Facco M, Bonamico S, Baesso I, Grego F, Menegolo M, de Kreutzenberg S V, Tiengo A, Agostini C, Avogaro A. Circulating endothelial progenitor cells are reduced in peripheral vascular complications of type 2 diabetes mellitus.  J Am Coll Cardiol. 2005;  45 1449-1457
    CrossrefPubMedSearch in Google Scholar
  • 8 Hill J M, Zalos G, Halcox J P, Schenke W H, Waclawiw M A, Quyyumi A A, Finkel T. Circulating endothelial progenitor cells, vascular function, and cardiovascular risk.  N Engl J Med. 2003;  348 593-600
    CrossrefPubMedSearch in Google Scholar
  • 9 Himann J E, Cunningham D A, Rechnitzer P A, Paterson D H. Age-related changes in speed of walking.  Med Sci Sports Exerc. 1988;  20 161-166
    PubMedSearch in Google Scholar
  • 10 Johansen K L, Chertow G M, Ng A V, Mulligan K, Carey S, Schoenfeld P Y, Kent-Braun J A. Physical activity level in patient on hemodialisis and healthy sedentary controls.  Kidney Int. 2000;  57 2564-2570
    CrossrefPubMedSearch in Google Scholar
  • 11 Kojda G, Hambrecht R. Molecular mechanisms of vascular adaptations to exercise. Physical activity as an effective antioxidant therapy?.  Cardiovasc Res. 2005;  67 187-197
    CrossrefPubMedSearch in Google Scholar
  • 12 Kouidi E, Albani M, Natsis K, Megalopoulos A, Gigis P, Guiba-Tziampiri O, Tourkantonis A, Deligiannis A. The effects of exercise training on muscle atrophy in haemodialysis patients.  Nephrol Dial Transplant. 1998;  13 685-699
    PubMedSearch in Google Scholar
  • 13 Laufs U, Werner N, Link A, Endres M, Wassmann S, Jurgens K, Miche E, Bohm M, Nickenig G. Physical training increases endothelial progenitor cells, inhibits neointima formation, and enhances angiogenesis.  Circulation. 2004;  109 220-226
    CrossrefPubMedSearch in Google Scholar
  • 14 Manfredini F, Conconi F, Malagoni A M, Manfredini R, Mascoli F, Liboni A, Zamboni P. Speed rather than distance: a novel graded treadmill test to assess claudication.  Eur J Vasc Endovasc Surg. 2004;  28 303-309
    CrossrefPubMedSearch in Google Scholar
  • 15 McKenna M, Wolfson S, Kuller L. The ratio of ankle and arm arterial pressure as an independent predictor of mortality.  Atherosclerosis. 1991;  87 119-128
    CrossrefPubMedSearch in Google Scholar
  • 16 Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood J E. Exercise capacity and mortality among men referred for exercise testing.  N Engl J Med. 2002;  346 793-801
    CrossrefPubMedSearch in Google Scholar
  • 17 O'Hare A M, Tawney K, Bacchetti P, Johansen K L. Decreased survival among sedentary patients undergoing dialysis: results from the dialysis morbidity and mortality study wave 2.  Am J Kidney Dis. 2003;  41 447-454
    CrossrefPubMedSearch in Google Scholar
  • 18 Peichev M, Naiyer A J, Pereira D, Zhu Z, Lane W J, Williams M, Oz M C, Hicklin D J, Witte L, Moore M AS, Rafii S. Expression of VEGFR‐2 and AC133 by circulating human CD34+ cells identifies a population of functional endothelial precursors.  Blood. 2000;  95 952-958
    PubMedSearch in Google Scholar
  • 19 Prior B M, Yang H T, Terjung R L. What makes vessels grow with exercise training?.  J Appl Physiol. 2004;  97 1119-1128
    CrossrefPubMedSearch in Google Scholar
  • 20 Rehman J, Li J, Parvathaneni L, Karlsson G, Panchal V R, Temm C J, Mahenthiran J, March K L. Exercise acutely increases circulating endothelial progenitor cells and monocyte-/macrophage-derived angiogenic cells.  J Am Coll Cardiol. 2004;  43 2314-2318
    CrossrefPubMedSearch in Google Scholar
  • 21 Rehman J. Can angiogenesis be exercised?.  EXS & G Breier, Birkhðuser Verlag & G Breier, Birkhðuser VerlagEXS 2005;. 2005;  94 155-161
    PubMedSearch in Google Scholar
  • 22 Rostagno C, Olivo G, Comeglio M, Boddi V, Banchelli M, Galanti G, Gensini G F. Prognostic value of 6-minute walk corridor test in patients with mild to moderate heart failure: comparison with other methods of functional evaluation.  Eur J Heart Fail. 2003;  5 247-252
    PubMedSearch in Google Scholar
  • 23 Sandri M, Adams V, Gielen S, Linke A, Lenk K, Krankel N, Lenz D, Erbs S, Scheinert D, Mohr F W, Schuler G, Hambrecht R. Effects of exercise and ischemia on mobilization and functional activation of blood-derived progenitor cells in patients with ischemic syndromes: results of 3 randomized studies.  Circulation. 2005;  111 3391-3399
    CrossrefPubMedSearch in Google Scholar
  • 24 Schmidt-Lucke C, Rossig L, Fichtlscherer S, Vasa M, Britten M, Kamper U, Dimmeler S, Zeiher A M. Reduced number of circulating endothelial progenitor cells predicts future cardiovascular events. Proof of concept for the clinical importance of endogenous vascular repair.  Circulation. 2005;  111 2981-2987
    CrossrefPubMedSearch in Google Scholar
  • 25 Sklar A H, Riesenberg L A, Silber A K, Ahmed W, Ali A. Postdialysis fatigue.  Am J Kidney Dis. 1996;  28 732-736
    PubMedSearch in Google Scholar
  • 26 Steiner S, Niessner A, Ziegler S, Richter B, Seidinger D, Pleiner J, Penka M, Wolzt M, Huber K, Wojta J, Minar E, Kopp C W. Endurance training increases the number of endothelial progenitor cells in patients with cardiovascular risk and coronary artery disease.  Atherosclerosis. 2005;  181 305-310
    CrossrefPubMedSearch in Google Scholar
  • 27 Valgimigli M, Rigolin G M, Fucili A, Porta M D, Soukhomovskaia O, Malagutti P, Bugli A M, Bragotti L Z, Francolini G, Mauro E, Castoldi G, Ferrari R. CD34+ and endothelial progenitor cells in patients with various degrees of congestive heart failure.  Circulation. 2004;  110 1209-1212
    CrossrefPubMedSearch in Google Scholar
  • 28 Vasa M, Fichtlscherer S, Aicher A, Adler K, Urbich C, Martin H, Zeiher A M, Dimmeler S. Number and migratory activity of circulating endothelial progenitor cells inversely correlate with risk factors for coronary artery disease.  Circ Res. 2001;  89 E1-E7
    CrossrefPubMedSearch in Google Scholar

MD Fabio Manfredini

Department of Biochemistry and Molecular Biology
Section: Biochemistry of Exercise - Center for Biomedical Studies Applied to Sport
University of Ferrara

Via Gramicia 35

44100 Ferrara

Italy

Phone: + 39 05 32 29 10 70-29 10 75

Fax: + 39 05 32 70 50 18

Email: mdf@unife.it