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Thromb Haemost 2005; 94(04): 707-712
DOI: 10.1160/TH04-12-0795
Theme Issue Article
Schattauer GmbH

Circulating endothelial cells in acute ischaemic stroke

Sunil K. Nadar
1   Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
,
Gregory Y. H. Lip
1   Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
,
Kaeng W. Lee
1   Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
,
Andrew D. Blann
1   Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
› Author Affiliations
Further Information

Publication History

Received13 December 2005

Accepted after resubmission15 May 2005

Publication Date:
07 December 2017 (online)

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Summary

Increased numbers of CD146-bearing circulating endothelial cells (CECs) in the peripheral blood probably represent the most direct evidence of endothelial cell damage. As acute ischaemic strokes are associated with endothelial abnormalities, we hypothesised that these CECs are raised in acute stroke, and that they would correlate with the other indices of endothelial perturbation, i.e. plasma von Willebrand factor (vWf) and soluble E-selectin. We studied 29 hypertensive patients (19 male; mean age 63 years) who presented with an acute stroke and compared them with 30 high risk hypertensive patients (21 male; mean age 62 years) and 30 normotensive controls (16 male; mean age 58 years). CECs were estimated by CD146 immunobead capture, vWf and soluble E-selectin by ELISA. Patients with an acute ischaemic stroke had significantly higher numbers of CECs/ml of blood (p<0.001) plasma vWf (p=0.008) soluble E-selectin (p=0.002) and higher systolic blood pressure (SBP) as compared to the other groups. The number of CECs significantly correlated with soluble E-selectin (r=0.432, p<0.001) and vWf (r=0.349, p=0.001) but not with SBP (r=0.198, p=0.069). However, in multivariate analysis, only disease group (i.e. health, hypertension or stroke) was associated with increased CECs. Acute ischaemic stroke is associated with increased numbers of CECs. The latter correlate well with established plasma markers of endothelial dysfunction or damage, thus unequivocally confirming severe vasculopathy in this condition. However, the greatest influence on CECs numbers was clinical group.

Keywords

Endothelial damage - acute ischaemic stroke - hypertension - circulating endothelial cells - CD146
 

  • References

  • 1 Lee AJ. The role of rheology and haemostatic factors in hypertension. J Human Hypertens 1997; 11: 767-76.
    CrossrefPubMedGoogle Scholar
  • 2 Lane DA, Wolff S, Ireland H. et al. Activation of coagulation and fibrinolytic systems following stroke. Br J Haematol 1983; 53: 655-8.
    CrossrefPubMedGoogle Scholar
  • 3 Lip GYH, Blann AD, Farooqi I S. et al. Abnormal haemorheology, endothelial function and thrombogenesis in relation to hypertension in acute (ictus <12 hours) stroke patients. Blood Coagul Fibrinolysis 2001; 12: 307-15.
    CrossrefPubMedGoogle Scholar
  • 4 Bath PMW, Blann A, Smith N. et al. Von Willebrand factor, P-selectin and fibrinogen levels in patients with acute ischaemic and haemorrhagic stroke, and their relationship with stroke subtype and functional outcome. Platelets 1998; 9: 155-9.
    CrossrefPubMedGoogle Scholar
  • 5 Liu L, Lin Z, Shen Z. Changes in von Willebrand factor and antithrombin III levels in acute stroke: difference between thrombotic and haemorrhagic stroke. Thromb Res 1993; 72: 353-8.
    CrossrefPubMedGoogle Scholar
  • 6 Felmeden DC, Spencer CG, Chung N A. et al. Relation of thrombogenesis in systemic hypertension to angiogenesis and endothelial damage/dysfunction (a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)). Am J Cardiol 2003; 92: 400-5.
    CrossrefPubMedGoogle Scholar
  • 7 Widlansky ME, Gokce N, Keaney Jr. JF. et al. The clinical implications of endothelial dysfunction. J Am Coll Cardiol 2003; 42: 1149-60.
    CrossrefPubMedGoogle Scholar
  • 8 Woywodt A, Bahlmann FH, De Groot K. et al. Circulating endothelial cells: life, death, detachment and repair of the endothelial cell layer. Nephrol Dial Transplant 2002; 17: 1728-30.
    CrossrefPubMedGoogle Scholar
  • 9 Mutin M, Canavy I, Blann A. et al. Direct evidence of endothelial injury in acute myocardial infarction and unstable angina by demonstration of circulating endothelial cells. Blood 1999; 93: 2951-8.
    CrossrefPubMedGoogle Scholar
  • 10 Woywodt A, Streiber F, De Groot K. et al. Circulating endothelial cells as markers for ANCA-associated small-vessel vasculitis. Lancet 2003; 361: 206-10.
    CrossrefPubMedGoogle Scholar
  • 11 Woywodt A, Scheer J, Hambach L. et al. Circulating endothelial cells as a marker of endothelial damage in allogeneic hematopoietic stem-cell transplantation. Blood 2004; 103: 3603-5.
    CrossrefPubMedGoogle Scholar
  • 12 Makin AJ, Blann AD, Chung N A. et al. Assessment of endothelial damage in atherosclerotic vascular disease by quantification of circulating endothelial cells; Relationship with von Willebrand factor and tissue factor. Eur Heart J 2004; 25: 371-6.
    CrossrefPubMedGoogle Scholar
  • 13 Bull TM, Golpon H, Hebbel R P. et al. Circulating endothelial cells in pulmonary hypertension. Thromb Haemost 2003; 90: 698-703.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Folkow B. Hypertension and endothelial dysfunction – aspects of atheroma protection. Blood Pressure. 1992 01 11-12.
    PubMedGoogle Scholar
  • 15 Drexler H. Endothelial dysfunction: clinical implications. Prog Cardiovasc Dis 1997; 4: 287-324.
    CrossrefPubMedGoogle Scholar
  • 16 Blann AD, Lip GY. The endothelium in atherothrombotic disease: assessment of function, mechanisms and clinical implications. Blood Coagul Fibrinolysis 1998; 9: 297-306.
    CrossrefPubMedGoogle Scholar
  • 17 Felmeden DC, Blann AD, Spencer C G. et al. A comparison of flow-mediated dilatation and von Willebrand factor as markers of endothelial cell function in health and in hypertension: relationship to cardiovascular risk and effects of treatment. Blood Coagul Fibrinolysis 2003; 14: 425-31.
    CrossrefPubMedGoogle Scholar
  • 18 Lee KW, Lip GY, Tayebjee M. et al. Circulating endothelial cells, Von Willebrand Factor, interleukin-6 and prognosis in patients with acute coronary syndromes. Blood 2005; 105: 526-32.
    CrossrefPubMedGoogle Scholar
  • 19 Quilici J, Banzet N, Ambrosi P. et al. Circulating endothelial cell count as a diagnostic marker for non-ST elevation acute coronary syndromes. Circulation 2004; 110: 1586-91.
    CrossrefPubMedGoogle Scholar
  • 20 Chong AY, Blann AD, Patel J. et al. Endothelial dysfunction and damage in congestive heart failure. relation of flow-mediated dilation to circulating endothelial cells, plasma indexes of endothelial damage, and brain natriuretic peptide. Circulation 2004; 110: 1794-8.
    CrossrefPubMedGoogle Scholar
  • 21 Thompson SG, Kienast J, Pyke SDM, Haverkate F. et al. Haemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris. New Engl J Med 1995; 332: 635-41.
    CrossrefPubMedGoogle Scholar
  • 22 Roldan V, Marin F, Lip G Y. et al. Soluble E-selectin in cardiovascular disease and its risk factors. A review of the literature. Thromb Haemost 2003; 90: 1007-20.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Preston RA, Ledford M, Materson B J. et al. Effects of severe, uncontrolled hypertension on endothelial activation: soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1 and von Willebrand factor. J Hypertens 2002; 20: 871-7.
    CrossrefPubMedGoogle Scholar
  • 24 Bitsch A, Klene W, Murtada L. et al. A longitudinal prospective study of soluble adhesion molecules in acute stroke. Stroke 1998; 29: 2129-35.
    CrossrefPubMedGoogle Scholar
  • 25 Fassbender K, Mossner R, Motsch L. et al. Circulating selectin- and immunoglobulin-type adhesion molecules in acute ischemic stroke. Stroke 1995; 26: 1361-4.
    CrossrefPubMedGoogle Scholar
  • 26 Pop GA, Koudstaal PJ, Meeder H J. et al. Predictive value of clinical history and electrocardiogram in pa-tients with transient ischemic attack or minor ischemic stroke for subsequent cardiac and cerebral ischemic events. The Dutch TIA Trial Study Group. Arch Neurol 1994; 51: 333-41.
    CrossrefPubMedGoogle Scholar
  • 27 Gates P, Peppard R, Kempster P. et al. Clinically unsuspected cardiac disease in patients with cerebral ischaemia. Clin Exp Neurol 1987; 23: 75-80.
    PubMedGoogle Scholar
  • 28 Pigott R, Dillon LP, Hemingway I H. et al. Soluble forms of Eselectin, ICAM1 and VCAM1 are present in the supernatants of cytokine activated cultured endothelial cells. Biochem Biophys Res Comm 1992; 187: 5849.
    CrossrefPubMedGoogle Scholar
  • 29 Burger PE, Coetzee S, McKeehan WL. et al. Fibroblast growth factor receptor-1 is expressed by endothelial progenitor cells. Blood 2002; 100: 3527-35.
    CrossrefPubMedGoogle Scholar
  • 30 Trojan L, Thomas D, Friedrich D. et al. Expression of different vascular endothelial markers in prostate cancer and BPH tissue: an immunohistochemical and clinical evaluation. Anticancer Res 2004; 24: 1651-6.
    PubMedGoogle Scholar
  • 31 Lackner C, Jukic Z, Tsybrovskyy O. et al. Prognostic relevance of tumour-associated macrophages and von Willebrand factor-positive microvessels in colorectal cancer. Virchows Arch 2004; 445: 160-7.
    CrossrefPubMedGoogle Scholar
  • 32 De Raeve H, Van Marck E, Van Camp B. et al. Angiogenesis and the role of bone marrow endothelial cells in haematological malignancies. Histol Histopathol 2004; 19: 935-50.
    PubMedGoogle Scholar
  • 33 George F, Brisson C, Poncelet P. et al. Rapid isolation of human endothelial cells from whole blood using S-Endo-1 monoclonal antibody coupled to immuno-magnetic beads: demonstration of endothelial injury after angioplasty. Thromb Haemost 1992; 67: 147-53.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Blann AD, Woywodt A, Bertolini F. et al. Circulating endothelial cells: Biomarker of vascular disease. Thromb Haemost 2005; 93: 228-35.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 McClung JA, Naseer N, Saleem M. et al. Circulating endothelial cells are elevated in patients with type 2 diabetes mellitus independently of HbA(1)c. Diabetologia 2005; 48: 345-50.
    CrossrefPubMedGoogle Scholar
  • 36 Solovey A, Gui L, Key N S. et al. Tissue factor expression by endothelial cells in sickle cell anaemia. J Clin Invest 1998; 101: 1899-904.
    CrossrefPubMedGoogle Scholar
  • 37 Wagner DD. Cell biology of von Willebrand factor. Ann Rev Cell Biol 1990; 6: 217-46.
    CrossrefPubMedGoogle Scholar