ABSTRACT. Objective: A relevant biological role of circulating endothelial progenitor cells (EPC) was recently demonstrated. EPC are generated in the bone marrow, and interact with damaged endothelium, restoring the integrity of the monolayer. Therefore, aim of the present study was to evaluate EPC in the blood of patients with untreated Graves' hyperthyroidism (GD), in whom an increased oxidative stress was observed. Design and methods: Twenty-three patients with untreated active GD and 18 matched normal controls (NC) were included in the study. Circulating EPC were isolated from peripheral blood. Mononuclear cells were cultured with endothelial basal medium supplemented with EGM SingleQuots, and were identified by positive double staining after 7 days in culture. Circulating levels of C reactive protein, total antioxidant power, interleukin (
INTRODUCTIONGraves' disease (GD) is a thyroid disorder caused by an antibody-mediated immune reaction against the receptor for TSH resulting in an abnormal chronic stimulation of the gland and consequent hyperthyroidism (1, 2). This, in turn, causes the clinical symptoms of hyperthyroidism. Indeed, thyroid hormones may exert multiple effects on the heart and vascular system, inducing an hyperkinetic status and the onset of isolated systolic hypertension (3, 4). Activation of the sympathetic and of the renin-angiotensin-aldosterone (RAS) systems may elicit a major role in inducing cardiovascular changes in GD (5). Moreover, in hyperthyroidism, an unbalance between oxidant and antioxidant substances has been identified, thus leading to enhanced generation of reactive oxygen species (ROS), able to induce vascular dysfunction and damage (6). This may be the consequence of both an activation of RAS system and of a stimulation of energy metabolism induced by thyroid hormones (5). In addition, chronic inflammation has been shown in active GD, as well as in autoimmune thyroid disorders, and production of acute-phase proteins and proinflammatory cytokines [such as interleukin (IL)-12, IL-18, and tumor necrosis factor-α (TNF-α)] (7). Hemodynamic and metabolic changes may lead to vascular injury, as suggested by an increase of markers of endothelial damage observed in GD (8-10). In the last years, endothelial progenitor cells (EPC) have been recognized to play important roles in post-natal neovascularization and vascular repair, and, therefore in maintaining endothelial integrity and function (11,12). EPC are generated from bone marrow and represent precursors which preserve stem cell features, able therefore to proliferate, migrate, and differentiate in mature endothelial cells (11,12). EPC number has been demonstrated to be correlated with the number of cardiovascular risk factors, with indices of endothelial dysfunction (13-15), and the incidence of cardiovascular events (16,17). However, no data are presently available about the EPC number in hyperthyroidism caused by GD. Therefore the aim of the present study is to investigate the presence of oxidative stress and inflammation ...