Background-High-density lipoprotein (HDL)-raising therapies are currently under intense evaluation, but the effects of HDL may be highly heterogeneous. We therefore compared the endothelial effects of HDL from healthy subjects and from patients with type 2 diabetes mellitus and low HDL (meeting the criteria for metabolic syndrome), who are frequently considered for HDL-raising therapies. Moreover, in diabetic patients, we examined the impact of extended-release (ER) niacin therapy on the endothelial effects of HDL. Methods and Results-HDL was isolated from healthy subjects (nϭ10) and patients with type 2 diabetes (nϭ33) by sequential ultracentrifugation. Effects of HDL on endothelial nitric oxide and superoxide production were characterized by electron spin resonance spectroscopy analysis. Effects of HDL on endothelium-dependent vasodilation and early endothelial progenitor cell-mediated endothelial repair were examined. Patients with diabetes were randomized to a 3-month therapy with ER niacin (1500 mg/d) or placebo, and endothelial effects of HDL were characterized. HDL from healthy subjects stimulated endothelial nitric oxide production, reduced endothelial oxidant stress, and improved endothelium-dependent vasodilation and early endothelial progenitor cell-mediated endothelial repair. In contrast, these beneficial endothelial effects of HDL were not observed in HDL from diabetic patients, which suggests markedly impaired endothelial-protective properties of HDL. ER niacin therapy improved the capacity of HDL to stimulate endothelial nitric oxide, to reduce superoxide production, and to promote endothelial progenitor cell-mediated endothelial repair. Further measurements suggested increased lipid oxidation of HDL in diabetic patients, and a reduction after ER niacin therapy. Conclusions-HDL from patients with type 2 diabetes mellitus and metabolic syndrome has substantially impaired endothelial-protective effects compared with HDL from healthy subjects. ER niacin therapy not only increases HDL plasma levels but markedly improves endothelial-protective functions of HDL in these patients, which is potentially more important.
Background-Endothelial progenitor cells (EPCs) are thought to contribute to endothelial recovery after arterial injury.We therefore compared in vivo reendothelialization capacity of EPCs derived from patients with diabetes mellitus and healthy subjects. Moreover, we examined the effect of treatment with the peroxisome proliferator-activated receptor-␥ agonist rosiglitazone on oxidant stress, nitric oxide (NO) bioavailability, and the in vivo reendothelialization capacity of EPCs from diabetic individuals. Methods and Results-In vivo reendothelialization capacity of EPCs from diabetic patients (nϭ30) and healthy subjects (nϭ10) was examined in a nude mouse carotid injury model. Superoxide and NO production of EPCs was determined by electron spin resonance spectroscopy. Thirty patients with diabetes mellitus were randomized to 2 weeks of rosiglitazone (4 mg BID PO) or placebo treatment. In vivo reendothelialization capacity of EPCs derived from diabetic subjects was severely reduced compared with EPCs from healthy subjects (reendothelialized area: 8Ϯ3% versus 37Ϯ10%; PϽ0.001). EPCs from diabetic individuals had a substantially increased superoxide production and impaired NO bioavailability. Small-interfering RNA silencing of NAD(P)H oxidase subunit p47 phox reduced superoxide production and restored NO bioavailability and in vivo reendothelialization capacity of EPCs from diabetic patients. Importantly, rosiglitazone therapy normalized NAD(P)H oxidase activity, restored NO bioavailability, and improved in vivo reendothelialization capacity of EPCs from diabetic patients (reendothelialized area: placebo versus rosiglitazone, 8Ϯ1% versus 38Ϯ5%; PϽ0.001). Conclusions-In vivo reendothelialization capacity of EPCs derived from individuals with diabetes mellitus is severely impaired at least partially as a result of increased NAD(P)H oxidase-dependent superoxide production and subsequently reduced NO bioavailability. Rosiglitazone therapy reduces NAD(P)H oxidase activity and improves reendothelialization capacity of EPCs from diabetic individuals, representing a potential novel mechanism whereby peroxisome proliferatoractivated receptor-␥ agonism promotes vascular repair. association of reduced EPC numbers with peripheral artery disease and its severity in diabetic patients. 6,7 Experimental studies have demonstrated that EPCs promote endothelial repair after injury. 8 -10 In diabetic patients, however, an impaired migration capacity and tube formation of EPCs have been observed in vitro, 11,12 and a diabetesinduced delay in reendothelialization by EPCs has been described for diabetic mice, 13 raising the question of whether the in vivo reendothelialization capacity of human EPCs from patients with diabetes mellitus is altered. Moreover, mechanisms underlying EPC dysfunction in diabetic individuals remain largely unknown. In the present study, we therefore compared the in vivo reendothelialization capacity of EPCs derived from diabetic and healthy subjects and analyzed mechanisms of EPC dysfunction.Increased oxidant s...
Objective. Rituximab is a therapeutic anti-CD20 antibody used for in vivo depletion of B cells in proliferative and autoimmune diseases. However, the mechanisms of action are not fully understood, since not all of the therapy-mediated effects can be explained by the depletion of antibody-secreting cells. In addition to B cells, there is also a small population of T cells coexpressing CD20 in all individuals. This study was conducted to examine the phenotype and function of CD3؉CD20؉ T cells in patients with rheumatoid arthritis (RA) and healthy controls.Methods. The phenotype and apoptosis of peripheral blood mononuclear cells from healthy donors and RA patients were examined by 4-color fluorescenceactivated cell sorting analyses. Cytokine production was determined by intracellular staining and measurement of cytokines in the supernatants. Proliferation of sorted T cell populations was analyzed using 3 H-thymidine uptake assays.Results. In healthy individuals, 0.1-6.8% of peripheral blood T cells (mean 1.6%; n ؍ 142) coexpressed CD20, which was not significantly different from that in the peripheral blood of RA patients, in whom 0.4-2.6% of T cells (mean 1.2%; n ؍ 27) were CD20؉. During rituximab therapy, the CD20؉ T cells along with the B cells were eliminated from the RA peripheral blood. Among the CD20؉ T cells, 45% coexpressed CD8 and 55% coexpressed CD4. Polyclonal CD3؉CD20؉ cells were functionally characterized by constitutive cytokine production (i.e., interleukin-1 and tumor necrosis factor ␣), a low proliferative capacity, a high activation state, and enhanced susceptibility to apoptosis.Conclusion. These findings suggest that CD20؉ T cells represent a terminally differentiated cell type with immune-regulatory and proinflammatory capacities. Depletion of CD20؉ T cells may be an additional mechanism by which anti-CD20 therapy functions in patients with RA.
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