Serum vascular endothelial growth factor levels, circulating endothelial progenitor and endothelial cell numbers and the relationship of these parameters with the disease activity in takayasu arteritis

Background and Objective: In Takayasu arteritis with unknown etiopathogenesis, it is very important to monitor the disease activity as necessity of intensive treatment arises during active periods. Today?s clinical and laboratory activity criteria alone are not very satisfactory for follow-up in TA. This study aims to investigate the level of vascular endothelial growth factor (VEGF) and the numbers of circulating endothelial (CEC) and endothelial precursor cells (CEPC) and the relation of these parameters with the disease activity in patients with TA.Patients and Methods: 32 patients with TA and 25 with systemic lupus erythematosus (SLE / patient control group) followed by Dokuz Eylül University, Department of Internal Medicine, Division of Rheumatology and 30 healthy subjects were included in this study. At the first step, all the patients were called by telephone and invited to the hospital. After taking informed consent, detailed medical history was obtained and full physical examination was done in all patients applying to the hospital. Blood was taken from all patients and control subjects for CEC, CEPC and VEGF evaluation. On all TA patients, disease activity was evaluated in according to the NIH activation criteria, to DEI-TAK scoring system and to DEI-TAK `?physician?s global opinion?. Carotid intima-media thickness (IMT) was measured by B-mode USG method in all patients and healthy controls. In patients with TA, doppler USG and MR angiography investigastions were evaluated in regards to the disease activation. For comparison of the groups, Krusskall-Wallis analysis or chi square tests were utilized. When significance were determined between the groups, they were recompared in pairs by way of Mann-Whitney U test. For the purpose of testing the correlations between the variables, Spearman?s correlation analysis was applied.Results: Of the 32 patients with TA, 29 were female, 3 were male and the mean age was 43.5±11.3 years. Mean disease duration was found to be 5.4 (0-17) years in TA patiens. The age (p=0.423) and sex (p=0.676) distribution of TA, SLE patients and healthy controls was similar. Eighteen patients with TA (57%) had type 5 involvement. 21 (68.7%) of patients with TA were using corticosteroid treatment.According to NIH activation criteria of patients with TA, 18.8% of all were active; according to DEI-TAK ?physician global opinion?, 18.8% were active, 28.1% were grumbling and 53.1% were inactive and; according to the radiological findings, 31% were active. A significant relation was determined among the NIH activation criteria, DEI-TAK scoring and ?physician?s global opinion?. Serum CRP levels in TA patients (p=0.018) and SLE patients (p=0.009) were significantly higher in comparison to healthy control group. ESH has been found to be higher in patients with SLE than healthy control group (p<0,001).The number of CEC was higher in patients with TA (p=0.001) and patients with SLE (p<0.001) in comparison to healthy control group and it correlated positively with serum CRP levels. Between the TA and SLE groups, there was no significant difference in regards to CEC counts (p=0.923). Serum VGEF levels and CEPC numbers did not show significant difference between the groups.Carotid Intima-Media Thickness (IMT) has been found to be significantly higher in patients with TA in comparison to patients with SLE and healthy control group (p<0.001). In regards to IMT, there was no significant difference between the patients with SLE and healthy control group. (p=0.89; left and p=0.74; right). The frequency of atherosclerotic plaque did not show a statistical difference between the groups.Conclusion: It is concluded that the numbers of CEC might be useful in monitoring the disease activity and planning the treatment. The DEI-TAK scoring, DEI-TAK ?physician?s global opinion? and ?radiological activity? indexes which run in parallel to NIH activation criteria may also be utilized for the purpose of monitoring the disease activity and deciding on the treatment.Key words: Takayasu arteritis, vascular endothelial growth factor (VEGF), circulating endothelial cells (CEC), circulating endothelial progenitor cells (CEPC), NIH activation criteria, DEI-TAK scoring