# The Role of Endothelial Progenitor Cells (EPCs) and Circulating Endothelial Cells (CECs) as Early Biomarkers of Endothelial Dysfunction in Children with Newly Diagnosed Type 1 Diabetes

## TL;DR

This study explores how endothelial progenitor cells and circulating endothelial cells might serve as early signs of blood vessel damage in children newly diagnosed with type 1 diabetes.

## Contribution

The study identifies EPCs and CECs as potential biomarkers for endothelial dysfunction in children with newly diagnosed type 1 diabetes.

## Key findings

- Children with T1D had higher EPC levels than healthy controls, but no differences in CEC levels.
- Better clinical conditions in T1D patients correlated with lower EPCs and EPC/CEC ratios.
- CECs were higher in patients who later experienced partial remission of diabetes.

## Abstract

The aim of this study is to assess endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) at the time of type 1 diabetes (T1D) recognition concerning patients’ clinical state, remaining insulin secretion, and further partial remission (PR) occurrence. We recruited 45 children that were admitted to hospital due to newly diagnosed T1D (median age 10.8 yrs), and 20 healthy peers as a control group. EPC and CEC levels were measured at disease onset in PBMC isolated from whole peripheral blood with the use of flow cytometry. Clinical data regarding patients’ condition, C-peptide secretion, and further PR prevalence were analyzed. T1D-diagnosed patients presented higher EPC levels than the control group (p = 0.026), while no statistical differences in CEC levels and EPC/CEC ratio were observed. Considering only T1D patients, those with better clinical conditions presented lower EPCs (p = 0.021) and lower EPC/CEC ratios (p = 0.0002). Patients with C-peptide secretion within a normal range at disease onset presented lower EPC/CEC ratios (p = 0.027). Higher levels of EPCs were observed more frequently in patients with higher glucose, decreased fasting C-peptide, and lower stimulated C-peptide (all p < 0.05). The presence of DKA was related to higher EPC/CEC ratios (p = 0.034). Significantly higher levels of CECs were observed in patients who presented partial remission of the disease at 6 months after diagnosis (p = 0.03) only. In the study group, positive correlations of CECs with age, BMI at onset, and BMI in following years were observed. EPC/CEC ratios correlated positively with glucose levels at hospital admission and negatively with age, BMI, pH, and stimulated C-peptide level. We reveal a new potential for the application of EPCs and CECs as biomarkers, reflecting both endothelial injury and reconstruction processes in children with T1D. There is a need for further research in order to reduce cardiovascular risk in children with T1D.