Impact Of α-lipoic Acid On Circulating Endothelial Progenitor Cells In Patients With Diabetic Peripheral Neuropathy

Aims: Endothelial progenitor cells(EPCs) play an important role in repairing vascular endothelial. Quantity reduction and impaired function of EPCs contribute to the development of type 2 diabetic complications.The purpose of this study was to investigate the impact of α-lipoic acid on circulating endothelial progenitor cells in patients with diabetic peripheral neuropathy(DPN), and to explore the potential factors,providing for prevention and treatment of diabetic vascular complications.Methods:1 50 inpatients(31 males, 19 females) with type 2 diabetes mellitus(T2DM) and DPN were recruited in this study from August 2014 to January 2015. DPN was diagnosed in accordance with the criteria in Chinese diabetic peripheral neuropathy diagnosis and treatment practices published in 2009. Gender, age, course of T2 DM, height and weight of each patient were recorded. Body mass index(BMI) was calculated based on height and weight. To every patient, insulin was used for glucose lowering therapy and statin was used for lipid lowering therapy and vascular protection. After the glucose and blood pressure were reached the target(FBG < 7.0mmol/L, 2h PG <10.0mmol/L,Bp<140/80 mm Hg), all patients were randomly divided into two groups.Patients in the control group(n=20)were intervened with mecobalamin, alprostadil and sodium tanshinone sulphonate IIA for two weeks; while patients in the lipoic acid group(n=30)were intervened with above drugs and α-lipoic acid.2 The number of circulating EPCs was detected by the flow cytometry.3The triglyceride(TG), total cholesteral(T-CHO), low-density lipoprotein cholesteral(LDL-C)and high-density lipoprotein cholesteral(HDL-C)were detected by enzymic method.Malondialdehyde(MDA) was detected by thiobarbituril acid method,8-hydroxy-2 deoxyguanosine(8-OHDG) was detected by ELISA. detecting the activity of superoxide dismutase(SOD) and glutathione peroxidase(GSH-PX).4 All data was analyzed with the SPSS17.0 software,measurement data using t test and nonparamerer test,correlation analysis of multiple linear stepwise regression analysis.Results:1 There were no statistical differences in age, gender, course of T2 DM, systolic or diastolic blood pressure, BMI, fasting blood glucose, Hb A1 c, TG, T-CHO, HDL-C, LDL-C, circulating EPCs, SOD, GSH-PX, MDA and 8-OHd G between the control group and ALA group in baseline(P>0.05).2 Compared with the baseline, there were no significant differences in EPCs, SOD, GSH-PX, MDA and 8-OHd G after the treatment in the control group(P>0.05). The TG, T-CHOand LDL-C were significantly decreased after intervention compared with those before the intervention, HDL-C were significantly increased after intervention compared with those before the intervention(P<0.05).3 In the ALA group, the number of circulating EPCs, SOD and GSH-PX were significantly increased after the treatment compared with the baseline(P<0.05), while MDA and 8-OHd G were significantly decreased after the treatment(P<0.05). The TG, T-CHO and LDL-C were significantly decreased after intervention compared with those before the intervention, HDL-C were significantly increased after intervention compared with those before the intervention(P<0.05).4 After the intervention, the number of circulating EPCs, SOD and GSH-PX were significantly higher in ALA group than those in control group(P<0.05),while MDA and 8-OHd G were significantly lower in ALA group than those in control group(P<0.05).There were no significant differences in the lipid profile between the two groups(P>0.05).5 The changes of circulating EPCs, SOD, GSH-PX after the treatment were significantly higher in ALA group than those in control group(P>0.05);while MDA and 8-OHd G were significantly lower in ALA group than those in control group(P<0.05). There were no significant differences in the lipid profile between the two groups(P>0.05).6 Multivariate linear regression showed GSH-PX、MDA were associated with EPCs. The regression equation:Y=6.349+0.195X2-3.335X3,X2 stands for the diffirence of GSH-PX(P=0.01),X3 stands for the diffirence of MDA(P=0.041).The number of endothelial progenitor cells was correlated with GSH-PX and MDA.Conclusions:1 The treatment with α-lipoic acid increased the circulating EPCs in patients with diabetic peripheral neuropathy.2 The treatment with α-lipoic acid improved the oxidative stress in patients with diabetic peripheral neuropathy, increased SOD and GSH-PX activity, reduced MDA and 8-OHd G production.3 The impact of α-lipoic acid on circulating EPCs was associated with oxidative stress.