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Dysbalance of angiogenic and angiostatic mediators in patients with mixed connective tissue disease
  1. Jörg H W Distler1,
  2. Tobias Strapatsas1,
  3. Dörte Huscher2,
  4. Clara Dees1,
  5. Alfiya Akhmetshina1,
  6. Hans P Kiener3,
  7. Ingo H Tarner4,5,
  8. Britta Maurer6,
  9. Marcel Walder6,
  10. Beat Michel6,
  11. Steffen Gay6,
  12. Josef S Smolen3,
  13. Ulf Müller-Ladner4,5,
  14. Georg Schett1,
  15. Oliver Distler6
  1. 1Department of Internal Medicine 3 and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
  2. 2Department of Epidemiology, German Rheumatism Research Centre, Berlin, Germany
  3. 3Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
  4. 4Department of Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Giessen, Germany
  5. 5Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine, Kerckhoff-Klinik, Bad Nauheim, Germany
  6. 6Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Dr Jörg H W Distler, Department of Internal Medicine 3 and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Glückstr 4a, Erlangen D-91054, Germany; joerg.distler{at}


Objective Vascular disease is common in mixed connective tissue disease (MCTD). The aim of the present study was to investigate, whether dysbalance of angiogenic and angiostatic factors occurs in MCTD.

Methods In all, 38 patients with MCTD, and 40 patients with systemic sclerosis (SSc) for comparison, were included. Four centres contributed to this cross-sectional analysis. A total of 66 healthy volunteers were used as controls. The serum levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and endostatin were determined by ELISA. For comparisons between controls and patients with MCTD and detection of associations of serum levels with dichotomous clinical parameters in patients with MCTD the Mann–Whitney test was used.

Results Serum levels of the angiogenic factor VEGF were significantly elevated in patients with MCTD and SSc. Significantly increased levels of the angiostatic factor endostatin were also detected in MCTD, but not in SSc. No differences were observed for bFGF. Levels of VEGF were higher in patients with MCTD with pulmonary arterial hypertension (PAH), acrosclerosis and myositis. In multivariate linear regression analysis, an additive model of PAH, myositis and lymphadenopathy accounted for 79% of the variability of the VEGF levels (r=0.889).

Conclusions Molecular factors modulating angiogenic responses are dysregulated in patients with MCTD and SSc with increases of VEGF in MCTD and SSc and selective upregulation of endostatin in MCTD. Furthermore, high serum levels of VEGF might characterise patients with MCTD with a more severe course of the disease with increased prevalence of PAH and myositis.

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  • Funding Grant A20 of the Interdisciplinary Center of Clinical Research (IZKF) in Erlangen and the Career Support Award of Medicine of the Ernst Jung Foundation, FP-7 Autocure and Institute of Arthritis Research Epalinges.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Erlangen-Nuremberg, University Hospital Zurich, University of Vienna and at the University of Giessen.

  • Provenance and peer review Not commissioned; externally peer reviewed.