Role of Endothelial Progenitor Cells in Restenosis and Progression of Coronary Atherosclerosis After Percutaneous Coronary Intervention. A Prospective Study

Francesco Pelliccia, Cinzia Cianfrocca, Giuseppe Rosano, Giuseppe Mercuro, Giulio Speciale, Vincenzo Pasceri

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Abstract

Objectives: We prospectively investigated the relationship of circulating endothelial progenitor cells at time of percutaneous coronary intervention to the subsequent development of in-stent restenosis or progression of coronary atherosclerosis. Background: Endothelial progenitor cells provide an endogenous repair mechanism of the dysfunctional endothelium and therefore can play a pathogenic role in coronary atherosclerosis. Methods: We studied 155 consecutive stable angina patients (92 men, age 60 ± 11 years). All patients had flow cytometry the day before elective percutaneous coronary intervention in order to derive subpopulations of endothelial progenitor cells. A control group of 20 normal subjects was considered for comparison. Results: At 8-month control angiography, 30 patients showed in-stent restenosis (restenosis group), 22 patients showed progression of coronary atherosclerosis (progression group), whereas the remaining 103 patients had neither in-stent restenosis nor progression of coronary atherosclerosis (stable group). Comparison of the 3 groups did not show any difference in risk factors, cardiac morphology and function, extension of coronary artery disease, and treatment. Absolute numbers of CD34+/KDR+/CD45- cells (i.e., progenitors of endothelial lineage) measured in the restenosis group (1.41 ± 0.64 cells/μl) were significantly higher than in the progression, stable, and control groups (1.03 ± 0.53 cells/μl, 1.07 ± 0.46 cells/μl, and 0.95 ± 0.44 cells/μl, respectively, p <0.05). Similarly, CD133+/KDR+/CD45- cells (i.e., progenitors of endothelial cells at an earlier stage) were significantly higher in the restenosis (0.63 ± 0.23 cells/μl) compared with progression, stable, and control groups (0.33 ± 0.19 cells/μl, 0.41 ± 0.32 cells/μl, and 0.36 ± 0.15 cells/μl, respectively, p <0.001). Also, numbers of CD14+/CD45+ cells (i.e., which have a role in angiogenesis via a paracrine effect) were significantly different among the restenosis, progression, stable, and control groups (0.72 ± 0.56 cells/μl vs. 0.51 ± 0.52 cells/μl vs. 0.28 ± 0.54 cells/μl vs. 0.62 ± 0.67 cells/μl, respectively, p <0.05), whereas CD105+/CD45-/CD34- cells (i.e., which have a receptor for transforming growth factor-beta) were similar among groups. Conclusions: Patients with restenosis have higher numbers of subpopulations of endothelial progenitor cells that incorporate into endothelial cells or play a role in arteriogenesis compared with controls and patients with either progression of coronary atherosclerosis or stable disease.

Original languageEnglish
Pages (from-to)78-86
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume3
Issue number1
DOIs
Publication statusPublished - Jan 2010

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Percutaneous Coronary Intervention
Coronary Artery Disease
Prospective Studies
Stents
Control Groups
Endothelial Progenitor Cells
Transforming Growth Factor beta Receptors
Stable Angina
Endothelium
Angiography
Flow Cytometry

Keywords

  • angiogenesis
  • endothelial progenitor cells
  • percutaneous coronary intervention
  • restenosis
  • stem cells

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Role of Endothelial Progenitor Cells in Restenosis and Progression of Coronary Atherosclerosis After Percutaneous Coronary Intervention. A Prospective Study. / Pelliccia, Francesco; Cianfrocca, Cinzia; Rosano, Giuseppe; Mercuro, Giuseppe; Speciale, Giulio; Pasceri, Vincenzo.

In: JACC: Cardiovascular Interventions, Vol. 3, No. 1, 01.2010, p. 78-86.

Research output: Contribution to journalArticle

Pelliccia, Francesco ; Cianfrocca, Cinzia ; Rosano, Giuseppe ; Mercuro, Giuseppe ; Speciale, Giulio ; Pasceri, Vincenzo. / Role of Endothelial Progenitor Cells in Restenosis and Progression of Coronary Atherosclerosis After Percutaneous Coronary Intervention. A Prospective Study. In: JACC: Cardiovascular Interventions. 2010 ; Vol. 3, No. 1. pp. 78-86.
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AU - Pelliccia, Francesco

AU - Cianfrocca, Cinzia

AU - Rosano, Giuseppe

AU - Mercuro, Giuseppe

AU - Speciale, Giulio

AU - Pasceri, Vincenzo

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N2 - Objectives: We prospectively investigated the relationship of circulating endothelial progenitor cells at time of percutaneous coronary intervention to the subsequent development of in-stent restenosis or progression of coronary atherosclerosis. Background: Endothelial progenitor cells provide an endogenous repair mechanism of the dysfunctional endothelium and therefore can play a pathogenic role in coronary atherosclerosis. Methods: We studied 155 consecutive stable angina patients (92 men, age 60 ± 11 years). All patients had flow cytometry the day before elective percutaneous coronary intervention in order to derive subpopulations of endothelial progenitor cells. A control group of 20 normal subjects was considered for comparison. Results: At 8-month control angiography, 30 patients showed in-stent restenosis (restenosis group), 22 patients showed progression of coronary atherosclerosis (progression group), whereas the remaining 103 patients had neither in-stent restenosis nor progression of coronary atherosclerosis (stable group). Comparison of the 3 groups did not show any difference in risk factors, cardiac morphology and function, extension of coronary artery disease, and treatment. Absolute numbers of CD34+/KDR+/CD45- cells (i.e., progenitors of endothelial lineage) measured in the restenosis group (1.41 ± 0.64 cells/μl) were significantly higher than in the progression, stable, and control groups (1.03 ± 0.53 cells/μl, 1.07 ± 0.46 cells/μl, and 0.95 ± 0.44 cells/μl, respectively, p <0.05). Similarly, CD133+/KDR+/CD45- cells (i.e., progenitors of endothelial cells at an earlier stage) were significantly higher in the restenosis (0.63 ± 0.23 cells/μl) compared with progression, stable, and control groups (0.33 ± 0.19 cells/μl, 0.41 ± 0.32 cells/μl, and 0.36 ± 0.15 cells/μl, respectively, p <0.001). Also, numbers of CD14+/CD45+ cells (i.e., which have a role in angiogenesis via a paracrine effect) were significantly different among the restenosis, progression, stable, and control groups (0.72 ± 0.56 cells/μl vs. 0.51 ± 0.52 cells/μl vs. 0.28 ± 0.54 cells/μl vs. 0.62 ± 0.67 cells/μl, respectively, p <0.05), whereas CD105+/CD45-/CD34- cells (i.e., which have a receptor for transforming growth factor-beta) were similar among groups. Conclusions: Patients with restenosis have higher numbers of subpopulations of endothelial progenitor cells that incorporate into endothelial cells or play a role in arteriogenesis compared with controls and patients with either progression of coronary atherosclerosis or stable disease.

AB - Objectives: We prospectively investigated the relationship of circulating endothelial progenitor cells at time of percutaneous coronary intervention to the subsequent development of in-stent restenosis or progression of coronary atherosclerosis. Background: Endothelial progenitor cells provide an endogenous repair mechanism of the dysfunctional endothelium and therefore can play a pathogenic role in coronary atherosclerosis. Methods: We studied 155 consecutive stable angina patients (92 men, age 60 ± 11 years). All patients had flow cytometry the day before elective percutaneous coronary intervention in order to derive subpopulations of endothelial progenitor cells. A control group of 20 normal subjects was considered for comparison. Results: At 8-month control angiography, 30 patients showed in-stent restenosis (restenosis group), 22 patients showed progression of coronary atherosclerosis (progression group), whereas the remaining 103 patients had neither in-stent restenosis nor progression of coronary atherosclerosis (stable group). Comparison of the 3 groups did not show any difference in risk factors, cardiac morphology and function, extension of coronary artery disease, and treatment. Absolute numbers of CD34+/KDR+/CD45- cells (i.e., progenitors of endothelial lineage) measured in the restenosis group (1.41 ± 0.64 cells/μl) were significantly higher than in the progression, stable, and control groups (1.03 ± 0.53 cells/μl, 1.07 ± 0.46 cells/μl, and 0.95 ± 0.44 cells/μl, respectively, p <0.05). Similarly, CD133+/KDR+/CD45- cells (i.e., progenitors of endothelial cells at an earlier stage) were significantly higher in the restenosis (0.63 ± 0.23 cells/μl) compared with progression, stable, and control groups (0.33 ± 0.19 cells/μl, 0.41 ± 0.32 cells/μl, and 0.36 ± 0.15 cells/μl, respectively, p <0.001). Also, numbers of CD14+/CD45+ cells (i.e., which have a role in angiogenesis via a paracrine effect) were significantly different among the restenosis, progression, stable, and control groups (0.72 ± 0.56 cells/μl vs. 0.51 ± 0.52 cells/μl vs. 0.28 ± 0.54 cells/μl vs. 0.62 ± 0.67 cells/μl, respectively, p <0.05), whereas CD105+/CD45-/CD34- cells (i.e., which have a receptor for transforming growth factor-beta) were similar among groups. Conclusions: Patients with restenosis have higher numbers of subpopulations of endothelial progenitor cells that incorporate into endothelial cells or play a role in arteriogenesis compared with controls and patients with either progression of coronary atherosclerosis or stable disease.

KW - angiogenesis

KW - endothelial progenitor cells

KW - percutaneous coronary intervention

KW - restenosis

KW - stem cells

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