Endothelial progenitor cells: novel biomarker and promising cell therapy for cardiovascular disease
Shaundeep Sen1, Stephen P McDonald, P Toby H Coates
1Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.
Insights
Endothelial progenitor cells (EPCs) are key to vascular health. While cell counts offer some insight, EPC function, not just number, is crucial for accurate cardiovascular disease risk assessment and personalized therapy.
Area of Science:
- Cardiovascular Research
- Cell Biology
- Vascular Medicine
Background:
- Bone-marrow-derived endothelial progenitor cells (EPCs) are vital for endothelium regulation, protection, and neovascularization.
- Circulating EPC number and function serve as significant biomarkers for vascular risk in cardiovascular disease (CVD).
- EPCs offer potential for improved endothelial function and recovery from ischemia, independent of traditional risk factors.
Purpose of the Study:
- To address limitations in using EPC counts for cardiovascular disease risk stratification.
- To explore the role of EPC function and interactions with other cells in vascular control.
- To identify strategies for improving risk stratification and personalizing patient care based on EPC functional abnormalities.
Main Methods:
- Review of current literature on EPCs in cardiovascular disease.
- Analysis of factors influencing EPC number and function.
- Discussion of the interaction between EPCs and other vascular cells (pericytes, smooth muscle cells, macrophages).
Main Results:
- EPC counts alone are insufficient for comprehensive vascular disease risk assessment due to variability in definitions and patient-specific risk factors.
- EPC function, rather than number, may be a more accurate indicator of vascular risk in certain CVD states.
- Interactions between EPCs and other vascular cells impact overall vascular control.
Conclusions:
- Standardized definitions for EPC subtypes are necessary for clinical application.
- Focusing on EPC function and addressing specific functional abnormalities is key for improved risk stratification.
- Future therapies may involve optimizing EPC function alongside adjunct cell types to enhance tissue priming for therapeutic effects.
Abstract:
Bone-marrow-derived EPCs (endothelial progenitor cells) play an integral role in the regulation and protection of the endothelium, as well as new vessel formation. Peripheral circulating EPC number and function are robust biomarkers of vascular risk for a multitude of diseases, particularly CVD (cardiovascular disease). Importantly, using EPCs as a biomarker is independent of both traditional and non-traditional risk factors (e.g. hypertension, hypercholesterolaemia and C-reactive protein), with infused ex vivo-expanded EPCs showing potential for improved endothelial function and either reducing the risk of events or enhancing recovery from ischaemia. However, as the number of existing cardiovascular risk factors is variable between patients, simple EPC counts do not adequately describe vascular disease risk in all clinical conditions and, as such, the risk of CVD remains. It is likely that this limitation is attributable to variation in the definition of EPCs, as well as a difference in the interaction between EPCs and other cells involved in vascular control such as pericytes, smooth muscle cells and macrophages. For EPCs to be used regularly in clinical practice, agreement on definitions of EPC subtypes is needed, and recognition that function of EPCs (rather than number) may be a better marker of vascular risk in certain CVD risk states. The present review focuses on the identification of measures to improve individual risk stratification and, further, to potentially individualize patient care to address specific EPC functional abnormalities. Herein, we describe that future therapeutic use of EPCs will probably rely on a combination of strategies, including optimization of the function of adjunct cell types to prime tissues for the effect of EPCs.
