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J Am Coll Cardiol, 2007; 49:1585, doi:10.1016/j.jacc.2007.01.058 (Published online 26 March 2007).
© 2007 by the American College of Cardiology Foundation
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CORRESPONDENCE: LETTER TO THE EDITOR

Endothelial Progenitor Cells in Coronary Artery Disease

Gian Paolo Fadini, MD*, Carlo Agostini, MD and Angelo Avogaro, MD, PhD

* Policlinico Universitario, Dipartimento di Medicina Clinica e Sperimentale, v. Giustiniani, 2, 35100 Padova, Italy (Email: gianpaolofadini{at}hotmail.com).

We have been prompted to write by the small study of Güven et al. (1) showing increased endothelial progenitor cell (EPC) colonies in patients with coronary artery disease (CAD). In contrast, a wide literature demonstrates that the extent of the EPC pool is an indicator of cardiovascular health, as EPCs negatively correlate with severity of both peripheral and coronary atherosclerosis (2,3).

The investigators attribute their paradoxical results to the longer culture method they used to distinguish between true EPCs and circulating angiogenic cells (CACs) in comparison with previous studies. Even if we consider that earlier studies evaluated CACs rather than true EPCs, the findings by Güven et al. (1) are contrasting, because they report higher CACs in patients with CAD. The researchers hypothesize that significantly ischemic CAD triggers the mobilization of EPCs/CACs from bone marrow. However, patients with actual myocardial ischemia, for whom increase in EPCs/CACs have been previously demonstrated, were excluded from the study, and only patients with stable CAD were enrolled. Moreover, whereas EPC colonies directly correlated with maximum stenosis, they did not correlate with the number of diseased vessels, which should be more informative on the extent of myocardial ischemia.

We suggest that the use of intravascular ultrasound may provide further information on coronary atherosclerosis and help explain the paradoxical results when CAD is assessed angiographically. Finally, should the data by Güven et al. (1) really reflect a previously unknown regulation of EPCs in CAD, we would like to offer a counter explanation: the increase in circulating cells with high angiogenic potential dependent on CAD severity may be causally related to plaque angiogenesis and growth (4) the Janus face of EPCs in cardiovascular diseases.


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  1. Güven H, Shepherd RM, Bach RG, Capoccia BJ, Link DC. The number of endothelial progenitor cell colonies in the blood is increased in patients with angiographically significant coronary artery disease J Am Coll Cardiol 2006;48:1579-1587.[Abstract/Free Full Text]
  2. Fadini GP, Coracina A, Baesso I, et al. Peripheral blood CD34+KDR+ endothelial progenitor cells are determinants of subclinical atherosclerosis in a middle-aged general population Stroke 2006;37:2277-2282.[Abstract/Free Full Text]
  3. Kunz GA, Liang G, Cuculoski F, et al. Circulating endothelial progenitor cells predict coronary artery disease severity Am Heart J 2006;152:190-195.[CrossRef][ISI][Medline]
  4. George J, Afek A, Abashidze A, et al. Transfer of endothelial progenitor and bone marrow cells influences atherosclerotic plaque size and composition in apolipoprotein E knockout mice Arterioscler Thromb Vasc Biol 2005;25:2636-2641.[Abstract/Free Full Text]

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Daniel C. Link and Richard G. Bach
J. Am. Coll. Cardiol. 2007 49: 1585-1586. [Full Text] [PDF]




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