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J Am Coll Cardiol, 2006; 48:1579-1587, doi:10.1016/j.jacc.2006.04.101 (Published online 25 September 2006).
© 2006 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

The Number of Endothelial Progenitor Cell Colonies in the Blood Is Increased in Patients With Angiographically Significant Coronary Artery Disease

Hasan Güven, MD*, Rebecca M. Shepherd, MD{dagger}, Richard G. Bach, MD, FACC*, Benjamin J. Capoccia, BS{ddagger} and Daniel C. Link, MD{ddagger},*

* Cardiology
{dagger} Rheumatology
{ddagger} Oncology, Washington University School of Medicine, St. Louis, Missouri

Manuscript received December 5, 2005; revised manuscript received March 29, 2006, accepted April 4, 2006.

* Reprint requests and correspondence: Dr. Daniel Link, Division of Oncology, Washington University School of Medicine, Box 8007, 660 South Euclid Avenue, St. Louis, Missouri 63110. (Email: dlink{at}im.wustl.edu).

OBJECTIVES: The objective of this study was to determine whether the number of endothelial progenitor cells (EPCs) and circulating angiogenic cells (CACs) in peripheral blood was associated with the presence and severity of coronary artery disease (CAD) in patients undergoing coronary angiography.

BACKGROUND: Previous studies have suggested an inverse relationship between levels of circulating EPCs/CACs and the presence of CAD or cardiovascular risk factors, whereas other studies have observed increased numbers of EPCs in the setting of acute ischemia. However, the criteria used to identify specific angiogenic cell subpopulations and methods of evaluating CAD varied in these studies. In the present study, we used rigorous criteria to identify EPCs and CACs in the blood of patients undergoing coronary angiography.

METHODS: The number of EPCs and CACs were measured in the blood of 48 patients undergoing coronary angiography. Patients with acute coronary syndromes were excluded.

RESULTS: Compared with patients without angiographically significant CAD, the number of EPCs was increased (1.11 ± 2.50 vs. 4.01 ± 3.70 colonies/well, p = 0.004) and the number of CACs trended higher (175 ± 137 vs. 250 ± 160 cells per mm2, p = 0.09) among patients with significant CAD. The highest levels of EPCs were isolated from patients subsequently selected for revascularization (5.03 ± 4.10 colonies/well).

CONCLUSIONS: In patients referred for coronary angiography, higher numbers of EPCs, and a trend toward higher numbers of CACs, were associated with the presence of significant CAD, and EPC number correlated with maximum angiographic stenosis severity. Endothelial progenitor cell levels were highest in patients with CAD selected for revascularization.

Abbreviations and Acronyms
  AMI = acute myocardial infarction
  CABG = coronary artery bypass grafting
  CAC = circulating angiogenic cell
  CAD = coronary artery disease
  EPC = endothelial progenitor cell
  FITC = fluorescein isothiocynate
  hs-CRP = high-sensitivity C-reactive protein
  LDL = low-density lipoprotein
  PBS = phosphate buffered saline
  VEGF = vascular endothelial growth factor


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