The relationship between endothelial progenitor cell populations and epicardial and microvascular coronary disease-a cellular, angiographic and physiologic study.

Kim H Chan Philippa J L Simpson Andy S Yong Louise L Dunn Chirapan Chawantanpipat Chijen Hsu Young Yu Anthony C Keech David S Celermajer Martin K C Ng

PLoS One

Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; The Heart Research Institute, Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.

Published: January 2015

Endothelial progenitor cells (EPCs) play a role in protecting against vascular disease, but their relationship with epicardial coronary artery disease (CAD) severity is unclear, leading to this study exploring the connection between different EPC types and coronary health.
A study involving 33 patients with isolated left anterior descending artery disease measured coronary health through various physiological tests, isolating early EPCs and late outgrowth endothelial cells (OECs) for further examination.
Findings revealed that higher levels of circulating OECs were linked to lower epicardial CAD severity, while early EPCs showed no significant correlation; however, OEC function also impacted coronary flow reserve, indicating differing roles for each EPC population.

Background: Endothelial progenitor cells (EPCs) are implicated in protection against vascular disease. However, studies using angiography alone have reported conflicting results when relating EPCs to epicardial coronary artery disease (CAD) severity. Moreover, the relationship between different EPC types and the coronary microcirculation is unknown. We therefore investigated the relationship between EPC populations and coronary epicardial and microvascular disease.

Methods: Thirty-three patients with a spectrum of isolated left anterior descending artery disease were studied. The coronary epicardial and microcirculation were physiologically interrogated by measurement of fractional flow reserve (FFR), index of microvascular resistance (IMR) and coronary flow reserve (CFR). Two distinct EPC populations (early EPC and late outgrowth endothelial cells [OECs]) were isolated from these patients and studied ex vivo.

Results: There was a significant inverse relationship between circulating OEC levels and epicardial CAD severity, as assessed by FFR and angiography (r=0.371, p=0.04; r=-0.358, p=0.04; respectively). More severe epicardial CAD was associated with impaired OEC migration and tubulogenesis (r=0.59, p=0.005; r=0.589, p=0.004; respectively). Patients with significant epicardial CAD (FFR<0.75) had lower OEC levels and function compared to those without hemodynamically significant stenoses (p<0.05). In contrast, no such relationship was seen for early EPC number and function, nor was there a relationship between IMR and EPCs. There was a significant relationship between CFR and OEC function.

Conclusions: EPC populations differ in regards to their associations with CAD severity. The number and function of OECs, but not early EPCs, correlated significantly with epicardial CAD severity. There was no relationship between EPCs and severity of coronary microvascular disease.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3988011	PMC
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0093980	PLOS

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