The effects of external counter pulsation therapy on circulating endothelial progenitor cells in patients with angina pectoris.
OBJECTIVE
External counter pulsation therapy (ECPT) offers symptomatic relief and improves ischemia in patients with refractory angina pectoris. We aimed to determine the effects of ECPT on circulating endothelial progenitor cells (EPCs).


METHODS
We prospectively studied 25 patients with angina pectoris treated with ECPT (n = 15) or receiving standard care (n = 10). The number of EPCs positive for CD34 and kinase insert domain receptor (KDR) was determined by flow cytometry and the number of colony-forming units (CFUs) was assessed in a 7-day culture, before ECPT and after 9 weeks.


RESULTS
ECPT improved anginal score from a median of 3.0 to 2.0 (p < 0.001). Concomitantly, ECPT increased EPC number from a median of 10.2 to 17.8/10(5) mononuclear cells (p < 0.05), and CFUs from 3.5 to 11.0 (p = 0.01). Flow-mediated dilatation was improved by ECPT from 7.4 to 12.2% (p < 0.001) and correlated with EPC-CFUs (r = 0.461, p = 0.027). The levels of asymmetric dimethylarginine were reduced by ECPT from 0.70 to 0.60 micromol/l (p < 0.01). In contrast, the same parameters did not change in the control group, before and after follow-up.


CONCLUSIONS
The present pilot study shows, for the first time, that ECPT is associated with increased number and colony-forming capacity of circulating EPCs.
Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Hashomer, Israel.
Alon
A
Barsheshet
Hanoch
H
Hod
Michael
M
Shechter
Orna
O
Sharabani-Yosef
Eti
E
Rosenthal
Israel M
IM
Barbash
Shlomi
S
Matetzky
Reshef
R
Tal
Ariel G
AG
Bentancur
Ben-Ami
BA
Sela
Arnon
A
Nagler
Jonathan
J
Leor
D000368:Aged; D000787:Angina Pectoris / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D002452:Cell Count; D003114:Colony-Forming Units Assay; D015908:Counterpulsation; D042783:Endothelial Cells / Q000473:pathology*; D004730:Endothelium, Vascular / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008297:Male; D013234:Stem Cells / Q000473:pathology*; D014664:Vasodilation