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Arteriosclerosis, Thrombosis, and Vascular Biology
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on February 26, 2004

Arteriosclerosis, Thrombosis, and Vascular Biology. 2004
Published online before print February 26, 2004, doi: 10.1161/01.ATV.0000124104.23702.a0
A more recent version of this article appeared on April 1, 2004
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Submitted on January 14, 2004
Accepted on January 24, 2004

Increase of Circulating Endothelial Progenitor Cells in Patients With Coronary Artery Disease After Exercise-Induced Ischemia

Volker Adams *; Karsten Lenk ; Axel Linke ; Dominik Lenz ; Sandra Erbs ; Markus Sandri ; Attila Tarnok ; Stephan Gielen ; Frank Emmrich ; Gerhard Schuler ; and Rainer Hambrecht

From University Leipzig (V.A., K.L., S.E., M.S., S.G., G.S., R.H.), Heart Center Leipzig, Clinic of Cardiology, and Pediatric Cardiology (D.L., A.T.), Germany; and Institute of Clinical Immunology and Transfusion Medicine (F.E.) University Leipzig, Germany.

* To whom correspondence should be addressed. E-mail: adav{at}medizin.uni-leipzig.de.

Objectives--The concept of neovascularization in response to tissue ischemia has been extended by the finding of postnatal vasculogenesis initiated by endothelial progenitor cells (EPCs). The aim of this study was to analyze whether a maximal stress test in patients with coronary artery disease (CAD) increases the number of circulating EPCs.

Methods and Results--Blood concentration of EPCs was analyzed by FACS and cell culture assay in CAD patients with (n=16) or without (n=12) exercise-induced myocardial ischemia and in healthy subjects (n=11) for up to 144 hours after maximal stress test. Plasma concentrations of vascular endothelial growth factor (VEGF), basic fibroblast growth factor, tumor necrosis factor-{alpha}, and granulocyte macrophage-colony stimulating factor were determined by ELISA. EPCs increased significantly in ischemic patients, with a maximum after 24 to 48 hours (cell culture: 3.3±0.5-fold increase; FACS: 3.1±0.6-fold increase) and returned to baseline within 72 hour. In nonischemic patients and healthy subjects, no EPC increase was detectable. VEGF levels in ischemic patients increased significantly after 2 to 6 hours (maximum after 2 hours; 4.0±1.1-fold increase) and no change was observed in nonischemic patients and healthy subjects; {Delta}VEGF and {Delta}EPC correlated significantly (r=0.66).

Conclusions--Patients with symptomatic CAD respond to a single episode of exercise-induced myocardial ischemia with a time-dependent increase in circulating EPCs. This increase may be related to and preceded by an increase in plasma VEGF.




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