Endothelial progenitor cells and cardiovascular disease.

Endothelial Progenitor Cells (EPCs) are bone-marrow derived stem cells that are postulated to contribute to post-natal vasculogenesis and to repair of damaged endothelium by incorporation into the vessel wall, secretion of paracrine hormones and stimulation of angiogenesis. Since the first description of the putative EPCs in 1997, and the role of these cells in neovascularisation of mouse and rabbit ischaemic limbs was originally described, there has been an explosion of research into the role of EPCs in human cardiovascular disease. There is now a large body of direct and indirect evidence to support an important role for EPCs in cardiovascular disease processes. This book chapter explores the following: 1. Correlation between EPCs and other cardiovascular risk markers 2. EPCs in patients with established cardiovascular disease 3. Reversible defects in EPC number and function in patients with an increased cardiovascular risk 4. Statins and EPC biology 5. The effect on EPCs of other interventions known to reduce cardiovascular risk - EPCs and treatment of diabetes, hypertension, subclinical hypothyroidism 6. Beneficial effects of EPC-based therapies animal models of ischaemia 7. Human Studies of EPC-based therapies A lower level of circulating EPCs and reduced EPC function in vitro are associated with an increased cardiovascular risk. The accumulated evidence suggests that a balance between the damaging effects of conventional cardiovascular risk factors and the ability of circulating EPCs to affect endothelial repair determines this cardiovascular risk.