Review Article

Are Endothelial Progenitor Cells the Real Solution for Cardiovascular Diseases? Focus on Controversies and Perspectives

Table 1

Origins and sources of EPCs cells.

Stem and progenitor cells Features and functionsReferences

Hematopoietic stem or progenitor cells
Hematopoietic stem cells (HSCs)Limited differentiation capacity compared to embryonic stem cells
Commonly identified by the expression of CD34+ and CD133 cell surface antigens
Clinically used for bone marrow transplantation in a variety of hematologic disorders
Potentiality to differentiate into cardiac myocytes
A subset of HSCs assume an endothelial phenotype promoting neovascularization by secreting proangiogenic growth factors and stimulating reendothelialization. These cells were named “endothelial progenitor cells” (EPC)
The pattern of EPC surface markers includes CD133, VEGFR-2, CD34, Tie-1, Tie-2, CD146, c-Kit, and CXCR-4
[13, 15, 16]
H-myeloid cellsMobilized from bone marrow
CD14+/CD34+ myeloid cells coexpress endothelial markers, form tubelike structures ex vivo, and differentiate in endothelial cells incorporated in newly formed blood vessels
Show a lower proliferation capacity than cord-blood-derived EPCs but have similar capacity to augment neovascularization in experimental models
[13, 15, 16]
H-mesenchymal stem cells (MSCs)Limited differentiation capacity compared to embryonic stem cells
Located in bone marrow and adipose tissues
Transdifferentiate into functional cardiomyocytes and a variety of other cells
Modulate immune responses
[13, 15, 16]

Nonhematopoietic stem and progenitors cells (non-HSCs)
Fat tissueCan be obtained in large quantities under local anesthesia with minimal discomfort
Adipose tissue-derived stromal vascular cells lack both CD31 and CD34 markers and differentiate into ECs promoting angiogenesis
[13, 1520]
Liver and intestineProgenitor cells derived from transplanted liver and intestine contribute to neovascularization after hind limb ischemia
it is still debated whether these incorporated progenitors are derived from vessel wall in the organ or they are tissue-resident progenitor cells of nonvascular origin
SpleenCan differentiate to give an “EPC phenotype” and modulate endothelial function or vascular remodelling
KidneyPax-2+ cells displaying mesenchymal markers
CD133+ cells derived from human renal carcinoma are able to differentiate into ECs and were found to be directly incorporated into neovessels
Skeletal myoblastsFirst cells to be injected into the ischemic myocardium as part of a cell-based strategy
Determine improvements in left ventricular function but little evidence shows transdifferentiation into cardiomyocytes
Blood vessel wall MSCs cells also called pericytes or adventitial cells

Cord blood stem cells
Greater plasticity than adult cells due to their prenatal origin
Lacking evidence of pluripotency after in vitro expansion
Cord blood contains a number of progenitor cell populations, including HSCs and MSCs
Having not yet been investigated in a clinical setting
[13, 15, 16]