CD34 + and Endothelial Progenitor Cells in Patients With Various Degrees of Congestive Heart Failure

Abstract

Background— Peripheral blood CD34 + cells and circulating endothelial progenitor cells (EPCs) increase in myocardial infarction and vascular injuries as a reflection of endothelial damage. Despite the occurrence of endothelial dysfunction in heart failure (HF), no data are available on EPC mobilization in this setting. We investigated the pattern of CD34 + cells and EPC mobilization during HF and their correlation with the severity and origin of the disease. Methods and Results— Peripheral blood CD34 + cells (n=91) and EPCs (n=41), assessed both as CD34 + cells coexpressing AC133 and vascular endothelial growth factor (VEGF) receptor-2 and as endothelial colony-forming units, were studied in HF patients (mean age 67±11 years) and 45 gender- and age-matched controls. Tumor necrosis factor-α (TNF-α) and its receptors (sTNFR-1 and sTNFR-2), VEGF, stromal derived factor-1 (SDF-1), granulocyte-colony stimulating factor (G-CSF), and B-type natriuretic peptide were also measured. CD34 + cells, EPCs, TNF-α and receptors, VEGF, SDF-1, and B-type natriuretic peptide were increased in HF. CD34 + cells and EPCs were inversely related to functional class and to TNF-α, being decreased in New York Heart Association class IV compared with class I and II and controls. No role was found for the origin of the disease. Conclusions— CD34 + cells and EPC mobilization occurs in HF and shows a biphasic response, with elevation and depression in the early and advanced phases, respectively. This could be related to the myelosuppressive role of TNF-α.