Background Cardiac syndrome X (CSX) encompassses the constellation of anginal chest pain in the presence of a pathological functional test and a normal coronary angiogram. Endothelial progenitor cells (EPC) in the peripheral circulation contribute to tissue vascularization. A relationship has been observed between the circulating number and function of EPC and various pathological conditions associated with ischemia. Herein, we investigated the number and functional properties of circulating EPC in patients with CSX.
Methods Patients with CSX (n=17) and a referent population (n=20) were matched for age, atherosclerotic risk factors and use of medications. EPC numbers were studied by FACS, and their functional properties including their proliferative capacity, adherence to matrix and mature endothelial cells as well as their ability to support in vitro tube formation were investigated. Levels of soluble markers that associate with peripheral mobilization and homing were studied in the sera of all subjects.
Results Patients with CSX had significantly increased numbers of circulating EPC as compared to the referent population (both CD34+KDR and CD34+CD133+). Proliferative capacity of EPC as well as their ability to support in vitro tube formation was signficantly impaired in patients with CSX as compared to the referent population. However, adhesiveness of EPC from CSX patients to fibronectin and cultured mature endothelial cells was enhanced as compared to the referent population. Serum VEGF correlated with peripheral CD34+/KDR cell number whereas serum concentration of erythropoietin correlated with the number of circulating CD34+/CD133+ cells
Conclusion CSX patients have a significantly altered circulating EPC phenotype that could potentially aid in understanding the complex pathogenesis of the syndrome.
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