Clinical Trials Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Nov 26, 2020; 12(11): 526-539
Published online Nov 26, 2020. doi: 10.4330/wjc.v12.i11.526
Endothelial progenitor cells mobilization after maximal exercise according to heart failure severity
Christos Kourek, Eleftherios Karatzanos, Katherina Psarra, Georgios Georgiopoulos, Dimitrios Delis, Vasiliki Linardatou, Gerasimos Gavrielatos, Costas Papadopoulos, Serafim Nanas, Stavros Dimopoulos
Christos Kourek, Eleftherios Karatzanos, Dimitrios Delis, Vasiliki Linardatou, Serafim Nanas, Department of Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, Evaggelismos Hospital, Athens 10676, Greece
Katherina Psarra, Immunology and Histocompatibility Department, Evaggelismos Hospital, Athens 10676, Greece
Georgios Georgiopoulos, Department of Clinical Therapeutics, Alexandra Hospital, Athens 11528, Greece
Gerasimos Gavrielatos, Department of Cardiology, Tzaneio General Hospital of Piraeus, Piraeus 18536, Greece
Costas Papadopoulos, 2nd Cardiology Department, Korgialenio-Benakio Red Cross Hospital, Athens 11526, Greece
Stavros Dimopoulos, Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
Author contributions: Karatzanos E, Nanas S and Dimopoulos S contributed to the conception and design of the study; Kourek C, Delis D, Linardatou V, Gavrielatos G and Papadopoulos C contributed to the acquisition and interpretation of data; Kourek C, Karatzanos E, Georgiopoulos G and Psarra K performed the analysis; Kourek C drafted the manuscript; All authors contributed equally to the critical revision, editing and approval of the final version of the manuscript.
Supported by Greece and the European Union (European Social Fund-ESF) through the Operational Programme “Human Resources Development, Education and Lifelong Learning” in the context of the project “Strengthening Human Resources Research Potential via Doctorate Research”(MIS-5000432), implemented by the State Scholarships Foundation (ΙΚΥ); and the special account for research grants of the National and Kapodistrian University of Athens, Athens, Greece.
Institutional review board statement: The study was reviewed and approved by the Administration Board and the Ethics Committee of “Evaggelismos General Hospital” in Athens, Greece.
Clinical trial registration statement: This study is registered at Evaggelismos General Hospital of Athens trial registry. The registration identification number is 117/3-7-2017.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors state they have no real or potential conflicts-of-interest to declare.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Stavros Dimopoulos, MD, PhD, Doctor, Postdoc, Research Scientist, Senior Researcher, Staff Physician, Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, No. 356 L. Syggrou, Athens 17674, Greece. stdimop@gmail.com
Received: June 24, 2020
Peer-review started: June 24, 2020
First decision: July 25, 2020
Revised: July 28, 2020
Accepted: October 5, 2020
Article in press: October 5, 2020
Published online: November 26, 2020
ARTICLE HIGHLIGHTS
Research background

Vascular endothelial dysfunction is an underlying pathophysiological feature of chronic heart failure (CHF). Patients with CHF are characterized by impaired vasodilation and inflammation of the vascular endothelium. They also have low levels of endothelial progenitor cells (EPCs). EPCs have been used as an index of the endothelium restoration potential, therefore reflecting the vascular endothelial function. Exercise has a beneficial impact in the function of the vascular endothelium and EPCs.

Research motivation

Despite the proven beneficial effect of exercise training in patients with cardiovascular comorbidities, the effect of maximal exercise on EPCs in patients with CHF, and especially in patients of different severity, remains under investigation.

Research objectives

This study was conducted to assess, quantify and compare the acute mobilization of EPCs after maximal exercise in patients with CHF of both lower and higher severity.

Research methods

Forty-nine consecutive patients with stable CHF underwent a cardiopulmonary exercise testing (CPET) on a cycle ergometer. Venous blood was sampled before and after CPET. Five circulating endothelial populations were quantified by flow cytometry. Patients were divided in two groups of severity according to the median value of peak oxygen uptake (VO2), predicted peak VO2, ventilation (VE)/carbon dioxide output (VCO2) slope and ejection fraction (EF).

Research results

Patients with lower peak VO2 increased the mobilization of CD34+/CD45-/CD133+, CD34+/CD45-/CD133+/VEGFR2, CD34+/CD45-/CD133- and CD34+/CD45-/CD133-/VEGFR2, while patients with higher VO2 increased the mobilization of CD34+/CD45-/CD133+, CD34+/CD45-/CD133+/VEGFR2, CD34+/CD133+/VEGFR2, CD34+/CD45-/CD133- and CD34+/CD45-/CD133-/VEGFR2. A similar increase in the mobilization of at least four out of five cellular populations was observed after maximal exercise within each severity group regarding predicted peak, VE/VCO2 slope and EF, as well (P < 0.05). However, there were no statistically significant differences in the mobilization of endothelial cellular populations between severity groups in each comparison (P > 0.05).

Research conclusions

Our study has shown an increased EPC and CEC mobilization after maximal exercise in CHF patients, but this increase was not associated with syndrome severity.

Research perspectives

EPCs could be the cornerstone to the treatment of CHF. Understanding their possible mechanisms of action on vascular endothelial function through exercise would create innovative ideas regarding their distribution and proliferation in these patients in order to take advantage of their beneficial effects on the endothelium and reverse cardiac remodeling.