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Review
. 2022 Jul 10;9(7):222.
doi: 10.3390/jcdd9070222.

Exercise Training Effects on Circulating Endothelial and Progenitor Cells in Heart Failure

Christos Kourek  1   2 , Alexandros Briasoulis  3   4 , Virginia Zouganeli  5 , Eleftherios Karatzanos  1 , Serafim Nanas  1 , Stavros Dimopoulos  1   6
Affiliations
Review

Exercise Training Effects on Circulating Endothelial and Progenitor Cells in Heart Failure

Christos Kourek et al. J Cardiovasc Dev Dis. .

Abstract

Heart failure (HF) is a major public health issue worldwide with increased prevalence and a high number of hospitalizations. Patients with chronic HF and either reduced ejection fraction (HFrEF) or mildly reduced ejection fraction (HFmrEF) present vascular endothelial dysfunction and significantly decreased circulating levels of endothelial progenitor cells (EPCs). EPCs are bone marrow-derived cells involved in endothelium regeneration, homeostasis, and neovascularization. One of the unsolved issues in the field of EPCs is the lack of an established method of identification. The most widely approved method is the use of monoclonal antibodies and fluorescence-activated cell sorting (FACS) analysis via flow cytometry. The most frequently used markers are CD34, VEGFR-2, CD45, CD31, CD144, and CD146. Exercise training has demonstrated beneficial effects on EPCs by increasing their number in peripheral circulation and improving their functional capacities in patients with HFrEF or HFmrEF. There are two potential mechanisms of EPCs mobilization: shear stress and the hypoxic/ischemic stimulus. The combination of both leads to the release of EPCs in circulation promoting their repairment properties on the vascular endothelium barrier. EPCs are important therapeutic targets and one of the most promising fields in heart failure and, therefore, individualized exercise training programs should be developed in rehabilitation centers.

Keywords: acute exercise; circulating endothelial cells; endothelial progenitor cells; endothelium; exercise training; heart failure.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Differences between early and late Endothelial Progenitor cells. EPCs, endothelial progenitor cells.
Figure 2
Figure 2
Most common markers used for the identification of Endothelial Progenitor cells and Circulating Endothelial cells. EPCs, endothelial progenitor cells; CECs, circulating endothelial cells; VEGFR, vascular endothelial growth factor receptor.
Figure 3
Figure 3
Shear stress and hypoxic/ischemic stimulus as potential mechanisms of mobilization of Endothelial Progenitor cells from the bone marrow and restoration of the endothelial barrier after exercise. EPCs, endothelial progenitor cells; NOS, nitric oxide synthase; NO, nitric oxide; VEGF, vascular endothelial growth factor; SDF, Stromal cell-derived factor; VEGFR, vascular endothelial growth factor receptor; CXCR, C-X-C chemokine receptor.
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