Progress and prospects of endothelial progenitor cell therapy in coronary stent implantation

Abstract

Drug-eluting stents (DES) have been widely used to treat coronary artery disease (CAD) since their clinical use has significantly reduced the occurrence of in-stent restenosis (ISR) as compared with the initially applied bare-metal stents (BMS). However, analyses of long-term clinical outcome have raised concerns about the serious safety problem of DES, such as ISR caused by late or very late thrombosis. Various studies showed that those complications were associated with vascular endothelial injury/dysfunction or endothelialization delaying. Recently, through biological characterization of endothelial progenitor cells (EPCs), mechanistic understanding of rapid re-endothelialization of the vascular injury sites after coronary stenting has become possible and is a new research hotspot in the prevention of ISR and late/very late stent thrombosis. It has been well recognized that the formation of a functional endothelial layer from EPCs requires a coordinated sequence of multistep and signaling events, which includes cell mobilization, adhesion, migration and finally the differentiation to vascular endothelial cells (VECs). In this review, we summarize and discuss the currently relevant information about EPCs, the mechanism of DES interfering with the natural vascular healing process in preventing or delaying the formation of a functional endothelial layer, and EPCs-mediated acceleration of re-endothelialization at vascular injury sites. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1237-1247, 2016.

The efficacy of everolimus-eluting stent implantation in patients with ST-segment elevation myocardial infarction: outcomes of 2-year clinical follow-up

“…The weak point of first generation DES was the continued occurrence of the very late stent thrombosis at a constant rate. Reported causes of very late stent thrombosis with first-generation DES include delayed endothelial revascularization and inflammation in the vascular wall due to hyper-reactivity to the drug/polymer coatings [22]. Drug/ polymer coatings have improved in the second generation of DES such as the Xience V stent, which is comprised of a thin-strutted metallic stent platform, biocompatible polymer, and the anti-proliferative drug everolimus.…”

Analysis of Vascular Mechanical Characteristics after Coronary Degradable Stent Implantation

“…In the early stage of coronary stent implantation, the circumferential stress (strain) of the intima increased sharply, and the ECs were damaged. e blood cells adhering to the intima are the main source of early stenosis in the lumen [20]. Based on the results of numerical simulation, it is predicted that with stretch ratios were set to 5%; 10%, and 15%, respectively.…”

Effects of Catheterization on Artery Function and Health: When Should Patients Start Exercising Following Their Coronary Intervention?

“…EPC have been shown to decrease in count [125] and function [126] following PCI. However, EPC cannot predict recovery of vessels [17] and do not enhance reendothelialization or reduce restenosis [127,128]. Therefore, further research is needed to define the role of EPC in vascular recovery post coronary intervention.…”

“…Delayed recovery may be associated with endothelial dysfunction [134,135], explaining in-stent restenosis [33,34] or late thrombosis [35,36], post-PCI. However, it is important that the endothelial lining function well in order to reduce thrombosis and restenosis risk [136,137,67,128]. Even in arteries with intact endothelial coverage [68], functional abnormalities may occur and are related to intimal thickening [48,138,51,139].…”