The effect of acute exercise on endothelial progenitor cells is attenuated in chronic heart failure

Abstract

Exercise training improves endothelial function in patients with chronic heart failure (CHF) through functional enhancement of circulating angiogenic cells and increased numbers of circulating endothelial progenitor cells (EPC). In contrast to healthy subjects, an immediate effect of acute exercise on CD34(+)/KDR(+) EPC is absent in CHF. Whether this reflects an attenuated or rather delayed mobilization, is addressed in the present study by measuring CD34(+)/KDR(+) EPC over a longer time period post-exercise. Seven CHF patients and eight healthy subjects (HS; 4 young and 4 age-matched subjects) underwent graded exercise testing (GXT). Venous blood was sampled before and 10, 30, and 60 min, 2, 4, 8, 12, 24 and 48 h following GXT to determine numbers of circulating CD34(+)/KDR(+) EPC (flow cytometry) and serum levels of stromal cell-derived factor (SDF)-1α (ELISA). In both HS groups, CD34(+)/KDR(+) EPC numbers increased within 10 min following GXT and remained elevated for up to 2 h. In CHF patients, the initial increase was small and normalized within 30 min. Evolution of CD34(+)/KDR(+) EPC numbers over time following GXT overall was attenuated in CHF versus HS (p = 0.036). Exercise considerably influenced SDF-1α levels over time (p = 0.0008), without a relation to the changes in CD34(+)/KDR(+) EPC. The immediate effect of acute exercise on CD34(+)/KDR(+) EPC numbers is not delayed, but significantly attenuated in CHF patients compared to HS.

Circulating endothelial and progenitor cells: Evidence from acute and long-term exercise effects

“…The same research group just recently sought to investigate whether the above result reflected an attenuated or delayed mobilization of EPCs, so they measured CD34 + / KDR + EPCs over a longer time period post-graded exercise testing (GXT). Even though the number of subjects was small (7 CHF patients and 8 healthy controls), the authors reported that EPC numbers increased within 10 min following GXT and remained elevated for up to 2 h. In CHF patients, the initial increase was small and normalized within 30 min [132] . From the current literature it emerges that the acute effect of a single exercise session, either performed as an exercise test, or as a single bout of strenuous exercise, can lead to a significant rise in EPCs in healthy subjects.…”

“…In healthy subjects, tissue ischemia is not normally expected to occur due to exercise, but strenuous exercise at levels above what is defined as anaerobic levels, might induce oxidative stress and an inflammatory response and thus could stimulate the release of EPCs from the bone marrow [121,122] . Researchers have hypothesized [34,132] that, in an attempt to address vascular damage, EPCs show a compensatory increase in patients with mild to moderate CHF. Interestingly, VEGF and SDF are potent angiogenic factors that have been shown to increase after exercise sessions with concomitant rise in EPCs in cardiovascular disease, indicating a possible pathophysiological link.…”

Diet, Exercise, and Endothelial Function in Obese Adolescents

“…We postulate that these EPCs were incorporated in the endothelium, based on previous findings in young healthy men in which an increase in EPCs was noted up to 24 hours after maximal bicycle ergometry. 26 Later, due to long-term healing of endothelium by exercise, the amount of EPCs may decrease again.…”

Physical activity and progenitor cell-mediated endothelial repair in chronic heart failure: Is there a role for epigenetics?

“…In a study of the effect of graded exercise testing (GXT) on circulating CD34+/KDR+ EPC and SDF-1␣ serum levels conducted in CHF patients and healthy subjects, patients exhibited a reduced response of circulating EPCs to a maximal exercise bout immediately post exercise compared with healthy subjects; moreover, there was no significant correlation between SDF-1␣ levels and EPCs (Van Craenenbroeck et al, 2011). Notably, the time-course of circulating EPCs following a single exercise bout in patients differed from the biphasic response observed in healthy subjects.…”