Unraveling the potential of endothelial progenitor cells as a treatment following ischemic stroke

Abstract

Angiogénesis; Células progenitoras endoteliales; Ictus

Angiogènesi; Cèl·lules progenitores endotelials; Ictus

Angiogenesis; Endothelial progenitor cells; Stroke

Ischemic stroke is becoming one of the most common causes of death and disability in developed countries. Since current therapeutic options are quite limited, focused on acute reperfusion therapies that are hampered by a very narrow therapeutic time window, it is essential to discover novel treatments that not only stop the progression of the ischemic cascade during the acute phase, but also improve the recovery of stroke patients during the sub-acute or chronic phase. In this regard, several studies have shown that endothelial progenitor cells (EPCs) can repair damaged vessels as well as generate new ones following cerebrovascular damage. EPCs are circulating cells with characteristics of both endothelial cells and adult stem cells presenting the ability to differentiate into mature endothelial cells and self-renew, respectively. Moreover, EPCs have the advantage of being already present in healthy conditions as circulating cells that participate in the maintenance of the endothelium in a direct and paracrine way. In this scenario, EPCs appear as a promising target to tackle stroke by self-promoting re-endothelization, angiogenesis and vasculogenesis. Based on clinical data showing a better neurological and functional outcome in ischemic stroke patients with higher levels of circulating EPCs, novel and promising therapeutic approaches would be pharmacological treatment promoting EPCs-generation as well as EPCs-based therapies. Here, we will review the latest advances in preclinical as well as clinical research on EPCs application following stroke, not only as a single treatment but also in combination with new therapeutic approaches.

This study was partially supported by grants from the Xunta de Galicia (PH, JC, and TS: IN607A2018/3, TS: IN607D 2020/09, AC: IN606A-2021/015), the Science Ministry of Spain (TS: RTI2018-102165-B-I00 and RTC2019-007373-1), and the Instituto de Salud Carlos III (AR: PI19/00186 and RD21/0006/0007). Furthermore, this study was also supported by grants from the INTERREG Atlantic Area (LF and TS: EAPA_791/2018_ NEUROATLANTIC Project), INTER-REG V A España Portugal (POCTEP) (LF and TS: 0624_2IQBIONEURO_6_E), the European Regional Development Fund (ERDF), the PT2020 program (LF: FEDER, project LABEL: POCI-01-0247-FEDER-049268), and the Fundação para a Ciência e Tecnologia (LF: project ENDEAVOUR: EXPL/BTM-ORG/1348/2021). Moreover, DR-S (CD21/00166), MA-N (IFI18/00008), and TS (CPII17/00027) are recipients of Sara Borrell, iPFIS, and Miguel Servet contracts, respectively, from the Instituto de Salud Carlos III. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.