Les progéniteurs endothéliaux circulants, utilisation potentielle en thérapie cellulaire de l'ischémie

Abstract

The discovery of circulating endothelial progenitors (EPCs) in human blood has completely modified the concept of post natal angiogenesis. Many studies have further confirmed the existence of EPCs, their medullar origin and capacity to be integrated in vascular structures at the sites of neoangiogenesis. They suggest that EPCs could be naturally involved in the prevention of ischemia by participating directly to the formation of collateral vessels. These cells have a high tropism for the sites of angiogenesis. They may thus be used as a powerful tool to prevent or treat ischemic diseases and constitute an alternative to the risky local injection of pro-angiogenic growth factors. The efficiency of bone marrow cells autologous transplantation was recently proved by the first clinical trials. Bone marrow mononuclear cells locally injected to patients with limb or cardiac ischemia have been shown to improve reperfusion in ischemic tissues. These trials are still preliminary: they were performed with heterogeneous cells only on few patients and were not randomized. However they raise important questions, essentially on the necessity of cell purification prior to injection and on the nature of the bone marrow cells which are really involved in ischemic tissue regeneration. Further investigations are then required to improve the cell therapy outcome by 1) using more defined cell population, 2) clearly demonstrating the long term improvement of vascular function and 3) performing extensive analysis of the possible side effects.