Endothelial progenitor cells in acute myocardial infarction and sleep-disordered breathing

Am J Respir Crit Care Med. 2013 Jan 1;187(1):90-8. doi: 10.1164/rccm.201206-1144OC. Epub 2012 Nov 15.


Rationale: Mobilization and functions of endothelial progenitor cells (EPCs) are increased in patients with acute myocardial infarction (AMI). Yet, sleep-disordered breathing (SDB) is highly prevalent in patients with AMI.

Objectives: To compare EPC numbers and functions in patients with AMI with SDB (AMI-SDB) and without SDB (AMI-only) and to determine the effects of intermittent hypoxia (IH) in vitro on EPC proliferative and angiogenic properties.

Methods: Forty male patients with AMI underwent a whole-night sleep study using ambulatory monitoring. Nineteen had SDB (oxygen desaturation index > 5 events/h). AMI-SDB and AMI-only patients were matched by age, body mass index, blood chemistry, and comorbidities. Blood samples were analyzed by flow cytometry, endothelial cell colony-forming units (EC-CFU), paracrine measures, blood chemistry, and oxidative stress, inflammatory, and angiogenic markers. Effects of IH in vitro were studied in 12 healthy subjects.

Measurements and main results: Circulating EPCs (CD34(+)/KDR(+)), angiogenic T cells (CD3(+)/CD31(+)/CXCR4(+)), and vascular endothelial growth factor in monocytes were significantly higher in AMI-SDB patients, whereas plasma stromal cell-derived factor (SDF)-1α levels were significantly lower. Also, EC-CFU numbers and EC-CFU paracrine effects on endothelial tube formation were significantly higher in AMI-SDB compared with AMI-only patients. Similarly, in cell cultures from healthy subjects, EC-CFU numbers and their paracrine effects on endothelial tube formation were increased after exposure to IH in vitro compared with normoxia.

Conclusions: Coexistent mild to moderate SDB in patients with AMI increased the mobilization, proliferative and angiogenic capacities of EPCs, angiogenic T-cell numbers, and vascular endothelial growth factor expression in monocytes compared with patients with AMI without SDB. IH in vitro had similar effects on healthy EPC functions.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aryldialkylphosphatase / blood
  • C-Reactive Protein / analysis
  • Cell Count
  • Chemokine CXCL12 / blood
  • Comorbidity
  • Culture Media, Conditioned
  • Endothelium, Vascular / cytology*
  • Female
  • Humans
  • Hypoxia / physiopathology*
  • In Vitro Techniques
  • Lipids / analysis
  • Male
  • Matrix Metalloproteinase 9 / blood
  • Middle Aged
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / physiopathology*
  • Neovascularization, Physiologic / physiology
  • Sleep Apnea Syndromes / epidemiology
  • Sleep Apnea Syndromes / physiopathology*
  • Stem Cells / physiology*
  • Thiobarbituric Acid Reactive Substances / analysis
  • Ultrasonography
  • Vascular Endothelial Growth Factor A / blood
  • Young Adult


  • Chemokine CXCL12
  • Culture Media, Conditioned
  • Lipids
  • Thiobarbituric Acid Reactive Substances
  • Vascular Endothelial Growth Factor A
  • C-Reactive Protein
  • Aryldialkylphosphatase
  • Matrix Metalloproteinase 9