Cilostazol improves high glucose-induced impaired angiogenesis in human endothelial progenitor cells and vascular endothelial cells as well as enhances vasculoangiogenesis in hyperglycemic mice mediated by the adenosine monophosphate-activated protein kinase pathway

J Vasc Surg. 2016 Apr;63(4):1051-62.e3. doi: 10.1016/j.jvs.2014.10.103. Epub 2015 Jan 13.


Objective: Cilostazol is an antiplatelet agent with vasodilatory effects that works by increasing intracellular concentrations of cyclic adenosine monophosphate (cAMP). This study investigated the effects of cilostazol in preventing high glucose (HG)-induced impaired angiogenesis and examined the potential mechanisms involving activation of AMP-activated protein kinase (AMPK).

Methods: Assays for colony formation, adhesion, proliferation, migration, and vascular tube formation were used to determine the effect of cilostazol in HG-treated endothelial progenitor cells (EPCs) or human umbilical vein endothelial cells (HUVECs). Animal-based assays were performed in hyperglycemic ICR mice undergoing hind limb ischemia. An immnunoblotting assay was used to identify the expression and activation of signaling molecules in vitro and in vivo.

Results: Cilostazol treatment significantly restored endothelial function in EPCs and HUVECs through activation of AMPK/acetyl-coenzyme A carboxylase (ACC)-dependent pathways and cAMP/protein kinase A (PKA)-dependent pathways. Recovery of blood flow in the ischemic hind limb and the population of circulating CD34(+) cells were significantly improved in cilostazol-treated mice, and these effects were abolished by local AMPK knockdown. Cilostazol increased the phosphorylation of AMPK/ACC and Akt/endothelial nitric oxide synthase signaling molecules in parallel with or downstream of the cAMP/PKA-dependent signaling pathway in vitro and in vivo.

Conclusions: Cilostazol prevents HG-induced endothelial dysfunction in EPCs and HUVECs and enhances angiogenesis in hyperglycemic mice by interactions with a broad signaling network, including activation of AMPK/ACC and probably cAMP/PKA pathways.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AMP-Activated Protein Kinases / genetics
  • AMP-Activated Protein Kinases / metabolism*
  • Angiogenesis Inducing Agents / pharmacology*
  • Animals
  • Cell Adhesion / drug effects
  • Cell Movement / drug effects
  • Cell Proliferation / drug effects
  • Cells, Cultured
  • Cilostazol
  • Diabetes Mellitus, Experimental / enzymology*
  • Diabetes Mellitus, Experimental / pathology
  • Diabetes Mellitus, Experimental / physiopathology
  • Dose-Response Relationship, Drug
  • Endothelial Progenitor Cells / drug effects*
  • Endothelial Progenitor Cells / enzymology
  • Endothelial Progenitor Cells / pathology
  • Glucose / metabolism*
  • Hindlimb
  • Human Umbilical Vein Endothelial Cells / drug effects*
  • Human Umbilical Vein Endothelial Cells / metabolism
  • Human Umbilical Vein Endothelial Cells / pathology
  • Humans
  • Ischemia / drug therapy*
  • Ischemia / enzymology
  • Ischemia / pathology
  • Ischemia / physiopathology
  • Male
  • Mice, Inbred ICR
  • Muscle, Skeletal / blood supply*
  • Neovascularization, Physiologic / drug effects*
  • Phosphorylation
  • RNA Interference
  • Recovery of Function
  • Regional Blood Flow
  • Signal Transduction / drug effects
  • Tetrazoles / pharmacology*
  • Time Factors
  • Transfection


  • Angiogenesis Inducing Agents
  • Tetrazoles
  • AMPK alpha1 subunit, mouse
  • AMP-Activated Protein Kinases
  • PRKAA1 protein, human
  • Glucose
  • Cilostazol