Endothelial Progenitor Cells and Nitric Oxide in Cardiac Rehabilitation Program Participants
| Status: | Completed |
|---|---|
| Conditions: | Peripheral Vascular Disease, Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 21 - Any |
| Updated: | 4/21/2016 |
| Start Date: | March 2006 |
Mechanism and Vascular Effects of Endothelial Progenitor Cell Mobilization in Patients With Coronary Artery Disease Undergoing Cardiac Rehabilitation
This study will measure blood levels of endothelial progenitor cells (EPCs) and nitric oxide
(NO) in patients with coronary artery disease (CAD) who are participating in a 3-month
cardiac rehabilitation program at Suburban Hospital in Bethesda, MD. EPCs are a kind of stem
cell produced by the bone marrow that can develop into cells found in arteries and in the
heart and, therefore, can repair diseased vessels. The study will examine whether the EPCs
are affected by exercise and will look at how they may contribute to repair of cells lining
the diseased arteries as a result of participation in the rehabilitation program.
People with coronary artery disease may be eligible for this study. Candidates are screened
with a medical history, physical examination, electrocardiogram, and blood tests. CAD
patients also to a treadmill exercise test.
Volunteers' participation ends at the screening visit. The blood drawn at screening is used
to identify EPC specific genes to compare with the EPC genes from patients with CAD.
CAD patients participate in Suburban Hospital's cardiac rehabilitation program. The exercise
portion of the program includes 36 sessions of about 60 minutes each, spaced over
approximately 3 months. Patients have a baseline blood test at screening and repeat blood
tests at the end of each month of participation in the rehabilitation program. Some of the
blood will be used for genetic tests to see how genes of the EPCs are changed by the
patient's participation in the rehabilitation program.
(NO) in patients with coronary artery disease (CAD) who are participating in a 3-month
cardiac rehabilitation program at Suburban Hospital in Bethesda, MD. EPCs are a kind of stem
cell produced by the bone marrow that can develop into cells found in arteries and in the
heart and, therefore, can repair diseased vessels. The study will examine whether the EPCs
are affected by exercise and will look at how they may contribute to repair of cells lining
the diseased arteries as a result of participation in the rehabilitation program.
People with coronary artery disease may be eligible for this study. Candidates are screened
with a medical history, physical examination, electrocardiogram, and blood tests. CAD
patients also to a treadmill exercise test.
Volunteers' participation ends at the screening visit. The blood drawn at screening is used
to identify EPC specific genes to compare with the EPC genes from patients with CAD.
CAD patients participate in Suburban Hospital's cardiac rehabilitation program. The exercise
portion of the program includes 36 sessions of about 60 minutes each, spaced over
approximately 3 months. Patients have a baseline blood test at screening and repeat blood
tests at the end of each month of participation in the rehabilitation program. Some of the
blood will be used for genetic tests to see how genes of the EPCs are changed by the
patient's participation in the rehabilitation program.
Exercise training has long been recommended as a means of improving effort tolerance and
reducing morbidity and mortality in patients with coronary artery disease (CAD). One
mechanism of benefit may be through improved endothelial function with enhanced nitric oxide
(NO) bioactivity. Such an effect may augment blood flow to exercising skeletal muscle and to
the myocardium, and reduce vascular inflammation, platelet activation and adherence which
could diminish the risk of thrombosis. In 46 patients with CAD, participating in the
Suburban Hospital cardiac rehabilitation program (Protocol 03-H-0086), we detected increases
in circulating endothelial progenitor cells (EPCs), which may have the capacity to repair
diseased or dysfunctional endothelium. In the last 23 participants (following amendment of
the protocol) a subset showed increase in whole blood nitrite - a marker of intravascular NO
- at completion of program. However, not all patients showed EPC mobilization or increased
intravascular NO despite compliant program participation and improved effort tolerance. One
possibility is that EPCs from patients who fail to derive vascular benefit as evidenced by
increased intravascular NO may have different EPC gene expression profiles at baseline or in
response to repetitive exercise, resulting in diminished protection of EPCs against oxidant
stress with initiation of apoptosis, compared with EPC gene expression in patients who show
evidence of EPC mobilization and endothelial repair. The purpose of our study is to 1)
Prospectively demonstrate a relationship between EPC mobilization and increased whole blood
nitrite as a marker of improved vascular NO bioactivity due to EPC mobilization, and 2)
Determine EPC gene expression profiles, with a focus on activation or suppression of genes
whose products regulate intravascular redox potential, apoptosis and growth factor and
cytokine secretion. We hypothesize that activation or suppression of critical genes in EPCs
at baseline or during exercise may determine EPC mobilization, endothelial differentiation
and vascular repair potential as evidenced by increased intravascular NO.
reducing morbidity and mortality in patients with coronary artery disease (CAD). One
mechanism of benefit may be through improved endothelial function with enhanced nitric oxide
(NO) bioactivity. Such an effect may augment blood flow to exercising skeletal muscle and to
the myocardium, and reduce vascular inflammation, platelet activation and adherence which
could diminish the risk of thrombosis. In 46 patients with CAD, participating in the
Suburban Hospital cardiac rehabilitation program (Protocol 03-H-0086), we detected increases
in circulating endothelial progenitor cells (EPCs), which may have the capacity to repair
diseased or dysfunctional endothelium. In the last 23 participants (following amendment of
the protocol) a subset showed increase in whole blood nitrite - a marker of intravascular NO
- at completion of program. However, not all patients showed EPC mobilization or increased
intravascular NO despite compliant program participation and improved effort tolerance. One
possibility is that EPCs from patients who fail to derive vascular benefit as evidenced by
increased intravascular NO may have different EPC gene expression profiles at baseline or in
response to repetitive exercise, resulting in diminished protection of EPCs against oxidant
stress with initiation of apoptosis, compared with EPC gene expression in patients who show
evidence of EPC mobilization and endothelial repair. The purpose of our study is to 1)
Prospectively demonstrate a relationship between EPC mobilization and increased whole blood
nitrite as a marker of improved vascular NO bioactivity due to EPC mobilization, and 2)
Determine EPC gene expression profiles, with a focus on activation or suppression of genes
whose products regulate intravascular redox potential, apoptosis and growth factor and
cytokine secretion. We hypothesize that activation or suppression of critical genes in EPCs
at baseline or during exercise may determine EPC mobilization, endothelial differentiation
and vascular repair potential as evidenced by increased intravascular NO.
- INCLUSION CRITERIA:
Adults older than 21 years.
Coronary artery disease established by angiography.
At least two months interval since myocardial infarction or coronary artery bypass
surgery.
At least one month interval since percutaneous coronary intervention or congestive heart
failure symptoms.
No medical condition that might prohibit safe participation in cardiac rehabilitation.
Subject understands protocol and provides written, informed consent in addition to
willingness to comply with specified follow-up evaluations.
EXCLUSION CRITERIA:
Significant structural heart disease (e.g. hypertrophic or dilated cardiomyopathy,
valvular heart disease) as determined by echocardiography.
Angina pectoris that is prolonged in duration (greater than 20 minutes), or does not
respond to nitroglycerin (2 tablets) within 2 weeks of referral to the program.
Subjects physically unable to perform cardiac rehabilitation protocol due to neurologic or
orthopedic conditions.
Women of childbearing age unless recent pregnancy test is negative.
Lactating women.
Implantable cardioverter-defibrillator (ICD)
We found this trial at
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sites
Suburban Hospital Suburban Hospital is a community-based, not-for-profit hospital serving Montgomery County and the surrounding...
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9000 Rockville Pike
Bethesda, Maryland 20892
Bethesda, Maryland 20892
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