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Circulation. 2002;105:3017-3024
Published online before print May 20, 2002, doi: 10.1161/01.CIR.0000018166.84319.55
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(Circulation. 2002;105:3017.)
© 2002 American Heart Association, Inc.


Basic Science Reports

Statin Therapy Accelerates Reendothelialization

A Novel Effect Involving Mobilization and Incorporation of Bone Marrow-Derived Endothelial Progenitor Cells

Dirk H. Walter, MD; Kilian Rittig, MD; Ferdinand H. Bahlmann, MD; Rudolf Kirchmair, MD; Marcy Silver, BS; Toshinori Murayama, MD, PhD; Hiromi Nishimura, MD, PhD; Douglas W. Losordo, MD; Takayuki Asahara, MD, PhD; Jeffrey M. Isner, MD{dagger}

From the Department of Medicine (Cardiovascular Research), St Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, Mass.

Correspondence to Takayuki Asahara, MD, PhD, St Elizabeth’s Medical Center, 736 Cambridge St, Boston, MA 02135. E-mail asa777@ aol.com

Background Primary and secondary prevention trials suggest that statins possess favorable effects independent of cholesterol reduction. We investigated whether statin therapy may also accelerate reendothelialization after carotid balloon injury.

Methods and Results Simvastatin treatment in 34 male Sprague-Dawley rats accelerated reendothelialization of the balloon-injured arterial segments (reendothelialized area at 2 weeks, 12.3±1.8 versus 5.4±1.1 mm2, P< 0.01) and resulted in a dose-dependent (0.2 or 1 mg/kg IP) significant reduction in neointimal thickening at 2, 3, and 4 weeks compared with saline-injected controls (n=18). To elucidate the mechanism, we investigated the contribution of bone marrow–derived endothelial progenitor cells (EPCs) by bone marrow transplantation from Tie2/lacZ mice to background mice or nude rats. X-gal staining of mouse carotid artery specimens revealed a 2.9-fold increase in the number of ß-gal–positive cells per square millimeter appearing on the carotid artery luminal surface at 2 weeks, and double-fluorescence immunohistochemistry disclosed a significant 5-fold increase in the number of double-positive cells (ß-gal, isolectin B4) on the luminal surface in carotid arteries of statin-treated nude rats (20±3 versus 4±1 cells/mm surface length, P<0.005). Statins increased circulating rat EPCs (2.4-fold at 2 weeks and 2.5-fold at 4 weeks, P<0.001) and induced adhesiveness of cultured human EPCs by upregulation of the integrin subunits {alpha}5, ß1, {alpha} v, and ß5 of human EPCs as shown by reverse transcription–polymerase chain reaction and fluorescence-activated cell sorting.

Conclusions These findings establish additional mechanisms by which statins may specifically preempt disordered vascular wall pathology and constitute physiological evidence that EPC mobilization represents a functionally relevant consequence of statin therapy.


Key Words: coronary disease • endothelium • angiogenesis • statins • cells




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R. P. Brandes
Novel Faces to Old Friends: A Central Role of Inducible NO Synthase for Progenitor Cell Recruitment and a New Antiinflammatory Mechanisms of Statins
Circ. Res., February 17, 2006; 98(3): 303 - 305.
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Circ. Res.Home page
H. Langer, A. E. May, K. Daub, U. Heinzmann, P. Lang, M. Schumm, D. Vestweber, S. Massberg, T. Schonberger, I. Pfisterer, et al.
Adherent Platelets Recruit and Induce Differentiation of Murine Embryonic Endothelial Progenitor Cells to Mature Endothelial Cells In Vitro
Circ. Res., February 3, 2006; 98(2): e2 - e10.
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Arterioscler. Thromb. Vasc. Bio.Home page
N. Werner and G. Nickenig
Influence of Cardiovascular Risk Factors on Endothelial Progenitor Cells: Limitations for Therapy?
Arterioscler Thromb Vasc Biol, February 1, 2006; 26(2): 257 - 266.
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J. Am. Soc. Nephrol.Home page
H. Zhang, A. Zhang, D.E. Kohan, R.D. Nelson, F.J. Gonzales, T. Yang, C. Schmidt-Lucke, L. Rossig, S. Fichtlscherer, M. Vasa, et al.
Edema and Congestive Heart Failure from Thiazolidone Insulin Sensitizers--Excess Sodium Reabsoption in the Collecting Duct: Collecting Duct-Specific Deletion of Peroxisome Proliferator-Activated Receptor {gamma} Blocks Thiazolidinedione-Induced Fluid Retention. Proc Nat Acad Sci U S A 102: 9406-9411, 2005
J. Am. Soc. Nephrol., November 1, 2005; 16(11): 3139 - 3142.
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J Am Coll CardiolHome page
K. K. Ray and C. P. Cannon
The Potential Relevance of the Multiple Lipid-Independent (Pleiotropic) Effects of Statins in the Management of Acute Coronary Syndromes
J. Am. Coll. Cardiol., October 18, 2005; 46(8): 1425 - 1433.
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Am. J. Physiol. Renal Physiol.Home page
C. T. Chan, S. H. Li, and S. Verma
Nocturnal hemodialysis is associated with restoration of impaired endothelial progenitor cell biology in end-stage renal disease
Am J Physiol Renal Physiol, October 1, 2005; 289(4): F679 - F684.
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J Am Coll CardiolHome page
V. Fuster, P. R. Moreno, Z. A. Fayad, R. Corti, and J. J. Badimon
Atherothrombosis and High-Risk Plaque: Part I: Evolving Concepts
J. Am. Coll. Cardiol., September 20, 2005; 46(6): 937 - 954.
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NEJMHome page
N. Werner, S. Kosiol, T. Schiegl, P. Ahlers, K. Walenta, A. Link, M. Bohm, and G. Nickenig
Circulating Endothelial Progenitor Cells and Cardiovascular Outcomes
N. Engl. J. Med., September 8, 2005; 353(10): 999 - 1007.
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J. Clin. Endocrinol. Metab.Home page
J. Sugawara, M. Mitsui-Saito, C. Hayashi, T. Hoshiai, M. Senoo, H. Chisaka, N. Yaegashi, and K. Okamura
Decrease and Senescence of Endothelial Progenitor Cells in Patients with Preeclampsia
J. Clin. Endocrinol. Metab., September 1, 2005; 90(9): 5329 - 5332.
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Circ. Res.Home page
A. Leri and J. Kajstura
Endothelial Progenitor Cells: Unexpected Disclosures
Circ. Res., August 19, 2005; 97(4): 299 - 301.
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J. Thorac. Cardiovasc. Surg.Home page
Y. J. Woo, T. J. Grand, M. F. Berry, P. Atluri, M. A. Moise, V. M. Hsu, J. Cohen, O. Fisher, J. Burdick, M. Taylor, et al.
Stromal cell-derived factor and granulocyte-monocyte colony-stimulating factor form a combined neovasculogenic therapy for ischemic cardiomyopathy
J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 321 - 329.
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CirculationHome page
J. I. Rotmans, J. M.M. Heyligers, H. J.M. Verhagen, E. Velema, M. M. Nagtegaal, D. P.V. de Kleijn, F. G. de Groot, E. S.G. Stroes, and G. Pasterkamp
In Vivo Cell Seeding With Anti-CD34 Antibodies Successfully Accelerates Endothelialization but Stimulates Intimal Hyperplasia in Porcine Arteriovenous Expanded Polytetrafluoroethylene Grafts
Circulation, July 5, 2005; 112(1): 12 - 18.
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HypertensionHome page
V. J. Dzau, M. Gnecchi, A. S. Pachori, F. Morello, and L. G. Melo
Therapeutic Potential of Endothelial Progenitor Cells in Cardiovascular Diseases
Hypertension, July 1, 2005; 46(1): 7 - 18.
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CirculationHome page
C. Schmidt-Lucke, L. Rossig, S. Fichtlscherer, M. Vasa, M. Britten, U. Kamper, S. Dimmeler, and A. M. Zeiher
Reduced Number of Circulating Endothelial Progenitor Cells Predicts Future Cardiovascular Events: Proof of Concept for the Clinical Importance of Endogenous Vascular Repair
Circulation, June 7, 2005; 111(22): 2981 - 2987.
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JEMHome page
L. Rossig, C. Urbich, T. Bruhl, E. Dernbach, C. Heeschen, E. Chavakis, K.-i. Sasaki, D. Aicher, F. Diehl, F. Seeger, et al.
Histone deacetylase activity is essential for the expression of HoxA9 and for endothelial commitment of progenitor cells
J. Exp. Med., June 6, 2005; 201(11): 1825 - 1835.
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StrokeHome page
G. P. Fadini, C. Agostini, A. Avogaro, U. Ghani, A. Shuaib, A. Salam, A. Nasir, U. Shuaib, T. Jeerakathil, F. Sher, et al.
Endothelial Progenitor Cells in Cerebrovascular Disease * Response:
Stroke, June 1, 2005; 36(6): 1112 - 1113.
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CirculationHome page
U. Landmesser, F. Bahlmann, M. Mueller, S. Spiekermann, N. Kirchhoff, S. Schulz, C. Manes, D. Fischer, K. de Groot, D. Fliser, et al.
Simvastatin Versus Ezetimibe: Pleiotropic and Lipid-Lowering Effects on Endothelial Function in Humans
Circulation, May 10, 2005; 111(18): 2356 - 2363.
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J Am Coll CardiolHome page
C. Heiss, S. Keymel, U. Niesler, J. Ziemann, M. Kelm, and C. Kalka
Impaired Progenitor Cell Activity in Age-Related Endothelial Dysfunction
J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1441 - 1448.
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J Am Coll CardiolHome page
C. Dong, L. E. Crawford, and P. J. Goldschmidt-Clermont
Endothelial Progenitor Obsolescence and Atherosclerotic Inflammation
J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1458 - 1460.
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ChestHome page
P. N. Kao
Simvastatin Treatment of Pulmonary Hypertension: An Observational Case Series
Chest, April 1, 2005; 127(4): 1446 - 1452.
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Am. J. Physiol. Heart Circ. Physiol.Home page
E. O. Weinberg, M. Scherrer-Crosbie, M. H. Picard, B. A. Nasseri, C. MacGillivray, J. Gannon, Q. Lian, K. D. Bloch, and R. T. Lee
Rosuvastatin reduces experimental left ventricular infarct size after ischemia-reperfusion injury but not total coronary occlusion
Am J Physiol Heart Circ Physiol, April 1, 2005; 288(4): H1802 - H1809.
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J. Clin. Endocrinol. Metab.Home page
J. Sugawara, M. Mitsui-Saito, T. Hoshiai, C. Hayashi, Y. Kimura, and K. Okamura
Circulating Endothelial Progenitor Cells during Human Pregnancy
J. Clin. Endocrinol. Metab., March 1, 2005; 90(3): 1845 - 1848.
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J. Am. Soc. Nephrol.Home page
V. Schachinger and A. M. Zeiher
Stem Cells and Cardiovascular and Renal Disease: Today and Tomorrow
J. Am. Soc. Nephrol., March 1, 2005; 16(3_suppl_1): S2 - S6.
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Am J Crit CareHome page
L. G. Futterman and L. Lemberg
Cardiac Repair With Autologous Bone Marrow Stem Cells
Am. J. Crit. Care., November 1, 2004; 13(6): 512 - 518.
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