Application of endothelial progenitor cells for the stimulation of angiogenesis, and cardiac tissue regeneration in preclinical rodent studies: a systematic review and meta-analysis

Abstract

Purpose Myocardial infarction (MI), the leading cause of human mortality, is induced by the sudden interruption of blood supply. Among various stem cell types, endothelial progenitor cells (EPCs) are novel and valid cell sources for the restoration of vascularization in the ischemic tissue. The present study aimed to evaluate the regenerative properties of EPCs in rodent models of MI. Methods: A comprehensive systematic search was implemented in Cochrane Library, Embase, PubMed, Scopus, and Web of Science databases without language limitation in Sep 2024. Of a total of 67 papers that were pooled, 42 studies met the inclusion criteria and were subjected to analyses. Results: Compared to the MI group, the overall effect size was confirmed in the groups received EPC with enhanced angiogenesis (SMD: 2.02, CI 95%: 1.51-2.54, p<0.00001; I2: 82%), reduced fibrosis (SMD: -1.48; 95% CI − 2.15, -0.81; p < 0.0001; I2: 88%), improved ejection fraction (EF; SMD: 1.72; 95% CI − 1.21, 2.23; p < 0.00001; I2: 87%), and fractional shortening (FS; SMD: 1.58; 95% CI − 1.13, 2.03; p < 0.00001; I2: 82%). Data confirmed significant improvements in the cardiac tissue parameters after intramyocardial injection of EPCs. Conclusion: These data showed that EPC transplantation is an alternative therapy to ameliorate ischemic myocardium in rodents via the stimulation of angiogenesis, reduction of fibrosis, and improvement of fractional shortening, and ejection fraction.

Keywords: Endothelial Progenitor Cells, Myocardial infarction, Rodents, Regenerative outcomes