Influence of Endothelial Progenitor Cells on Outcomes in Cerebrovascular Disease

Abstract

BACKGROUND: Endothelial progenitor cells (EPCs) contribute to vascular repair and may play a critical role in recovery following cerebrovascular disease. This study aimed to evaluate the association between circulating EPC levels and clinical outcomes in patients with ischemic stroke, hemorrhagic stroke, and transient ischemic attack. METHODS: We conducted a prospective observational study at Hospital Universitario de Gran Canaria Doctor Negrín (Spain) between September 2023 and June 2024. We evaluated the association between circulating EPC levels and clinical outcomes in 126 patients with cerebrovascular disease (mean age, 70.4±12.9 years; 58.7% male), recruited within 48 hours of symptom onset. EPCs were quantified at admission (<48 hours), day 7, and 12 weeks. The primary outcome was favorable functional status at 3 months (modified Rankin Scale score, 0–2). Secondary outcomes included stroke severity (National Institutes of Health Stroke Scale), hospital stay, and mortality. RESULTS: Higher EPC levels on day 7 were independently associated with favorable functional outcome at 3 months (odds ratio, 0.769 [95% CI, 0.605–0.977]; P=0.032). Significant negative correlations were found between EPCs at day 7 and stroke severity at admission (r=–0.205; P=0.034) and length of hospital stay (r=–0.253; P=0.008). EPCs at day 7 were significantly lower in patients who died during follow-up (mean rank, 44.40 versus 56.34; P=0.004). Subgroup analysis in patients with ischemic stroke confirmed that day-7 EPC levels remained an independent predictor of good outcome (odds ratio, 0.743 [95% CI, 0.570–0.968]; P=0.028), shorter hospitalization (r=–0.278; P=0.006), and survival (U=552.000; P=0.043). CONCLUSIONS: EPC levels at day 7 may serve as a prognostic biomarker for recovery and mortality in cerebrovascular disease. These findings suggest a potential therapeutic window targeting endothelial repair mechanisms.