[Frontiers in Bioscience E2, 111-121, January 1, 2010]

Enhanced external counterpulsation is a regenerative therapy

Coty W. Jewell1, Philip D. Houck1, Linley E. Watson1, David E. Dostal2, Gregory J. Dehmer1

1Department of Medicine (Cardiology Division) University Health Science Center College of Medicine and the Scott and White Clinic, Temple, Texas, 2Cardiovascular Research Institute, Texas A and M University Health Science Center College of Medicine and the Scott and White Clinic, Temple, Texas


1. Abstract
2. Introduction
2.1. History of EECP
2.2. Hemodynamic effects of EECP
2.3. Progenitor cells
2.4. Proposed mechanism of action
2.5. Clinical studies
3. Pilot study for proposed mechanism of action
3.1. Study patients
3.2. Study design
3.2.1. Collection of Blood Samples
3.2.2. Isolation of leukocytes
3.2.3. Labeling of CD clones
3.2.4. Flow Cytometry
3.3. Statistical analysis
3.4. Results
4. Discussion
4.1. Regenerative therapy is a new concept
4.2. Model of regenerative therapy
4.3. Growth and development
4.4. Definition of disease states based on model of regeneration
4.5. Failure of regeneration
4.6. Therapies promoting regeneration
4.7. Proposed therapies to promote regeneration
4.7.1.Confirmatory study Study patients Study design Statistical analysis Results
4.8. Proposed therapies to promote degeneration
4.9. Increasing circulating stems cells is a component of regenerative therapy
5. Summary and future perspectives
5.1. Review of possible mechanisms
5.2. Future perspectives
6. Acknowledgements
7. References


Enhanced external counterpulsation (EECP) is used for the treatment of severe angina and heart failure in patients who are not candidates for revascularization. The clinical benefits of EECP extend well beyond the time period of any hemodynamic effects, but the cause of this prolonged effect is not understood. The prolonged clinical benefits suggest EECP could be a regenerative therapy. This study was performed to determine whether EECP increased circulating hematopoietic progenitor cells (HPCs) or endothelial progenitor cells (EPCs) and thus be a possible regenerative therapy. The proposed mechanism of the increase in regenerative circulating stem cells is the enhanced shear forces induced on the endothelial boundary by the flow reversal produced by the sequential inflation of the pneumatic cuffs during EECP therapy.