Background: In the PLATO trial treatment with ticagrelor was associated with decreased adverse ischemic cardiovascular events. An unexpected finding was the reduction in vascular mortality associated with ticagrelor treatment. The mechanism explaining this remains unclear. We hypothesized that ticagrelor, via an adenosine-related mechanism, may affect endothelial progenitor cells (EPCs), known to be involved in vascular repair.
Objectives: To examine the effect of ticagrelor on EPC’s level and function in patients with non ST elevation MI (NSTEMI).
Methods: Twenty patients with non-ST elevation MI were initially treated with clopidogrel until coronary cathetarization. After percutaneous coronary intervention (PCI) they were switched to ticagrelor (180mg/d). Blood samples were taken at 3 time points: baseline (on clopidogrel before ticagrelor), 2-4 weeks after PCI, and 6-8 weeks after (on ticagrelor). All samples were processed for the isolation of peripheral mononuclear cells. EPCs were identified by flow cytometry as CD34+VEGFR-2+ cells or CD133+VEGFR-2+ cells. Functionalities of the cells were evaluated by colony forming units assay following cultures, and cells viability was measured by MTT tests.
Results: Twenty patients with NSTEMI were enrolled (10% women, mean age 60.5±11.6 years). 75% of the patients completed follow up. EPC`s flow cytometry and MTT tests results are presented in Table 1.There was a significant increase in CD34+VEGFR+ EPC’S from baseline to the third point (p=0.007). As well as a significant increase in MTT levels between the first and second point and between the second and third point (p=0.004).
Conclusion: In this preliminary study, ticagrelor treatment given to patients with NSTEMI appears to improve aspects of EPC’s level and function. These findings may contribute to better understanding of the positive effects of ticagrelor in patients with acute coronary syndrome.
