Endothelial Progenitor Cells as a Therapeutic Approach for Intracerebral Hemorrhage

Background: Intracerebral hemorrhage (ICH) is the most lethal subtype of stroke, a leading cause of death and disability in developed countries. Therapeutic options are notably limited. There is no specific pharmacological treatment, and early surgery has few indications that represent only a small clinically relevant survival advantage. It is therefore mandatory to investigate repairing processes after ICH in order to develop related therapeutic strategies. Methods: The goal of this review is to discuss the current status of knowledge about the potential therapeutic role of endothelial progenitor cells (EPCs) in ICH, as well as the possible molecular mechanisms and future perspectives. Results: ICH is characterized by a primary vascular rupture, followed by a secondary vascular tearing due to the peripheral pressure exerted by the hematoma. Hypoperfusion may also play a role, although not as markedly as in ischemic stroke. In this context, the repairing of damaged vessels and the development of new ones seem logical therapeutic targets. Circulating EPCs have been suggested to play a major role in re-endothelization, angiogenesis and vasculogenesis. Congruently, EPC levels have been associated with good neurological and functional outcome as well as with reduced residual volume in patients with acute ICH. Conclusion: An EPC-based therapy, acting primarily through angiogenic mechanisms, may be a valid therapeutic option in ICH.