Background: Recently, we reported that murine bone marrow derived CD31
+
cells have hemangioblastic activities. In this study, we hypothesized that human peripheral blood derived CD31
+
cells (hCD31
+
) have robust angio-vasculogenic potential and can induce therapeutic neovascularization in hindlimb ischemia.
Methods and Results: hCD31
+
cells were isolated using a magnetic bead separation technique. By FACS analysis, we confirmed that more than 98% of hCD31
+
cells are positive for CD45, suggesting that hCD31
+
cells are not circulating endothelial cells. In endothelial progenitor cell (EPC) culture assay, hCD31
+
cells almost exclusively gave rise to EPCs and produced significantly higher colony forming activity than hCD31
-
cells (n=5, each) (25.2 ± 2.2 vs. 3.6 ± 0.5/mm
2
, P<0.01). In the matrigel tube formation assay, coculturing HUVEC with hCD31
+
cells revealed that hCD31
+
cells robustly contributed to network formation with HUVECs suggestive of angio-vasculogenic activity. Real-time PCR showed that hCD31
+
cells express higher levels of angiogenic genes (fold increase: angiopoietin-1, 5.6 ± 0.8; HGF, 2.7 ± 0.6; VEGF-A, 3.8 ± 0.5; FGF-2, 2.0 ± 0.5) and lower levels of inflammatory genes (fold decrease: Interferonγ, 13.2 ± 2.5; TNFα, 2.3 ± 0.9) than hCD31
−
cells. To investigate therapeutic potential, we surgically induced hindlimb ischemia in athymic nude mice, and injected hCD31
+
cells, hCD31
−
cells and PBS into the ischemic limbs (n=9, each). The hCD31
+
treated group showed a higher limb salvage rate than other groups [total salvage/tip necrosis/amputation; hCD31
+
cells 5/4/0, hCD31
−
cells 2/5/2, PBS control 0/5/4] (P<0.01). At 14 days, perfusion ratio and capillary density were significantly higher in the hCD31
+
treated group compared to the hCD31
−
and PBS treated groups. Histologic analysis demonstrated that a fraction of injected DiI-labeled hCD31
+
cells exhibit endothelial phenotypes during the follow-up period of 8 weeks.
Conclusion: The present study demonstrated that hCD31
+
cells have robust angio-vasculogenic potential with low inflammatory activity, and enhanced post-ischemia recovery. These data suggested that hCD31
+
cell transplantation may represent a novel therapeutic option for treating ischemic cardiovascular diseases.