Endothelial cell isolation feasible in 43% of ANOCA patients in observational study

Photo by Nathan Rimoux / Unsplash

medRxiv Published April 16, 2026 Medically reviewed April 25, 2026 Study authors: de Jong, E. A. M.; Kapteijn, D.; Daniels, M.; Nijkamp, T.; Zalewski, P. D.; Beltrame, J. F.; Damman,… DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider endothelial cell isolation feasible in ANOCA for research, but interpret cautiously due to observational data.

This observational study assessed the feasibility of isolating and expanding endothelial cells (ECs) from catheterization material in 79 patients with angina with nonobstructive coronary arteries (ANOCA), with a population that was 84% female and had a mean age of 58 years. The intervention involved isolation and culturing of ECs, with no comparator specified. Main results showed EC isolation was successful in 43 out of 79 cases (43%), yielding 34 primary EC cultures that could be expanded up to passage 10. Isolation success was independent of clinical or procedural characteristics. EC marker gene expression remained largely stable over time, while stress- and defense-related gene expression increased and proliferation-related processes decreased over passages.

Safety and tolerability data were not reported, including adverse events, serious adverse events, and discontinuations. Key limitations include that the study primarily aimed to assess feasibility, and specific methodological limitations were not explicitly stated in the abstract. Funding or conflicts of interest were also not reported.

Practice relevance is restrained: this study offers primary EC cultures as a tool to study mechanisms underlying endothelial dysfunction in ANOCA, but its observational design and lack of safety data limit immediate clinical application. The findings should be interpreted as preliminary evidence supporting further research into endothelial biology in this patient population.

Study Details

EvidenceLevel 5

PublishedApr 2026

View Original Abstract ↓

Background | Angina with nonobstructive coronary arteries (ANOCA) is a heterogeneous condition encompassing distinct endotypes representing different underlying pathophysiological mechanisms. Endothelial dysfunction is considered a central hallmark of ANOCA. However, studying patient-derived endothelial cells (ECs) remains challenging due to the limited availability of disease-specific endothelial samples. We therefore aimed to assess the feasibility of isolating and culturing ECs from catheterization material obtained during routine coronary function testing in ANOCA patients. Methods | Catheterization material was collected from 79 ANOCA patients (84% female, age 58{+/-}10 years) undergoing coronary function testing. ECs were isolated, expanded and characterized using immunostaining, flow cytometry, gene expression profiling and functional assays. Results | EC isolation was successful in 43% of cases and resulted in 34 primary EC cultures that were expanded up to passage 10. Isolation success was independent of clinical or procedural characteristics. Isolated cells exhibited typical EC morphology and expressed EC markers confirmed by immunostaining, flow cytometry and gene expression analyses. EC marker gene expression remained largely stable over passages. However, stress- and defense-related gene expression programs increased over time, while proliferation-related processes decreased. Functional assays demonstrated that the coronary catheterization-derived ECs showed typical properties of wound healing, angiogenesis, activation responses upon stimuli and monocyte adhesion. Conclusions | This study demonstrates the feasibility of isolating and expanding ECs directly from catheterization material collected during routine coronary function testing in ANOCA patients. These patient-derived ECs retain characteristic endothelial features and functionality. This approach offers primary EC cultures to study the mechanisms underlying endothelial dysfunction in ANOCA.