Stroke is one of the leading causes of death and disability worldwide. Tremendous improvements have been achieved in the acute care of stroke patients with the implementation of stroke units, thrombolytic drugs and endovascular trombectomies. However, stroke survivors with neurological deficits require long periods of neurorehabilitation, which is the only approved therapy for post- stroke recovery. With this scenario more treatments are urgently needed, and only the understanding of the mechanisms of brain recovery might contribute to identify new therapeutic agents. Fortunately brain injury after stroke is counteracted by the birth and migration of several populations of progenitor cells towards the injured areas, where angiogenesis and vascular remodeling play a key role providing trophic support and guidance during neurorepair. Endothelial Progenitor cells (EPC) constitute a pool of circulating bone-marrow derived cells that mobilize after an ischemic injury with the potential to incorporate into the damaged endothelium, to form new vessels or to secrete trophic factors stimulating vessel remodeling. The circulating levels of EPC are altered after stroke and several subpopulations have proved to boost brain neurorepair in pre-clinical models of cerebral ischemia. The goal of this review is to discuss the current state of the neuroreparative actions of EPC focusing on their paracrine signaling mechanisms thorough their secretome and released extracellular vesicles (EVs).
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