Isolation of buffy coat mononuclear cells from 60 ml of blood typically yields 100-150x106 total white blood cells. When plated into a single T-75 flask, the large number of cells in the unlysed cell suspension makes it difficult to resolve individual adherent cells using brightfield microscopy. Repeated medium changes result in the clearance of non-adherent cells and allow for the visualization of the adherent population of monocytic "early" EPCs. At day 7, the T-75 will contain approximately 7x106 of these elongated adherent cells. From day 7 to 14, colonies of BOECs should appear within the flask (Figure 2A). Colonies first appear as 3 to 5 adjacent cells. Outgrowth colony number can vary from 1 to 10 colonies per 60 ml of blood. Generally, younger donors (i.e., 20-25 years old) tend to produce a greater number of outgrowth colonies, which also appear earlier in culture. BOECs proliferate from this central group of cells to form circular colonies consisting of several hundred cells. Cells within these colonies exhibit a classic endothelial cobblestone morphology.
It is preferable to passage initial colonies when they contain approximately 1000 cells per colony. Outgrowth colonies typically reach this size 7 days after their original appearance in culture. Once the original colonies are passaged into a new T-75 flask, they should proliferate to form a confluent monolayer (3-5x106 cells per flask) within 5 days or less (Figure 2B). In a small percentage of isolations (<10%), outgrowth colonies fail to appear, or do not proliferate sufficiently following this initial passaging step. BOECs that exhibit low proliferation after their first passaging rarely go on to become stable BOEC isolations and often stop proliferating within two to three passages. The monocytic early EPCs contained within the BOEC cultures are non-proliferative and are typically cleared from the cultures within 1-2 passages. Clearance of these early cells is due to cell death, failure of the early cells to re-adhere after passaging and dilution of the non-proliferative early EPCs with repeated passaging.
Passage 1 cells can either be passaged further in culture or frozen down for later use. Once a stable isolation is generated, cells can be passaged at a rate of 1 confluent flask to 3-5 new T-75 flasks up until passage 8 or 9 before becoming quiescent. Again, cell density is critical throughout culture. In our experience, no fewer than 750,000 cells should be plated in a T-75 flask, as lower cell densities can cause growth arrest. Despite the high proliferative potential of BOECs, cells should also not be allowed to become overconfluent (i.e., >5x106 cells per flask) as this can cause conversion of BOECs to a non-proliferative phenotype.
We propose that any cell being labeled as a BOEC should display appropriate cell surface and intracellular staining for endothelial markers. Characterization of BOECs can be achieved by flow cytometry (Figure 3) or fluorescence microscopy (Figure 4), following staining for typical endothelial cell markers. BOECs are positive for the endothelial surface markers CD31 and VEGFR2 and are negative for the monocyte marker CD14 and the pan-leukocyte marker CD45. BOECs also posess Weibel-Palade bodies and thus express Von Willebrand Factor (vWF) as discrete, punctate cytoplasmic staining. Unlike other mature endothelial cell types, such as pulmonary artery or aortic endothelial cells, BOECs also express the progenitor and activation marker CD34 on their surface.

Figure 1. Schematic diagram of BOEC generation protocol. Peripheral blood mononuclear cells are isolated from venous blood by density gradient centrifugation and cultured on collagen-coated plates in endothelial growth medium containing defined FBS. BOEC colonies appear within 7-14 days of culture. Please click here to view a larger version of this figure.

Figure 2. Brightfield images of representative BOEC cultures. (A) Outgrowth colonies appear in cultures between days 7 and 14. Colonies present as collections of endothelial-like cells, which are arranged in a cobblestone monolayer and proliferate radially out from a central point. Surrounding the outgrowth colonies are the adherent monocytic cells that make up the vast majority of cells in early cultures. These cells, previously described as "early" endothelial progenitor cells, have a spindle-like morphology and express the monocytic marker CD14. (B) Following passaging, the highly proliferative BOECs take over cultures, as the non-proliferative monocytic cells either die off or fail to re-attach after passaging. Scale bar 250μm. Please click here to view a larger version of this figure.

Figure 3. Characterization of BOECs by flow cytometry. BOECs were trypsinized and stained with fluorescently-conjugated isotype control antibodies (grey filled peak) or antibodies directed against specific surface markers (red line). Surface markers for cytometric characterization include the hematopoietic markers CD45 and CD14, the endothelial markers CD31 and VEGFR2 and the progentior and endothelial activation marker CD34. Please click here to view a larger version of this figure.

Figure 4. Immunofluorescent staining of BOECs for endothelial cell markers. Representative immunofluorescence images of BOECs immunostained with antibodies directed against endothelial cell surface marker CD144 (VE-cadherin, top right panel) and the blood glycoprotein von Willebrand Factor (vWF, bottom right panel). Corresponding panels showing nuclear DAPI staining are shown to the left. Scale bar 50μm. for CD144. Please click here to view a larger version of this figure.