Stem Cell Mobilization by Granulocyte Colony-Stimulating Factor in Patients With Acute Myocardial InfarctionA Randomized Controlled Trial
- 1 March 2006
- journal article
- research article
- Published by American Medical Association (AMA) in JAMA
- Vol. 295 (9), 1003-10
- https://doi.org/10.1001/jama.295.9.1003
Abstract
Experimental studies and early phase clinical trials suggest that transplantation of blood-derived or bone marrow-derived stem cells may improve cardiac regeneration and neovascularization after acute myocardial infarction. Granulocyte colony-stimulating factor (G-CSF) induces mobilization of bone marrow stem cells. To assess the value of stem cell mobilization by G-CSF therapy in patients with acute myocardial infarction. Randomized, double-blind, placebo-controlled trial of patients diagnosed with ST-segment elevation acute myocardial infarction who had successful reperfusion by percutaneous coronary intervention within 12 hours after onset of symptoms in Germany between February 24, 2004, and February 2, 2005. Patients were randomly assigned to receive subcutaneously either a daily dose of 10 microg/kg of G-CSF or placebo for 5 days. The primary end point was reduction of left ventricular infarct size according to technetium Tc 99m sestamibi scintigraphy performed at baseline and at 4 to 6 months after randomization. Secondary end points included improvement of left ventricular ejection fraction measured by magnetic resonance imaging and the incidence of angiographic restenosis. Of the 114 patients, 56 were assigned to receive treatment with G-CSF and 58 were assigned to receive placebo. Treatment with G-CSF produced a significant mobilization of stem cells. Between baseline and follow-up, left ventricular infarct size according to scintigraphy was reduced by a mean (SD) of 6.2% (9.1%) in the G-CSF group and 4.9% (8.9%) in the placebo group (P = .56) and left ventricular ejection fraction was improved by 0.5% (3.8%) in the G-CSF group and 2.0% (4.9%) in the placebo group (P = .14). Angiographic restenosis occurred in 19 (35.2%) of 54 patients in the G-CSF group and in 17 (30.9%) of 55 patients in the placebo group (P = .79). The most common adverse event among patients assigned to G-CSF was mild to moderate bone pain and muscle discomfort. Stem cell mobilization by G-CSF therapy in patients with acute myocardial infarction and successful mechanical reperfusion has no influence on infarct size, left ventricular function, or coronary restenosis. ClinicalTrials.gov Identifier: NCT00126100.This publication has 38 references indexed in Scilit:
- Cardiac Stem Cells and Mechanisms of Myocardial RegenerationPhysiological Reviews, 2005
- Granulocyte colony‐stimulating factor promotes neovascularization by releasing vascular endothelial growth factor from neutrophilsThe FASEB Journal, 2005
- Mobilization of bone marrow-derived stem cells after myocardial infarction and left ventricular functionEuropean Heart Journal, 2005
- G-CSF prevents cardiac remodeling after myocardial infarction by activating the Jak-Stat pathway in cardiomyocytesNature Medicine, 2005
- Bone Marrow Cells Differentiate in Cardiac Cell Lineages After Infarction Independently of Cell FusionCirculation Research, 2005
- Increased circulating hematopoietic and endothelial progenitor cells in the early phase of acute myocardial infarctionBlood, 2005
- Synergistic Effect of Bone Marrow Mobilization and Vascular Endothelial Growth Factor-2 Gene Therapy in Myocardial IschemiaCirculation, 2004
- Acceleration of the Healing Process and Myocardial Regeneration May Be Important as a Mechanism of Improvement of Cardiac Function and Remodeling by Postinfarction Granulocyte Colony–Stimulating Factor TreatmentCirculation, 2004
- Mobilized bone marrow cells repair the infarcted heart, improving function and survivalProceedings of the National Academy of Sciences of the United States of America, 2001
- Neovascularization of ischemic myocardium by human bone-marrow–derived angioblasts prevents cardiomyocyte apoptosis, reduces remodeling and improves cardiac functionNature Medicine, 2001