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Granulocyte colony-stimulating factor-induced blood stem cell mobilisation in patients with chronic heart
Andreas Hüttmann1, Ulrich Dührsen, Jörg Stypmann
1Klinik für Hämatologie, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 Essen, Germany.
Insights
Granulocyte colony-stimulating factor (G-CSF) treatment may improve physical function in heart failure patients by mobilizing stem cells. While feasible, G-CSF carries risks, particularly for ischemic cardiomyopathy patients.
Area of Science:
- Cardiology
- Regenerative Medicine
- Stem Cell Biology
Background:
- Bone marrow-derived stem cells show potential for non-hematopoietic organ regeneration.
- Chronic heart failure (CHF) remains a significant clinical challenge with limited regenerative treatment options.
Purpose of the Study:
- To investigate if increasing circulating stem cell numbers with granulocyte colony-stimulating factor (G-CSF) can improve myocardial function in patients with chronic heart failure.
- To assess the safety and efficacy of sequential G-CSF administration in patients with dilated (DCM) and ischemic cardiomyopathy (ICM).
Main Methods:
- Sixteen male patients with CHF (7 DCM, 9 ICM) received G-CSF for four 10-day cycles.
- Safety and efficacy were monitored through regular assessments.
- Changes in New York Heart Association (NYHA) class and six-minute walking distance were primary efficacy endpoints.
Main Results:
- Nine out of 12 patients who completed four G-CSF cycles showed a one-class improvement in NYHA class and increased six-minute walking distance.
- No significant changes in echocardiographic parameters were observed.
- Cardiac adverse events in ICM patients included dyspnea, angina, and one fatal ventricular fibrillation.
Conclusions:
- Sequential G-CSF administration is a feasible approach for potentially improving physical performance in chronic heart failure patients.
- G-CSF may offer benefits for patients with DCM and ICM, but careful monitoring is required.
- Patients with ICM face increased risks of angina and arrhythmias during G-CSF treatment.
Abstract:
Bone marrow-derived stem cells may contribute to the regeneration of non-haematopoietic organs. In order to test whether an increase in circulating stem cell numbers improves impaired myocardial function we treated 16 male patients with chronic heart failure due to dilated (DCM; n = 7) or ischaemic cardiomyopathy (ICM; n = 9) with the stem cell mobilising cytokine granulocyte colony-stimulating factor (G-CSF; four 10-day treatment periods interrupted by treatment-free intervals of equal length). Safety and efficacy analyses were performed at regular intervals. Peak CD34+ cell counts remained constant from cycle to cycle. Cardiac side effects in ICM patients included occasional episodes of dyspnea or angina and one episode of fatal ventricular fibrillation. Nine (4 DCM, 5 ICM) of 12 patients receiving four full G-CSF cycles experienced an improvement by one New York Heart Association (NYHA) class and a statistically significant increase in six-minute walking distance. By contrast, none of 8 ICM historical controls had a change in NYHA class during a similar time period. Statistically significant changes in echocardiographic parameters were not recorded. Sequential administration of G-CSF is feasible and possibly effective in improving physical performance in patients with chronic heart failure. Patients with ICM may be at risk of increased angina and arrhythmias.
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