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Delayed Intramyocardial Delivery of Stem Cells after Ischemia Reperfusion Injury in a Murine Model
Published on: September 3, 2020
Stem cells mobilization in acute myocardial infarction (stem-AMI trial): preliminary data of a perspective,
1Department of Cardiology, Alessandro Manzoni Hospital, Lecco, Italy. c.malafronte@ospedale.lecco.it
Insights
Granulocyte colony-stimulating factor (G-CSF) shows potential safety in acute myocardial infarction patients. However, preliminary data do not conclusively support its effectiveness in improving left ventricular function after primary PCI.
Area of Science:
- Cardiology
- Regenerative Medicine
- Interventional Cardiology
Background:
- Granulocyte colony-stimulating factor (G-CSF) has demonstrated safety in acute myocardial infarction (AMI) patients.
- Previous studies show mixed results regarding G-CSF's efficacy in improving left ventricular (LV) function post-AMI.
- Distinguishing the effects of early revascularization versus regenerative therapy on LV function remains a challenge.
Purpose of the Study:
- To evaluate the efficacy of G-CSF in improving LV ejection fraction (LVEF) in patients with acute anterior myocardial infarction (AMI).
- To assess G-CSF's impact on LV function using cardiac magnetic resonance imaging (MRI) in patients undergoing primary percutaneous coronary intervention (PCI).
- To differentiate the therapeutic effects of G-CSF from those of early revascularization in AMI.
Main Methods:
- A prospective randomized trial involving 50 patients with first anterior ST-elevation myocardial infarction (STEMI) undergoing primary PCI.
- Patients received standard care plus subcutaneous G-CSF (150 microg/m2 bis in die) from day 0 to day 4.
- Comprehensive assessments included echocardiography, Holter monitoring, SPECT, and MRI at baseline and 6 months, with repeat coronary angiography to assess in-stent restenosis.
Main Results:
- 13 patients were enrolled; 5 received G-CSF. All underwent PCI and stenting of the left anterior descending artery.
- Mean baseline LVEF by echocardiography, SPECT, and MRI was 36%, 33%, and 38%, respectively.
- No adverse events were reported during G-CSF administration. Mean white blood cell count on day 5 was 36.1 x 10(9)/L +/- 2.90.
Conclusions:
- Preliminary data from this study do not yield conclusive results on G-CSF efficacy.
- The study design may help differentiate the effects of revascularization and regenerative therapy on LV function in AMI patients.
- Further research with larger cohorts is needed to confirm G-CSF's role in AMI treatment.
Aim:
Clinical trials demonstrated that granulocyte colony-stimulating factor (G-CSF) administration seems to be safe in patients with acute myocardial infarction but the results about the effectiveness are not so encouraging. The main problem is to distinguish the effects that early revascularization and regenerative therapy have on left ventricular (LV) function. The purpose of our perspective randomized trial is to evaluate the efficacy of G-CSF administration, assessed by improvement of LV ejection fraction by cardiac magnetic resonance imaging (MRI), in patients with acute anterior myocardial infarction undergoing primary percutaneous coronary intervention (PCI) and with evidence of LV dysfunction.
Methods:
Fifty consecutive patients with first anterior ST-elevation myocardial infarction (STEMI), undergoing primary PCI, with symptom to balloon >2 and <12 hours and ejection fraction (EF) =or<45%, are randomized to 150 microg/m2 G-CSF bis in die subcutaneously (from day 0 to day 4) in addition to standard care. Patients are submitted to echocardiography, Holter monitoring, gated single photon emission computed tomography (SPECT) and MRI at baseline and at 6 months of follow up. Coronary angiogram is repeated at 6 months to evaluate in-stent restenosis.
Results:
From July 2006 until August 2007, 13 consecutive patients were enrolled and 5 of them were assigned to G-CSF administration. All patients underwent PCI and stenting of left anterior descending artery. Mean baseline EF evaluated by echocardiography, SPECT and MRI was respectively 36%, 33% and 38%. No adverse events were observed during G-CSF administration. The mean white blood cells count, in the treatment arm, was 36.1 x 10(9)/L +/- 2.90 on day 5.
Conclusion:
Preliminary data of our study do not support any conclusive result. However, the characteristics of our population could allow us to distinguish the effects that revascularization and regenerative therapy have on LV function in patients with acute myocardial infarction.
