A cohort study of circulating progenitor cells after ST-segment elevation and non-ST segment elevation myocardial
Andreas Baumbach1,2, Yu-Xin Cui1, Rebecca N Evans1,3
1Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
Insights
Myocardial infarction (MI) impacts progenitor cell migration, with type-2 diabetes altering this response. The study found that while MI severity and diabetes interact to affect CD34+/CXCR4+ cell migration, this migratory activity did not predict cardiac outcomes.
Area of Science:
- Cardiovascular Biology
- Stem Cell Research
- Diabetes Complications
Background:
- Myocardial infarction (MI) normally increases circulating progenitor cells for repair.
- Type-2 diabetes mellitus (T2DM) impairs this crucial reparative response.
- Understanding these interactions is vital for improving cardiac recovery post-MI.
Purpose of the Study:
- To investigate the interactive effects of MI severity and T2DM on the migratory function of CD34+/CXCR4+ progenitor cells.
- To determine if the in vitro migratory capacity of these cells can predict cardiac outcomes after MI.
- To analyze the influence of STEMI versus NSTEMI on progenitor cell mobilization and migration in diabetic and non-diabetic patients.
Main Methods:
- A longitudinal study involving patients with ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI), with or without T2DM.
- Quantification of peripheral blood CD34+/CXCR4+ cells via flow cytometry.
- In vitro assessment of progenitor cell migratory activity using samples from days 0 and 4 post-MI.
- Cardiac function evaluation at 3 months using cardiac MRI.
Main Results:
- STEMI and T2DM were associated with altered proportions of CD34+/CXCR4+ cells and their migratory activity.
- A significant interaction was observed: STEMI increased migration in non-diabetic patients but reduced it in diabetic patients.
- No significant correlation was found between circulating progenitor cell levels or their in vitro migration and cardiac MRI outcomes.
Conclusions:
- The study demonstrates a significant interaction between MI severity and T2DM in modulating the migratory activity of CD34+/CXCR4+ progenitor cells.
- The in vitro migratory potential of these progenitor cells did not serve as a predictor for cardiac functional outcomes in this cohort.
- These findings highlight the complex interplay between diabetes and ischemic injury on endogenous repair mechanisms.
Background:
Myocardial infarction induces elevation of progenitor cells in the circulation, a reparative response inhibited by type-2 diabetes.
Objectives:
Determine if myocardial infarct severity and diabetes interactively influence the migratory activity of CD34+/CXCR4+ progenitor cells and if the migratory test predicts cardiac outcomes.
Materials And Methods:
A longitudinal study was conducted on patients with or without diabetes with a STEMI or NSTEMI. CD34+/CXCR4+ cells were measured in the peripheral blood using flow cytometry, and migratory activity was tested in vitro on cells isolated from samples collected on days 0 and 4 post-infarct. Cardiac function was assessed at three months using cardiac MRI.
Results:
Of 1,149 patients screened, 71 (6.3%) were eligible and consented. Fifty had STEMI (16 with diabetes) and 21 NSTEMI (8 with diabetes). The proportion of CD34+/CXCR4+ cells within blood mononuclear cells was 1.96 times higher after STEMI compared with NSTEMI (GMR = 1.96, 95% CI 0.87, 4.37) and 1.55 times higher in patients with diabetes compared to patients without diabetes (GMR = 1.55, 95% CI 0.77, 3.13). In the latter, STEMI was associated with a 2.42-times higher proportion of migrated CD34 + /CXCR4 + cells compared with NSTEMI (GMR = 2.42, 95% CI 0.66, 8.81). In patients with diabetes, the association was the opposite, with a 55% reduction in the proportion of migrated CD34+/CXCR4+ cells. No statistically significant associations were observed between the frequency in peripheral blood or in vitro migration capacity of CD34+/CXCR4+ cells and MRI outcomes.
Conclusion:
We document the interaction between infarct and diabetes on the migratory activity of CD34+/CXCR4+ cells. The test did not predict functional outcomes in the studied cohort.
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