Differential Effect of Intracoronary Infusion of Mobilized Peripheral Blood Stem Cells by Granulocyte Colony–Stimulating Factor on Left Ventricular Function and Remodeling in Patients With Acute Myocardial Infarction Versus Old Myocardial Infarction

Abstract

Background-The efficacy of intracoronary infusion of granulocyte colony-stimulating factor (G-CSF) mobilized peripheral blood stem cells (PBSCs) has not been compared between patients with acute (AMI) versus old myocardial infarction (OMI). In addition, the potential risk of restenosis associated with G-CSF-based stem cell therapy has not been evaluated in the setting of drug eluting stent (DES) implantation. Methods and Results-We randomly allocated 96 patients with myocardial infarction who underwent coronary revascularization with DES for the culprit lesion into 4 groups. Eighty-two patients completed 6-month follow-up; AMI cell infusion (nϭ25), AMI control (nϭ25), OMI cell infusion (nϭ16), and OMI control group (nϭ16). In cell infusion groups, PBSCs were mobilized by G-CSF for 3 days and delivered to infarcted myocardium via intracoronary infusion. The AMI cell infusion group showed a significant additive improvement in left ventricular ejection fraction (LVEF) and remodeling compared with controls (change of LVEF: ϩ5.1Ϯ9.1% versus Ϫ0.2Ϯ8.6%, PϽ0.05; change of end-systolic volume: Ϫ5.4Ϯ17.0 mL versus 6.5Ϯ21.9 mL, PϽ0.05). In OMI patients, however, there was no significant change of LVEF and ventricular remodeling in spite of significant improvement of coronary flow reserve after cell infusion. G-CSF-based cell therapy did not aggravate neointimal growth with DES implantation. Conclusions-Intracoronary infusion of mobilized PBSCs with G-CSF improves LVEF and remodeling in patients withAMI but is less definite in patients with OMI. G-CSF-based stem cell therapy with DES implantation is both feasible and safe, eliminating any potential for restenosis.

Effects of Stem Cell Therapy on Left Ventricular Remodeling After Acute Myocardial Infarction: A Meta‐Analysis

“…Myocardial infarction leads to the loss of cardiomyocytes, followed by pathological LV remodeling and progression Jin-Ho Choi [30] Huikuri HV [29] Meluzin J(Low) [28] Meluzin J(Hi) [28] MAGIC Cell-3-DES [27] Janssens S [25] BOOST (18) [24] BOOST(6) [24] Li Zhan-quan [23] REPAIR-AMI [21] Study ID Figure 3. Effects of stem cell therapy compared with standard treatment on changes in LVESV in post-AMI patients.…”

“…No heterogeneity for this outcome was found (heterogeneity test: I 2 = 29.8%, P = 0.162). ASTAMI [22] li Zhan-quan [23] BOOST(6) [24] BOOST (18) MAGIC Cell-3-DES [27] Meluzin J(Hi) [28] Meluzin J(Low) [28] Huikuri HV [29] Jin-Ho Choi [30] José Suárez [31] −58 58 0 Overall (I-Squared = 1.1%, p = 0.435) Subgroup analysis by RCT/non-RCT was performed to investigate whether this feature of study design would influence the effectiveness of cell therapy. No significant differences in effect size between RCT and non-RCT studies were found (test of heterogeneity between groups: for LVEDV, P = 0.445; for LVESV, P = 0.794; Table 2).…”

From bench to bedside, work in cell-based myocardial regeneration therapy

“…The first randomized, double blind, and placebo-controlled study on CPC transplantation demonstrated an improvement in coronary flow reserve, decline in the number of hibernating segments, and an increase in LVEF at 3 months after transplantation, indicating that CPC transplantation was effective for OMI patients [62]. Contrary to this finding, The MAGIC cell-3DES randomized and controlled trial revealed that, although CPC transplantation had a positive impact on cardiac performance in AMI patients, it had no effect on OMI patients [63]. Assumus et al supported these results in his paper [49].…”

Randomized Clinical Trials in Stem Cell Therapy for the Heart - Old and New Types of Cells for Cardiovascular Repair

“…Then the investigators changed the design and used drug-eluting stents. In the MAGIC 3-DES trial, positive results in terms of LVEF were found after mobilization and intracoronary injection of isolated cells (Kang et al, 2006). Table 2.…”