Consider The Evidence: Med/Peds Journal Roundup

February 28, 2006

G-CSF can’t stem the tide of Acute MI

Filed under: Cardiology, JAMA, myocardial infarction, stem cells — medblog @ 10:45 pm

JAMA 3/1 – Disappointing results from Zohlnhofer et al. in this weeks’ JAMA from a trial utilizing G-CSF to mobilize stem cells after acute MI (free full text avail.) Although some preliminary studies were promising, this is the first true RCT to address the subject. The researchers administered G-CSF 5 days after infarct and then followed up patients with T-99 scintigraphy, MRI, and/or angio. Although a significant increase of CD34+ cells was detected, indicating a surge of stem cells was mobilized – there was no significant difference in LVEF or infarct size at follow up. . .

The process of stem cell homing is still incompletely understood, and there is evidently a time factor involved with the expression of homing cytokines that attract the stem cells to the target area. Could it be that the stimulation needs to occur earlier or later, or for different lengths of time than studied in this experiment? Or do we need to invoke other cytokines to create the right effect? Hopefully further study on the subject will clear up these issues?

Dietlind Zohlnhofer; Ilka Ott; Julinda Mehilli; Kathrin Schomig; Fabian Michalk; Tareq Ibrahim; Gunther Meisetschlager; Jasper von Wedel; Hildegard Bollwein; Melchior Seyfarth; Josef Dirschinger; Claus Schmitt; Markus Schwaiger; Adnan Kastrati; Albert Schomig; for the REVIVAL-2 Investigators
Stem Cell Mobilization by Granulocyte Colony-Stimulating Factor in Patients With Acute Myocardial Infarction: A Randomized Controlled Trial
JAMA 2006 295: 1003-1010

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