Effects of intracoronary infusion of peripheral blood stem-cells mobilised with granulocyte-colony stimulating factor on left ventricular systolic function and restenosis after coronary stenting in myocardial infarction: the MAGIC cell randomised clinical trial.
BACKGROUND
Bone-marrow stem-cell transplantation has been shown to improve cardiac function in patients with myocardial infarction. We examined the feasibility and efficacy of granulocyte-colony stimulating factor (G-CSF) therapy and subsequent intracoronary infusion of collected peripheral blood stem-cells (PBSCs) in such patients.


METHODS
We prospectively randomised 27 patients with myocardial infarction who underwent coronary stenting for the culprit lesion of infarction into three groups; cell infusion (n=10), G-CSF alone (n=10), and control group (n=7). Changes in left ventricular systolic function and perfusion were assessed after 6 months. By December, 2003, seven patients from the cell infusion group, three from the G-CSF group, and one from the control group had been assessed.


RESULTS
G-CSF injection and intracoronary infusion of the mobilised PBSC did not aggravate inflammation and ischaemia during the periprocedural period. Exercise capacity (mean treadmill exercise time: 450 s [SD 178] at baseline vs 578 s [168] at 6 months' follow-up, p=0.004), myocardial perfusion (perfusion defect 11.6% [9.6] vs 5.3% [5.0], p=0.020) and systolic function (left ventricular ejection fraction 48.7% [8.3] vs 55.1% [7.4], p=0.005) improved significantly in patients who received cell infusion. However, we noted an unexpectedly high rate of in-stent restenosis at culprit lesion in patients who received G-CSF, and therefore we stopped enrollment.


CONCLUSIONS
G-CSF therapy with intracoronary infusion of PBSC showed improved cardiac function, and promoted angiogenesis in patients with myocardial infarction. However, aggravation of restenosis could be a serious problem. In future studies with G-CSF based stem-cell therapy, patients should be carefully monitored for unexpected effects.
Kang
Hyun-Jae
HJ
Cardiovascular Laboratory, Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
Kim
Hyo-Soo
HS
Zhang
Shu-Ying
SY
Park
Kyung-Woo
KW
Cho
Hyun-Jai
HJ
Koo
Bon-Kwon
BK
Kim
Yong-Jin
YJ
Soo Lee
Dong
D
Sohn
Dae-Won
DW
Han
Kyou-Sup
KS
Oh
Byung-Hee
BH
Lee
Myoung-Mook
MM
Park
Young-Bae
YB
D001158:Arteries / Q000601:surgery; D003131:Combined Modality Therapy; D023903:Coronary Restenosis / Q000209:etiology*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery* / Q000628:therapy*; D018919:Neovascularization, Physiologic / Q000502:physiology; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
D016179:Granulocyte Colony-Stimulating Factor