title: Tight glycemic control may increase regenerative potential of myocardium during acute infarction.
abstract: OBJECTIVE
  We analyzed the effects of tight glycemic control on regenerative potential of myocardium during acute myocardial infarction.
  
  
  METHODS
  Seventy-five patients with their first acute myocardial infarction undergoing coronary bypass surgery were studied: 25 patients with glycemia below 140 mg/dl served as the control group; hyperglycemic patients (glucose>140 mg/dl) were randomized to intensive glycemic control (IGC; n=20; glucose goal, 80-140 mg/dl), conventional glycemic control (CGC; n=20; glucose goal, 180-200 mg/dl), or glucose-insulin-potassium (GIK; n=10; glucose goal, 180-200 mg/dl) for almost 3 d before surgery, using insulin infusion followed by sc insulin treatment. During surgery, myocyte precursor cells (MPC) (c-kit/MEFC2/GATA4-positive cells), oxidation of MPC DNA (c-kit/8-hydroxydeoxyguanosine-positive cells), senescent MPC (c-kit/p16INK4a-positive cells), and cycling cardiomyocytes (Ki-67-positive cells) were analyzed in biopsy specimens taken from the peri-infarcted area.
  
  
  CONCLUSIONS
  Before surgery, plasma glucose reduction was greater in the IGC group than in the CGC and GIK groups (P<0.001 for both). IGC patients had higher MPC (P<0.01) and cycling myocytes (P<0.01), as well as less oxidized (P<0.01) and senescent MPC (P<0.01) in peri-infarcted specimens compared with both CGC and GIK patients. Tight glycemic control, by reducing senescent MPC, may increase regenerative potential of the ischemic myocardium.
authors.affiliation: Department of Geriatrics and Metabolic Diseases, Second University of Naples, Piazza Miraglia, 2, 80138 Naples, Italy. raffaele.marfella@unina2.it
authors.forename: Raffaele
authors.initials: R
authors.lastname: Marfella
authors.forename: Ferdinando Carlo
authors.initials: FC
authors.lastname: Sasso
authors.forename: Federico
authors.initials: F
authors.lastname: Cacciapuoti
authors.forename: Michele
authors.initials: M
authors.lastname: Portoghese
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Rizzo
authors.forename: Mario
authors.initials: M
authors.lastname: Siniscalchi
authors.forename: Ornella
authors.initials: O
authors.lastname: Carbonara
authors.forename: Franca
authors.initials: F
authors.lastname: Ferraraccio
authors.forename: Michele
authors.initials: M
authors.lastname: Torella
authors.forename: Antonello
authors.initials: A
authors.lastname: Petrella
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Balestrieri
authors.forename: Paola
authors.initials: P
authors.lastname: Stiuso
authors.forename: Giannantonio
authors.initials: G
authors.lastname: Nappi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Paolisso
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery; D009206:Myocardium / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin