Abstract
Granulocyte-colony-stimulating factor (G-CSF) seems to have direct cardioprotective effects related to mobilization of autologous bone-marrow mononuclear CD34+ cells. These properties have attracted the attention of researchers investigating new therapeutic strategies for acute myocardial infarction. The role of G-CSF in bone-marrow cell mobilization removes the need for bone-marrow aspiration and repeated invasive procedures. This factor, coupled with the fact that G-CSF can be administered by noninvasive subcutaneous injection, give this approach a potential advantage over other cell-therapy options. This article is intended to present a concise overview of the current experimental and clinical findings for G-CSF therapy after acute myocardial infarction. In particular, we discuss the conflicting findings from the front-integrated revascularization and stem cell liberation in evolving acute myocardial infarction (FIRSTLINE-AMI) and the Regenerate Vital Myocardium by Vigorous Activation of Bone Marrow Stem Cells (REVIVAL-2) studies.
Key Points
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Granulocyte-colony-stimulating factor (G-CSF) seems to have direct cardioprotective effects
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This growth factor can be administered by subcutaneous injection without the need for bone-marrow aspiration, manipulation of stem cells in culture, or repeated invasive procedures
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Potential beneficial effects of G-CSF therapy after AMI reported in the FIRSTLINE-AMI study have been challenged by the REVIVAL-2 study, but the two studies had important differences in design
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An adequately powered, double-blind, randomized, multicenter study is required, without a time delay between percutaneous coronary intervention and G-CSF application
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Firm prognostic conclusions about G-CSF therapy after percutaneous coronary intervention for ST-segment elevation myocardial infarction cannot yet be drawn
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Ince, H., Nienaber, C. Granulocyte-colony-stimulating factor in acute myocardial infarction: future perspectives after FIRSTLINE-AMI and REVIVAL-2. Nat Rev Cardiol 4 (Suppl 1), S114–S118 (2007). https://doi.org/10.1038/ncpcardio0731
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DOI: https://doi.org/10.1038/ncpcardio0731
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