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Medical Journal of Cairo University [The]. 2005; 73 (3): 603-609
en Inglés | IMEMR | ID: emr-73378

RESUMEN

Reports on stem cell transplantation-an innovative approach to repair damaged myocardium following acute myocardial infarction [AMI]-have raised the question of a possible spontaneous mobilization of corresponding stem cells from the bone marrow of ischemic patients. Exposed to vascular endothelial-derived growth factor [VEGF], such cells would differentiate into myocardial cells within the infarcting myocardium, thus hopefully initiating the reparative process. The present work assessed the prevalence of marrow derived stem cells expressed in term of percent of CD34 + cells in the peripheral blood of patients sustaining AMI, as well as the serum level of VEGF needed for their differentiation into cardiac myocytes. We studied 21 male patients with AMI [mean age 52.5 +/- 8.9 years]. Myocardial infarction was anterior in 10 and inferior in 11 patients. Eleven healthy males [mean age 53.9 +/- 9.4 years] served as controls. Following admission, all patients and controls were subjected to clinical examination including 12-lead ECG with routine laboratory evaluation comprising total and differential CBC, hepatic and renal functions, as well as relevant cardiac serum enzymes with the latter repeatedly measured every 8 hours to detect the highest peak of CK. Specific laboratory measurements included flowcytometric analysis of peripheral blood mononuclear cells to detect CD34 + population and serum VEGF level by ETA on admission, 3 day, and prior to discharge. Comparing the mean percent values of CD34 + cells on admission [7.02 +/- 3.08], ischemic patients exhibited insignificantly higher levels of CD34 on the 3rd day [8.57 +/- 3.5] as well as on discharge [8.45 +/- 3.5]. The above mentioned values were also insignificantly different from samples withdrawn from control subjects [8.84 +/- 3.4]. However, CD34 cell population was positively correlated with the extent of myocardial damage expressed in terms of peak CK. Thus with an arbitrary limit of >/= 30% rise in CD34, two patients subgroups could be stratified, with 12 patients having >/= 30% rise in CD 34, exhibiting a peak CK of 2498.6 IU/L, and 9 patients showing < 30% rise in CD34 presenting a peak CK of 1312.9 IU/L. However this relationship was not of statistical significance. Serum VEGF surprisingly showed a trend towards decrease rather than increase when compared to control subjects [1.23 +/- 0.99 versus 2.79 +/- 1.67 respectively, p = 0.001], with the decline maintained over the 3rd day and prior to discharge in most patients, raising the issue of increased consumption during the process of stem cell differentiation. Acute myocardial infarction apparently initiated a series of molecular and biological events whereby continued mobilization of bone marrow stem cells [expressed by continuing rise of CD34 marker] was triggered. Subsequent homing into myocardium lead to continuous consumption of VEGF needed for their differentiation into cardiac myocytes. This phenomenon could be part of a spontaneous reparative process potentially raising hopes of therapeutic applications


Asunto(s)
Humanos , Masculino , Factores de Crecimiento Endotelial , Endotelio Vascular , Células Madre , Ecocardiografía , Creatina Quinasa , Antígenos CD34/métodos , Electrocardiografía , Citometría de Flujo
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