Stem Cell Migratory Activity: Prognostic Marker in Myocardial Ischemia

MAIN OBJECTIVES OF THE STUDY:

Characterization of circulating CD133+ stem cells in a group of 170 patients with MI (mean post-MI follow up, 6 months):

• Counting total mononuclear cells and FACS analysis of CD133 stem cells.
• Characterization of CD133+ stem cell biology: Migratory assay, imaging of cytoskeleton, angiogenesis tests in vitro.
• Evaluation of migratory signalling, with specific focus on the PI3K/Akt/eNOS system.

Assessment of the prognostic value of the stem cell migration assay.

• Relationship between cell biology tests on CD133+ cells and changes in circulating cytokines and pro-angiogenic factors after MI.
• Assessment of area at risk by ECG-synchronized Single Photon Emission Computed Tomography (gated-SPECT) in subgroups with different patterns of stem cell migratory tests.
• Assessment of ventricular remodelling (echocardiography, NMR) in relation with patterns of stem cell migratory test.

EXPECTED RESULTS:

Clarification of the implication of stem cell migratory deficit in post-ischemic HF.

• Identification of underlying mechanisms
• Identification of a cellular marker for prediction of patients at risk of HF.

RELEVANCE TO PUBLIC HEALTH:

• Introduction of a biological test for the early diagnosis of post-MI HF
• Recognition of therapeutic targets for the rescue of stem cell migratory liabilities

Inclusion criteria

• Age >= 18 years
• Thoracic pain lasting at least 20 min and ST changes or left B block, not present in previous ECG.
• MI confirmed by elevation of troponin I and CK-MB.
• Patients with Killip II e III LV dysfunction will be included.

Exclusion criteria

• Patients reporting thoracic pain 24 hours prior to hospitalization
• HF symptoms resistant to therapy
• Haemoglobin< 10 gr/dl
• Haemodynamic instability (systolic pressure <90 mmHg after treatment)
• Alterations in haematopoiesys
• Concurrent neoplastic disease
• No written informed consent or other conditions that affect patient's compliance to protocol.