Author/Editor     Vrtovec, Bojan; Sever, Matjaž; Jensterle Sever, Mojca; Poglajen, Gregor; Janež, Andrej; Kravos, Nika Aleksandra; Zemljič, Gregor; Cukjati, Marko; Černelč, Peter; Haddad, François; Wu, Joseph C.; Jorde, Ulrich P.
Title     Efficacy of CD34[sup]+ stem cell therapy in nonischemic dilated cardiomyopathy is absent in patients with diabetes but preserved in patients with insulin resistance
Type     članek
Publication year     2016
ISSN     2157-6580 - Stem cells translational medicine
Language     eng
Abstract     We evaluated the association of diabetes and insulin resistance with the response to cell therapy in patients with nonischemic dilated cardiomyopathy (DCM). A total of 45 outpatients with DCM received granulocyte colony-stimulating factor for 5 days. CD34[sup]+ cells were then collected by apheresis and injected transendocardially. Twelve patients had diabetes mellitus (DM group), 17 had insulin resistance (IR group), and 16 displayed normal glucose metabolism (no-IR group). After stimulation, we found higher numbers of CD34[sup]+ cells in the IR group (94+-73x10[sup]6 cells per liter) than in the no-IR group (54 +- 35 x 10[sup]6 cells per liter) or DM group (31 +- 20 x 10[sup]6 cells per liter; p = .005). Similarly, apheresis yielded the highest numbers of CD34[sup]+ cells in the IR group (IR group, 216+-110x10[sup]6 cells; no-IR group, 127+-82x10[sup]6 cells; DMgroup, 77+-83x10[sup]6 cells; p = .002). Six months after cell therapy, we found an increase in left ventricular ejection fraction in the IR group (+5.6%+-6.9%) and the no-IR group (+4.4% + 7.2%) but not in the DM group (-0.9% +- 5.4%; p = .035). The N-terminal probrain natriuretic peptide levels decreased in the IR and no-IR groups, but not in the DMgroup (-606+- 850 pg/ml; -698 +- 1,105 pg/ml; and +238 +- 963 pg/ml, respectively; p = .034). Transendocardial CD34+ cell therapy appears to be ineffective in DCM patients with diabetes. IR was associated with improved CD34+ stem cell mobilization and a preserved clinical response to cell therapy.
Keywords     sladkorna bolezen
odpornost na insulin
zdravljenje z matičnimi celicami
diabetes
insulin resistence
stem cell therapy