Stem Cell Migratory Activity: Prognostic Marker in Myocardial Ischemia

Study Overview
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Brief Summary
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The present project aims to determine whether a deficit in migration of stem cells could be implicated in the failure to mount an adequate collateralization after Myocardial Infarction (MI) and thereby facilitate the development of post-ischemic heart failure (HF) and to dissect underlying molecular mechanisms. Furthermore, the investigators wish to determine the predictive value of stem cell migration assay in patients with MI.

Detailed Description
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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

Official Title
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Migratory and Angiogenic Dysfunction of Circulating CD133 Stem Cells: a New Prognostic Marker in Myocardial Ischemia.

Conditions
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Myocardial Infarction

Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Acute Myocardial Infarction patients<br>Patients with thoracic pain lasting at least 20 min and ST changes or left B block, not present in previous ECG. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prognostic value of CD133+ stem cells in MI | Correlation of clinical parameters of disease evolution and biological features | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation of disease evolution and other biomarkers |  | 12 months |