Aims: Recent data have demonstrated the feasibility of therapeutic induction of coronary collateral growth
(arteriogenesis); however, mechanisms of action of such therapeutic collateral stimulation in humans are unknown. The
aim of this study was to evaluate potential mechanisms, especially the involvement of arteriogenesis-relevant genes.
Methods and Results: A total of 52 patients were randomized into two groups: subcutaneous G-CSF (10μg/kg; n=26) or
placebo (n=26). Before and after this 2-week treatment, collateral-flow index (CFI) was determined by simultaneous
measurement of mean aortic, distal coronary occlusive and central venous pressure. CD34+ endothelial progenitor cells
(EPC) and monocytes were quantified before, during and after treatment; gene-expression analysis of monocytes was performed
with real-time polymerase chain reaction (RT-PCR). G-CSF lead to a significant increase of EPC and monocytes
(4.8 and 2.6 fold, p<0.05); for both cell types, the extent of increase correlated with CFI increase (r=0.23 and 0.14,
p<0.05). G-CSF also induced a change in gene expression of pro-and anti-arteriogenic genes in monocytes. Among nine
assessed genes, three were found to be differentially regulated (IL8, JAK2, and PNPLa4; p<0.05). Conclusions: The
mechanism of induction of collateral growth by G-CSF is related to an increase of EPC and of peripheral monocytes.
It also leads to a change toward a pro-arteriogenic gene expression in peripheral monocytes.
Keywords: Arteriogenesis, collateral circulation, granulocyte-colony stimulating factor, endothelial progenitor cells, monocytes, gene expression
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