Key result
STEMI was associated with a non-significant 1.96-times higher proportion of CD34+/CXCR4+ cells compared with NSTEMI, while diabetes reversed the effect of infarct severity on progenitor cell migratory activity.
Why the study?
To determine whether myocardial infarct severity and diabetes interactively influence CD34+/CXCR4+ progenitor cell migratory activity and whether this migratory test predicts cardiac outcomes.
Cohort (n=71)
No
Diabetes reverses the normal increase in migratory activity of CD34+/CXCR4+ progenitor cells seen after STEMI compared to NSTEMI, though this did not predict 3-month functional MRI outcomes.
Answers are grounded in this paper and cite their sources.
Diabetes blunting of progenitor migration post-STEMI should not change practice; leaves open mechanistic and prognostic implications for regenerative strategies.
Background Myocardial infarction induces elevation of progenitor cells in the circulation, a reparative response inhibited by type-2 diabetes. Objectives Determine if myocardial infarct severity and diabetes interactively influence the migratory activity of CD34+/CXCR4+ progenitor cells and if the migratory test predicts cardiac outcomes. Materials and methods A longitudinal study was conducted on patients with or without diabetes with a STEMI or NSTEMI. CD34+/CXCR4+ cells were measured in the peripheral blood using flow cytometry, and migratory activity was tested in vitro on cells isolated from samples collected on days 0 and 4 post-infarct. Cardiac function was assessed at three months using cardiac MRI. Results Of 1,149 patients screened, 71 (6.3%) were eligible and consented. Fifty had STEMI (16 with diabetes) and 21 NSTEMI (8 with diabetes). The proportion of CD34+/CXCR4+ cells within blood mononuclear cells was 1.96 times higher after STEMI compared with NSTEMI (GMR = 1.96, 95% CI 0.87, 4.37) and 1.55 times higher in patients with diabetes compared to patients without diabetes (GMR = 1.55, 95% CI 0.77, 3.13). In the latter, STEMI was associated with a 2.42-times higher proportion of migrated CD34 + /CXCR4 + cells compared with NSTEMI (GMR = 2.42, 95% CI 0.66, 8.81). In patients with diabetes, the association was the opposite, with a 55% reduction in the proportion of migrated CD34+/CXCR4+ cells. No statistically significant associations were observed between the frequency in peripheral blood or in vitro migration capacity of CD34+/CXCR4+ cells and MRI outcomes. Conclusion We document the interaction between infarct and diabetes on the migratory activity of CD34+/CXCR4+ cells. The test did not predict functional outcomes in the studied cohort.
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Baumbach et al. (2022) conducted a cohort in Myocardial Infarction (STEMI or NSTEMI) (n=71). STEMI vs. NSTEMI was evaluated on Proportion of CD34+/CXCR4+ cells within blood mononuclear cells (GMR 1.96, 95% CI 0.87-4.37). STEMI was associated with a non-significant 1.96-times higher proportion of CD34+/CXCR4+ cells compared with NSTEMI, while diabetes reversed the effect of infarct severity on progenitor cell migratory activity.
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