Ruolo del G-CSF e GM-CSF nel trattamento dell'infarto miocardico acuto e dell'ischemia critica degli arti inferiori

In spite of novel pharmacological and reperfusion strategies, many patients with acute myocardial infarction (AMI) and critical limb ischemia (CLI) due to peripheral arterial disease (PAD) have an unfavorable prognosis. Recent studies suggest that bone marrow cell mobilization with granulocyte colony-stimulating factor (GCSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) may have a beneficial effect in AMI and CLI, likely due to endothelial progenitor cell-mediated angiogenesis and enhanced blood flow to the ischemic tissues. However, controversy still exists because published studies evaluated the effect of bone marrow cell mobilization in different patient populations, timing for drug administration in relationship to the acute event and to the reperfusion procedure differed, clinical endpoints and the techniques used for assessing cardiac function and volumes were not the same. Nevertheless, these small clinical studies provided useful information that helped design large phase III clinical trials and, ultimately, will establish whether bone marrow cell mobilization can have a role in AMI and CLI treatment.