Abstract 11778: EPC Mobilization After Erythropoietin Treatment in Acute St-elevation Myocardial Infarction: The Reveal EPC Substudy
Aims: Erythropoietin (EPO) may mitigate reperfusion injury, in part via mobilization of endothelial progenitor cells (EPCs). The multicenter REVEAL trial demonstrated no effect of EPO on infarct size in patients when administered shortly after ST-segment elevation myocardial infarction. In a substudy, we aimed to determine the feasibility of centrally analyzing EPCs from multiple centers to assess the relationship between EPC levels, and EPO administration and infarct size. Methods: Mononuclear cells (MNCs) were locally cryopreserved and shipped to a core lab for central processing from samples obtained prior to rescue or primary percutaneous coronary intervention, as well as at 24 h and 48-72 h post-intervention, and analyzed for cells expressing CD133, CD34, and aldehyde dehydrogenase activity. Results: Sampling of EPCs was attempted in 163 of 222 enrolled patients. At least one analyzable sample was obtained in 125 patients, and all three time points were available in 83 patients. There were no statistically significant differences in EPC numbers over time or in the absolute EPC levels between EPO- and placebo-treated patients. There was a trend toward a greater increase in EPC levels from 24 h post-intervention to 48-72 h post-intervention in patients receiving ≥30 000 U of EPO (Δ = 0.11 (placebo) vs. 0.092 (EPO), p=0.05). EPC numbers at baseline were inversely related to infarct size (p=0.006, r=-0.39).
Conclusions: Local whole cell cryopreservation and central EPC analysis in the context of a multicenter randomized trial is feasible. High-dose (≥30 000 U) EPO may mobilize EPCs at 48-72 h. Baseline EPC levels are inversely associated with infarct size, suggesting that acute EPC mobilization may be a viable strategy to minimize acute injury.
- Endothelial progenitor cell
- Reperfusion injury
- Myocardial infarction, STEMI
- Infarct size
- Regenerative medicine stem cells
- © 2012 by American Heart Association, Inc.