Efficacy of CD34+ Stem Cell Therapy in Nonischemic Dilated Cardiomyopathy Is Absent in Patients With Diabetes but Preserved in Patients With Insulin Resistance

Abstract

© AlphaMed Press 2016. We evaluated the association of diabetes and insulin resistance with the response to cell therapy in patients with nonischemic dilated cardiomyopathy (DCM). A total of 45 outpatients with DCM received granulocyte colony-stimulating factor for 5 days. CD34 + cells were then collected by apheresis and injected transendocardially. Twelve patients had diabetes mellitus (DM group), 17 had insulin resistance (IR group), and 16 displayed normal glucose metabolism (no-IR group). After stimulation, we found higher numbers of CD34 + cells in the IR group (94 ± 73×10 6 cells per liter) than in the no-IR group (54 ± 35 × 10 6 cells per liter) or DM group (31 ± 20 × 10 6 cells per liter; p =.005). Similarly, apheresis yielded the highest numbers of CD34 + cells in the IR group (IR group, 21661103106 cells; no-IR group, 127 ± 82 × 10 6 cells;DMgroup, 77 ± 83×10 6 cells; p =.002). Six months after cell therapy, we found an increase in left ventricular ejection fraction in the IR group (+5.6%66.9%) and the no-IR group (+4.4% 6 7.2%) but not in the DM group (20.9% 6 5.4%; p =.035). The N-terminal probrain natriuretic peptide levels decreased in the IR and no-IR groups, but not in theDMgroup (-606 ± 850 pg/ml; -698 ± 1,105 pg/ml; and +238 ± 963 pg/ml, respectively; p =.034). Transendocardial CD34 + cell therapy appears to be ineffective in DCM patients with diabetes. IR was associated with improved CD34 + stem cell mobilization and a preserved clinical response to cell therapy.