Despite their names, the cytokines granulocyte- and granulocyte-macrophage-colony stimulating factor (G-CSF and GM-CSF respectively) have actions far beyond simply stimulating the proliferation of neutrophil and monocyte lineage cells. A comprehensive body of evidence now exists demonstrating that G-CSF and GM-CSF effectively mobilize bone-marrow-derived progenitor cells into the peripheral circulation. These mobilized progenitor cells can be conveniently harvested for use in reconstituting bone marrow by transplantation after myelo-ablative treatment of hematological malignancies. In addition, much evidence has recently emerged to suggest that these cytokines may have multiple direct and indirect beneficial cardiovascular effects--including neovascularization of ischemic myocardium and reducing the extent of myocardial damage after infarction. Based on this knowledge and a strong safety record in hematological applications, a number of early clinical trials have evaluated the use of G-CSF or GM-CSF in patients with both acute and chronic myocardial ischemia. Although the interpretation of these trials is complicated by heterogeneity in study design, small patient numbers and methodological concerns related to appropriate selection and blinding of patients, the results of ongoing larger phase II/III trials should soon be available to determine if these agents will be useful additions to the cardiovascular armamentarium.

译文

尽管它们的名字,细胞因子粒细胞和粒细胞巨噬细胞集落刺激因子 (分别为g-csf和gm-csf) 的作用远远超出了简单地刺激中性粒细胞和单核细胞谱系细胞的增殖。目前存在大量证据,表明g-csf和gm-csf有效地将骨髓来源的祖细胞动员到外周循环中。这些动员的祖细胞可以方便地收集,用于在骨髓消融治疗血液系统恶性肿瘤后通过移植重建骨髓。此外,最近出现了许多证据,表明这些细胞因子可能具有多种直接和间接的有益心血管作用-包括缺血心肌的新血管形成和减少梗塞后心肌损伤的程度。基于这些知识和血液学应用中的强大安全性记录,许多早期临床试验已经评估了g-csf或gm-csf在急性和慢性心肌缺血患者中的使用。尽管这些试验的解释因研究设计的异质性,患者人数少以及与患者的适当选择和盲法相关的方法学问题而变得复杂,但正在进行的大型II/III期试验的结果应很快可用,以确定这些药物是否将成为心血管武器库的有用补充。

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