TY - JOUR
T1 - START trial - A pilot study on STimulation of ARTeriogenesis using subcutaneous application of granulocyte-macrophage colony-stimulating factor as a new treatment for peripheral vascular disease
AU - van Royen, Niels
AU - Schirmer, Stephan H.
AU - Atasever, Bektas
AU - Behrens, Casper Y. H.
AU - Ubbink, Dirk
AU - Buschmann, Eva E.
AU - Voskuil, Michiel
AU - Bot, Pieter
AU - Hoefer, Imo
AU - Schlingemann, Reinier O.
AU - Biemond, Bart J.
AU - Tijssen, J. G.
AU - Bode, Christoph
AU - Schaper, Wolfgang
AU - Oskam, Jacques
AU - Legemate, Dink A.
AU - Piek, Jan J.
AU - Buschmann, Ivo
PY - 2005
Y1 - 2005
N2 - Background-Granulocyte-macrophage colony-stimulating factor (GM-CSF) was recently shown to increase collateral flow index in patients with coronary artery disease. Experimental models showed beneficial effects of GM-CSF on collateral artery growth in the peripheral circulation. Thus, in the present study, we evaluated the effects of GM-CSF in patients with peripheral artery disease. Methods and Results-A double-blinded, randomized, placebo-controlled study was performed in 40 patients with moderate or severe intermittent claudication. Patients were treated with placebo or subcutaneously applied GM-CSF (10 mu g/kg) for a period of 14 days (total of 7 injections). GM-CSF treatment led to a strong increase in total white blood cell count and C- reactive protein. Monocyte fraction initially increased but thereafter decreased significantly as compared with baseline. Both the placebo group and the treatment group showed a significant increase in walking distance at day 14 (placebo: 127 +/- 67 versus 184 +/- 87 meters, P=0.03, GM-CSF: 126 +/- 66 versus 189 +/- 141 meters, P=0.04) and at day 90. Change in walking time, the primary end point of the study, was not different between groups. No change in ankle-brachial index was found on GM-CSF treatment at day 14 or at day 90. Laser Doppler flowmetry measurements showed a significant decrease in microcirculatory flow reserve in the control group (P=0.03) and no change in the GM-CSF group. Conclusions-The present study does not support the use of GM-CSF for treatment of patients with moderate or severe intermittent claudication. Issues that need to be addressed are dosing, the selection of patients, and potential differences between GM-CSF effects in the coronary and the peripheral circulation
AB - Background-Granulocyte-macrophage colony-stimulating factor (GM-CSF) was recently shown to increase collateral flow index in patients with coronary artery disease. Experimental models showed beneficial effects of GM-CSF on collateral artery growth in the peripheral circulation. Thus, in the present study, we evaluated the effects of GM-CSF in patients with peripheral artery disease. Methods and Results-A double-blinded, randomized, placebo-controlled study was performed in 40 patients with moderate or severe intermittent claudication. Patients were treated with placebo or subcutaneously applied GM-CSF (10 mu g/kg) for a period of 14 days (total of 7 injections). GM-CSF treatment led to a strong increase in total white blood cell count and C- reactive protein. Monocyte fraction initially increased but thereafter decreased significantly as compared with baseline. Both the placebo group and the treatment group showed a significant increase in walking distance at day 14 (placebo: 127 +/- 67 versus 184 +/- 87 meters, P=0.03, GM-CSF: 126 +/- 66 versus 189 +/- 141 meters, P=0.04) and at day 90. Change in walking time, the primary end point of the study, was not different between groups. No change in ankle-brachial index was found on GM-CSF treatment at day 14 or at day 90. Laser Doppler flowmetry measurements showed a significant decrease in microcirculatory flow reserve in the control group (P=0.03) and no change in the GM-CSF group. Conclusions-The present study does not support the use of GM-CSF for treatment of patients with moderate or severe intermittent claudication. Issues that need to be addressed are dosing, the selection of patients, and potential differences between GM-CSF effects in the coronary and the peripheral circulation
U2 - https://doi.org/10.1161/CIRCULATIONAHA.104.529552
DO - https://doi.org/10.1161/CIRCULATIONAHA.104.529552
M3 - Article
C2 - 16087795
SN - 0009-7322
VL - 112
SP - 1040
EP - 1046
JO - Circulation
JF - Circulation
IS - 7
ER -