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To the Editor: We would like to raise possible reasons for the treatment failure of granulocyte colony-stimulating factor (G-CSF) in the Regenerate Vital Myocardium by Vigorous Activation of Bone Marrow Stem Cells (REVIVAL-2) trial by Dr Zohlnhöfer and colleagues¹ based on what we believe to be the mechanism of action of G-CSF in both the myocardium and the brain.

Protective effects of G-CSF in experimental acute myocardial infarction (AMI) or stroke have been shown,^2-4 but the probable mechanism of action has remained uncertain. Most studies have assumed activation and mobilization of bone marrow–derived stem cells by G-CSF that integrate into the infarcted organ and contribute to recovery by transdifferentiation or other unknown mechanisms. Based on this assumption, REVIVAL-2 was designed with a delayed treatment start (5 days after AMI), and with a G-CSF dose sufficient to stimulate bone marrow mobilization (10 µg/kg per day for 5 days).¹ However, recent evidence . . . [Full Text of this Article]

Wolf-Rüdiger Schäbitz, MD
schabitz@uni-muenster.de
Department of Neurology

Sigrid Nikol, MD
Department of Cardiology
University of Münster
Münster, Germany

Armin Schneider
Axaron Bioscience AG
Heidelberg, Germany

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