Treatment of acute cerebral infarction with subcutaneous injection of granulocyte colony-stimulating factor: efficacy, safety and impact on blood perfusion in the infarcted area

Background: Several study showed that granulocyte colony-stimulating factor (G-CSF) may improve prognosis of patients with cerebral infarction (CI), but information is limited concerning dosing regimen, timing of administration and safety. Objective: To explore the efficacy, safety, and impact on cerebral blood perfusion of G-CSF in the treatment of CI. Methods: This was a prospective, randomized, open study of 82 patients within 7 days postCI with infarct sizes >15 mL, randomized to either G-CSF (n=40) or control (n=42) groups. Both groups received standardized therapy; the G-CSF group also received subcutaneous G-CSF injections (twice daily, 300 μg each) for 5 days. CD34+ cell number, routine blood tests, and coagulation, liver and kidney function were monitored daily in the G-CSF group during the 5-day administration period and subsequent 3 days. All patients were assessed by the National Institute of Health Stroke Scale (NIHSS) and Barthel Index (BI) at enrollment and at the end of 1, 2 and 3 months. Cerebral CT perfusion was performed before and 3 months after treatment. Results: CD34+ cell counts in the G-CSF group peaked on day 6 (22.43 ± 4.44/μL), 16 times higher than baseline values (1.48 ± 0.45/μL). After 3 months, NIHSS score was significantly lower in the G-CSF group (5.50 ± 0.63) than in the control group (6.56 ± 0.81, P<0.01). The degree of disability (BI) did not differ significantly between the two groups. Cerebral blood volume and flow in the infarcted area were significantly increased after 3 months in all patients, particularly in the G-CSF group (P<0.05). Axillary vein thrombosis and acute myocardial infarction occurred in one patient in the G-CSF group, but no sequelae remained after treatment. Conclusion: Subcutaneous G-CSF injections are safe in patients less than 7 days post-CI with infarct sizes >15 mL, and at 3 months can improve neurological dysfunction and perfusion of the infarcted area, but not the degree of disability.