Angiographic Demonstration of Neoangiogenesis After Intra-arterial Infusion of Autologous Bone Marrow Mononuclear Cells in Diabetic Patients With Critical Limb Ischemia

被引:60
作者
Ruiz-Salmeron, Rafael [3 ]
de la Cuesta-Diaz, Antonio [3 ]
Constantino-Bermejo, Manuel [3 ]
Perez-Camacho, Immaculada [3 ]
Marcos-Sanchez, Francisco [3 ]
Hmadcha, Abdelkrim [1 ,2 ]
Soria, Bernat [1 ,2 ]
机构
[1] Ctr Andaluz Biol Mol & Med Regenerativa CABIMER, Seville 41092, Spain
[2] CIBER Diabet & Enfermedades Metab Asociadas CIBER, Barcelona, Spain
[3] Hosp Univ San Lazaro & Virgen Macarena, Seville, Spain
关键词
Bone marrow-derived mononuclear cells (BMMNCs); Peripheral artery disease (PAD); Critical limb ischemia (CLI); Ankle-brachial index (ABI); Digital subtraction angiography (DSA); Below the knee; ENDOTHELIAL PROGENITOR CELLS; PERIPHERAL ARTERIAL-DISEASE; STEM-CELL; THERAPEUTIC ANGIOGENESIS; VASCULAR COMPLICATIONS; LOWER-EXTREMITY; TRANSPLANTATION; IMPLANTATION; ASSOCIATION; MANAGEMENT;
D O I
10.3727/096368910X0177
中图分类号
Q813 [细胞工程];
学科分类号
摘要
Critical limb ischemia in diabetic patients is associated with high rates of morbidity and mortality. Suboptimal responses to the available medical and surgical treatments are common in these patients, who also demonstrate limited vascular homeostasis. Neovasculogenesis induced by stem cell therapy could be a useful approach for these patients. Neovasculogenesis and clinical improvement were compared at baseline and at 3 and 12 months after autologous bone marrow-derived mononuclear cell (BMMNC) transplantation in diabetic patients with peripheral artery disease. We conducted a prospective study to evaluate the safety and efficacy of intra-arterial administration of autologous BMMNCs (100-400 x 106 cells) in 20 diabetic patients with severe below-the-knee arterial ischemia. Although the time course of clinical effects differed among patients. after 12 months of follow-up all patients presented a notable improvement in the Rutherford-Becker classification, the University of Texas diabetic wound scales, and the Ankle-Brachial Index in the target limb. The clinical outcome was consistent with neovasculogenesis, which was assessed at 3 months by digital subtraction angiography and quantified by Meta Morph software. Unfortunately, local cell therapy in the target limb had no beneficial effect on the high mortality rate in these patients. In diabetic patients with critical limb ischemia, intra-arterial perfusion of BMMNCs is a safe procedure that generates a significant increase in the vascular network in ischemic areas and promotes remarkable clinical improvement.
引用
收藏
页码:1629 / 1639
页数:11
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