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2011, Number 2

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Acta Med 2011; 9 (2)

Transplantation of autologous mononuclear bone marrow stem cells in patients with advanced limb ischemia

Padilla L, Rodríguez-Trejo J, Escotto I, De Diego J, Rodríguez N, Tapia J, Landero T, Carranza PH, Lecuona N, Olguín H, Marmolejo M, Di Silvio LM

Language: Spanish
References: 17
Page: 57-62
PDF size: 267.79 Kb.


ABSTRACT

Objectives: To compare between bone marrow progenitor mononuclear cell (MNC) transplant applied via intramuscular and distal retrograde intravenous (saphenous vein), and intramuscular injection, in patients with severe ischemia of lower extremity. Material and methods: 20 lower extremities in 14 patients with severe ischemia (Fontaine II-b, Rutherford 3) Group 1 (IM): 10 extremities with MNC applied via intramuscular, and Group 2 (IM+IV): 10 extremities with MNC transplant applied via intramuscular and distal retrograde intravenous (saphenous vein). Cellular harvest was enriched with granulocyte-colony stimulating factor (G-CSF) for 5 days (5 µg s.c.). Total cell transplant count was 15.3 x 108 ± 5.6 x 108 CD 34+. Results: Mean treatment follow-up was 23 months; Group 1: 1 extremity amputation was necessary. In the rest, distal pain disappeared for 62-350 m, ankle/arm index was 0.42 to 0.68, and measure of perfusion by Doppler Laser was 7.14 to 225.31. Group 2: No amputations were necessary, pain distance ranged from 57-450 m, ankle/arm index ranged from 0.38 to 0.65 and perfusion went from 6.64 to 299.2. Conclusions: Both IM and IM+IV MNC transplant result in effective neo-vascularization, preventing amputation and resulting in better clinical parameters. No statistical significance in results was found between both procedures.


REFERENCES

  1. Dormandy JP, Rutherford RB. Transatlantic interconsensus (tasc) management of peripheral arterial disease. J Vasc Surg 2000; 31: S1-S278.

  2. Franz R, Parks A et al. Use of autologus bone marrow mononuclear cell implantation therapy as a limb salvage procedure in patients with severe peripheral arterial disease. J Vasc Surg 2009; 50: 1378-1390.

  3. Aranguren XL, Verfaillie CM, Lettun A. Emerging hurdles in stem cell therapy for peripheral vascular disease. J Mol Med 2009; 87: 3-16.

  4. Tateishi-Yuyama E, Matsubara H, Murohara T et al. Therapeutic angiogenesis for patients with limb ischemia by autologus transplantation of bone marrow cells: a pilot study and randomized controlled trial. Lancet 2002; 360: 427-425.

  5. Yang X, Wu Y, Wang H et al. Transplantation of mobilized peripheral blood mononuclear cells of peripheral arterial occlusive disease of the lower extremity. J Ger Car 2006; 3: 181-3.

  6. Shiba Y, Takahashi M, Ikeda U. Models for the study of angiogenesis. Curr Pharmac Design 2008; 14: 371-7.

  7. Durdu S, Akar AR, Arat M, Sancak T, Eren NT, Ozyurda U. Autologous bone marrow mononuclear cell implantation for patients with Rutherford grade II-III thromboangiitis obliterans. J Vasc Surg 2006; 44: 732-9.

  8. Sprengers RW, Moll F, Teraa M et al. Rationale and designing of the JUVENTAS trial for repeated intra-arterial infusion of autologus bone marrow-derived mononuclear cells in patients with critical limb ischemia. J Vasc Surg 2010; 51: 1564-8.

  9. Bartch T, Brehm M et al. Transplantation of autologus mononuclear bone marrow stem cells in patients with peripheral arterial disease (The TAM-PAD study). Clin Res Cardiol 2007; 96: 819-899.

  10. Van Tongeren R, Hamming J et al. Intramuscular or combined intramuscular/intra-arterial administration of bone marrow mononuclear cells: a clinical trail in patients with advanced limb ischemia. J Cardiovasc Surg 2008; 49: 51-8.

  11. Padilla SL, Krötzsch E, Schalch P et al. Administration of bone marrow cells into surgically induced fibrocollagenous tunnels induces angiogenesis. In ischemic rat hind limb model. Microsurgery 2003; 23: 568-574.

  12. Padilla SL, Krötzsch E, Rodríguez J, Escotto I, Villegas F, Di Silvio M. Bone marrow mononuclear cells stimulate angiogenesis when transplanted into surgically induced fibrocollagenous tunnels: Results from a canine ischemic hind limb model. Microsurgery 2007; 27: 91-97.

  13. Yeh Y, Cummins H. Localized fluid flows measurements with a He-Ne laser spectrometer. Appl Phys Lett 1964; 4: 176-178.

  14. Kvernebo K, Slagsvold CE et al. Laser Doppler flowmetry in evaluation of lower limb resting skin circulation. A study in healthy controls and atherosclerotic patients. Scandinavian Journal of Clinical & Laboratory Investigation 1988; 48(7): 621-626.

  15. Padilla SL, Rodríguez TJ, Escotto SI, De Diego FJ, Rodríguez RN et al. Trasplante de células mononucleares progenitoras derivadas de médula ósea por vía endovenosa retrógrada distal para inducir angiogénesis en miembros inferiores con isquemia. Cir Gen 2009; 31: 213-218.

  16. Tepper OM, Capla JM, Galiano RD, Callaghan MJ. Adult vasculogenesis occurs through in situ recruitment, proliferation, and tubulization of circulating bone marrow-derived cells. Blood 2009; 105: 1068-1077.

  17. Lawall H, Bramage P, Amann B. Stem cell and progenitor cell therapy in peripheral artery disease. Thromb Haemost 2010; 103: 696-709.




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