Bone Marrow Stem Cell Treatment for Critical Limb Ischemia John (Jeb) Hallett The first U.S. Food and Drug Administration (FDA)–approved randomized clinical trials for saving lower limbs by the patient’s own bone marrow stem cell transplants have been under way since 2007. The initial results are encouraging and provide promise that this form of cell therapy could play a future role in managing advanced peripheral arterial occlusive disease. Aggressive endovascular therapy with angioplasty and stenting and open surgical approaches with distal vein grafting have reduced the amputation rates in many communities. However, approximately 30% of patients with peripheral artery disease exhaust these options and face amputation if nothing more can be done to improve peripheral perfusion. The transplantation of the patient’s own mononuclear stem cells (e.g., CD34 cells) from iliac crest bone marrow appears to be another important new option for limb salvage. In fact, bone marrow transplants, a relatively easy technical procedure, may become the first option in treating patients with early critical limb ischemia (CLI). Cell Biology of Vasculogenesis Bone marrow contains progenitor CD34 cells that can migrate to ischemic tissue to form new blood vessels. These progenitor cells adhere to ischemic endothelium and then migrate into the local environ to cause vasculogenesis. The biology of this complicated process has been studied extensively in the laboratory and is now the basis for human clinical trials. Pioneering Work In Japan and Germany, pioneering clinical trials of autologous bone marrow transplants for critical limb ischemia have been ongoing since the turn of the century. Tateishei (Japan) reported diabetic patients randomized to the injection of either bone marrow concentrates of progenitor cells versus peripheral blood containing circulating progenitor cells. He identified improved ankle pressures, improved transcutaneous oxygen levels, and less wound pain in 70% of patients who received the bone marrow concentrates. Three-year limb salvage rate has been 60%. In Germany, Berthold Ammann and colleagues reported their nonrandomized experience with CLI treated by injection of bone marrow concentrates of CD34 cells into the ischemic limb. They salvaged 58% of limbs, with a coincident amputation rate of 42% for nonresponders. Longer-term data revealed a 53% limb-salvage rate between 1 and 2 years. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Technical Aspects of Percutaneous Carotid Angioplasty and Stenting for Arteriosclerotic Disease In-Situ Treatment of Aortic Graft Infection with Prosthetic Grafts and Allografts Treatment of Dyslipidemia and Hypertriglyceridemia Intraoperative Assessment of the Technical Adequacy of Carotid Endarterectomy Stay updated, free articles. Join our Telegram channel Join Tags: Current Therapy in Vascular and Endovascular Surgery Aug 25, 2016 | Posted by admin in CARDIOLOGY | Comments Off on Bone Marrow Stem Cell Treatment for Critical Limb Ischemia Full access? Get Clinical Tree
Bone Marrow Stem Cell Treatment for Critical Limb Ischemia John (Jeb) Hallett The first U.S. Food and Drug Administration (FDA)–approved randomized clinical trials for saving lower limbs by the patient’s own bone marrow stem cell transplants have been under way since 2007. The initial results are encouraging and provide promise that this form of cell therapy could play a future role in managing advanced peripheral arterial occlusive disease. Aggressive endovascular therapy with angioplasty and stenting and open surgical approaches with distal vein grafting have reduced the amputation rates in many communities. However, approximately 30% of patients with peripheral artery disease exhaust these options and face amputation if nothing more can be done to improve peripheral perfusion. The transplantation of the patient’s own mononuclear stem cells (e.g., CD34 cells) from iliac crest bone marrow appears to be another important new option for limb salvage. In fact, bone marrow transplants, a relatively easy technical procedure, may become the first option in treating patients with early critical limb ischemia (CLI). Cell Biology of Vasculogenesis Bone marrow contains progenitor CD34 cells that can migrate to ischemic tissue to form new blood vessels. These progenitor cells adhere to ischemic endothelium and then migrate into the local environ to cause vasculogenesis. The biology of this complicated process has been studied extensively in the laboratory and is now the basis for human clinical trials. Pioneering Work In Japan and Germany, pioneering clinical trials of autologous bone marrow transplants for critical limb ischemia have been ongoing since the turn of the century. Tateishei (Japan) reported diabetic patients randomized to the injection of either bone marrow concentrates of progenitor cells versus peripheral blood containing circulating progenitor cells. He identified improved ankle pressures, improved transcutaneous oxygen levels, and less wound pain in 70% of patients who received the bone marrow concentrates. Three-year limb salvage rate has been 60%. In Germany, Berthold Ammann and colleagues reported their nonrandomized experience with CLI treated by injection of bone marrow concentrates of CD34 cells into the ischemic limb. They salvaged 58% of limbs, with a coincident amputation rate of 42% for nonresponders. Longer-term data revealed a 53% limb-salvage rate between 1 and 2 years. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Technical Aspects of Percutaneous Carotid Angioplasty and Stenting for Arteriosclerotic Disease In-Situ Treatment of Aortic Graft Infection with Prosthetic Grafts and Allografts Treatment of Dyslipidemia and Hypertriglyceridemia Intraoperative Assessment of the Technical Adequacy of Carotid Endarterectomy Stay updated, free articles. Join our Telegram channel Join
