Problems and prospects of cell therapy for critical ischaemia of lower limbs

2020 ◽  
Vol 26 (2) ◽  
pp. 23
Author(s):  
O. S. Osipova ◽  
Sh. B. Saaia ◽  
A. A. Karpenko ◽  
S. M. Zakiian
Keyword(s):  
Cell Therapy ◽  
Lower Limbs ◽  
Critical Ischaemia

Autologous Bone Marrow-Derived Stem Cell Therapy: A Promising and Prospective Approach in the Treatment of Patients with Severe Buerger’s Disease.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1135-1135
Author(s):  
Zoltan Boda ◽  
Miklos Udvardy ◽  
Katalin Razso ◽  
Mariann Szarvas ◽  
Zsolt Olah ◽  
...  
Keyword(s):  
Stem Cell ◽  
Cell Therapy ◽  
Stem Cell Therapy ◽  
Autologous Bone Marrow ◽  
Lower Limbs ◽  
Walking Distance ◽  
Rest Pain ◽  
Buerger’S Disease ◽  
Buerger's Disease ◽  
Cd34 Cells

Abstract No effective blood-flow enhancement therapies are available for patients with severe peripheral arterial disease (SPAD), thus amputation remains the only option for relief of rest pain or gangrene. Autologous bone marrow-derived stem cell therapy (ABMSCT) is an emerging modality to induce angiogenesis from endothelial progenitors. Eight lower limbs of seven patients with SPAD (seven limbs of six patients with Buerger’s disease) were treated by ABMSCT using isolated CD34+ cells with characterized phenotype and administered by intramuscular injections. The follow-up before and 1-, 3-, 6-, 9- and 12 months after ABMSCT was based on clinical (rest pain, walking distance without pain, non-healing ulcers, ABI) and laboratory (DS-angiography, duplex- and laser ultrasonography, TcPO2) measurements. Therapeutic benefit was demonstrated by complete regression of rest pain in all of the 7 patients, and by the significant improvement of pain-free walking distance (40 m vs 500 m). The average of ABI improved significantly on the treated (before:0.41, after twelve months: 0.83), but did not change on the contralateral limb. Non-healing ischemic ulcers disappeared in five, and became smaller and thinner in two lower limbs, the ulcer remained unchanged in one case, only. The clinical improvement started one month after ABMSCT, it became more prominent after at three months, and the best clinical results were observed after twelve months of the stem cell therapy. In all of the seven cases we observed improvement on the treated limb only, the contra-lateral symptoms and ulcers remained unchanged or worsened. Confirmed by posttrial observations obtained at 18 months after ABMSCT the clinical improvement was evaluated as stable and long lasting. New collaterals were detected by angiography in three patients, but duplex ultrasonography detected improvement in two patients only. Laser ultrasonography did not show significant changes whereas TcPO2 values improved on the foot from 18.80/16.78/23.83 mmHg, and on the calf from 36.66/31.25/45.00 mmHg. These laboratory parameters did not show improvement after 1 month, however, after 6 and 12 months improved values were recorded. Severe adverse events, complications were not observed. We conclude that ABMSCT with isolated CD34+ cells is safe, effective, localized and results in local and sustained clinical benefit for patients with severe forms of Buerger’s disease. We show for the first time that low number of isolated bone marrowderived CD34+ stem cells that involve CD34+CD133+, CD34+CD133−, CD34+CD45− and CD34+CD45+ cells with different vessel forming ability confers vasculogenesis upon intramuscular implantation to patients with Buerger’s disease.

Critical limb ischaemia and the response to bone marrow-derived cell therapy according to tcPO2 measurement

VASA ◽  
2017 ◽  
Vol 46 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Mario Maufus ◽  
Marie Antoinette Sevestre-Pietri ◽  
Carmine Sessa ◽  
Bernard Pignon ◽  
Harald Egelhofer ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cell Therapy ◽  
Mononuclear Cells ◽  
Cellular Therapy ◽  
Success Probability ◽  
Lower Limbs ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Sitting Position ◽  
Vascular Reserve

Abstract. Background: Cell therapy is an emerging potential biotherapy for critical limb ischaemia (CLI) patients who are not eligible for revascularization. However, the findings on this technique’s efficacy are inconsistent. Trials investigating this topic focused on the more severe CLI patients who were often beyond any therapy. Therefore, identifying those who may truly benefit from cell transplantation is now warranted. To this end, we studied the prognostic value of tcPO2 for major amputation after 1 year in patients treated with bone marrow-derived cells. Patients and methods: CLI patients ineligible for revascularization were included in a cell-therapy pilot study. On inclusion, patients underwent tcPO2 measurement in supine and sitting positions. For a tcPO2 < 10 mmHg in the supine position, the vascular reserve was defined by tcPO2 > 30 mmHg in the sitting position. Patients were administered intramuscular injections of mononuclear cells derived from aspirated bone marrow. Results: In total, 25 patients (a lower limbs) were included for analysis. At inclusion, 11 lower limbs had tcPO2 at rest > 10 mmHg, and 16 lower limbs had a tcPO2 < 10 mmHg. The success probability for cell therapy was 0.79 (95 % CI 0.38–0.94) and 0.44 (95 % CI 0.18–0.67), respectively (p = 0.1). Of the 16 limbs with tcPO2 < 10 mmHg, the success rate was considerably higher in patients demonstrating a tcPO2 increase in a sitting position of over 30 mmHg (6/8, success probability 0.71, 95 % CI 0.26–0.92) compared to those without (2/8, success probability 0.15, 95 % CI 0.01–0.48, p = 0.03). Conclusions: For patients with chronic CLI for whom cellular therapy is a therapeutic option, a tcPO2 < 10 mmHg at rest, without vascular reserve (i. e. < 30 mmHg when sitting), is a prognostic indicator for poor outcome.


scholarly journals Lower-Extremity Amputation: A 6-Year Follow-up Study in Brazil

2005 ◽  
Vol 13 (2) ◽  
pp. 164-166 ◽  
Author(s):  
JMP de Godoy ◽  
MF de Godoy ◽  
F Batigalia ◽  
ARF Trávolo ◽  
EHF Monteiro
Keyword(s):  
Lower Limb ◽  
Survival Curve ◽  
Lower Limb Amputation ◽  
Lower Limbs ◽  
Limb Amputation ◽  
First Year ◽  
Actuarial Survival ◽  
Critical Ischaemia ◽  
Leg Amputation

Purpose. To evaluate the 6-year mortality in 50 patients following lower-limb amputation. Methods. The cumulative survival rate of 50 (28 men, 22 women) amputees aged 54 to 94 years (mean, 67.3; median, 73.5) was retrospectively studied from 1993 to 1998. Indications for above- or below-knee amputation were trauma (n=2), vasculitis (n=2), and critical ischaemia of the lower limbs (n=46). Leg amputation was performed after anamnesis, physical examination, and angiography. All patients were followed up for 6 years by phone or domiciliary visit. A death certificate was verified when a patient was lost to follow-up. Statistical analysis was expressed by the actuarial survival curve. Results. Of 50 amputees, 36 died in the 6 years following leg amputation: 22 in the first year, 3 in the second year, 5 in the third year, 2 in the fourth year, 2 in the fifth year, 2 in the sixth year; 14 remained alive after 6 years. Conclusion. Patients who underwent lower-limb amputation had a high 6-year mortality. Most deaths occurred in the first year.

1468: Novel Cell Therapy Approaches for Renal Failure

2006 ◽  
Vol 175 (4S) ◽  
pp. 474-474
Author(s):  
Akira Joraku ◽  
Toshihiko Machiguchi ◽  
James J. Yoo ◽  
Anthony Atala
Keyword(s):  
Renal Failure ◽  
Cell Therapy

Mid-aortic syndrome: computed tomography angiography depicting extensive collateral circulation in an 11-year-old patient with thoracoabdominal aortic coarctation

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 132-135 ◽  
Author(s):  
Krohn ◽  
Gebauer ◽  
Hübler ◽  
Beck
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Collateral Circulation ◽  
Intestinal Ischemia ◽  
Clinical Presentation ◽  
Lower Limbs ◽  
Upper Body ◽  
Descending Aorta ◽  
Before And After ◽  
Blood Pressures

The mid-aortic syndrome is an uncommon clinical condition characterized by severe narrowing of the descending aorta, usually with involvement of its renal and visceral branches, presenting with uncontrollably elevated blood pressures of the upper body, renal and cardiac failure, intestinal ischemia, encephalopathy symptoms and claudication of the lower limbs, although clinical presentation is variable. In this article we report the case of an eleven-year-old patient with the initial diagnosis of a mid-aortic syndrome and present the computed tomography angiography pictures and reconstructions before and after surgical therapy.

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