Document Detail


Autologous transplantation of bone marrow mononuclear cells for limb ischemia in a caucasian population with atherosclerosis obliterans.
MedLine Citation:
PMID:  18221334     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Autologous transplantation of bone marrow mononuclear cells (ATBMMNC) has been used successfully in critical limb ischemia. All reported patients were of Asian descent, however, and several studies included only young patients with thromboangiitis obliterans. Whether the beneficial results can be extrapolated to older Caucasian patients with atherosclerosis obliterans and a heavy burden of cardiovascular risk factors remains unclear. METHODS: We enrolled 16 patients (age 78 +/- 2 year) with critical limb ischemia and a high prevalence of hypertension, smoking, diabetes, hypercholesterolemia and uremia. Mononuclear cells were isolated from the bone marrow and injected in the gastrocnemius muscle of the affected limb. RESULTS: Four patients died because of progressive gangrene (two) or unrelated causes (two). Three patients required an amputation and one patient a femorocrural bypass within 12 weeks. The remaining eight patients had a modest improvement of resting pain and/or trophic lesions. Transcutaneous oxygen pressure (ratio lesion/reference) improved from 0.51 +/- 0.11 before to 0.86 +/- 0.03 (P < 0.001) after 12 weeks, whereas ankle-brachial index did not change significantly (0.42 +/- 0.15 vs. 0.59 +/- 0.1; P = 0.23). The number of visible collateral vessels on digital subtraction angiography changed with 0.89 +/- 0.86 on a scale of 1-4 (P = 0.33). Capillary surface area in a biopsy of gastrocnemius, evaluated by immunostaining for endothelial nitric oxide synthase, increased from 0.61 +/- 0.07% to 2.38 +/- 0.73% (P < 0.05). CONCLUSIONS: Although ATBMMNC was associated with objective signs of neovascularization, symptomatic improvement was only modest and restricted to the least affected patients. The discrepancy with previous findings may be related to the high prevalence of cardiovascular risk factors which causes endothelial progenitor cell dysfunction.
Authors:
A S De Vriese; J Billiet; J Van Droogenbroeck; J Ghekiere; J A De Letter
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Publication Detail:
Type:  Journal Article     Date:  2008-01-21
Journal Detail:
Title:  Journal of internal medicine     Volume:  263     ISSN:  1365-2796     ISO Abbreviation:  J. Intern. Med.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-07     Completed Date:  2008-04-09     Revised Date:  2009-01-07    
Medline Journal Info:
Nlm Unique ID:  8904841     Medline TA:  J Intern Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  395-403     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, AZ Sint-Jan AV, Brugge, Belgium. an.devriese@azbrugge.be
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Angiogenesis Inducing Agents / administration & dosage
Angiography, Digital Subtraction / methods
Arteriosclerosis Obliterans / complications,  surgery*
Bone Marrow Cells / immunology
Bone Marrow Transplantation / adverse effects,  methods*
Female
Humans
Ischemia / complications,  surgery,  therapy*
Limb Salvage / methods*
Male
Prognosis
Transplantation, Autologous / adverse effects,  methods
Treatment Outcome
Chemical
Reg. No./Substance:
0/Angiogenesis Inducing Agents
Comments/Corrections
Comment In:
J Intern Med. 2008 Sep;264(3):288-9; author reply 290   [PMID:  18793334 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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