Cell Therapy, a New Standard in Management of Chronic Critical Limb Ischemia and Foot Ulcer

Fifty percent of diabetics (7% of general population) suffer from peripheral arterial occlusive disease, which may lead to amputation due to critical limb ischemia (CLI). The aim of our study was to prevent major limb amputation (MLA) in this group of patients using a local application of autologous...

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Main Authors: V. Procházka M.D., Ph.D., M.Sc., J. Gumulec, F. Jalůvka, D. Šalounová, T. Jonszta, D. Czerný, J. Krajča, R. Urbanec, P. Klement, J. Martinek, G. L. Klement
Format: Article
Language:English
Published: SAGE Publishing 2010-11-01
Series:Cell Transplantation
Online Access:https://doi.org/10.3727/096368910X514170
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spelling doaj-172c9092656d435c853d440fcae8729b2020-11-25T03:16:20ZengSAGE PublishingCell Transplantation0963-68971555-38922010-11-011910.3727/096368910X514170Cell Therapy, a New Standard in Management of Chronic Critical Limb Ischemia and Foot UlcerV. Procházka M.D., Ph.D., M.Sc.0J. Gumulec1F. Jalůvka2D. Šalounová3T. Jonszta4D. Czerný5J. Krajča6R. Urbanec7P. Klement8J. Martinek9G. L. Klement10Radiodiagnostic Institute, University Hospital Ostrava, Ostrava-Poruba, Czech RepublicHemato-Oncological Center, University Hospital Ostrava, Ostrava-Poruba, Czech RepublicSurgery Clinic and Anaesthesiology Department, University Hospital Ostrava, Ostrava-Poruba, Czech RepublicDepartment of Mathematical Methods in Economy, VŠB-Technical University Ostrava, Ostrava-Poruba, Czech RepublicRadiodiagnostic Institute, University Hospital Ostrava, Ostrava-Poruba, Czech RepublicRadiodiagnostic Institute, University Hospital Ostrava, Ostrava-Poruba, Czech RepublicRadiodiagnostic Institute, University Hospital Ostrava, Ostrava-Poruba, Czech RepublicSurgery Clinic and Anaesthesiology Department, University Hospital Ostrava, Ostrava-Poruba, Czech RepublicHenderson Research Center, McMaster University, Hamilton, Ontario, CanadaClinical Laboratory, J.G. Mendel Cancer Center, Novy Jicin, Czech RepublicChildren's Hospital, Dana-Farber Cancer Institute, Harvard Medical University, Boston, MA, USAFifty percent of diabetics (7% of general population) suffer from peripheral arterial occlusive disease, which may lead to amputation due to critical limb ischemia (CLI). The aim of our study was to prevent major limb amputation (MLA) in this group of patients using a local application of autologous bone marrow stem cells (ABMSC) concentrate. A total of 96 patients with CLI and foot ulcer (FU) were randomized into groups I and II. Patients in group I ( n = 42, 36 males, 6 females, 66.2 ± 10.6 years) underwent local treatment with ABMSC while those in group II ( n = 54, control, 42 males, 12 females, 64.1 ± 8.6 years) received standard medical care. The frequency of major limb amputation in groups I and II was 21% and 44% within the 120 days of follow up, respectively ( p < 0.05). Only in salvaged limbs of group I both toe pressure and toe brachial index increased (from 22.66 ± 5.32 to 25.63 ± 4.75 mmHg and from 0.14 ± 0.03 to 0.17 ± 0.03, respectively, mean ± SEM). The CD34 + cell counts in bone marrow concentrate (BMC) decreased (correlation, p = 0.024) with age, even though there was no correlation between age and healing. An unexpected finding was made of relative, bone marrow lymphopenia in the initial bone marrow concentrates in patients who failed ABMSC therapy (21% of MLA). This difference was statistically significant ( p < 0.040). We conclude ABMSC therapy results in 79% limb salvage in patients suffering from CLI and FU. In the remaining 21% lymphopenia and thrombocytopenia were identified as potential causative factors, suggesting that at least a partial correction with platelet supplementation may be beneficial.https://doi.org/10.3727/096368910X514170
collection DOAJ
language English
format Article
sources DOAJ
author V. Procházka M.D., Ph.D., M.Sc.
J. Gumulec
F. Jalůvka
D. Šalounová
T. Jonszta
D. Czerný
J. Krajča
R. Urbanec
P. Klement
J. Martinek
G. L. Klement
spellingShingle V. Procházka M.D., Ph.D., M.Sc.
J. Gumulec
F. Jalůvka
D. Šalounová
T. Jonszta
D. Czerný
J. Krajča
R. Urbanec
P. Klement
J. Martinek
G. L. Klement
Cell Therapy, a New Standard in Management of Chronic Critical Limb Ischemia and Foot Ulcer
Cell Transplantation
author_facet V. Procházka M.D., Ph.D., M.Sc.
J. Gumulec
F. Jalůvka
D. Šalounová
T. Jonszta
D. Czerný
J. Krajča
R. Urbanec
P. Klement
J. Martinek
G. L. Klement
author_sort V. Procházka M.D., Ph.D., M.Sc.
title Cell Therapy, a New Standard in Management of Chronic Critical Limb Ischemia and Foot Ulcer
title_short Cell Therapy, a New Standard in Management of Chronic Critical Limb Ischemia and Foot Ulcer
title_full Cell Therapy, a New Standard in Management of Chronic Critical Limb Ischemia and Foot Ulcer
title_fullStr Cell Therapy, a New Standard in Management of Chronic Critical Limb Ischemia and Foot Ulcer
title_full_unstemmed Cell Therapy, a New Standard in Management of Chronic Critical Limb Ischemia and Foot Ulcer
title_sort cell therapy, a new standard in management of chronic critical limb ischemia and foot ulcer
publisher SAGE Publishing
series Cell Transplantation
issn 0963-6897
1555-3892
publishDate 2010-11-01
description Fifty percent of diabetics (7% of general population) suffer from peripheral arterial occlusive disease, which may lead to amputation due to critical limb ischemia (CLI). The aim of our study was to prevent major limb amputation (MLA) in this group of patients using a local application of autologous bone marrow stem cells (ABMSC) concentrate. A total of 96 patients with CLI and foot ulcer (FU) were randomized into groups I and II. Patients in group I ( n = 42, 36 males, 6 females, 66.2 ± 10.6 years) underwent local treatment with ABMSC while those in group II ( n = 54, control, 42 males, 12 females, 64.1 ± 8.6 years) received standard medical care. The frequency of major limb amputation in groups I and II was 21% and 44% within the 120 days of follow up, respectively ( p < 0.05). Only in salvaged limbs of group I both toe pressure and toe brachial index increased (from 22.66 ± 5.32 to 25.63 ± 4.75 mmHg and from 0.14 ± 0.03 to 0.17 ± 0.03, respectively, mean ± SEM). The CD34 + cell counts in bone marrow concentrate (BMC) decreased (correlation, p = 0.024) with age, even though there was no correlation between age and healing. An unexpected finding was made of relative, bone marrow lymphopenia in the initial bone marrow concentrates in patients who failed ABMSC therapy (21% of MLA). This difference was statistically significant ( p < 0.040). We conclude ABMSC therapy results in 79% limb salvage in patients suffering from CLI and FU. In the remaining 21% lymphopenia and thrombocytopenia were identified as potential causative factors, suggesting that at least a partial correction with platelet supplementation may be beneficial.
url https://doi.org/10.3727/096368910X514170
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