Mesenchymal Stem Cells in the Treatment of Limb Ischemia

Despite recent progress in medical and endovascular therapy of patients with critical limb ischemia (CLI), the prognosis of patients with no option for revascularization remains poor. Most of the cases end up in amputation (40%) and even death (20%) within 6 months. 

Trials analyzing the effect of growth factors such as vascular endothelial growth factor (VEGF), and fibroblast growth factor (FGF-1) on the prognosis of patients with CLI lead to an improvement in the ischemia but haven’t shown significant effects on reducing amputations. 

The use of mesenchymal stem cells (MSCs) is a new therapeutic alternative that could be explained by the secretion of factors that have multiple effects by modulating the inflammatory and immune responses. 

Up to 73% Decrease in Amputation Cases

Recently a study showed that the application of autologous bone marrow mononuclear cells in a trial involving 41 patients with advanced critical limb ischemia that were not eligible for revascularization prevented major limb amputation in up to 73% of the cases during 6 months that the trial lasted. 

In another trial performed by the same group of researchers, the team divided the patients in two groups depending on the clinical outcome of the treatment. One group of responders and one of the non-responders. They evaluated the biological properties of the stem cells in both groups. 

The results showed that mesenchymal stem cells caused an increment in the secretion of  IL-4, IL-6, and MIP-1b in the group of patients that responded to the treatment. Also, a higher expression of E-cadherin and PDX-1/IPF1 genes were found in responders compared to non-responder patients. 

Overall, both studies showed that the use of MSCs is a good therapeutic option for the treatment of critical limb ischemia, a condition for which most treatments fail to prevent the incidence of leg amputation. 

Source:

Altaner C, Altanerova V, Cihova M, Hunakova L, Kaiserova K, et al. (2013) Characterization of Mesenchymal Stem Cells of “No-Options” Patients with Critical Limb Ischemia Treated by Autologous Bone Marrow Mononuclear Cells. PLoS ONE 8(9): e73722. doi:10.1371/journal.pone.0073722 

Image from:

Photo by CDC on Unsplash