Peripheral arterial disease and stem cell therapy: Critical appraisal

Abstract

The treatment of peripheral arterial disease and critical limb ischaemia includes a variety of medical or surgical modalities, such as exercise training, revascularization with bypass surgery and angioplasty, and medical treatment with cilostazol or prostaglandins. On the basis of initial reports from cardiologists and cardiac surgeons, cell-based therapy was applied in patients with end-stage peripheral critical ischaemia. Numerous clinical studies have demonstrated the potential of a variety of experimental therapies, such as therapeutic angiogenesis and vasculogenesis, for ischaemic diseases. These include gene therapy, angiogenic cytokine therapy and cell therapy. Somatic cell therapy, a fascinating and challenging field in modern medicine, is still in its infancy. After first being applied in cardiac disease stem cell treatment, it was used as a supplement in patients suffering from critical limb ischaemia. Until now, the active principle of somatic stem cell therapy has not been well defined. However, it is undisputed that the treatment effects depend on synergistic effects caused by a combination of different cells and humoral factors. Large-scale randomized, controlled, multicentric trials will be essential to evaluate the long-term safety and efficacy of stem cell and endothelial progenitor cell therapy for the treatment of tissue ischaemia and vessel repair. Since only short- and intermediate-term follow-up data are available, concerns remain regarding the potential side-effects, such as neovascularization of occult neoplasias and the development of age- and diabetes-related vasculopathies.

Keywords

• stem cell
• peripheral arterial disease