Stem-cell therapies in critical limb ischemia

Abstract

Background: Due to stimulation of muscular regeneration in ischemic extremities and increasing blood flow, stem cells are considered a promising new strategy for patients with critical limb ischemia (CLI). So, it is demonstrated that mesenchymal stem cells (MSCs), mononuclear cells derived from bone marrow, peripheral and umbilical blood, adipose tissue encourage genesis of endothelial cells (ECs) and vascular smooth muscle cells (VSMCs). By application of stem cell-based therapy, the following results are obtained: increased rate of ulcer healing, increased ankle-brachial index (ABI) and transdermal oxygen pressure (TcPO2 ), improved revascularization, and reduced rate of amputation surgery. So, stem cell-based therapy demonstrates good clinical outcomes. However, some adverse events related to cell sampling and mobilizations are reported. In addition, because of poor cell survival in condition of ischemia their therapeutic efficacy remains low that indicates further researchers are necessary in this field. Conclusions: Cell-based therapy is a promising approach in CLI treatment. Its promising results have been already shown in smaller studies; however, large-scale studies are entailed to ascertain their definitive role in anti-ischemic therapy.

Keywords

• hypoxia
• critical limb ischemia
• peripheral arterial disease
• transplantation
• stem-cell therapy
• tissue repair
• angiogenesis