Clinical features and predictors of patients with critical limb ischemia who responded to autologous mononuclear cell transplantation for therapeutic angiogenesis

• Published in: Heart and vessels 2017-09, Vol.32 (9), p.1099-1108
• Main Authors: Aoyama, Naoyoshi, Nishinari, Makoto, Ohtani, Shinichi, Kanai, Akifumi, Noda, Chiharu, Hirata, Mitsuhiro, Miyamoto, Akira, Watanabe, Masafumi, Minamino, Tohru, Izumi, Tohru, Ako, Jyunya
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Amputation; Angiogenesis; Arteries; Arteriosclerosis; Autografts; Biomedical Engineering and Bioengineering; Cardiac Surgery; Cardiology; Cardiovascular system; CD34 antigen; Cell Transplantation - methods; Computed Tomography Angiography; Female; Fibroblast growth factor 2; Follow-Up Studies; Humans; Interleukin 6; Interleukins; Ischemia; Ischemia - diagnostic imaging; Ischemia - physiopathology; Ischemia - therapy; Leukocytes, Mononuclear - transplantation; Lower Extremity - blood supply; Magnetic Resonance Angiography; Male; Medicine; Medicine & Public Health; Middle Aged; Neovascularization, Physiologic; Original Article; Oxygen tension; Patients; Peripheral blood; Retrospective Studies; Surgery; Tension; Thromboangiitis obliterans; Transplantation; Transplantation, Autologous; Treatment Outcome; Ultrasonography; Vascular Surgery
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-017-0968-5

The clinical features of patients with critical limb ischemia (CLI) who responded to angiogenesis using autologous peripheral blood mononuclear cell transplantation (PB-MNC) have not yet been fully characterized, and there are no useful predictors to judge the curative effect in the early period after PB-MNC. This study sought to clarify the clinical features and predictors in patients with CLI who were successfully treated using PB-MNC. 30 consecutive patients [arteriosclerosis obliterans: 24 patients, thromboangiitis obliterans: 6 patients] who were diagnosed with major amputation despite maximal medical therapy were enrolled in this study. The study endpoint was major amputation within 3 months after PB-MNC. The collected data were evaluated for correlation between patients with and without major amputation within 3 months after PB-MNC. Six patients underwent major amputation and 1 patient underwent minor amputation. In the patients with major amputation, transcutaneous oxygen tension before PB-MNC and transplanted CD34-positive cells were lower than those of patients without major amputation. In the patients with amputation, interleukin-6 (IL-6) continued to increase after the first PB-MNC, and basic fibroblast growth factor (bFGF) decreased within 3 days after the first PB-MNC. PB-MNC was useful for the patients who were managed for inflammation and who had revascularization of the upper-popliteal arteries and two of the infra-popliteal arteries by endovascular and/or surgical revascularization. Variation in IL-6 and bFGF in the early period after PB-MNC could be useful predictors for the requirement of amputation within 3 months after PB-MNC.