Issue №5-87, 2018

Сellular Therapy in the Treat Ment of Peripheral Arterial Disease

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1,2 Sсherbak S.G., 2 Lisovets D.G., 1,2 Sarana A.M., 1,2 Makarenko S.V., 2 Kamilova T.A., 1,2 Bogdanov A.N., 2 Noskov A.V.

1 St. Petersburg state university, Department of postgraduate medical education, Medical faculty, St. Petersburg, Russia
2 St. Petersburg municipal hospital №40, St. Petersburg, Russia


ABSTRACT

Peripheral arterial disease contributes to decreased exercise tolerance, impaired proprioception, muscle atrophy andweakness, with advanced cases resulting in critical limb ischemia, ulceration and gangrene. Current treatment options byre-establishing in line blood supply to the limb are limited, with poor outcomes predicted by multilevel arterial disease.Therapeutic angiogenesis has been considered for the treatment of patients with critical limb ischemia who do not qualifyfor surgical revascularisation or percutaneous intervention. Angiogenesis can be induced with growth factors and/or withstem cell preparations containing bone marrow derived mesenchymal stromal cells and endothelial progenitor cells, alsocapable of forming vascular endothelium. Numerous trials published in 2000–2014 showed that bone marrow-derived stemcells containing endothelial progenitor cells and mesenchymal stem cell have been successfully and safely harvested andimplanted in patients with critical limb ischemia as intravenous or intramuscular infusions and and there was a significantclinical improvement in patients as measured by pain scores, amputation rates, claudication distance and appearance onangiography. This trials did show a significant lengthening in the «time to treatment failure», determined as doubling ofulceration, major amputation or new gangrene. This trials did not demonstrate any adverse effects due to the intravenousor intramuscular injection of autologous bone marrow-derived tissue repair cells. In patients who have received transplants,observed improvement of microcirculation and complete healing of ulcers. After stem cell application the foot amputationwas possible to avoid the major amputation.


KEYWORDS: peripheral arterial disease, critical limb ischemia, therapeutic angiogenesis, autologous bone marrow, bone marrow stem cell, mesenchymal stromal cells, endothelial progenitor cells, transplantation



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