European Heart Journal Advance Access originally published online on April 26, 2005
European Heart Journal 2005 26(18):1903-1909; doi:10.1093/eurheartj/ehi285
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Therapeutical potential of blood-derived progenitor cells in patients with peripheral arterial occlusive disease and critical limb ischaemia
1Department of Cardiology, University of Leipzig Heart Center, Strümpellstrasse 39, D-04289 Leipzig, Germany
2Department of Angiology, University of Leipzig Heart Center, Strümpellstrasse 39, D-04289 Leipzig, Germany
3Institute of Clinical Immunology and Transfusion Medicine, Leipzig, Germany
Received 17 August 2004; revised 8 March 2005; accepted 24 March 2005; online publish-ahead-of-print 26 April 2005.
* Corresponding author. Tel: +49 341 865 1426; fax:+49 341 865 1461. E-mail address: hamr{at}medizin.uni-leipzig.de
Aims Despite considerable advances in the therapy of patients with peripheral arterial occlusive disease (PAOD) and critical limb ischaemia (CLI), a substantial number remain, in whom amputation has to be considered the only and final option. Recent evidence from animal models of hind limb ischaemia suggests that neovascularization induced by circulating blood-derived progenitor cells (CPCs) may permit limb salvage. It remains unclear, however, whether an intra-arterial application of autologous CPCs in patients with infrapopliteal PAOD and CLI is safe, feasible, and of potentially beneficial effects.
Methods and results Seven patients with critical PAOD were treated with an intra-arterial infusion of autologous CPCs (39±24x106) isolated from peripheral blood. Pre-interventional stimulation with G-CSF and CPC application was well tolerated. Twelve weeks after CPC administration, the pain-free walking distance increased from 6±13 to 195±196 m. A significant increase in the ankle-brachial index, transcutaneous O2, flow-dependent vasodilation, flow reserve in response to adenosine, and endothelium-dependent vasodilation was observed.
Conclusion These preliminary data in a small series of patients with CLI without surgical or interventional options indicate that CPC application is safe, feasible, and may improve both functional and clinical indices.
Key Words: Circulating progenitor cells • Angiogenesis • Critical limb ischaemia • Neovascularization • Peripheral arterial occlusive disease
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