Vnitr Lek 2009, 55(3):173-178

Autologous Bone Marrow Stem Cell Transplantation in Patients with End-Stage Chronical Critical Limb Ischemia and Diabetic Foot

V. Procházka^1,*, J. Gumulec², J. Chmelová¹, P. Klement³, G. L. Klement⁴, T. Jonszta¹, D. Czerný¹, J. Krajča¹

¹ Radiodiagnostic Institute University Hospital Ostrava-Poruba, head of the department Jana Chmelová, MD, PhD.

² Hemato-Oncological Center University Hospital Ostrava-Poruba, head Jaromír Gumulec, MD

³ Henderson Research Center - McMaster University Hamilton, Ontario, Canada, director Dr. Jeffrey Weitz, MD, FRCP(C), FACP

⁴ Children's Hospital, Dana-Farber Cancer Institute, Harvard MU, Boston, USA, president and Chief Executive Officer Edward J. Benz, Jr., MD

A total 37 patients suffering from end stage-IV Fontaine (CLI and diabetic foot) with an ulcerated limb in whom all previous therapeutic strategies failed (e. g. surgical revascularization and endovascular repair) were selected and underwent local transplantation of Autologous Bone Marrow Stem Cells (ABMSCs). The efficacy/safety of this therapy was assessed by using several endpoints such as (a) prevention of amputation, (b) wound healing and (c) degree of angiogenesis. In order to assess the limb ischemia and hypoxia the several tests and measurements were performed pre- and post transplantation at a variety of time intervals. The measurements include: TP-toe pressure measurements (by Periflux 5000 Laser Doppler and Oxymetry system), SPP-skin perfusion pressure, ABI-ankle brachial index, LDP-Laser Doppler baseline and heat perfusion assessment, TcpO₂ without and with O₂ provocation inhalation test. In addition, a battery of biochemical and hematological tests of peripheral venous blood samples and bone marrow analysis were performed. Limb salvage was 81% in 30 patients, 7 patients (19%) were amputated for terminal severe ischemia and gangrene progression. In the group of limb salvage patients initial Toe pressure 23.119 (std. error 5.358) increased in 90 days follow-up into 29.888 (std. error 5.99), Toe brachial index increased from 0.1469 (std. 0.0326) to 0.1991(std. 0.401). In LASER doppler and TcpO₂, TcpCO₂ tissue perfusion examination TcpO₂% Increase after O₂ provocation inhalation test was elevated from 162.95 ( %) to 229.86% which confirmed a very good tissue vasoreactivity after BMSC transplantation.

Keywords: critical limb ischemia; diabetic foot; bon marrow stem cells; transplantation

Received: February 3, 2009; Published: March 1, 2009  Show citation