Hangzhou, China -
The use of autologous bone marrow stem cells for peripheral artery disease is occuring in the US as part of clinical trials. The rational is that insertion of stem cells into ischemic muscle leads to angiogenesis either through the endothelial precursor cells in the bone marrow differentiating into new blood vessels, or through stimulation of chemotactic factor secretion subsequent to administration of the stem cells in the ischemic muscle.
One of the potential issues with administration of autologous bone marrow is that the bone marrow extraction procedure can be relatively painful. In order to circumvent this, in the field of hematology/oncology there has been a shift away from bone marrow as a source of stem cells and more towards the use of peripheral blood that has been mobilized. By mobilized, we mean addition of an agent, usually G-CSF, that stimulates exit of hematopoietic stem cells from the bone marrow and into systemic circulation. Other experimental methods of mobilization are also currently evaluated. In a recent paper (Zhang et al. Therapeutic Angiogenesis of Bone Marrow Mononuclear Cells (MNCs) and Peripheral Blood MNCs: Transplantation for Ischemic Hindlimb. Ann Vasc Surg. 2007 Dec 14) the use of autologous G-CSF mobilized stem cells was assessed in patients with advanced peripheral artery disease in the form of critical limb ischemia.
15 patients recieved autologous mononuclear cells after G-CSF mobilization. 8 weeks after, 6 of the 15 ulcers were healed and a statistically significant improvement in pain scale, skin level of oxygen in the lower extremity, ability to walk, and blood flow to the ankle was observed.
These data suggest that in some situations it may be possible to substitute mobilized peripheral blood for bone marrow when stimulating angiogenesis.
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