title: Therapeutic angiogenesis by bone marrow implantation for critical hand ischemia in patients with peripheral arterial disease: a pilot study.
abstract: OBJECTIVE
  Implantation of bone marrow mononuclear cells (BM-MNCs), including endothelial progenitor cells, into ischemic lower limbs has been shown to improve symptoms in patients with peripheral arterial diseases (PAD). This study investigated whether BM-MNC implantation (BMI) is also effective for the ischemic hands of these patients.
  
  
  METHODS
  Seven PAD patients with hand ischemia were enrolled: six patients had thromboangiitis obliterans and one had collagen disease. All seven had symptoms involving either resting pain or non-healing ischemic ulcers of the hand. Approximately 600 mL of MNCs were separated from BM and concentrated to a final volume of 40-50 mL, which were injected into ischemic hands. Ischemic status was evaluated by measuring the digital/brachial pressure index (DBI), visual analog pain scale, and the healing of ulcers before and 6 months after BMI.
  
  
  RESULTS
  The mean number of implanted MNCs, CD34-positive cells, and CD34,133-positive cells was 3.67 +/- 0.53 x 10(9), 4.94 +/- 2.45 x 10(7), and 2.52 +/- 1.57 x 10(7), respectively. Mean DBI in those patients was 0.15 +/- 0.30 before BMI and significantly increased to 0.67 +/- 0.19 at 6 months after BMI (p = 0.004). All patients also showed improvement of pain scale and ischemic ulcers. There was no significant correlation between the number of implanted cells and improvement in the degree of DBI or the pain scale.
  
  
  CONCLUSIONS
  Autologous BMI could be a promising and safe method of therapeutic angiogenesis for critical hand ischemia in PAD patients.
authors: Division of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Matsumoto, Japan.
authors: Megumi
authors: M
authors: Koshikawa
authors: Shigetaka
authors: S
authors: Shimodaira
authors: Toru
authors: T
authors: Yoshioka
authors: Hiroki
authors: H
authors: Kasai
authors: Noboru
authors: N
authors: Watanabe
authors: Yuko
authors: Y
authors: Wada
authors: Tatsuichiro
authors: T
authors: Seto
authors: Daisuke
authors: D
authors: Fukui
authors: Jun
authors: J
authors: Amano
authors: Uichi
authors: U
authors: Ikeda