title: Autologous mesenchymal stem cells foster revascularization of ischemic limbs in systemic sclerosis: a case report.
abstract: BACKGROUND
  Mesenchymal stem cells can differentiate into endothelial cells and participate in angiogenesis in adults. In experimental models of acute myocardial infarction, mesenchymal stem cells led to the recovery of cardiac function through the formation of a new vascular network.
  
  
  OBJECTIVE
  To describe treatment with intravenous infusions of expanded autologous mesenchymal stem cells in 1 patient with critical limb ischemia due to systemic sclerosis.
  
  
  METHODS
  Case report.
  
  
  METHODS
  The rheumatology unit at the University of Florence, Florence, Italy.
  
  
  METHODS
  A woman, aged 34 years, with systemic sclerosis who developed acute gangrene of the upper and lower limbs.
  
  
  METHODS
  3 intravenous pulses of expanded autologous mesenchymal stem cells.
  
  
  METHODS
  Angiography, skin histopathology, and immunohistochemistry.
  
  
  RESULTS
  Areas of necrotic skin were reduced after the first mesenchymal stem-cell infusion. After the third infusion, angiography showed revascularization of the patient's extremities. Skin section analysis revealed cell clusters with tubelike structures, and angiogenic factors were strongly expressed.
  
  
  CONCLUSIONS
  Causality cannot be established by a single case.
  
  
  CONCLUSIONS
  In patients with systemic sclerosis who have severe peripheral ischemia, intravenous infusion of expanded autologous mesenchymal stem cells may foster the recovery of the vascular network, restore blood flow, and reduce skin necrosis.
  
  
  BACKGROUND
  Fondazione Cassa di Risparmio di Pistoia e Pescia (partial funding).
authors.affiliation: Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy. s.guiducci@hotmail.com
authors.forename: Serena
authors.initials: S
authors.lastname: Guiducci
authors.forename: Francesco
authors.initials: F
authors.lastname: Porta
authors.forename: Riccardo
authors.initials: R
authors.lastname: Saccardi
authors.forename: Stefano
authors.initials: S
authors.lastname: Guidi
authors.forename: Lidia
authors.initials: L
authors.lastname: Ibba-Manneschi
authors.forename: Mirko
authors.initials: M
authors.lastname: Manetti
authors.forename: Benedetta
authors.initials: B
authors.lastname: Mazzanti
authors.forename: Simone
authors.initials: S
authors.lastname: Dal Pozzo
authors.forename: Anna Franca
authors.initials: AF
authors.lastname: Milia
authors.forename: Silvia
authors.initials: S
authors.lastname: Bellando-Randone
authors.forename: Irene
authors.initials: I
authors.lastname: Miniati
authors.forename: Ginevra
authors.initials: G
authors.lastname: Fiori
authors.forename: Rossana
authors.initials: R
authors.lastname: Fontana
authors.forename: Laura
authors.initials: L
authors.lastname: Amanzi
authors.forename: Francesca
authors.initials: F
authors.lastname: Braschi
authors.forename: Alberto
authors.initials: A
authors.lastname: Bosi
authors.forename: Marco
authors.initials: M
authors.lastname: Matucci-Cerinic
mesh_terms: D000328:Adult; D001132:Arm / Q000098:blood supply*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D045164:Mesenchymal Stem Cell Transplantation; D059630:Mesenchymal Stem Cells / Q000502:physiology; D009336:Necrosis / Q000628:therapy; D018919:Neovascularization, Physiologic; D012595:Scleroderma, Systemic / Q000150:complications*