title: Application of autologous bone marrow mononuclear cells in six patients with advanced chronic critical limb ischemia as a result of diabetes: our experience.
abstract: OBJECTIVE
  Previous clinical studies have reported that the injection of bone marrow (BM)-derived mononuclear cells (MNC) results in improvement in symptoms and healing of ulcers in patients with critical limb ischemia (CLI) up to stage IV of Fontaine's classification. However, most patients with Fontaine stage IV CLI limbs had to undergo amputation even after stem cell therapy. We report on six patients, who had poorly controlled diabetes with extensive ulceration and gangrene of limbs because of Fontaine stage IV CLI and had been advised amputation elsewhere, who underwent injection of autologous BM MNC.
  
  
  METHODS
  In all six patients, BM was aspirated and the isolated MNC from the BM were injected intralesionally at various sites of the ulcer and its surroundings after necessary debridement. The patients were followed up at regular intervals for at least 6 months.
  
  
  RESULTS
  At the end of the 6-month follow-up, the lower limb pain and ulcers had improved significantly in all patients. The mean toe-brachial index had increased from 0.26 to 0.36. One patient died a month after therapy because of causes unrelated to the procedure. Limb salvage was possible in the remaining five patients and they had a pain-free walking distance of 100 m within 6 months.
  
  
  CONCLUSIONS
  Limb salvage was possible in all six diabetic patients with Fontaine stage IV CLI following autologous BM MNC injection. The procedure was safe without any adverse outcomes.
authors.affiliation: Vascular Surgery Department, Vijaya Hospital, Chennai, India.
authors.forename: Rathnavelpandian
authors.initials: R
authors.lastname: Subrammaniyan
authors.forename: Joseph
authors.initials: J
authors.lastname: Amalorpavanathan
authors.forename: Rajendran
authors.initials: R
authors.lastname: Shankar
authors.forename: Murugesan
authors.initials: M
authors.lastname: Rajkumar
authors.forename: Subramani
authors.initials: S
authors.lastname: Baskar
authors.forename: Sadananda Rao
authors.initials: SR
authors.lastname: Manjunath
authors.forename: Rajappa
authors.initials: R
authors.lastname: Senthilkumar
authors.forename: Palanisamy
authors.initials: P
authors.lastname: Murugan
authors.forename: Venkaba Rao
authors.initials: VR
authors.lastname: Srinivasan
authors.forename: Samuel
authors.initials: S
authors.lastname: Abraham
mesh_terms: D000368:Aged; D001854:Bone Marrow Cells / Q000166:cytology; D002908:Chronic Disease; D048909:Diabetes Complications; D018450:Disease Progression; D005121:Extremities / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005734:Gangrene / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007511:Ischemia; D007963:Leukocytes, Mononuclear / Q000166:cytology / Q000378:metabolism* / Q000637:transplantation; D023821:Limb Salvage / Q000379:methods; D008297:Male; D008875:Middle Aged; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous; D014456:Ulcer