title: [Treatment of critical limb ischemia and diabetic foot disease by the use of autologous stem cells].
abstract: OBJECTIVE
  The aim of our study was to assess safety and effectiveness of therapy of critical limb ischaemia by autologous stem cells and evaluation of potential adverse events.
  
  
  METHODS
  Fourteen patients were included into the study (11 men, 3 women, mean age 61.9 +/- 9.6 years, mean diabetes duration 23.5 +/- 11.1 years, mean glycated hemoglobin 6 +/- 1%). Eight patients were treated by bone marrow stromal cells, 6 patients by peripheral blood progenitor cells after stimulation by filgrastim. The suspension of stem cells was then applied into the muscles of ischemic limbs. We evaluated transcutaneous oxygen tension (TcPO2), subjective pain sensation assessed by Visual Analog Scale (VAS) and wound healing.
  
  
  RESULTS
  TcPO2 significantly increased in all patients from 10 +/- 8.7 mm Hg before the treatment to 39.4 +/- 9.5 mm Hg after 6 months (p = 0.0005) after stem cell therapy. We also observed significant area defect reduction and pain decrease during the follow-up period. Median of area defect was reduced from 4.3 (0.7 - 31.7) before the treatment to 0.06 (0 - 0.5) cm2 after 6 months from the treatment (p = 0.0078). Decrease in rest pain was observed in all patients, mean VAS decreased from 5.3 +/- 1.8 to 1.1 +/- 1.3 after 6 months (p = 0.002).
  
  
  CONCLUSIONS
  Our study suggests that stem cell therapy of diabetic foot disease is an effective therapeutic option with no adverse events for patients with severe peripheral arterial disease. This treatment leads to increase of transcutaneous oxygen tension, improves wound healing and decreases the rest pain.
authors.affiliation: Centrum diabetologie IKEM Praha. michal.dubsky@ikem.cz
authors.forename: M
authors.initials: M
authors.lastname: Dubský
authors.forename: A
authors.initials: A
authors.lastname: Jirkovská
authors.forename: R
authors.initials: R
authors.lastname: Bém
authors.forename: L
authors.initials: L
authors.lastname: Pagácová
authors.forename: V
authors.initials: V
authors.lastname: Fejfarová
authors.forename: M
authors.initials: M
authors.lastname: Varga
authors.forename: J
authors.initials: J
authors.lastname: Skibová
authors.forename: S
authors.initials: S
authors.lastname: Langkramer
authors.forename: E
authors.initials: E
authors.lastname: Syková
mesh_terms: D000368:Aged; D001785:Blood Gas Monitoring, Transcutaneous; D048909:Diabetes Complications; D017719:Diabetic Foot / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D033581:Stem Cell Transplantation / Q000379:methods