title: Angiographic demonstration of neoangiogenesis after intra-arterial infusion of autologous bone marrow mononuclear cells in diabetic patients with critical limb ischemia.
abstract: Critical limb ischemia in diabetic patients is associated with high rates of morbidity and mortality. Suboptimal responses to the available medical and surgical treatments are common in these patients, who also demonstrate limited vascular homeostasis. Neovasculogenesis induced by stem  cell therapy could be a useful approach for these patients. Neovasculogenesis and clinical improvement were compared at baseline and at 3 and 12 months after autologous bone marrow-derived mononuclear cell (BMMNC) transplantation in diabetic patients with peripheral artery disease. We conducted  a prospective study to evaluate the safety and efficacy of intra-arterial administration of autologous BMMNCs (100-400 × 10(6) cells) in 20 diabetic patients with severe below-the-knee arterial ischemia. Although the time course of clinical effects differed among patients,  after 12 months of follow-up all patients presented a notable improvement in the Rutherford-Becker classification, the University of Texas diabetic wound scales, and the Ankle-Brachial Index in the target limb. The clinical outcome was consistent with neovasculogenesis, which was assessed  at 3 months by digital subtraction angiography and quantified by MetaMorph software. Unfortunately, local cell therapy in the target limb had no beneficial effect on the high mortality rate in these patients. In diabetic patients with critical limb ischemia, intra-arterial perfusion of BMMNCs  is a safe procedure that generates a significant increase in the vascular network in ischemic areas and promotes remarkable clinical improvement.
authors.affiliation: Hospitales Universitarios San Lázaro and Virgen Macarena, Seville, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ruiz-Salmeron
authors.forename: Antonio
authors.initials: A
authors.lastname: de la Cuesta-Diaz
authors.forename: Manuel
authors.initials: M
authors.lastname: Constantino-Bermejo
authors.forename: Immaculada
authors.initials: I
authors.lastname: Pérez-Camacho
authors.forename: Francisco
authors.initials: F
authors.lastname: Marcos-Sánchez
authors.forename: Abdelkrim
authors.initials: A
authors.lastname: Hmadcha
authors.forename: Bernat
authors.initials: B
authors.lastname: Soria
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D055109:Ankle Brachial Index; D001854:Bone Marrow Cells / Q000166:cytology; D016026:Bone Marrow Transplantation / Q000379:methods*; D003925:Diabetic Angiopathies / Q000601:surgery*; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D007511:Ischemia / Q000503:physiopathology / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery; D007963:Leukocytes, Mononuclear / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D058729:Peripheral Arterial Disease / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome