title: Autologous peripheral blood-derived mononuclear cells induced by erythropoietin improve critical ischemic limbs.
abstract: OBJECTIVE
  Efficient and secure collection of CD34+ cells are crucial for the angiogenic therapies. We have developed autologous peripheral blood-mononuclear cell (MNC) transplantation induced by erythropoietin (rhEPO) for critical ischemic limbs.
  
  
  METHODS
  Seven patients, including five with arteriosclerosis obliterans, one with Buerger's disease and one with progressive systemic sclerosis, underwent ten cell therapies. The first administration of rhEPO was performed two weeks before apheresis, and the second administration and blood donation were performed one week before apheresis to activate bone marrow. MNCs including CD34+ cells, isolated from peripheral blood by apheresis, were immediately injected intramuscularly into ischemic limbs.
  
  
  RESULTS
  The number of peripheral blood-CD34 + cells had significantly increased from 1.32 ± 0.83/microL, before the rhEPO induction, to 1.86 ± 0.94/microL, before the apheresis. The number of transplanted MNCs ranged between 0.5 × 10(9) and 16.5 × 10(9), and that of CD34+ cells, between 0.1 × 10(6) and 12.7 × 10(6), accounting for 0.02%-0.1% of MNCs. There were no serious complications. Finger ulcers with Buerger's disease were significantly improved one month after the transplantations, but the same or other ulcer(s) appeared 2-6 months later. Three patients had an improvement in rest pain, and one patient extended maximum pain-free walking distance.
  
  
  CONCLUSIONS
  Erythropoietin-induced autologous peripheral blood-MNC transplantation is a useful and safe alternative for ischemic limbs.
authors.affiliation: Department of Cardiovascular Surgery, Institute for Health Biosciences, The University of Tokushima Graduate School, Tokushima, Tokushima, Japan.
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kanbara
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Kurobe
authors.forename: Takashi
authors.initials: T
authors.lastname: Kitaichi
authors.forename: Mikio
authors.initials: M
authors.lastname: Sugano
authors.forename: Taisuke
authors.initials: T
authors.lastname: Nakayama
authors.forename: Hajime
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Takashi
authors.initials: T
authors.lastname: Iwase
authors.forename: Masafumi
authors.initials: M
authors.lastname: Akaike
authors.forename: Masahiro
authors.initials: M
authors.lastname: Abe
authors.forename: Masataka
authors.initials: M
authors.lastname: Sata
authors.forename: Toshio
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kitagawa
keywords: Keywordserythropoietin; angiogenesis; autologous peripheral blood-derived mononuclear cell transplantation; critical ischemic limbs
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