The effect of autologous endothelial progenitor cell transplantation combined with extracorporeal shock-wave therapy on ischemic skin flaps in rats.
BACKGROUND
Endothelial progenitor cells (EPCs) have been used to revascularize ischemic tissues, but only limited effect can be achieved. Extracorporeal shock-wave therapy (ESWT) is a promising angiogenic strategy. We hypothesized that EPC transplantation combined with ESWT would greatly benefit the survival of ischemic skin flaps.


METHODS
Sixty-four male Sprague-Dawley rats were divided into 4 groups (n = 16 in each group): group 1 (serving as sham control), group 2 (treated with subcutaneous EPC implantation, 1.0 × 10(6) cells), group 3 (treated with ESWT, 300 impulses at 0.10 mJ/mm(2)) and group 4 (treated with EPCs implantation combined with ESWT). Ischemic skin flaps were made on the backs of rats and treated accordingly. Blood flow of skin flaps was measured periodically after operation, and flap survival rates were compared. Tissue samples were harvested at 2 weeks postoperatively from each group.


RESULTS
The survival rate of skin flaps in group 4 was 87.5 ± 10.23%, which was statistically significantly higher than other groups. Histologic examination showed that the capillary density was higher in the dual-treatment group than in the two single-treatment groups. Compared with groups 2 and 3, blood perfusion increased significantly in group 4. A drastic increase of vWF+ cells was observed in the ischemic skin flaps on immunofluorescence staining in group 4. The expressions of chemotactic factors and angiogenic factors were higher in group 4.


CONCLUSIONS
Combined treatment with EPCs and ESWT is superior to either EPCs or ESWT alone in improving the survival of ischemic skin flaps in rats.
Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Xiongliang
X
Zhang
Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Xiaoyu
X
Yan
Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Chunyang
C
Wang
Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Shengdi
S
Lu
Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Tingting
T
Tang
Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. Electronic address: chaiyimin@gmail.com.
Yimin
Y
Chai
D000818:Animals; D017690:Cell Transplantation; D064987:Cell- and Tissue-Based Therapy; D066026:Endothelial Progenitor Cells / Q000166:cytology*; D006085:Graft Survival; D006801:Humans; D007511:Ischemia / Q000473:pathology / Q000628:therapy*; D008096:Lithotripsy; D051381:Rats; D017207:Rats, Sprague-Dawley; D013524:Surgical Flaps / Q000473:pathology
angiogenic factors; apoptotic factors; chemotactic factors; endothelial progenitor cells; extracorporeal shock-wave therapy; ischemic skin flaps