title: Clinical features and predictors of patients with critical limb ischemia who responded to autologous mononuclear cell transplantation for therapeutic angiogenesis.
abstract: The clinical features of patients with critical limb ischemia (CLI) who responded to angiogenesis using autologous peripheral blood mononuclear cell transplantation (PB-MNC) have not yet been fully characterized, and there are no useful predictors to judge the curative effect in the early period after PB-MNC. This study sought to clarify the clinical features and predictors in patients with CLI who were successfully treated using PB-MNC. 30 consecutive patients [arteriosclerosis obliterans: 24 patients, thromboangiitis obliterans: 6 patients] who were diagnosed with major amputation despite maximal medical therapy were enrolled in this study. The study endpoint was major amputation within 3 months after PB-MNC. The collected data were evaluated for correlation between patients with and without major amputation within 3 months after PB-MNC. Six patients underwent major amputation and 1 patient underwent minor amputation. In the patients with major amputation, transcutaneous oxygen tension before PB-MNC and transplanted CD34-positive cells were lower than those of patients without major amputation. In the patients with amputation, interleukin-6 (IL-6) continued to increase after the first PB-MNC, and basic fibroblast growth factor (bFGF) decreased within 3 days after the first PB-MNC. PB-MNC was useful for the patients who were managed for inflammation and who had revascularization of the upper-popliteal arteries and two of the infra-popliteal arteries by endovascular and/or surgical revascularization. Variation in IL-6 and bFGF in the early period after PB-MNC could be useful predictors for the requirement of amputation within 3 months after PB-MNC.
authors.affiliation: Division of Internal and Emergency Medicine, Department of Comprehensive Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan. aoyama@med.kitasato-u.ac.jp.
authors.forename: Naoyoshi
authors.identifier: http://orcid.org/0000-0002-4866-0361
authors.initials: N
authors.lastname: Aoyama
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Nishinari
authors.affiliation: Department of Transfusion Medicine and Cell Transplantation, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ohtani
authors.affiliation: Division of Dolorology, Department of Comprehensive Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Akifumi
authors.initials: A
authors.lastname: Kanai
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Chiharu
authors.initials: C
authors.lastname: Noda
authors.affiliation: Division of Surgical Operation Management, Department of Comprehensive Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Hirata
authors.affiliation: Cardiology Department, Cardiovascular Center, Takatsu General Hospital, Kawasaki, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Miyamoto
authors.affiliation: Department of Cardiovascular Medicine, University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Minamino
authors.affiliation: Niigata Minami Hospital, Niigata, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Izumi
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Jyunya
authors.initials: J
authors.lastname: Ako
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017690:Cell Transplantation / Q000379:methods*; D000072226:Computed Tomography Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D007963:Leukocytes, Mononuclear / Q000637:transplantation*; D035002:Lower Extremity / Q000098:blood supply*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Arteriosclerosis obliterans (ASO); Autologous peripheral blood mononuclear cell transplantation (PB-MNC); Critical limb ischemia (CLI); Peripheral arterial disease (PAD); Therapeutic angiogenesis; Thromboangiitis obliterans (TAO)