Stem cell therapy in no-option critical limb ischemia patients

摘要: Critical limb ischemia (CLI) is a severe form of peripheral arterial disease (PAD), characterised by stenoses and / or occlusion the leg arteries, resulting in chronic ischemic rest pain non-healing skin lesions. CLI associated with high morbidity reduced life expectancy. This thesis shows that patients score extremely poor on every health dimension commonly used quality (QoL) questionnaires. QoL becomes particularly apparent when compared to milder forms PAD cardiovascular risk factors only. The scores were calculated using norm based scoring method, may therefore serve as reference for increasing number studies investigating new experimental therapies patients. expectancy mainly due risks events. To identify at highest such events, prediction model allows simple assessment this proposed. valuable tool vascular secondary care select could benefit from intensified treatment. With regard salvage, treatment options are limited: there no effective pharmacological therapy available approximately half ineligible traditional interventions aimed revascularisation affected leg. Amputation often remains only option relieve symptoms, but itself prognosis. New thus needed ameliorate burden CLI. In past decade, stimulating neovascularisation means stem progenitor cell has emerged therapeutic strategy. Neovascularisation involves mobilisation endothelial cells (EPC) bone marrow (BM) towards circulation. These EPC subsequently contribute sprouting blood vessels direct incorporation proliferation into layer existing paracrine effects mature cells. explores novel describes rationale design ongoing JUVENTAS study, large randomised, placebo-controlled, double-blind trial investigates clinical Increasing evidence however suggests have impaired function, which negatively affect effectiveness therapy. study also encompasses fundamental research characterisation functional properties we show despite cues, circulating levels do not increase Together observed reduction MMP-9 soluble c-Kit BM plasma, suggestive impairment, possibly NO availability. Stem promising CLI, its be confirmed randomised trials. Combined treatments augmenting become compelling no-option