Treatment of peripheral arterial disease using stem and progenitor cell therapy

Peripheral arterial disease (PAD) is a highly prevalent atherosclerotic syndrome associated with significant morbidity and mortality. PAD is most commonly caused by atherosclerosis obliterans (ASO) and thromboangiitis obliterans (TAO), and can lead to claudication and critical limb ischemia (CLI), often resulting in a need for major amputation and subsequent death. Standard treatment for such severe cases of PAD is surgical or endovascular revascularization. However, up to 30% of patients are not candidates for such interventions, due to high operative risk or unfavorable vascular involvement. Therefore, new strategies are needed to offer these patients a viable therapeutic option. Bone-marrow derived stem and progenitor cells have been identified as a potential new therapeutic option to induce angiogenesis. These findings prompted clinical researchers to explore the feasibility of cell therapies in patients with peripheral and coronary artery disease in several small trials. Clinical benefits were reported from these trials including improvement of ankle-brachial index (ABI), transcutaneous partial pressure of oxygen (TcO2), reduction of pain, and decreased need for amputation. Nonetheless, large randomized, placebo-controlled, double-blind studies are necessary and currently ongoing to provide stronger safety and efficacy data on cell therapy. Current literature is supportive of intramuscular bone marrow cell administration as a relatively safe, feasible, and possibly effective therapy for patients with PAD who are not subjects for conventional revascularization.Clinical RelevanceThis article describes the background and first results of stem and progenitor cell therapy in patients with critical limb ischemia not suitable for revascularization. The principle as far as it is understood and the methods are described. Compelling evidence suggests that progenitor cell therapy might become a useful adjunct to the treatment options at present. Due to poor prognosis and the increasing number of patients, there is a need for new therapeutic methods. The article gives an overview of first encouraging results provided by early-phase clinical trials. Challenges in this new therapeutic option still include open questions such as cell phenotype, processing, dosing, route of optimal delivery, and frequency of application. Validation by more rigorous controlled trials involving homogenous patient populations are required to confirm the first hopeful results

Personality Goes a Long Way

This article reviews books which test the personalization of politics, looking at different dimensions of the growing importance of leaders over time, namely for political parties, in electoral behaviour and in the media. Only recently have wide-ranging comparative longitudinal studies on leaders been carried out. The personalization thesis is not equally demonstrated across all dimensions. Indeed, we find something of a puzzle: There is no strong trend towards personalization of party organizations, whereas in electoral behaviour the evidence points to the increasing use by voters of leaders as heuristics. This attests to the decline of the importance of parties. The personalization of media may be the mechanism which explains the change in voting behaviour, and the third and final section of the review looks into that arena. We conclude with some suggestions on further research on the personalization of politics.info:eu-repo/semantics/publishedVersio

ESVM Guideline on peripheral arterial disease

International audienc

Impact of diabetes on outcome in critical limb ischemia with tissue loss: a large-scaled routine data analysis

BACKGROUND: Patients with diabetes concomitant to critical limb ischemia (CLI) represent a sub-group at particular risk. Objective of this analysis is to evaluate the actual impact of diabetes on treatment, outcome, and costs in a real-world scenario in Germany. METHODS: We obtained routine-data on 15,332 patients with CLI with tissue loss from the largest German health insurance, BARMER GEK from 2009 to 2011, including a follow-up until 2013. Patient data were analyzed regarding co-diagnosis with diabetes with respect to risk profiles, treatment strategy, in-hospital and long-term outcome including costs. RESULTS: Diabetic patients received less overall revascularizations in Rutherford grades 5 and 6 (Rutherford grade 5: 45.0 vs. 55.5%; Rutherford grade 6: 46.5 vs. 51.8; p < 0.001) and less vascular surgery (Rutherford grade 5: 13.4 vs. 23.4; Rutherford grade 6: 19.7 vs. 29.6; p < 0.001), however more often endovascular revascularization in Rutherford grade 6 (31.0 vs. 28.1; p = 0.004) compared to non-diabetic patients. Diabetes was associated with a higher observed ratio of infections (35.3 vs. 23.5% Rutherford grade 5; 44.3 vs. 27.4% Rutherford grade 6; p < 0.001) and in-hospital amputations (13.0 vs. 7.3% Rutherford grade 5; 47.5 vs. 36.7% Ruth6; p < 0.001). Diabetes further increased the risk for amputation during follow-up [Rutherford grade 5: HR 1.51 (1.38–1.67); Rutherford grade 6: HR 1.33 (1.25–1.41); p < 0.001], but not for death.CONCLUSIONS: Diabetes increases markedly the risk of amputation attended by higher costs in CLI patients with tissue loss (OR 1.67 at Rutherford 5, OR 1.53 at Rutherford 6; p < 0.001), but is associated with lower revascularizations. However, in Rutherford grades 5 and 6, concomitant diabetes does not further worsen the overall poor survival.<br

MOESM1 of Impact of diabetes on outcome in critical limb ischemia with tissue loss: a large-scaled routine data analysis

Additional file 1: Table S1. ICD- and OPS codes of diagnoses and procedures