Stem-cell therapies in critical limb ischemia

Abstract

Department of Anatomy and Clinical Anatomy, and Laboratory of Tissue Engineering and Cell Cultures, Department of Histology, Cytology and Embryology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, the Republic of Moldova, Institute of Emergency Medicine, Chisinau, the Republic of MoldovaAbstract. Background: Due to stimulation of muscular regeneration in ischemic extremities and increasing blood flow, stem cells are considered a promising new strategy for patients with critical limb ischemia (CLI). So, it is demonstrated that mesenchymal stem cells (MSCs), mononuclear cells derived from bone marrow, peripheral and umbilical blood, adipose tissue encourage the genesis of endothelial cells (ECs) and vascular smooth muscle cells (VSMCs). By application of stem cell-based therapy, the following results are obtained: increased rate of ulcer healing, increased ankle-brachial index (ABI), and transdermal oxygen pressure (TcPO2), improved revascularization, and reduced rate of amputation surgery. So, stem cell-based therapy demonstrates good clinical outcomes. However, some adverse events related to cell sampling and mobilizations are reported. In addition, because of poor cell survival in the condition of ischemia their therapeutic efficacy remains low which indicates further researchers are necessary for this field. Conclusions: Cell-based therapy is a promising approach in CLI treatment. Its promising results have been already shown in smaller studies; however, large-scale studies are entailed to ascertain their definitive role in anti-ischemic therapy