Autologous bone marrow derivated mononucleer stem cell i̇mplantati̇on experiences in peripheral vascular disease

Thromboangiitis obliterans (TAO), or Buerger's disease, is a non-atherosclerotic, episodic, sharply segmental, inflammatory, thrombotic-occlusive and non-destructive vascular disease of unknown origin that leads to gangrene and tissue loss. It initially involves the distal vessels and nerves within the neuro-vascular bundles of the legs (infrequently, the arms might be involved, and less commonly, the cerebral visceral vessels). The disease appears to start distally and then extends proximally. The aim of our study investigated the efficacy and safety of autologous bone marrow-mononuclear cells (ABMMNC) implantation in patients with critical limb ischemia (CLI) due to thromboangiitis obliterans (Buerger's disease). The paramaters collected on 1, 3 and 6 months after implantation and used to evaluate the functional outcomes of the stem cell implantation. The first follow up was approximately 1 month after the implantation. The statisticaly analysis of the datas was done to Biostatistics Division of Akdeniz University with SPSS software pack v.18.0. 11 patient with Rutherford Grade II-III thromboanjiitis obliterans who was applicated to the polyclinic of the Division Cardiovascular Surgery of Akdeniz University were carried out stem cell implantation between May 2006 and June 2011. All patients underwent a standard vascular examination that included measurement of ankle-brachial pressure index (ABPI), measurement of the pain free walking distance with Treadmill protocol include the 12% gradient with 2 km/hour, Visual Analog Scala test and DSA or BT angiography tests. The follow up performed after the 6 months the ABMMNC implantation, average pain free walking distance measured that 310±172,54 meters and the differance between the result of average pain free walking distance on the Treadmill tests performed to before the implantation was 272,27±164,96 meters. This differance was seen significant on the Bonferroni correction Wilcoxon signed rank test (p=0,003*, p<0,08). The follow up performed after the 6 months the ABMMNC implantation, average Visual Analog Scala score measured that 6,25±1,50 points and the differance between the result of average Visual Analog Scala score on the Visual Analog Scala tests performed to before the implantation was 1,97±0,86 points. This differance was seen significant on the Bonferroni correction Wilcoxon signed rank test (p=0,003*, p<0,08). The Ankle-Brachial Blood Pressure measurement perfomed before the implantation of ABMMNC for observe the tissue perfusion and this measurement results averages was 0,507±0,06. The follow up after the implantation ABPI measurement repeat up and result average was calculated 0,66±0,10. The differance between before the implantation ABPI results and after the implantation APBI results was seen significant on the Bonferroni correction Wilcoxon signed rank test (p=0,003*, p<0,08). The follow up 6 months after the implantation, DSA angiography or BT angiography was performed all patient for observe the new vessel formation and collateralisation. According to angiographic results 4 to 11 (36,36%) patients shown +3 points collateralisation, 2 to 11 (18,18%) patients shown +2 points collateralisation, 4 to 11 (36,36%) patients shown +1 points collateralisation and 1 to 11 (36,36%) patients shown +0 points collateralisation. In addition to the studies which about the cell therapy on the peripheral vascular disease, the 6 months result of our study is promising. Also more clinical studies are needed increase to safety and utility and evaluate the efficiency of the ABMMNC implantation. It is seems that cell therapy will be a major therapeutic strategy in the threatment of the patients with peripheral vascular disease in the future.