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Clinical features and predictors of patients with critical limb ischemia who responded to autologous mononuclear cell transplantation for therapeutic angiogenesis

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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.

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Acknowledgements

We express our thanks to the members of Cardiovascular Center, Blood Transfusion Department, and Department of Dolorology, Kitasato University Hospital, for their kind assistance and many helpful suggestions. We also express our sincere gratitude to our irreplaceable colleagues, scientific officer Kazuyo Yagi in Blood Transfusion Department and scientific officer Kazumi Nakazato in Department of Cardiovascular Medicine, for their contribution to this study.

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Authors and Affiliations

  1. 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

    Naoyoshi Aoyama

  2. Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan

    Makoto Nishinari, Chiharu Noda & Jyunya Ako

  3. Department of Transfusion Medicine and Cell Transplantation, Kitasato University School of Medicine, Sagamihara, Japan

    Shinichi Ohtani

  4. Division of Dolorology, Department of Comprehensive Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan

    Akifumi Kanai

  5. Division of Surgical Operation Management, Department of Comprehensive Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan

    Mitsuhiro Hirata

  6. Cardiology Department, Cardiovascular Center, Takatsu General Hospital, Kawasaki, Japan

    Akira Miyamoto

  7. Department of Cardiovascular Medicine, University of Tokyo Hospital, Tokyo, Japan

    Masafumi Watanabe

  8. Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Tohru Minamino

  9. Niigata Minami Hospital, Niigata, Japan

    Tohru Izumi

Authors
  1. Naoyoshi Aoyama
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  2. Makoto Nishinari
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  3. Shinichi Ohtani
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  4. Akifumi Kanai
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  6. Mitsuhiro Hirata
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  7. Akira Miyamoto
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  8. Masafumi Watanabe
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  9. Tohru Minamino
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  10. Tohru Izumi
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  11. Jyunya Ako
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Correspondence to Naoyoshi Aoyama.

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Aoyama, N., Nishinari, M., Ohtani, S. et al. Clinical features and predictors of patients with critical limb ischemia who responded to autologous mononuclear cell transplantation for therapeutic angiogenesis. Heart Vessels 32, 1099–1108 (2017). https://doi.org/10.1007/s00380-017-0968-5

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  • DOI: https://doi.org/10.1007/s00380-017-0968-5

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