Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Feb 22;9(1):43.
doi: 10.1186/s13287-018-0784-6.

Autologous bone marrow-derived mononuclear cell therapy in Chinese patients with critical limb ischemia due to thromboangiitis obliterans: 10-year results

Jianming Guo  1   2   3 , Lianrui Guo  1   2 , Shijun Cui  1   2 , Zhu Tong  1   2 , Alan Dardik  4 , Yongquan Gu  5   6
Affiliations

Autologous bone marrow-derived mononuclear cell therapy in Chinese patients with critical limb ischemia due to thromboangiitis obliterans: 10-year results

Jianming Guo et al. Stem Cell Res Ther. .

Abstract

Background: For patients with thromboangiitis obliterans (TAO), revascularization with bypass or angioplasty is frequently not feasible due to the poor outflow of the distal small vessels. We evaluated the long-term results of our experience treating patients with TAO with autologous bone marrow-derived mononuclear cells (ABMMNCs) to determine the safety and efficacy of ABMMNC therapy in patients with critical limb ischemia due to TAO.

Methods: This was a retrospective chart review from a single university hospital vascular surgery center between January 2005 and July 2006. Patients were treated with smoking cessation and either aspirin (100 mg/day) alone or aspirin and ABMMNC injection according to patient preference. Groups were compared for demographics, clinical characteristics, and short-term and long-term results.

Results: Of 59 patients with TAO who were treated, 19 patients elected aspirin alone and 40 patients elected aspirin and ABMMNC injection. No patients suffered perioperative complications and 49 (83%) patients remained smoke-free for 10 years. The 10-year amputation-free survival was 85.3% (29/34) in patients treated with ABMMNCs compared to 40% (6/15) in patients treated with aspirin alone (p = 0.0019). Ulcer area (p < 0.0001), toe-brachial index (TBI; p < 0.0001), transcutaneous oxygen pressure (TcPO2; p < 0.0001), and pain score (p < 0.0001) were also significantly improved with ABMMNC treatment, although there was no difference in mean ankle-brachial index (ABI; p = 0.806).

Conclusions: In patients with critical limb ischemia due to TAO, ABMMNC treatment was safe and effective. ABMMNC treatment significantly improved amputation-free survival, ulcer healing, and pain, although there is no difference in ABI compared to treatment with aspirin alone.

Keywords: Bone marrow; Critical limb ischemia; Mononuclear cell; Thromboangiitis obliterans.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval for the study was obtained from the Xuanwu Hospital review board and all patients provided written informed consent to participate in the study.

Consent for publication

All related patients and all authors agreed and signed the consent form.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Representative images of ABMMNC treatment. a Bone marrow harvested from the posterior superior iliac spine. b Bone marrow separated into red cells and ABMMNCs. c ABMMNC injection. d Appearance of the leg after ABMMNC injections; blue arrows show the injection sites. e Representative angiogram, with blue arrows showing the injection sites along the tibial arteries
Fig. 2
Fig. 2
Representative images of an ulcer healing after ABMMNC treatment. a Prior to treatment; b at 3 months; c at 6 months; d at 120 months
Fig. 3
Fig. 3
Time-dependent changes in a ulcer area (p < 0.0001), b ABI (p = 0.806), c TBI (p < 0.0001), d transcutaneous oxygen pressure (TcPO2; p < 0.0001), and e pain score (p < 0.0001). ABMMNC autologous bone marrow-derived mononuclear cells
Fig. 4
Fig. 4
Amputation-free survival in patients treated with smoking cessation, aspirin, and with or without autologous bone marrow-derived mononuclear cell (ABMMNC) treatment; Kaplan-Meier analysis through 10-year follow up. Amputation includes both major and minor amputations
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Buerger L. Thrombo-angiitis obliterans: a study of the vascular lesions leading to presenile spontaneous gangrene. Am J Med Sci. 1908;136:567–580. doi: 10.1097/00000441-190810000-00011. - DOI - PubMed
    1. Ohta T, Ishioashi H, Hosaka M, Sugimoto I. Clinical and social consequences of Buerger disease. J Vasc Surg. 2004;39:176–180. doi: 10.1016/j.jvs.2003.08.006. - DOI - PubMed
    1. Graziani L, Morelli L, Parini F, Franceschini L, Spano P, Calza S, Sigala S. Clinical outcome after extended endovascular recanalization in Buerger’s disease in 20 consecutive cases. Ann Vasc Surg. 2012;26:387–395. doi: 10.1016/j.avsg.2011.08.014. - DOI - PubMed
    1. Jun HJ. Endovascular revascularization for the obstruction after patch angioplasty in Buerger’s disease. Korean J Thorac Cardiovasc Surg. 2014;47:174–177. doi: 10.5090/kjtcs.2014.47.2.174. - DOI - PMC - PubMed
    1. Tateishi-Yuyama E, Matsubara H, Murohara T, Ikeda U, Shintani S, Masaki H, Amano K, Kishimoto Y, Yoshimoto K, Akashi H, et al. Therapeutic angiogenesis for patients with limb ischaemia by autologous transplantation of bone-marrow cells: a pilot study and a randomised controlled trial. Lancet. 2002;360:427–435. doi: 10.1016/S0140-6736(02)09670-8. - DOI - PubMed

Publication types