Phase I trial: the use of autologous cultured adipose-derived stroma/stem cells to treat patients with non-revascularizable critical limb ischemia

• Published in: Cytotherapy (Oxford, England) Vol. 16; no. 2; pp. 245 - 257
• Main Authors: Bura, Alessandra, Planat-Benard, Valerie, Bourin, Philippe, Silvestre, Jean-Sebastien, Gross, Fabian, Grolleau, Jean-Louis, Saint-Lebese, Bertrand, Peyrafitte, Julie-Anne, Fleury, Sandrine, Gadelorge, Melanie, Taurand, Marion, Dupuis-Coronas, Sophie, Leobon, Bertrand, Casteilla, Louis
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.02.2014
• Subjects: adipose tissue; Adipose Tissue - cytology; Adult; Adult Stem Cells - cytology; Adult Stem Cells - metabolism; Adult Stem Cells - transplantation; Advanced Basic Science; Aged; Aged, 80 and over; ASC; Cell Culture Techniques; cell therapy; Cells, Cultured; CLI; Extremities - blood supply; Extremities - pathology; Extremities - transplantation; Feasibility Studies; Female; Homeodomain Proteins - metabolism; Humans; Injections, Intramuscular; Ischemia - therapy; Male; mesenchymal stromal cells; Middle Aged; Nanog Homeobox Protein; Neovascularization, Physiologic; Octamer Transcription Factor-3 - metabolism; Other; Peripheral Arterial Disease - therapy; Stem Cell Transplantation; Stromal Cells - cytology; Stromal Cells - metabolism; Stromal Cells - transplantation; Treatment Outcome; adipose tissue; ASC; CLI; cell therapy; mesenchymal stromal cells
• ISSN: 1465-3249; 1477-2566
• DOI: 10.1016/j.jcyt.2013.11.011

Abstract Background aims Non-revascularizable critical limb ischemia (CLI) is the most severe stage of peripheral arterial disease, with no therapeutic option. Extensive preclinical studies have demonstrated that adipose-derived stroma cell (ASC) transplantation strongly improves revascularization and tissue perfusion in ischemic limbs. This study, named ACellDREAM, is the first phase I trial to evaluate the feasibility and safety of intramuscular injections of autologous ASC in non-revascularizable CLI patients. Methods Seven patients were consecutively enrolled, on the basis of the following criteria: (i) lower-limb rest pain or ulcer; (ii) ankle systolic oxygen pressure <50 or 70 mm Hg for non-diabetic and diabetic patients, respectively, or first-toe systolic oxygen pressure <30 mm Hg or 50 mm Hg for non-diabetic and diabetic patients, respectively; (iii) not suitable for revascularization. ASCs from abdominal fat were grown for 2 weeks and were then characterized. Results More than 200 million cells were obtained, with almost total homogeneity and no karyotype abnormality. The expressions of stemness markers Oct4 and Nanog were very low, whereas expression of telomerase was undetectable in human ASCs compared with human embryonic stem cells. ASCs (108 ) were then intramuscularly injected into the ischemic leg of patients, with no complication, as judged by an independent committee. Trans-cutaneous oxygen pressure tended to increase in most patients. Ulcer evolution and wound healing showed improvement. Conclusions These data demonstrate the feasibility and safety of autologous ASC transplantation in patients with objectively proven CLI not suitable for revascularization. The improved wound healing also supports a putative functional efficiency.