Successful Bone Marrow Transplantation Reveals the Lack of Endothelial Progenitor Cells Mobilization in a Patient With Critical Limb Ischemia: A Case Report

• Published in: Transplantation proceedings Vol. 42; no. 7; pp. 2816 - 2820
• Main Authors: Cobellis, G, Botti, C, Taddeo, A, Silvestroni, A, Lillo, S, Da Ponte, A, Villa, M.L, Sica, V, Della Bella, S
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.09.2010; Elsevier
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aorta, Abdominal - diagnostic imaging; Arterial Occlusive Diseases - complications; Biological and medical sciences; Blood Flow Velocity; Bone Marrow Transplantation - methods; Bone marrow, stem cells transplantation. Graft versus host reaction; Cholesterol, HDL - blood; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hematopoietic Stem Cell Mobilization - methods; Humans; Hyperemia - diagnostic imaging; Hyperemia - physiopathology; Iliac Artery - diagnostic imaging; Ischemia - etiology; Ischemia - pathology; Kidney Function Tests; Leg - blood supply; Liver Function Tests; Male; Medical sciences; Neovascularization, Physiologic; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Tomography, X-Ray Computed; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Human; Endothelial cell; Stem cell; Hematopoietic cell; Homograft; Bone marrow transplantation; Cardiovascular disease; Lower limb ischemia; Patient; Transplantation; Vascular disease; Case study; Medicine; Mobilization; Treatment; Surgery; Bone marrow; Progenitor cell
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.04.047

Abstract Restoring blood flow to ischemic tissue is a prerequisite for treatment of ischemic diseases. Cell-based therapy based on bone marrow transplantation is a promising option for patients with critical limb ischemia (CLI). The efficacy of cell therapies to augment neovascularization seems to involve endothelial progenitor cells (EPCs); however, the mechanisms underlying the efficacy have not been fully elucidated. Herein we have described the case of a young patient with severe CLI, who experienced a 24-month beneficial clinical response to autologous bone marrow transplantation. The exceptional amelioration enabled him to perform standardized maximal treadmill exercise test that demonstrated lack of exercise-induced EPC mobilization, despite adequate stromal-derived factor 1 and vascular endothelial growth factor responses. Therefore, tissue ischemia is not sufficient to promote the recruitment of EPCs that have been demonstrated to be involved in the recovery from ischemia. The local implantation of marrow-derived elements may provide cells and/or trophic factors, which have the capacity to augment angiogenesis, opening new approaches to the etiopathogenesis of the disease.