Bone-marrow Cell Transplantation Could Save Limbs

Injecting a patient’s bone-marrow cells into their legs could help repair damaged circulatory systems in those with limb ischaemia, suggest authors of a trial in this week’s issue of THE LANCET.

Lower limb ischaemia is due to narrowing of the arteries and is a common condition, which if left untreated can lead to gangrene, amputation, and sometimes death. The disorder is usually associated with chronic peripheral arterial disease and can result in severe leg pain at rest and walking, as well as non-healing ulcers on the leg and foot.

Certain cells from bone marrow (bone marrow-mononuclear cells), when injected into a patient’s leg, can start the growth of new blood vessels in the area, in a process called angiogenesis. These new vessels restore blood and oxygen supply to the damaged limb, which could reduce pain and help ulcers to heal.

Eriko Tateishi-Yuyama from the Department of Medicine and cardiovascular centre in Kansai Medical University, Osaka, Japan, and colleagues tested their treatment for the constriction of blood vessels by injecting bone-marrow cells into one leg, and cells from peripheral blood or saline into the other.

Four weeks after the procedure, 37 of 45 patients had their pain reduced or relieved completely, 15 of 20 were able to avoid scheduled amputation of a toe, and leg ulcers improved in six of ten patients. Positive benefits of the bone- marrow cell transplantation were still evident 6 months after the procedure.

The authors comment: “Implantation of bone marrow-mononuclear cells could be a safe and effective strategy for achievement of therapeutic angiogenesis, because of the natural ability of marrow cells to supply endothelial progenitor cells and to secrete various angiogenic factors”.

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