Critical Limb Ischemia Clinical Trial
Official title:
Monocentric Randomized Study for the Therapy of Critic Limb Ischemia With Bone Marrow- or Peripheral Blood-derived Stem Cells
The investigators designed a randomized clinical trial (stem cell emergency life threatening arteriopathy or SCELTA) to compare the therapeutic efficacy of the auto-transplant of enriched circulating EPCs (ECEPCs) with auto-transplant of BM-MNCs. ECEPCs, obtained by immunoselection of CD14+ and CD34+ cells, or BM-MNCs, were injected intramuscularly in the affected limb of patients with critical limb ischemia (CLI).
Peripheral arterial disease comprises a clinical spectrum that extends from no symptoms to
presentation with critical limb ischemia (CLI), which is a very invalidating condition
characterized by rest pain, march inability, trophic lesions and unavoidable progression to
major amputations, which are burdened by a high mortality in the first year. The
pathophysiology of CLI often associates with a defect in the development of collateral
vessels and angiogenesis, a process which refers to the formation of new blood vessels into
tissue, due to circulating endothelial progenitor cells (EPCs) and vascular progenitor
cells. In the last few years, significant improvement of this condition has been reported
following bone marrow (BM) autotransplant or autotransplant of peripheral EPCs mobilized
from BM through the injection of granulocyte-colony stimulatory factor (G-CSF). In a
previous study, the investigators found that individually variable proportions of
circulating CD14+ cells expressed low levels of CD34 (CD14+CD34low) and revealed the
functional phenotype of EPCs. The investigators therefore designed a monocentric randomized
clinical trial to compare the therapeutic efficacy of BM autotransplant with the
autotransplant of a population of circulating CD34+ and CD14+CD34low enriched by a closed
sterile immunomagnetic system (enriched circulating EPCs or ECEPCs), without a previous EPC
mobilization from BM.
Patients will be evaluated for clinical parameters and ABI, TBI, TCp02 before autotransplant
and at three follow-up times after the autotransplant (4, 24 and 52 weeks); also angio-TAC
of legs, capillaroscopy, and photoplethysmography will be evaluated at 4, and even at 52
weeks.
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