Abstract
Background
Peripheral arterial disease (PAD) is a common cause of disability and mortality. Up
to one third of patients are not susceptible to traditional revascularization and
may benefit from stem cell therapies.
Objective
In this meta-analysis, we sought to determine whether autologous cell therapy is effective
in the treatment of PAD.
Methods
We searched the English literature in Medline, Excerpta Medica and the Cochrane database
for trials of autologous cell therapy in patients with PAD published before 31 January
2009. We included controlled and non-controlled, randomized and non-randomized trials
using autologous bone marrow or granulocyte colony stimulating factor (G-CSF) mobilized
peripheral blood cells to treat PAD. We also collected data from trials of G-CSF monotherapy,
as a control treatment.
Results
In a meta-analysis of 37 trials, autologous cell therapy was effective in improving
surrogate indexes of ischemia, subjective symptoms and hard endpoints (ulcer healing
and amputation). On the contrary, G-CSF monotherapy was not associated with significant
improvement in the same endpoints. Patients with thromboangiitis obliterans showed
some larger benefits than patients with atherosclerotic PAD. The intramuscular route
of administration and the use of bone marrow cells seemed somehow more effective than
intrarterial administration and the use of mobilized peripheral blood cells. The procedures
were well tolerated and generally safe.
Conclusion
This meta-analysis indicates that intramuscular autologous bone marrow cell therapy
is a feasible, relatively safe and potentially effective therapeutic strategy for
PAD patients, who are not candidate for traditional revascularization. Larger, placebo-controlled,
randomized multicenter trials need to be planned and conducted to confirm these findings.
Keywords
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Article info
Publication history
Published online: September 10, 2009
Accepted:
August 17,
2009
Received in revised form:
August 5,
2009
Received:
June 17,
2009
Identification
Copyright
© 2009 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
