Therapeutical potential of autologous peripheral blood mononuclear cell transplantation in patients with type 2 diabetic critical limb ischemia

Aim: The aim was to evaluate the therapeutic effectiveness of granulocyte colony-stimulating factor (G-CSF) mobilized peripheral blood mononuclear cells (PBMNCs) in critical limb is:hernia (CLI) of type 2 diabetic patients. Method: Forty diabetic patients with CLI were enrolled and randomized to treatment and control groups. In the treatment group, the patients received subcutaneous injections of recombinant human G-CSF (30 MU/day) for 5 days to mobilize stem cells. PBMNCs were collected and transplanted by multiple intramuscular injections of 1 ml in 1-1.5-cm depth into ischemic limbs. Results: At the end of 12 weeks of follow-up, the baseline and end point results in transplant group were as follows: Fontaine score improved from 3.8 +/- 03 to 3 +/- 0.5 (P=.0001), ankle brachial pressure index increased from 0.68 +/- 0.24 to 0.87 +/- 024 (P=.001), transcutaneous oxygen increased from 33 14 mmHg to 44 +/- 10 mmHg (P=.0001), and 6-min walking distance improved from 280 +/- 82 m to 338 +/- 98 m (P=.0001). Pain score decreased from 8.2 +/- 1.3 to 5.63 +/- 1.6 (P=.001), and the number of patients with limb ulcers was reduced from 9/20 (45%) to 3/20 (15%) (P=.031). In the control group, Fontaine score, 6-min walking distance, and pain score were improved; ankle brachial pressure index and transcutaneous oxygen pressure were not improved. The number of patients with limb ulcers did not change in the control group. There are improvement in amputation rates, collateral vessel development, and number of limb ulcers healed. Conclusions: These results indicate that the autologous transplantation of G-CSF that mobilized PBMNCs in CLI diabetic patients is safe and effective in patient compliant reduction and improved perfusion. (C) 2012 Elsevier Inc. All rights reserved.