Vascular disease and stem cell therapies

Introduction and background: Peripheral vascular disease is the leading cause of limb ischemia (LI). LI is manifested by claudication, ischemic rest pain, ulcers or gangrene. It is the result of peripheral arterial disease due to atherosclerosis. Over the last decade, several centers around the world have initiated clinical trials utilizing stem cells as a treatment for this disease. Sources of data: Published medical literature, clinical trials announced in clinical trials.gov and TCA cellular therapy experience. Areas of agreement: There is general agreement that stem cells are useful for LI. Areas of controversy: These arise from the type of cells, dose, route of administration and methods to evaluate efficacy. Growing points: Growing evidence suggests that bone marrow derived-mesenchymal stem cells are as good as or superior to mononuclear cells, and a combination of both cell types may be even better. Areas timely for developing research: Based on current trials and publications, several promising biological products could become part of the therapeutic arsenal for LI. This may include combinations of more than one type of adult/induced pluripotent stem cells/embryonic stem cells, use of stem cells with growth factors or extracellular matrix molecules.