Therapeutic strategies for cell-based neovascularization in critical limb ischemia.
Therapeutic strategies for cell-based neovascularization in critical limb ischemia.
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DOI：
10.1186/s12967-017-1153-4
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发表时间：
2017-02-24
影响因子：
7.4
通讯作者：
Hamano K
中科院分区：
文献类型：
--
作者：
Samura M;Hosoyama T;Takeuchi Y;Ueno K;Morikage N;Hamano K
严重肢体缺血（CLI）会导致下肢严重的缺血性静息痛、溃疡和坏疽。尽管进行了血管成形术和手术，但在病变中没有合适的动脉流入或足够的血管床的CLI患者通常被迫进行主要肢体截肢。基于细胞的治疗性血管生成具有通过促进侧支血管网络和血管床的形成来治疗缺血性病变的潜力。外周血单核细胞和骨髓来源的单核细胞是CLI临床试验中最常用的细胞类型。然而，使用这些细胞的基于细胞的治疗性血管生成的临床结果尚未为CLI患者提供所承诺的益处，从而加强了对新型基于细胞的治疗性血管生成策略的需求，以治愈无法治疗的CLI患者。最近的研究表明，预处理的移植细胞可能提高缺血性疾病的治疗效果。此外，从过去的临床试验来看，确定适当的移植时机和对基于细胞的治疗的应答者对于改善临床环境中CLI患者的治疗结果非常重要。因此，建立基于细胞的治疗性血管生成作为CLI患者的最有前途的治疗策略之一，其优点和局限性应加以考虑。
Critical limb ischemia (CLI) causes severe ischemic rest pain, ulcer, and gangrene in the lower limbs. In spite of angioplasty and surgery, CLI patients without suitable artery inflow or enough vascular bed in the lesions are often forced to undergo amputation of a major limb. Cell-based therapeutic angiogenesis has the potential to treat ischemic lesions by promoting the formation of collateral vessel networks and the vascular bed. Peripheral blood mononuclear cells and bone marrow-derived mononuclear cells are the most frequently employed cell types in CLI clinical trials. However, the clinical outcomes of cell-based therapeutic angiogenesis using these cells have not provided the promised benefits for CLI patients, reinforcing the need for novel cell-based therapeutic angiogenesis strategies to cure untreatable CLI patients. Recent studies have demonstrated the possible enhancement of therapeutic efficacy in ischemic diseases by preconditioned graft cells. Moreover, judging from past clinical trials, the identification of adequate transplant timing and responders to cell-based therapy is important for improving therapeutic outcomes in CLI patients in clinical settings. Thus, to establish cell-based therapeutic angiogenesis as one of the most promising therapeutic strategies for CLI patients, its advantages and limitations should be taken into account.