2014, Number 4
Primer caso de trasplante de células progenitoras derivadas de la médula ósea en isquemia crítica de miembros inferiores como terapéutica consolidada
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ABSTRACTBackground. We present the first case of a bone marrow derived stem cell transplant for a patient with chronic bilateral lower limb ischemia. On November 12th, 2013 we obtained the approval of the Comisión Federal para la Protección contra Riesgos Sanitarios (COFEPRIS) CAS/01/0R/1934/2013.
Clinical case. Forty-two year-old male, heavy smoker, with a history of diabetes mellitus and hypertension. The patient started with claudication at 50 meters (m), quickly progressing to 5 m, ischemic ulcers and bilateral digital necrosis. On February 2011, the patient’s right limb showed femoral and popliteal 1/3 pulses, non-palpable tibial pulses, ankle brachial pressure index (ABI) of 0.16, left pelvic limb with femoral and popliteal 1/3 pulses, non-palpable tibial pulses and ABI of 0.5. Angiotomography. Occluded right iliac artery, left limb with total occlusion at the adductor (Hunter) canal level with two output vessels. On March 2011, angioplasty of the right iliac, superficial and deep femoral arteries was done, with stent implantation on right common iliac artery. PO. The result was a right pelvic limb with an ABI of 0.42, left pelvic limb with an ABI of 0.60 and on follow-up the patient showed claudication of 200 m. Bilateral ABI of 0.5 on September 2012 and deterioration with claudication at 50 m, with vein flow but no arterial flow. The patient was considered non-candidate to revascularization and an autologous bone marrow derived stem cell transplant was proposed as a possible therapy to induce angiogenesis and neo-vascularization. Purification process. 240 mL of bone marrow aspirate was obtained, the total volume was divided in 4 reservoirs of 60 mL. Cells were centrifuged at 2,500 and 2,300 RPM for 15 min. The total final volume of cell concentrate was 40 mL with a cell concentration of 32 x 106 ± 7.2 CD 34 + and 80 mL of plasm rich in growth factors (PRGF). Cell transplant. A bilateral transplant procedure was performed. 32 mL of cell concentrate were transplanted, divided into 16 injections of 2 mL at the muscle compartments. 80 mL of PRGF were applied for a second time close to the site of cell concentrate transplantation. Finally, 8 mL of cell concentrate were applied through the saphenous vein at the level of internal malleolus retrograde and distally.
Results. The patient showed a marked improvement 3 months after the procedure, with claudication at 250 m, monophasic posterior tibial flow and ABI values for right and left limb were 0.2 and 0.3 respectively.
Tateishi-Yuyama E, Matsubara H, Murohara T, Ikeda U, Shintani S. Masaki H, et al. Therapeutic angiogenesis using cells transplantation (TACT) Study Investigators. Therapeutic angiogenesis for patients with limb ischemic by autologous. Transplantation of bone-marrow cells: A pilot study and a randomized controlled trial. Lancet 2002; 360: 427-35.
Padilla L, Rodríguez-Trejo J, Escotto I, De Diego J, Landero T, Carranza P, et al. Long-term effect of autologous progenitor cell therapy to induce neo-angiogenesis in patients with critical limb ischemia transplantated via intramuscular vs. combined intramuscular and distal retrograde intra-venous. Stem Cell Disc 2012; 2: 155-62.