Journal «Angiology and Vascular Surgery» • 

2020 • VOLUME 26 • №2

Problems and prospects of cell therapy for critical ischaemia of lower limbs

Osipova O.S., Saaya Sh.B., Karpenko A.A., Zakiyan S.M.

Department of Vascular Pathology and Hybrid Surgery, National Medical Research Centre named after Academician Meshalkin E.N. under the RF Ministry of Public Health, Novosibirsk, Russia

Background. Cell therapy was proposed as a procedure of indirect revascularization for patients with critical ischaemia of lower extremities for whom endovascular and surgical revascularization is impossible. We present herein a review of the state of the art of studies in the field of cell therapy of this cohort of patients.

Basic provisions. Cell therapy has proved safe, however, the results of studies of efficacy are relatively ambiguous and unconvincing. The number of patients in separately taken clinical trials is minimal. The reviewed studies differed not only by heterogeneity of the cell types used but by the routes of administration of cells (cells were delivered either intramuscularly (predominantly) or intraarterially) and the duration of follow up (time of assessment and duration of follow up varied from 1 month to 2 years). One of the problems became the lack of the routine study of the angiogenic potential of stem cells prior to their clinical application. It is known that the angiogenic activity of multipotent cells of apparently healthy patients may differ from that of patients suffering from atherosclerosis, chronic renal failure, diabetes.

Conclusions. It is supposed that treatment with stem cells or precursor cells is more efficient as compared to protein or gene therapy not only owing to direct vasculogenic properties but a paracrine action through excretion of proangiogenic biologically active substances. More studies with larger cohorts are necessary to provide stronger safety and efficacy data on cell therapy. Besides, a promising trend in the field of cellular approaches is modulation of regenerative capability of stem cells, which may help overcome difficulties in understanding the place of cell therapy in therapeutic angiogenesis.

KEY WORDS: angiogenesis, bone marrow-derived stem cells, cell therapy, critical ischaemia of lower limbs, peripheral artery disease.

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