Therapeutic angiogenesis using umbilical cord blood stem cell transplantation for patients with critical limb ischemia due to Buerger`s disease

Abstract

Buerger`s disease is characterized pathologically as a panangiitis of medium and small blood vessels including both arteries and adjacent veins. The vascular involvement shows a predilection for distal extremity vessels including digital, palmar and plantar, and tibioperoneal arteries. The etilology is unknown but the association with cigarette smoking is striking characteristic. A possible allergy or hypersensitivity to a component of cigarette smoking may contribte to this disorder. Usually the symptoms start with claudication of the foot. Ischemic rest pain develops progressively and may affect not only the toes but also the fingers. Affected digits may show signs of cyanosis or dependent rubor. Gangrene and ulceration are the next step. Finally the affected limb and the aweful pain may be treated by ampution. 3 men with buerger`s disease who were already treated with medical and surgical therapies were nearly in narcotics-addicted status. They were performed with umbilical cord blood (UCB) stem cell transplantation on the affected areas, 2 upper and 1 lower extremities, with HLA typing after informed consent. The results were fantastic. 2 men showed sudden disappearance of pain sensation on their affected extremities after 2nd day of treatment. One man`s pain lasted 14 days after treatment but his pain was relieved within one month and he quitted narcotic analgesics after one month of treatment. Now they all stop analgesics and have only vasodilating drugs. The follow-up angiography showed increasing appearance of digital capillaries and decreasing vascular resistence in their extremities comparing with the preoperative study. These cases illustrate the remarkable efficacy of the UCB stem cell transplantation on Buerger`s didease. Thus we propose that therapeutic angiogenesis of UCB stem cell transplantation is an effective means for tissue salvage in patients with critical limb ischemia.