Autologous transplantation of bone marrow mesenchymal stem cells on diabetic patients with lower limb ischemia

<正>Objective:To study the efficacy and safety of autologous transplantation of bone marrow mesenchymal stem cells on diabetic patients with lower limb ischemia.Methods:Fifty Type 2 diabetic patients with lower limb ischemia were enrolled and randomized to either transplanted group or control group.Patients in both group received the same conventional treatment.Meanwhile,20 ml bone marrow from each transplanted patient were collected,and the mesenchymal stem cells were separated by density gradient centrifugation and cultured in the medium with autologous serum.After three-weeks adherent culture in vitro,7.32×10～8-5.61×10～9 mesenchymal stem cells were harvested and transplanted by multiple intramuscular and hypodermic injections into the impaired lower limbs.Results:At the end of 12-week follow-up,5 patients were excluded from this study because of clinical worsening or failure of cell culture. Main ischemic symptoms,including rest pain and intermittent claudication,were improved significantly in transplanted patients.The ulcer healing rate of the transplanted group (15 of 18,83.33%) was significantly higher than that of the control group (9 of 20,45.00%,P=0.012).The mean of resting ankle-brachial index (ABI) in transplanted group significantly was increased from 0.61±0.09 to 0.74±0.11 (P<0.001).Magnetic resonance angiography (MRA) demonstrated that there were more patients whose score of new vessels exceeded or equaled to 2 in the transplant patients (11 of 15) than in control patients (2 of 14,P=0.001).Lower limb amputation rate was significantly lower in transplanted group than in the control group (P=0.040).No adverse effects was observed in transplanted group. Conclusion:These results indicate that the autologous transplantation of bone marrow mesenchymal stem cells relieves critical lower limb ischemia and promotes ulcers healing in Type 2 diabetic patients.