Analysis of possible factors relating to prognosis in autologous peripheral blood mononuclear cell transplantation for critical limb ischemia

Background aimsAutologous transplantation of granulocyte colony-stimulating factor–mobilized peripheral blood mononuclear cells (M-PBMNCs) has been shown to be effective in treating critical limb ischemia (CLI); however, the studies of the possible prognosis predictors after autologous M-PBMNC transplantation are inadequate. The objective of the study was to assess the possible factors affecting the results of M-PBMNC transplantation for CLI.MethodsWe reviewed the clinical profiles of 87 patients with CLI who were treated with M-PBMNC implantation in the Blood Diseases Hospital, Chinese Academy of Medical Sciences, between December 2002 and December 2011, and we followed these patients. The patients were divided into a good prognosis group and a poor prognosis group on the basis of whether amputation was performed. The significant differences of clinical variables between two groups were analyzed by means of the Mann-Whitney test and χ² test, and logistic regression analysis was used to study the variables representing the possible prognostic factors for amputation.ResultsOf the 87 patients, three patients died and one patient was lost during the follow-up period. We analyzed 83 patients. The diseases included CLI complicated by diabetes mellitus gangrene (35 cases, 42.2%), arteriosclerosis obliterans (31 cases, 37.3%) and thromboangiitis (17 cases, 20.5%). The mean age was 62 years (range, 30–87). The median follow-up time for the surviving patients was 5 years. The 5-year amputation-free rate was 72.2%, and no adverse effects related to M-PBMNC transplantation were observed.ConclusionsThe significant prognostic factors associated with poor angiogenesis were fibrinogen >4 g/L and fasting blood glucose >6 mmol/L.     

Autologous bone marrow mononuclear cell therapy improves symptoms in patients with end-stage peripheral arterial disease and reduces inflammation-associated parameters

Background aimsThe purpose of this study was to evaluate the effect of autologous bone marrow mononuclear cells (BM-MNCs) on symptoms and perfusion indices in severely symptomatic patients with peripheral arterial disease (PAD) without further option for endovascular or surgical revascularization.MethodsOnly patients with severe symptomatic PAD (Fontaine class IIb-IV, Rutherford category 3–6) not amenable for revascularization were treated. Bone marrow from both cristae iliacae was harvested; MNCs were isolated by the Ficoll density-gradient method and transplanted by means of intra-arterial and intramuscular injection in the index limb. Functional (pain score, ulcer healing, maximum walking distance) and perfusion indices such as ankle-brachial-index and transcutaneous oxygen pressure were documented before and after BM-MNC therapy. Additionally, serum concentration of C-reactive protein and interleukin-6 were measured as markers of inflammation before and after BM-MNC treatment.ResultsSixteen consecutive patients (four women; mean age, 63.0 ± 13 years) were treated with a mean dose of 4.2 ± 2.2 × 10⁸ BM-MNCs. At 6 months' follow-up, ankle-brachial-index, transcutaneous oxygen pressure and maximum walking distance significantly increased, whereas C-reactive protein and interleukin-6 conversely decreased (P < 0.01 versus baseline values), resulting in 88% limb salvage, 75% pain reduction and 71% complete wound healing and/or reduction of ulcer size. One major and one minor amputation were performed, both in patients with Rutherford category 6.ConclusionsAutologous BM-MNC therapy in patients with end-stage PAD improves tissue perfusion indices and decreases markers of inflammation. If our observations could be confirmed by large-scale, randomized controlled trials, BM-MNC transplantation could become an alternative therapeutic option for patients with end-stage PAD.     

Murine Model of Hindlimb Ischemia

In the United States, peripheral arterial disease (PAD) affects about 10 million individuals, and is also prevalent worldwide. Medical therapies for symptomatic relief are limited. Surgical or endovascular interventions are useful for some individuals, but long-term results are often disappointing. As a result, there is a need for developing new therapies to treat PAD. The murine hindlimb ischemia preparation is a model of PAD, and is useful for testing new therapies. When compared to other models of tissue ischemia such as coronary or cerebral artery ligation, femoral artery ligation provides for a simpler model of ischemic tissue. Other advantages of this model are the ease of access to the femoral artery and low mortality rate.In this video, we demonstrate the methodology for the murine model of unilateral hindimb ischemia. The specific materials and procedures for creating and evaluating the model will be described, including the assessment of limb perfusion by laser Doppler imaging. This protocol can also be utilized for the transplantation and non-invasive tracking of cells, which is demonstrated by Huang et al.¹.     

Role of proteomic technologies in understanding risk of arterial thrombosis

Arterial thrombosis is a pivotal event in the development of cardiovascular diseases. Plasma and cellular proteins have the potential to influence thrombus morphology and function. This review summarizes the latest studies to use proteomic technologies to characterize the cellular and plasma components involved in arterial thrombosis, with a view to understanding the pathogenesis and treatment of acute cardiovascular diseases. Proteomic approaches have been extensively used to profile the proteome of endothelial cells, leukocytes, vascular smooth muscle cells, platelets and plasma in the search for risk factors for cardiovascular disease; however, further work is required to validate the direct contribution of these proteins to arterial thrombosis.     

Bilateral administration of autologous CD133+ cells in ambulatory patients with refractory critical limb ischemia: lessons learned from a pilot randomized,double-blind,placebo-controlled trial

Background aimsCD133+ cells confer angiogenic potential and may be beneficial for the treatment of critical limb ischemia (CLI). However, patient selection, blinding methods and end points for clinical trials are challenging. We hypothesized that bilateral intramuscular administration of cytokine-mobilized CD133+ cells in ambulatory patients with refractory CLI would be feasible and safe.MethodsIn this double-blind, randomized sham-controlled trial, subjects received subcutaneous injections of granulocyte colony-stimulating factor (10 μg/kg per day) for 5 days, followed by leukapheresis, and intramuscular administration of 50–400 million sorted CD133+ cells delivered into both legs. Control subjects received normal saline injections, sham leukapheresis and intramuscular injection of placebo buffered solution. Subjects were followed for 1 year. An aliquot of CD133+ cells was collected from each subject to test for genes associated with cell senescence.ResultsSeventy subjects were screened, of whom 10 were eligible. Subject enrollment was suspended because of a high rate of mobilization failure in subjects randomly assigned to treatment. Of 10 subjects enrolled (7 randomly assigned to treatment, 3 randomly assigned to control), there were no differences in serious adverse events at 12 months, and blinding was preserved. There were non-significant trends toward improved amputation-free survival, 6-minute walk distance, walking impairment questionnaire and quality of life in subjects randomly assigned to treatment. Successful CD133+ mobilizers expressed fewer senescence-associated genes compared with poor mobilizers.ConclusionsBilateral administration of autologous CD133+ cells in ambulatory CLI subjects was safe, and blinding was preserved. However, poor mobilization efficiency combined with high CD133+ senescence suggests futility in this approach.     

脂肪组织功能失调在动脉血栓相关疾病中的作用

肥胖与代谢综合征是传统心血管疾病的危险因素.多项临床研究表明,肥胖也会增加患血栓性疾病(如急性心肌梗死和脑卒中)的风险.脂肪组织与血小板反应性增加和高凝状态形成以及纤溶功能降低等存在着重要联系.脂肪组织还是一个高度活跃的内分泌器官,其表达和分泌具有重要功能的脂肪因子和脂质代谢物参与调控全身代谢.深入地了解脂肪组织的内分...     

Type 2 cytokines promote angiogenesis in ischemic muscle via endothelial IL-4Rα signaling

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早期规范康复训练在缺血性脑卒中患者中的应用价值

目的:研究早期规范康复训练在缺血性脑卒中患者的临床应用价值.方法:160例缺血性脑卒中患者分为观察组和对照组各80例,两组患者均采用常规治疗,治疗组在此基础上进行72小时内进行康复训练,对照组在15～30天左右进行康复训练,观察两组患者临床神经功能缺损程度采,日常生活活动能力及肢体运动功能的改善情况.结果:两组患者治疗前神经功能缺损程度,日常生活活动能力及肢体运动功能差异无明显的统计学意义(P＞0.05),经过康复训练两组患者各项功能均较治疗前有明显的提高,并且观察组提高水平明显高于对照组,差异具有明显的统计学意义(P＜0.01).结论:早期与晚期康复均可促进缺血性脑卒中患者各种功能的恢复,但是早期康复的临床疗效明显优于晚期康复训练.     

Effects of iloprost,a PGI2 derivative,on ischemic myocardial energy and carbohydrate metabolism in dogs

Effects of iloprost, which is a stable prostacyclin analogue, on the ischemic myocardium were examined in the open-chest dog heart, in terms of biochemical parameters. Ischemia was initiated by ligating the left anterior descending coronary artery. When the coronary artery was ligated for 3 min, the levels or glycogen, fructose-1,6-diphosphate (FDP), adenosine triphosphate and creatinephosphate decreased, and the levels of glucose-6-phosphate (G6P), fructose-6-phosphate (F6P), lactate, adenosine diphosphate and adenosine monophosphate increased. During ischemia, therefore, energy charge potential was significantly decreased from 0.89±0.01 to 0.82±0.01, and ([G6P]+[F6P])/[FDP] and [lactate]/[pyruvate] ratios were significantly increased from 1.75±0.30 to 29.05±5.70 and 13±3 to 393±112, respectively. Iloprost (0.1, 0.3, or 1 g·kg^–1) was injected intravenously 5 min before the onset of ischemia. Iloprost (0.1, 0.3, and 1 g·kg^–1) reduced the ischemia-induced decrease in energy charge potential to 94, 74, and 86%, respectively, the increase in ([G6P]+[F6P]/[FDP] to 38, 29, 32%, respectively, and the increase in [lactate]/[pyruvate] to 67, 45, 65%, respectively. These results suggest that iloprost lessens the myocardial metabolic derangements produced by ischemia, and the most potent effect was obtained at the dose of 0.3 g·kg^–1.     

急性下肢动脉栓塞与急性血栓的临床特征对比研究

目的:观察对比急性下肢动脉栓塞(AAELE)与急性血栓(AAT)的临床特征。方法:回顾性分析2013年1月-2015年11月我院75例AAELE或者AAT患者的临床资料,根据造影结果分为AAELE组53例和AAT组22例。对比两组患者梗阻部位及发病位置,统计分析两组患者合并症和既往疾病史情况,记录患者的临床表现及缺血程度分级。结果:AAELE组在髂股动脉梗阻发生率为54.72%,显著高于AAT组的27.27%,差异有统计学意义(P0.05)。AAELE组的房颤和既往栓塞史的比例为67.92%、24.53%,均分别显著高于AAT组的22.73%、0.00%,伴高血压、糖尿病及吸烟史的比例为50.94%、28.30%、35.85%,均分别显著低于AAT组的86.36%、72.73%、72.73%,差异均有统计学意义(均P0.05)。AAELE组的感觉异常、运动障碍、对侧动脉搏动及缺血程度Ⅱb级的比例为86.79%、64.15%、81.13%及54.72%,均分别显著高于AAT组的63.64%、27.27%、31.82%及27.27%,而间歇性跛行及缺血程度Ⅱa级的比例为24.53%、33.96%,均分别显著低于AAT组的63.64%、63.64%,差异均有统计学意义(均P0.05)。结论:AAELE与AAT在临床症状、梗塞部位、合并症及既往疾病史、缺血程度方面表现均具有差异,临床掌握这些差异有助于更加准确地辅助判断患者的病情症状,值得重视。     

动脉平滑肌细胞原代培养贴块法的改良

对传统的动脉平滑肌细胞（ASMCs）的体外培养贴块法进行改良。用改良的贴块法进行ASMCs的原代培养,用传统的贴块培养法作对照。运用改良贴块法细胞长满瓶壁所需平均生长时间为6天,产量为60-60万/瓶;而在同等条件下对照组的传统贴块细胞长满瓶壁所需生长时间约需15天,产量仅为30万/瓶。并且,改良方法比传统方法具有较高的成功率,且无需选用胰岛素。新方法简单易行,结果稳定可靠。     

不同香烟烟雾暴露强度对大鼠骨骼肌线粒体功能的影响

目的:探讨不同烟熏暴露强度对大鼠外周骨骼肌线粒体功能的影响。方法:将SD大鼠随机分成4个组,分别接受正常空气或3个周期烟熏暴露(分别是4周、8周、12周)。采用western blot检测大鼠外周骨骼肌与线粒体生成有关的过氧化物酶体增殖物激活受体γ共激活因子1(PGC-1α)以及涉及氧化磷酸化的细胞色素c氧化酶(COX)4的蛋白表达,RT-PCR检测与线粒体氧化代谢有关的Sdhb、线粒体转录因子A(TFAM)的基因表达以及比色法检测琥珀酸脱氢酶(SDH)活性,电镜检测线粒体形态结构的改变。结果:香烟烟雾暴露能够下调大鼠伸趾长肌(EDL)PGC-1α和COX4的蛋白表达,PGC-1α的表达下调呈明显的暴露强度依赖性。香烟烟雾暴露能够诱发大鼠比目鱼肌Sdhb、TFAM基因水平的下调,降低大鼠比目鱼肌SDH活性并呈明显的暴露强度依赖性。电镜显示香烟烟雾暴露诱发伸趾长肌线粒体发生空泡样变性。结论:香烟烟雾暴露诱发大鼠骨骼肌线粒体功能障碍,但该作用与骨骼肌的纤维类型组成无明显相关性。