Autologous mesenchymal stem cells foster revascularization of ischemic limbs in systemic sclerosis: a case report.

BACKGROUND

Mesenchymal stem cells can differentiate into endothelial cells and participate in angiogenesis in adults. In experimental models of acute myocardial infarction, mesenchymal stem cells led to the recovery of cardiac function through the formation of a new vascular network.

OBJECTIVE

To describe treatment with intravenous infusions of expanded autologous mesenchymal stem cells in 1 patient with critical limb ischemia due to systemic sclerosis.

DESIGN

Case report.

SETTING

The rheumatology unit at the University of Florence, Florence, Italy.

PATIENT

A woman, aged 34 years, with systemic sclerosis who developed acute gangrene of the upper and lower limbs.

INTERVENTION

3 intravenous pulses of expanded autologous mesenchymal stem cells.

MEASUREMENTS

Angiography, skin histopathology, and immunohistochemistry.

RESULTS

Areas of necrotic skin were reduced after the first mesenchymal stem-cell infusion. After the third infusion, angiography showed revascularization of the patient's extremities. Skin section analysis revealed cell clusters with tubelike structures, and angiogenic factors were strongly expressed.

LIMITATION

Causality cannot be established by a single case.

CONCLUSION

In patients with systemic sclerosis who have severe peripheral ischemia, intravenous infusion of expanded autologous mesenchymal stem cells may foster the recovery of the vascular network, restore blood flow, and reduce skin necrosis.

PRIMARY FUNDING SOURCE

Fondazione Cassa di Risparmio di Pistoia e Pescia (partial funding).