The Wilf Family Cardiovascular Research Institute, Department of Medicine (Cardiology), Albert Einstein College of Medicine, Bronx, NY, United States.
Curr Opin Pharmacol. 2018 Apr;39:27-34. doi: 10.1016/j.coph.2018.01.005. Epub 2018 Feb 13.
Patients with severe peripheral artery disease (PAD) who are not candidates for revascularization have poor prognosis. Cell therapy using peripheral blood-derived or bone marrow-derived mononuclear cells, mesenchymal stem cells, or marker-specific subsets of bone marrow cells with angiogenic properties may hold promise for no-option PAD patients. Injected cells may exert beneficial actions by enhancing local angiogenesis (either through maturation of endothelial progenitors, or through secretion of angiogenic mediators), or by transducing cytoprotective signals that preserve tissue structure. Despite extensive research, robust clinical evidence supporting the use of cell therapy in patients with critical limb ischemia is lacking. Larger, well-designed placebo-controlled clinical trials did not support the positive results of smaller less rigorous studies. There is a need for high-quality clinical studies to test the effectiveness of cell therapy in PAD patients. Moreover, fundamental cell biological studies are needed to identify the optimal cell types, and to develop strategies that may enhance homing, survival and effectiveness of the injected cells.
严重外周动脉疾病（PAD）患者如果不适合血运重建，则预后不良。利用外周血来源或骨髓来源的单核细胞、间充质干细胞、或具有血管生成特性的骨髓细胞的标记物特异性亚群进行细胞治疗，可能为无选择机会的 PAD 患者带来希望。注入的细胞可能通过增强局部血管生成（通过内皮祖细胞的成熟，或通过分泌血管生成介质），或通过转导细胞保护信号来保存组织结构，从而发挥有益作用。尽管进行了广泛的研究，但缺乏支持细胞治疗在严重肢体缺血患者中应用的有力临床证据。较大的、设计良好的安慰剂对照临床试验并未支持较小、较不严格研究的阳性结果。需要高质量的临床研究来测试细胞治疗在外周动脉疾病患者中的有效性。此外，还需要进行基础细胞生物学研究，以确定最佳的细胞类型，并制定可能增强注射细胞归巢、存活和有效性的策略。
