Yunir Em, Kurniawan Farid, Rezaprasga Edo, Wijaya Ika Prasetya, Suroyo Indrati, Matondang Sahat, Irawan Cosphiadi, Soewondo Pradana
Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
Int J Stem Cells. 2021 Feb 28;14(1):21-32. doi: 10.15283/ijsc20088.
Diabetes mellitus (DM) remains one of the most important risk factors for peripheral artery disease (PAD), with approximately 20% of DM patients older than 40 years old are affected with PAD. The current standard management for severe PAD is endovascular intervention with or without surgical bypass. Unfortunately, up to 40% of patients are unable to undergo these revascularization therapies due to excessive surgical risk or adverse vascular side effects. Stem cell therapy has emerged as a novel therapeutic strategy for these 'no-option' patients. Several types of stem cells are utilized for PAD therapy, including bone marrow mononuclear cells (BMMNC) and peripheral blood mononuclear cells (PBMNC). Many studies have reported the safety of BMMNC and PBMNC, as well as its efficacy in reducing ischemic pain, ulcer size, pain-free walking distance, ankle-brachial index (ABI), and transcutaneous oxygen pressure (TcPO2). However, the capacity to establish the efficacy of reducing major amputation rates, amputation free survival, and all-cause mortality is limited, as shown by several randomized placebo-controlled trials. The present literature review will focus on comparing safety and efficacy between BMMNC and PBMNC as cell-based management in diabetic patients with PAD who are not suitable for revascularization therapy.
糖尿病（DM）仍然是外周动脉疾病（PAD）最重要的危险因素之一，约20% 40岁以上的糖尿病患者患有PAD。目前重度PAD的标准治疗方法是血管内介入治疗，可联合或不联合外科搭桥手术。不幸的是，高达40%的患者由于手术风险过高或血管副作用而无法接受这些血运重建治疗。干细胞疗法已成为这些“别无选择”患者的一种新型治疗策略。几种类型的干细胞被用于PAD治疗，包括骨髓单个核细胞（BMMNC）和外周血单个核细胞（PBMNC）。许多研究报道了BMMNC和PBMNC的安全性，以及它们在减轻缺血性疼痛、溃疡大小、无痛步行距离、踝臂指数（ABI）和经皮氧分压（TcPO2）方面的疗效。然而，如几项随机安慰剂对照试验所示，在降低大截肢率、无截肢生存率和全因死亡率方面确定疗效的能力有限。本综述将重点比较BMMNC和PBMNC作为细胞治疗方法，用于不适合血运重建治疗的糖尿病PAD患者时的安全性和疗效。
