Zamboni Matilde, Pedriali Massimo, Ferretto Luca, Scian Sabrina, Ghirardini Francesca, Bozza Riccardo, Martini Romeo, Irsara Sandro
Unit of Vascular and Endovascular Surgery, San Martino Hospital, 32100 Belluno, Italy.
Unit of Surgical Pathology, Azienda Ospedaliera-Universitaria, University of Ferrara, 44121 Ferrara, Italy.
Diagnostics (Basel). 2022 May 4;12(5):1137. doi: 10.3390/diagnostics12051137.
When in critical limb ischemia (CLI) the healing process aborts or does not follow an orderly and timely sequence, a chronic vascular wound develops. The latter is major problem today, as their epidemiology is continuously increasing due to the aging population and a growth in the incidence of the underlying diseases. In the US, the mean annualized prevalence of necrotic wounds due to the fact of CLI is 1.33% (95% CI, 1.32-1.34%), and the cost of dressings alone has been estimated at USD 5 billion per year from healthcare budgets. A promising cell treatment in wound healing is the local injection of peripheral blood mononuclear cells (PBMNCs). The treatment is aimed to induce angiogenesis as well to switch inflammatory macrophages, called the M1 phenotype, into anti-inflammatory macrophages, called M2, a phenotype devoted to tissue repair. This mechanism is called polarization and is a critical step for the healing of all human tissues. Regarding the clinical efficacy of PBMNCs, the level of evidence is still low, and a considerable effort is necessary for completing the translational process toward the patient bed site. From this point of view, it is crucial to identify some candidate biomarkers to detect the switching process from M1 to M2 in response to the cell treatment.
在严重肢体缺血（CLI）时，如果愈合过程中止或未按有序且及时的顺序进行，就会形成慢性血管伤口。由于人口老龄化和基础疾病发病率的上升，慢性血管伤口的流行病学情况持续增加，这已成为当今的一个主要问题。在美国，因CLI导致的坏死性伤口的年均患病率为1.33%（95%置信区间，1.32 - 1.34%），仅敷料的费用每年就估计从医疗保健预算中支出50亿美元。在伤口愈合方面一种有前景的细胞治疗方法是局部注射外周血单核细胞（PBMNCs）。该治疗旨在诱导血管生成，并将称为M1表型的炎性巨噬细胞转变为称为M2的抗炎巨噬细胞，M2表型致力于组织修复。这种机制称为极化，是所有人体组织愈合的关键步骤。关于PBMNCs的临床疗效，证据水平仍然较低，为了完成向患者床边的转化过程，还需要付出相当大的努力。从这个角度来看，识别一些候选生物标志物以检测细胞治疗后从M1到M2的转变过程至关重要。
