Medical Nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Tissue Engineering and Applied Cell Science, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Stem Cell Res Ther. 2022 Sep 6;13(1):462. doi: 10.1186/s13287-022-03148-9.
Critical limb ischemia (CLI), the terminal stage of peripheral arterial disease (PAD), is characterized by an extremely high risk of amputation and vascular issues, resulting in severe morbidity and mortality. In patients with severe limb ischemia with no alternative therapy options, such as endovascular angioplasty or bypass surgery, therapeutic angiogenesis utilizing cell-based therapies is vital for increasing blood flow to ischemic regions. Mesenchymal stem cells (MSCs) are currently considered one of the most encouraging cells as a regenerative alternative for the surgical treatment of CLI, including restoring tissue function and repairing ischemic tissue via immunomodulation and angiogenesis. The regenerative treatments for limb ischemia based on MSC therapy are still considered experimental. Despite recent advances in preclinical and clinical research studies, it is not recommended for regular clinical use. In this study, we review the immunomodulatory features of MSC besides the current understanding of different sources of MSC in the angiogenic treatment of CLI subjects and their potential applications as therapeutic agents. Specifically, this paper concentrates on the most current clinical application issues, and several recommendations are provided to improve the efficacy of cell therapy for CLI patients.
严重肢体缺血（CLI）是外周动脉疾病（PAD）的终末期，其特点是极高的截肢和血管问题风险，导致严重的发病率和死亡率。对于严重肢体缺血且没有其他治疗选择的患者，如血管内血管成形术或旁路手术，利用细胞疗法的治疗性血管生成对于增加缺血区域的血流量至关重要。间充质干细胞（MSCs）目前被认为是最有前途的细胞之一，可作为 CLI 手术治疗的再生替代物，包括通过免疫调节和血管生成来恢复组织功能和修复缺血组织。基于 MSC 治疗的肢体缺血再生治疗仍被认为是实验性的。尽管最近在临床前和临床研究方面取得了进展，但不建议常规临床使用。在这项研究中，我们除了目前对 CLI 患者血管生成治疗中不同来源的 MSC 的理解之外，还回顾了 MSC 的免疫调节特征及其作为治疗剂的潜在应用。具体来说，本文侧重于最当前的临床应用问题，并提供了一些建议，以提高细胞治疗 CLI 患者的疗效。
