Effectiveness of autologous implantation of bone marrow-mononuclear cells for severe limb ischemia: clinical analysis including hemodialysis patients

Abstract

Accumulating data show the efficacy and availability of bone marrow cell implantation (BMI) for ischemic heart disease and severe limb ischemia in animal models and in humans. Diabetic patients or hemodialysis patients tend to develop severe ischemic heart disease or limb ischemia. Despite the potency of BMI for limb ischemia in humans, there is no clinical report available showing the efficacy of BMI for patients with chronic kidney disease (CKD). We report here the effectiveness of BMI for severe limb ischemia in 6 cases including 2 CKD patients. In these CKD patients, BMI showed good effectiveness in one, but not in the other. Efficacy of this therapy was significantly correlated with the numbers of bone marrow mononuclear cells implanted (r=0.850, p=0.032). One CKD patient who did not respond to BMI had the smallest number of bone marrow mononuclear cells implanted among the 6 patients. Therefore, BMI effectiveness in CKD patients seemed to depend upon the number of bone marrow mononuclear cells implanted. Moreover, percentage of CD34+ cells in mononuclear cells by pre-operative bone marrow examination significantly correlated with the numbers of bone marrow cells obtained per kg body weight (r=0.854, p=0.031). Our findings suggested that even in the presence of CKD, the number of implanted bone marrow cells determined the efficacy of BMI. Moreover, preoperative examination of CD34 positive cells in the bone marrow may be useful to estimate the numbers of marrow cells available for the therapy.