Autologous Transplantation of Granulocyte Colony–Stimulating Factor–Mobilized Peripheral Blood Mononuclear Cells Improves Critical Limb Ischemia in Diabetes

Abstract

Conclusion:A paint with povidone-iodine by itself provides equal preoperative preparation of the abdominal wall as a scrub with povidoneiodine soap, followed by paint with povidone-iodine.Summary: The authors conducted a prospective randomized trial comparing scrub-and-paint with povidone-iodine soap followed by absorption with a sterile towel and subsequent paint with povidone-iodine versus surgical site preparation with paint only of povidone-iodine. The primary end point was wound infection at 30 days with wound infection defined as clinical signs of infection requiring therapeutic intervention. Excluded patients included those with active infection at the time of operation, known sensitivity to iodine, neutropenia, or insertion of prosthetic material during operation. Patients were randomized to a scrub-and-paint group or a paint only group with povidone-iodine.There were 115 patients randomized to the scrub-and-paint arm and 119 to the paint only arm of the trial. Patients were well matched with respect to surgical co-morbidities, age, operative time, drains, surgical procedure, and prophylactic antibiotic use. There were 12 wound infections in the scrub-and-paint patients (10%) and 12 wound infections in the paint only patients (10%).Comment: These data apply only to clean and clean-contaminated cases that do not involve placement of a prosthetic device. While the data are interesting, they do not provide guidance as to the proper surgical prep site technique for patients undergoing insertion of prosthetic grafts. The optimal surgical prep site technique with respect to insertion of prosthetic vascular grafts remains to be determined.

Significance of Endothelial Progenitor Cells in Subjects With Diabetes

“…In this light, ways to increase the number and improve the function of EPCs should be actively pursued. A practical consequence of this has been shown: Huang et al (46) have transplanted bone marrow-mobilized cells, as an EPCenriched fraction, into critically ischemic limbs of diabetic patients. Compared with standard therapy, cell therapy improved angiographic scores and ankle-brachial index values and reduced relevant end points, such as ulcer size and need for limb amputation.…”

A long term case study on therapeutic angiogenesis by transplantation of peripheral blood stem cells in critical limb ischemia after interventional revascularization

“…Many investigators, however, still prefer BM-MNCs for treatment (4,5). We used PBSCs to treat CLI PAD disease, as isolation of PBSCs is easier, convenient, less painful, more practical, and also safe and effective (6,9). G-CSF increased the number of WBC and CD34 positive cells in the peripheral blood, and thus large volume leukapheresis is commonly used for harvesting the PB-MNC fraction (10).…”

Endothelial Progenitor Cell Number: A Convergence of Cardiovascular Risk Factors

“…Further, EPCs in diabetics are dysfunctional when compared to EPCs from non-diabetic subjects. The depressed EPC numbers in diabetes are thought to contribute to impaired collateralization of vascular ischemic beds (Waltenberger 2001) and may predispose this group to developing nonhealing diabetic ulcers which may be ameliorated by injecting EPCs into ischemic lower limb muscles (Huang, Li et al 2005). Indeed, among diabetic patients with peripheral vascular disease, EPC numbers correlated negatively with the ankle brachial index and patients with ischemic ulcers had the lowest EPC numbers (Fadini, Miorin et al 2005).…”