Uso de células pluripotenciales en el tratamiento de la isquemia crítica

  • Cesar Eduardo Jiménez Hospital Universitario Clínica de San Rafael
  • Leonardo Randial Hospital Universitario Clínica de San Rafael
  • Iván Silva Hospital Universitario Clínica de San Rafael
Palabras clave: células madre pluripotentes, trasplante de células madre, isquemia, extremidad inferior, enfermedad arterial periférica

Resumen

La isquemia crítica de los miembros inferiores se define como la insuficiencia de flujo arterial a los miembros inferiores para mantener la viabilidad tisular, generalmente causada por enfermedad obstructiva arterial periférica. Las manifestaciones clínicas son dolor en reposo y presencia de úlceras o pérdida tisular espontánea.

El manejo con reperfusión quirúrgica (surgical revascularization) y terapia endovascular ha permitido lograr salvamentos importantes de extremidades pero, a pesar de estos avances, aproximadamente, entre el 20 y el 40 % de los pacientes con isquemia crítica no son candidatos a ninguno de estos tratamientos.

Se estima que anualmente se practican entre 120 y 500 amputaciones por cada millón de habitantes por enfermedad arterial; 25 % de los pacientes con amputaciones mayores no recibe ningún tipo de rehabilitación. Por lo tanto, se necesita contar con nuevas estrategias para promover el salvamento de extremidades y disminuir las tasas tan altas de amputaciones.

En los últimos 20 años, el uso de células madre pluripotenciales ha demostrado ser un tratamiento efectivo y seguro para los pacientes con isquemia crítica con gran riesgo de pérdida de las extremidades.

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Biografía del autor/a

Cesar Eduardo Jiménez, Hospital Universitario Clínica de San Rafael

Médico, cirujano vascular; jefe, Servicio de Cirugía Vascular, Hospital Universitario Clínica de San Rafael, Bogotá, D.C., Colombia

Leonardo Randial, Hospital Universitario Clínica de San Rafael

Médico, cirujano vascular, Hospital Universitario Clínica de San Rafael, Bogotá, D.C., Colombia

Iván Silva, Hospital Universitario Clínica de San Rafael

Médico, cirujano vascular, Hospital Universitario Clínica de San Rafael, Bogotá, D.C., Colombia

Referencias

Holger L, Bramlage P, Amann B. Treatment of peripheral arterial disease using stem and progenitor cell therapy. J Vasc Surg. 2011;53:445-53.

https://doi.org/10.1016/j.jvs.2010.08.060

Lawall H, Bramlage P, Amann B. Stem cell and progenitor cell therapy in peripheral artery disease. A critical appraisal. Thromb Haemost. 2010;103:696-709.

https://doi.org/10.1160/TH09-10-0688

Hirsch AT, Haskal ZJ, Hertzer NR, Chair Ziv J, Haskal L, Norman R, et al. ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic). Circulation. 2006;113:e463-654.

https://doi.org/10.1161/CIRCULATIONAHA.106.174526

Asahara T, Masuda H, Takahashi T, Kensuke N, Taguchi A, Chayama K, et al. Bone marrow origin of endothelial proge- nitor cells responsible for postnatal vasculogenesis in physio- logical and pathological neovascularization. Circulation Res. 1999;85:221-8.

https://doi.org/10.1161/01.RES.85.3.221

Matoba S, Tatsumi T, Murohara T, Imaizumi T, Katsuda Y, Ito M, et al. Long-term clinical outcome after intramuscular implantation of bone marrow mononuclear cells (Therapeutic Angiogenesis by Cell Transplantation [TACT] trial) in patients with chronic limb ischemia. Am Heart J. 2008;156:1010-8.

https://doi.org/10.1016/j.ahj.2008.06.025

Aranguren XL, Verfaillie CM, Luttun A. Emerging hurdles in stem cell therapy for peripheral vascular disease. J Mol Med. 2009;87:3-16.

https://doi.org/10.1007/s00109-008-0394-3

Meléndez M, Martiato M, Barrios S. Las células madre en la terapia celular, consideraciones éticas. Rev Cubana Invest Biomed. 2007;26:123-5.

Robert E. Stem cell tourism: The new "snake oil" of the 21st century. Dedmon Asian Biomedicine. 2009;3:339-42.

González-Sarasúa J, Pérez-López S, Álvarez-Viejo M, Pérez- Basterrechea M, Fernández-Rodríguez A, Ferrero-Gutiérrez A. Treatment of pressure ulcers with autologous bone marrow nuclear cells in patients with spinal cord injury. J Spinal Cord Med. 2011;34:56-7.

https://doi.org/10.1179/2045772311Y.0000000010

Amann B, Lüdemann C, Ratei R, Schmidt-Lucke JA. Auto- logous bone-marrow stem-cell transplantation for induction of arteriogenesis for limb salvage in critical limb ischaemia. Zentralbl Chir. 2009;134:298-304

https://doi.org/10.1055/s-0029-1224532

Tomanek RJ, Schatteman GC. Angiogenesis: New insights and therapeutic potential. Anat Rec. 2000;261:126-35.

https://doi.org/10.1002/1097-0185(20000615)261:3<126::AID-AR7>3.0.CO;2-4

Iafrati MD, Hallett JW, Geils G, Pearl G, Lumsden A, Peden E. Early results and lessons learned from a multicenter rando- mized, double-blind trial of bone marrow aspirate concentrate in critical limb ischemia. J Vasc Surg. 2011;54:1650-8.

https://doi.org/10.1016/j.jvs.2011.06.118

The European TAO Study Group: Oral iloprost in the treatment of thromboangiitis obliteran (Buerger's disease): A double- blind, randomised, placebo-controlled trial. Eur J Vasc Endo- vasc Surg. 1998;15:300-7.

https://doi.org/10.1016/S1078-5884(98)80032-4

Zijiang Y, Di Santo, Kalkac C. Current developments in the use of stem cell for therapeutic neovascularisation: Is the future therapy "cell-free"? Swiss Med Wkly. 2010;140:w13130.

https://doi.org/10.4414/smw.2010.13130

Burt R, Pearce W, Luo K, Oyama Y, Davidson C, Beohar N, et al. Hematopoietic stem cell transplantation for cardiac and peripheral vascular disease. Bone Marrow Transplant. 2003;32:S29-31.

https://doi.org/10.1038/sj.bmt.1704177

Losordo DW, Kibbe MR, Mendelsohn F, Marston M, Driver VR, Sharafuddin M, et al. A randomized controlled pilot study of autologous CD34+ cell therapy for critical limb ischemia. Circ Cardiovasc Interv. 2012;5:821-30.

https://doi.org/10.1161/CIRCINTERVENTIONS.112.968321

Duong van Huyen JP, Smadja D, Bruneval P. Bone marrow- derived mononuclear cell therapy induces distal angiogenesis after local injection in critical leg ischemia. Mod Pathol. 2008;21:837-46.

https://doi.org/10.1038/modpathol.2008.48

Akar R, Durdu S, Arat M, Tuncay N, Arslan O, Çorapçioglu T, et al. Therapeutic angiogenesis by autologous transplantation of bone-marrow mononuclear cells for Buerger' patients with retractable limb ischaemia: A preliminary report. Turk J Hae- matol. 2004;21:13-21.

Miyamoto K, Nishigami K, Nagaya N, Akutsu K. Unblinded pilot study of autologous transplantation of bone marrow mononuclear cells in patients with thromboangiitis obliterans. Circulation. 2006;114:2679-84.

https://doi.org/10.1161/CIRCULATIONAHA.106.644203

Nehler MR, Brass EP, Anthony R, Dormandy J. Adjunctive parenteral therapy with lipo-ecraprost, a prostaglandin E1 analog, in patients with critical limb ischemia undergoing distal revascularization does not improve 6-month outcomes. J Vasc Surg. 2007;45:953-61.

https://doi.org/10.1016/j.jvs.2006.12.057

Schiavetta A, Maione C, Botti C, Marino G, Lillo S, Garrone A, et al. A phase II trial of autologous transplantation of bone ma- rrow stem cells for critical limb ischemia: Results of the Naples and Pietra Ligure Evaluation of Stem Cells Study. Stem Cells Transl Med. 2012;1:572-8.

https://doi.org/10.5966/sctm.2012-0021

Lee KB, Kang ES, Kim AK, Kim MH, Do YS, Park KB, et al. Stem cell therapy in patients with thromboangiitis obliterans: Assessment of the long-term clinical outcome and analysis of the prognostic factors. Int J Stem Cells. 2011;4:88-98.

https://doi.org/10.15283/ijsc.2011.4.2.88

Amann B, Luedemann C, Ratei R, Schmidt-Lucke JA. Autolo- gous bone marrow cell transplantation increases leg perfusion and reduces amputations in patients with advanced critical limb ischemia due to peripheral artery disease. Cell Transplant. 2009;18:371-80.

https://doi.org/10.3727/096368909788534942

Asahara T, Murohara T, Sullivan A, Silver M, van der Zee R, Li T, et al. Isolation of putative progenitor endothelial cells for angiogenesis. Science. 1997;275:964-7.

https://doi.org/10.1126/science.275.5302.964

Idei N, Soga J, Hata T, Fujii Y, Fujimura N, Mikami S, et al. Autologous bone-marrow mononuclear cell implantation re- duces long-term major amputation risk in patients with criti- cal limb ischemia: A comparison of atherosclerotic peripheral arterial disease and Buerger disease. Circ Cardiovasc In- terv. 2011;4:15-25.

https://doi.org/10.1161/CIRCINTERVENTIONS.110.955724

Tateishi-Yuyama E, Matsubara H, Murohara T, Ikeda U, Shinta- ni S, Masaki H, et al. Therapeutic angiogenesis for patients with limb ischaemia by autologous transplantation of bone-marrow cells: A pilot study and a randomised controlled trial. Lancet. 2002;360:427-35.

https://doi.org/10.1016/S0140-6736(02)09670-8

Kim DI, Kim MJ, Joh JH, Shin SW, Do YS, Moon JY, et al. Angiogenesis facilitated by autologous whole bone ma- rrow stem cell transplantation for Buerger's disease. Stem Cells. 2006;24:1194-200.

https://doi.org/10.1634/stemcells.2005-0349

Fadini GP, Agostini C, Avogaro A. Autologous stem cell therapy for peripheral arterial disease meta-analysis and systematic review of the literature. Atherosclerosis. 2010;209:10-7.

https://doi.org/10.1016/j.atherosclerosis.2009.08.033

Amann B, Lüdemann C, Rückert R, Lawall H, Liesenfeld B, Schneider M, et al. Design and rationale of a randomized, double-blind, placebo-controlled phase III study for autologous bone marrow cell transplantation in critical limb ischemia: The Bone Marrow Outcomes Trial in Critical Limb Ischemia (BONMOT-CLI). Vasa. 2008;37:319-25.

https://doi.org/10.1024/0301-1526.37.4.319

Liu FP, Dong JJ, Sun SJ, Gao WY, Zhang ZW, Zhou XJ, et al. Autologous bone marrow stem cell transplantation in criti- cal limb ischemia: A meta-analysis of randomized controlled trials. Chin Med J (Engl). 2012;125:4296-300.

Brass D, Anthony R, Dormandy J. Parenteral therapy with lipo-ecraprost, a lipid-based formulation of a PGE1 analog, does not alter six-month outcomes in patients with critical leg ischemia. J Vasc Surg. 2006;43:752-9.

https://doi.org/10.1016/j.jvs.2005.11.041

García MG, Arismendi I. Transplante de células madre autólo- gas en pacientes con isquemia crítica no revascularizable. Rev Colomb Cir Vasc. 2007;7:12-6.

Publicado
2019-07-03
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JiménezC. E.; Randial, L.; Silva, I. Uso De células Pluripotenciales En El Tratamiento De La Isquemia crítica. Rev Colomb Cir 2019, 32, 146-151.
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