Abstract
Buerger’s disease or Thromboangiitis obliterans is an orphan vascular disease that most commonly affects nerves, small or medium-sized vessels in the upper and lower extremities, and is characterized by a non-atherosclerotic, segmental, inflammatory disorder. The etiology and the pathogenesis of the disease have not been fully elucidated. Although various interventions have been adopted recently, there is still no effective treatment for the prevention of the progression of the disease. This report presents three clinical cases that show the efficacies of autologous adipose tissue-derived mesenchymal stem cell (AdMSC) treatment in Buerger’s disease. Three male patients diagnosed with Buerger’s disease were between 46 and 55 years and had a smoking history. AdMSCs (5X106 cells/kg body weight) were injected intramuscularly into at least 38 points of the ischemic legion of the lower limb at one time. The patients were checked for safety and efficacy at one, three, and six months after AdMSC injection. No severe adverse events and no adverse drug events were observed in physical examination, vital signs, and laboratory tests for all three patients. Ulcers in the affected legs of the patients were healed completely after the treatment. Visual Analogue Scale scores and all the criteria (activities, emotional, pain, social, symptoms and total) of the King's College Hospital's Vascular Quality of Life Questionnaire (VascuQOL) of all the patients were improved from baseline to six months follow-up. Digital Infrared Thermal Imaging showed the gradual alleviation of lesions in the leg. Angiogenesis in the affected limbs was identified by CT-Angiography after AdMSC injection. The present cases show the improvement in patients with Buerger’s disease with the observation of angiogenesis after intramuscular injection of autologous AdMSCs. This suggests that autologous AdMSC can be an effective alternative treatment for Buerger’s disease.
Highlights
Buerger’s disease or Thromboangiitis obliterans is an orphan vascular disease that most commonly affects small/medium-sized vessels and is characterized by a non-atherosclerotic, occlusive, thrombotic, segmental, inflammatory disorder in the upper and lower extremities[1,2,3]
Angiogenesis is considered as a crucial condition to preserve the affected limbs and prohibit the aggravation of the disease, and previous studies report that mesenchymal stem cells (MSCs) has an angiogenic nature[7]
We previously studied that the safety and the efficacy of adiposederived mesenchymal stem cells (AdMSC) on the treatment of Buerger’s disease[8]
Summary
Buerger’s disease or Thromboangiitis obliterans is an orphan vascular disease that most commonly affects small/medium-sized vessels and is characterized by a non-atherosclerotic, occlusive, thrombotic, segmental, inflammatory disorder in the upper and lower extremities[1,2,3]. DITI images in Figure 2 showed gradual alleviation in the affected lower limbs after three months from the treatment, and improvement in the non-affected opposite limb six months after AdMSC injection. The ulcers on the right big and 2nd toes at baseline showed bone exposure and after six months exhibited a complete healed state with no additional ulcers observed and amputations required (Figure 4) This complete healed state was identified in the reinspection one year after AdMSC injection. No severe adverse events and no adverse drug events were observed during follow-up after treatment with AdMSCs regarding physical examination (including ulcer size check, capillary refill test), vital signs (temperature, pulse, and blood pressure respiration), laboratory tests (hematology, biochemistry, urinalysis) during the study. Arteries in the injected lesions was observed in the non-injected right leg at the final follow-up (Figure 7)
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