PDF(Pubmed)
Abstract：
Progressive peripheral arterial disease (PAD) can result in chronic limb-threatening ischemia (CLTI) characterized by clinical complications including rest pain, gangrene and tissue loss. These complications can propagate even more precipitously in the setting of common concomitant diseases in patients with CLTI such as diabetes mellitus (DM). CLTI ulcers are cutaneous, non-healing wounds that persist due to the reduced perfusion and dysfunctional neovascularization associated with severe PAD. Existing therapies for CLTI are primarily limited to anatomic revascularization and medical management of contributing factors such as atherosclerosis and glycemic control. However, many patients fail these treatment strategies and are considered \"no-option,\" thereby requiring extremity amputation, particularly if non-healing wounds become infected or fulminant gangrene develops. Given the high economic burden imposed on patients, decreased quality of life, and poor survival of no-option CLTI patients, regenerative therapies aimed at neovascularization to improve wound healing and limb salvage hold significant promise. Cell-based therapy, specifically utilizing mesenchymal stem/stromal cells (MSCs), is one such regenerative strategy to stimulate therapeutic angiogenesis and tissue regeneration. Although previous reviews have focused primarily on revascularization outcomes after MSC treatments of CLTI with less attention given to their effects on wound healing, here we review advances in pre-clinical and clinical studies related to specific effects of MSC-based therapeutics upon ischemic non-healing wounds associated with CLTI.
摘要：
进行性外周动脉疾病（PAD）可导致慢性威胁肢体缺血（CLTI），其临床并发症包括静息疼痛，坏疽和组织损失。在患有CLTI的患者的常见伴随疾病如糖尿病(DM)的情况下,这些并发症甚至可以更迅速地传播。CLTI溃疡是皮肤的,由于与严重PAD相关的灌注减少和功能失调的新生血管形成而持续存在的非愈合伤口。CLTI的现有疗法主要限于解剖血管重建术和诸如动脉粥样硬化和血糖控制的促成因素的医学管理。然而,许多患者未能通过这些治疗策略，被认为是“别无选择”，“因此需要四肢截肢，特别是如果不愈合的伤口被感染或暴发性坏疽发展。鉴于患者的高经济负担，生活质量下降，以及无选择的CLTI患者的低生存率，旨在改善伤口愈合和肢体挽救的新生血管再生疗法具有重要的前景。基于细胞的治疗，特别利用间充质干细胞/基质细胞（MSC），是刺激治疗性血管生成和组织再生的一种再生策略。尽管以前的综述主要集中在MSC治疗CLTI后的血运重建结果，但较少关注其对伤口愈合的影响。在此,我们综述了临床前和临床研究的进展,这些研究涉及基于MSC的疗法对与CLTI相关的缺血性不愈合伤口的具体影响.
