Stimulation of Neovasculogenesis as a Treatment of Chronic Obliterating Diseases of Arteries of Lower Extremities

Recent scientific studies have confirmed a high potential of application of cellular technologies for formation of collateral blood vessels in ischemic limbs by stimulating angiogenesis. Currently, cellular mechanisms and sources of angiogenesis mainly identified, and there are a variety of growth factors that stimulate the development of new blood vessels. Cell therapy is a safe and effective complementary method that improves blood circulation in the limb ischemia. The data obtained from experimental and clinical studies, allow us to recommend the application of cellular technologies to stimulate neovaskulogenesis in treatment of the chronic obliterating diseases of lower limb arteries. A differential approach of using cellular technology is possible, depending on the etiology of the disease and the presence of comorbidities (diabetes, etc.). It should be noted that if comorbidities are present, platelet rich plasma therapy is impossible. There are a lot of studies which postulate of vascular endothelium, platelet, fibrinolysis and hematopexis malfunctions in case of diabetes. The most important factors causing diabetic angiopathy are increased platelet activity and decreased antitrombogenic properies of vessel wall. That factors result in intravascular platelet clumping, adhesion of platelets to vessel wall and, as a result, trombogenesis. In this case it makes sense to use another cell types for angiogenesis stimulation. The angiogenesis by local intramuscular injections of bone marrow-derived autologous peripheral blood mononuclear cells or granulocyte macrophage colony stimulating factor-mobilized peripheral blood mononuclear cells is indicated for treatment of limb ischemia patients. According to the data of the pre-clinical studies, bone marrow-derived autologous peripheral blood mononuclear cells injections in ischemia affected area lead to the measurable increase of the capillary density in comparison with control. Development and application of modern therapy methods for treatment of chronic limb ischemia allows significantly improve of treatment outcome and life quality. Success in this regard admits to rely on perspectivity of cell technologies in chronic limb ischemia treatment. However, the application of neoangiogenesis in the ischemic tissues as new an original direction demand on long-term and prospective studies with unbiased estimate of positive and negative results.