Treatment of critical limb ischemia with localized scleroderma by local injection of umbilical cord mesenchymal stem cells

Hu, Qinglin; Li, Yuetong; Huang, Pingping

doi:10.1016/j.medcli.2020.07.023

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We reported a case for the first time the use of umbilical cord mesenchymal stem cells (UCMSCs) for the treatment of critical limb ischemia patient with localized scleroderma.A 75-year-old Chinese male who had suffered from double lower extremity pain accompanied by increased skin thickening for more than 2 years was admitted to the Chinese Academy of Medical Sciences Hematology Hospital on August 11th, 2015. The patient complained of pain in both lower extremities with skin sclerosis. Also, linear hard spots were visible on the abdominal skin of the patient. The patient had a history of diabetes for ten years. The skin of the lower extremities was hyperpigmented and stiff. The patient had pigmentation on the left side of the abdomen and hard skin. C-reactive protein, 11.4mg/L; rheumatoid factor, 196IU/ml. The lymphocyte occupied 34.1% of the nuclear cells. ANA (−). Cytokine test results: IL-2R, 907U/ml; IL-6, 7.4pg/ml; IL-8, 48.8pg/ml; TNF-α, 70.8pg/ml. Peripheral artery examination displayed: ankle/brachial index: left, 0.64; right, 0.80. Computed tomographic angiography (CTA) showed: double lower limb arterial obstruction, left more serious.According to the guidelines of critical limb ischemia and localized scleroderma,<a class="elsevierStyleCrossRefs" href="#bib0015">1,2</a> and based on the symptoms and results, we confirmed a diagnosis of critical limb ischemia (Fontaine classification III: Ischemic rest pain) with localized scleroderma. In the operating room, aseptically, the patient was treated with intravenous anesthesia and double-limb stem cell transplantation. The lower extremities were disinfected with ethanol and iodine 3 times from the proximal end to the distal end. Sterile tissues were placed and the umbilical cord blood mesenchymal stem cells suspension were injected at multiple sites into the lower limbs. The number of cells were 7×107/L, each point of 0.5–1ml, each point spacing of about 3cm×3cm, muscle tissue rich parts could be layered injection. Each time the patient was treated according to this dose, every two months, a total of three times. Observations were made for 6 months and various indicators were evaluated.After 3 times of treatments, the pain and hard skin symptoms of both lower extremities were significantly improved, and the skin color was lighter than before. The abdominal skin color of the patient returned to normal. The right ABI index returned to normal and the left ABI increased to 0.85. Furthermore, the right lower extremity arterial obstruction and peripheral arterial stiffness all returned to normal. After each transplant, the cytokine levels of the patient increased, especially with elevated levels of IL-6, IL-8, and TNF-α. In addition, the percentage of lymphocytes occupying the nucleus cells in patients showed a decrease. No complications were observed and no recurrence occurred in the next 2-year follow up.Funding sourcesThis study was supported by CAMS Fund (2017-I2M-1-016).Conflict of interestThe authors declare no conflicts of interest." 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