Bone-marrow or peripheral-blood based mononuclear and mesechymal stem cells therapy for

amputation prevention in peripheral arterial disease: A meta analysis of 10 years trends

Citra Aryanti1, Ida Bagus Budiarta2, I Gusti Agung Bagus Krisna Wibawa2

1
General Surgery Residency Training Programme, Departement of Surgery, Faculty of Medicine Udayana
University, Sanglah General Hospital
2
Division of Vascular Surgery, Departement of Surgery, Faculty of Medicine Udayana University, Sanglah
General Hospital

ABSTRACT

Introduction Despite emerging therapy development in peripheral arterial disease, the rate of amputation
is still high. Results of stem cells therapy in amputation prevention differed among studies, thus pooling
data is needed.

Objective To determine the amputation rate in the subject with peripheral arterial disease receiving bone-
marrowed or peripheral-blood based mononuclear and mesechymal stem cells or placebo.

Methods This is a meta analysis to compare the amputation rate in the subject with peripheral arterial
disease receiving stem cells therapy or placebo. This study was done by PRISMA guidelines, adhered to
Cochrane Handbook for Systematic Review of Interventions. Data were collected after literature research
and analyzed using Review Manager 5.3.

Results This meta analysis reported 5 studies with BM-MSCs, 11 studies with BM-MNCs, and 5 studies with PB-
MNCs therapy in peripheral arterial disease. BM-MSCs and BM-MNCs therapy showed significat improvement of
amputation rate compared to control (OR 0.55, p=0.04, I2 0%; OR 0.58, p=0.01, I2 8%; OR 23, p=0.0006; I2 0%,
respectively). All analysis showed low I2 indicating a low heterogenities among all studies. Doses varied among
studies, which need further analysis.

Discussion Stem cells, whether it is bone-marrowed or peripheral mononuclear, mesenchymal cells, were
found to be promising for peripheral arterial disease therapy. In the therapy, stem cell stimulate CD29,
CD34, CD45, CD54M CD71, CD73, CD90, CD105, CD166 to improve blood flow recovery to prevent
amputation.

Conclusion Bone-marrowed or peripheral-blood based mononuclear and mesechymal stem cells, should
be applied in peripheral arterial disease to prevent amputation. Well-planned randomized controlled
studies are still needed to assess the long-term effects of this therapy.

Keywords mononuclear, mesenchymal, amputation