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Meloni M, Giurato L, Andreadi A, Bellizzi E, Bellia A, Lauro D, Uccioli L. Peripheral Blood Mononuclear Cells: A New Frontier in the Management of Patients with Diabetes and No-Option Critical Limb Ischaemia. J Clin Med 2023; 12:6123. [PMID: 37834766 PMCID: PMC10573900 DOI: 10.3390/jcm12196123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
The current study aimed to evaluate the effectiveness of peripheral blood mononuclear cell (PB-MNC) therapy as adjuvant treatment for patients with diabetic foot ulcers (DFUs) and no-option critical limb ischaemia (NO-CLI). The study is a prospective, noncontrolled, observational study including patients with neuro-ischaemic DFUs and NO-CLI who had unsuccessful revascularization below the ankle (BTA) and persistence of foot ischaemia defined by TcPO2 values less than 30 mmHg. All patients received three cycles of PB-MNC therapy administered through a "below-the-ankle approach" in the affected foot along the wound-related artery according to the angiosome theory. The primary outcome measures were healing, major amputation, and survival after 1 year of follow-up. The secondary outcome measures were the evaluation of tissue perfusion by TcPO2 and foot pain defined by the numerical rating scale (NRS). Fifty-five patients were included. They were aged >70 years old and the majority were male and affected by type 2 diabetes with a long diabetes duration (>20 years); the majority of DFUs were infected and nearly 90% were assessed as gangrene. Overall, 69.1% of patients healed and survived, 3.6% healed and deceased, 10.9% did not heal and deceased, and 16.4% had a major amputation. At baseline and after PB-MNC therapy, the TcPO2 values were 17 ± 11 and 41 ± 12 mmHg, respectively (p < 0.0001), while the pain values (NRS) were 6.8 ± 1.7 vs. 2.8 ± 1.7, respectively (p < 0.0001). Any adverse event was recorded during the PB-MNC therapy. Adjuvant PB-MNC therapy seems to promote good outcomes in patients with NO-CLI and neuro-ischaemic DFUs.
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Affiliation(s)
- Marco Meloni
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy (E.B.); (A.B.); (D.L.)
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Laura Giurato
- Division of Endocrinology and Diabetes, CTO Andrea Alesini Hospital, 00145 Rome, Italy; (L.G.)
| | - Aikaterini Andreadi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy (E.B.); (A.B.); (D.L.)
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Ermanno Bellizzi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy (E.B.); (A.B.); (D.L.)
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy (E.B.); (A.B.); (D.L.)
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy (E.B.); (A.B.); (D.L.)
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Luigi Uccioli
- Division of Endocrinology and Diabetes, CTO Andrea Alesini Hospital, 00145 Rome, Italy; (L.G.)
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
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Scala P, Manzo P, Longo R, Giudice V, Ciardulli MC, Serio B, Selleri C, Guadagno L, Rehak L, Maffulli N, Della Porta G. Contribution of peripheral blood mononuclear cells isolated by advanced filtration system to myogenesis of human bone marrow mesenchymal stem cells co-cultured with myoblasts. Heliyon 2023; 9:e17141. [PMID: 37484299 PMCID: PMC10361327 DOI: 10.1016/j.heliyon.2023.e17141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 07/25/2023] Open
Abstract
Background Contribution of peripheral blood mononuclear cells (PBMCs) in myogenesis is still under debate, even though blood filtration systems are commonly used in clinical practice for successfully management of critic limb ischemia. Objectives A commercial blood filter used for autologous human PBMC transplantation procedures is characterized and used to collect PBMCs, that are then added to well-established 2D in vitro myogenic models assembled with a co-culture of human bone marrow-derived mesenchymal stem cells (hBM-MSCs) and skeletal myoblasts (hSkMs) whit the aim of investigating their potential contribution to stem cell myogenic commitment. Methods A commercial blood filter was physically and chemically studied to understand its morphological characteristics and composition. PBMCs were concentrated using this system, further isolated by Ficoll-Paque density gradient centrifugation, and then added in an upper transwell chamber to a 2D co-culture of hBM-MSCs and hSkMs. Myogenic commitment was investigated by RT-PCR, immunofluorescence, and flow cytometry immunophenotyping. Cytokine levels were monitored by ELISA assay in culture media. Results The blood filtration system was disassembled and appeared to be formed by twelve membranes of poly-butylene terephthalate fibers (diameters, 0.9-4.0 μm) with pore size distribution of 1-20 μm. Filter functional characterization was achieved by characterizing collected cells by flow cytometry. Subsequently, collected PBMCs fraction was added to an in-vitro model of hBM-MSC myogenic commitment. In the presence of PBMCs, stem cells significantly upregulated myogenic genes, such as Desmin and MYH2, as confirmed by qRT-PCR and expressed related proteins by immunofluorescence (IF) assay, while downregulated pro-inflammatory cytokines (IL12A at day 14) along the 21 days of culture. Novelty Our work highlights chemical-physical properties of commercial blood filter and suggests that blood filtrated fraction of PBMC might modulate cytokine expression in response to muscle injury and promote myogenic events, supporting their clinical use in autologous transplantation.
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Affiliation(s)
- Pasqualina Scala
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 43, 84081 Baronissi SA, Italy
| | - Paola Manzo
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi D'Aragona”, Largo Città d'Ippocrate, 1, 84131 Salerno SA, Italy
| | - Raffaele Longo
- Department of Industrial Engineering, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano SA, Italy
| | - Valentina Giudice
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 43, 84081 Baronissi SA, Italy
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi D'Aragona”, Largo Città d'Ippocrate, 1, 84131 Salerno SA, Italy
| | - Maria Camilla Ciardulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 43, 84081 Baronissi SA, Italy
| | - Bianca Serio
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi D'Aragona”, Largo Città d'Ippocrate, 1, 84131 Salerno SA, Italy
| | - Carmine Selleri
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 43, 84081 Baronissi SA, Italy
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi D'Aragona”, Largo Città d'Ippocrate, 1, 84131 Salerno SA, Italy
| | - Liberata Guadagno
- Department of Industrial Engineering, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano SA, Italy
| | - Laura Rehak
- Athena Biomedical Innovations, Viale Europa 139, Florence, 50126, Italy
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 43, 84081 Baronissi SA, Italy
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 275 Bancroft Road, London E1 4DG, UK
| | - Giovanna Della Porta
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 43, 84081 Baronissi SA, Italy
- Interdepartment Centre BIONAM, Università di Salerno, via Giovanni Paolo II, 132, 84084 Fisciano SA, Italy
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Vallini V, Venturini L, Carnesecchi P, Andreini R, Meini S. A Severe Necrotizing Inflammatory Reaction of Leg Wounds Following Autologous Peripheral Blood Total Nucleated Cells Treatment in an Old Patient With Rheumatoid Arthritis and No-Option Chronic Limb-Threatening Ischemia: Is Cell Therapy Suitable for All Patients? INT J LOW EXTR WOUND 2023; 22:179-184. [PMID: 33719646 DOI: 10.1177/1534734621997570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Chronic limb-threatening ischemia (CLTI) represents an unfavorable evolution of peripheral artery disease, characterized by pain at rest, ulceration, and gangrene and also by an increased risk of cardiovascular events, amputations, and death. According to scientific literature, in almost one third of cases affected by CLTI, defined as no-option CLTI patients, revascularization strategies are not feasible. In the past decade, several studies investigated the role of therapeutic angiogenesis through cell autologous therapy, administered through intramuscular injections or multiple local intralesional and perilesional injections. In this article, we report the case of a necrotizing inflammatory reaction in a patient affected by CLTI and chronic leg wounds that occurred on the multiple injection sites after autologous peripheral blood-derived mononuclear cells (PB-TNCs) transplantation. Since the patient was affected by corticosteroid-induced skin atrophy and rheumatoid arthritis, we hypothesize that an increased skin fragility and a mechanism of immune-mediated pathergy could have been main factors leading to worsening of wounds. This case report strongly suggests the urgent need to better define the indications and contraindications of cell therapy, and further studies of adequate methodology are required to definitively assess the efficacy and safety of autologous cell therapy by local injections of PB-TNCs in patients with chronic inflammatory disorder, such as rheumatoid arthritis, especially in case of concomitant marked skin atrophy. Pending definitive evidence from literature, a strong caution is needed in patients affected by chronic systemic inflammatory diseases, since multiple injections, acting as mechanical stimulus and pathergy trigger, might exacerbate a severe and uncontrolled inflammatory response.
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Affiliation(s)
| | | | | | | | - Simone Meini
- Felice Lotti Hospital, Pontedera, Pisa, Toscana, Italy
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Scala P, Manzo P, Lamparelli EP, Lovecchio J, Ciardulli MC, Giudice V, Selleri C, Giordano E, Rehak L, Maffulli N, Della Porta G. Peripheral blood mononuclear cells contribute to myogenesis in a 3D bioengineered system of bone marrow mesenchymal stem cells and myoblasts. Front Bioeng Biotechnol 2023; 10:1075715. [PMID: 36704300 PMCID: PMC9871311 DOI: 10.3389/fbioe.2022.1075715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Abstract
In this work, a 3D environment obtained using fibrin scaffold and two cell populations, such as bone marrow-derived mesenchymal stem cells (BM-MSCs), and primary skeletal muscle cells (SkMs), was assembled. Peripheral blood mononuclear cells (PBMCs) fraction obtained after blood filtration with HemaTrate® filter was then added to the 3D culture system to explore their influence on myogenesis. The best cell ratio into a 3D fibrin hydrogel was 1:1 (BM-MSCs plus SkMs:PBMCs) when cultured in a perfusion bioreactor; indeed, excellent viability and myogenic event induction were observed. Myogenic genes were significantly overexpressed when cultured with PBMCs, such as MyoD1 of 118-fold at day 14 and Desmin 6-fold at day 21. Desmin and Myosin Heavy Chain were also detected at protein level by immunostaining along the culture. Moreover, the presence of PBMCs in 3D culture induced a significant downregulation of pro-inflammatory cytokine gene expression, such as IL6. This smart biomimetic environment can be an excellent tool for investigation of cellular crosstalk and PBMC influence on myogenic processes.
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Affiliation(s)
- Pasqualina Scala
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Paola Manzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy,Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, Salerno, Italy
| | | | - Joseph Lovecchio
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi” (DEI), University of Bologna, Bologna, Italy
| | | | - Valentina Giudice
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy,Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, Salerno, Italy
| | - Carmine Selleri
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy,Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, Salerno, Italy
| | - Emanuele Giordano
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi” (DEI), University of Bologna, Bologna, Italy
| | - Laura Rehak
- Athena Biomedical innovations, Florence, Italy
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England
| | - Giovanna Della Porta
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy,Interdepartment Centre BIONAM, University of Salerno, Fisciano, Italy,*Correspondence: Giovanna Della Porta,
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Caravaggio F, Depalmi F, Antonelli M. Treatment of Achilles tendon partial injuries with injection of peripheral blood mononuclear cells (PB-MNCs): a case series. Eur J Transl Myol 2022; 32:10768. [PMID: 36325915 PMCID: PMC9830403 DOI: 10.4081/ejtm.2022.10768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022] Open
Abstract
Three patients with Achilles tendon partial injury were treated with local injection of peripheral blood mononuclear cells (PB-MNCs). All subjects were evaluated both clinically (American Orthopedic Foot and Ankle Society - AOFAS scale) and radiologically (MRI examination) at 2 months, and a clinical reassessment with the AOFAS scale was performed at 6 months. Functional and radiological signs of tendon healing processes were detected as early as 2 months after the procedure and the AOFAS scale rose from an initial average value of 37.0 to 82.7. Even though this study only involved a limited number of participants, our preliminary results indicate that regenerative therapies with PB-MNCs may be a valid alternative to surgical options for Achilles tendon partial injuries, especially in patients with contraindications to surgery, when other conservative approaches (exercises, physical therapies, sclerosing treatment) have failed. Further investigations on the subject seem rationally supported and advisable.
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Affiliation(s)
- Francesco Caravaggio
- Foot and Ankle Surgery Center, “Casa di Cura Città di Parma” (Parma, Italy), “Associazione Ex Alumni G. Pisani” (Cuneo, Italy),Foot and Ankle Surgery Center, “Casa di Cura Città di Parma”, Athos Maestri Square, 5, 43123 Parma, Italy. ORCID ID: 0000-0001-7366-5749
| | - Fabio Depalmi
- Foot and Ankle Surgery Center, “Casa di Cura Città di Parma” (Parma, Italy), “Associazione Ex Alumni G. Pisani” (Cuneo, Italy)
| | - Michele Antonelli
- Public Health Service, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Rusconi G, Cusumano G, Mariotta L, Canevascini R, Gola M, Gornati R, Soldati G. Upgrading Monocytes Therapy for Critical Limb Ischemia Patient Treatment: Pre-Clinical and GMP-Validation Aspects. Int J Mol Sci 2022; 23:ijms232012669. [PMID: 36293525 PMCID: PMC9604444 DOI: 10.3390/ijms232012669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 12/03/2022] Open
Abstract
Advanced cell therapy medicinal products (ATMP) are at the forefront of a new range of biopharmaceuticals. The use of ATMP has evolved and increased in the last decades, representing a new approach to treating diseases that are not effectively managed with conventional treatments. The standard worldwide recognized for drug production is the Good Manufacturing Practices (GMP), widely used in the pharma production of synthesized drugs but applying also to ATMP. GMP guidelines are worldwide recognized standards to manufacture medicinal products to guarantee high quality, safety, and efficacy. In this report, we describe the pre-clinical and the GMP upgrade of peripheral blood mononuclear cell (PBMC) preparation, starting from peripheral blood and ending up with a GMP-grade clinical product ready to be used in patients with critical limb ischemia (CLI). We also evaluated production in hypoxic conditions to increase PBMC functional activity and angiogenic potential. Furthermore, we extensively analyzed the storage and transport conditions of the final product as required by the regulatory body for ATMPs. Altogether, results suggest that the whole manufacturing process can be performed for clinical application. Peripheral blood collected by a physician should be transported at room temperature, and PBMCs should be isolated in a clean room within 8 h of venipuncture. Frozen cells can be stored in nitrogen vapors and thawed for up to 12 months. PBMCs resuspended in 5% human albumin solution should be stored and transported at 4 °C before injection in patients within 24 h to thawing. Hypoxic conditioning of PBMCs should be implemented for clinical application, as it showed a significant enhancement of PBMC functional activity, in particular with increased adhesion, migration, and oxidative stress resistance. We demonstrated the feasibility and the quality of a GMP-enriched suspension of monocytes as an ATMP, tested in a clean room facility for all aspects related to production in respect of all the GMP criteria that allow its use as an ATMP. We think that these results could ease the way to the clinical application of ATMPs.
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Affiliation(s)
| | | | - Luca Mariotta
- Swiss Stem Cell Foundation, 6900 Lugano, Switzerland
| | - Reto Canevascini
- Department of Surgery, Service of Angiology, Lugano Regional Hospital, 6900 Lugano, Switzerland
| | - Mauro Gola
- Swiss Stem Cell Foundation, 6900 Lugano, Switzerland
| | - Rosalba Gornati
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | - Gianni Soldati
- Swiss Stem Cell Foundation, 6900 Lugano, Switzerland
- Correspondence:
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7
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Panunzi A, Madotto F, Sangalli E, Riccio F, Sganzaroli AB, Galenda P, Bertulessi A, Barmina MF, Ludovico O, Fortunato O, Setacci F, Airoldi F, Tavano D, Giurato L, Meloni M, Uccioli L, Bruno A, Spinetti G, Caravaggi CMF. Results of a prospective observational study of autologous peripheral blood mononuclear cell therapy for no-option critical limb-threatening ischemia and severe diabetic foot ulcers. Cardiovasc Diabetol 2022; 21:196. [PMID: 36171587 PMCID: PMC9516816 DOI: 10.1186/s12933-022-01629-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cell therapy with autologous peripheral blood mononuclear cells (PB-MNCs) may help restore limb perfusion in patients with diabetes mellitus and critical limb-threatening ischemia (CLTI) deemed not eligible for revascularization procedures and consequently at risk for major amputation (no-option). Fundamental is to establish its clinical value and to identify candidates with a greater benefit over time. Assessing the frequency of PB circulating angiogenic cells and extracellular vesicles (EVs) may help in guiding candidate selection. Methods We conducted a prospective, non-controlled, observational study on no-option CLTI diabetic patients that underwent intramuscular PB-MNCs therapy, which consisted of more cell treatments repeated a maximum of three times. The primary endpoint was amputation rate at 1 year following the first treatment with PB-MNCs. We evaluated ulcer healing, walking capability, and mortality during the follow-up period. We assessed angiogenic cells and EVs at baseline and after each cell treatment, according to primary outcome and tissue perfusion at the last treatment [measured as transcutaneous oxygen pressure (TcPO2)]. Results 50 patients were consecutively enrolled and the primary endpoint was 16%. TcPO2 increased after PB-MNCs therapy (17.2 ± 11.6 vs 39.1 ± 21.8 mmHg, p < .0001), and ulcers healed with back-to-walk were observed in 60% of the study population (88% of survivors) during follow-up (median 1.5 years). Patients with a high level of TcPO2 (≥ 40 mmHg) after the last treatment showed a high frequency of small EVs at enrollment. Conclusions In no-option CLTI diabetic patients, PB-MNCs therapy led to an improvement in tissue perfusion, a high rate of healing, and back-to-walk. Coupling circulating cellular markers of angiogenesis could help in the identification of patients with a better clinical benefit over time. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01629-y.
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Affiliation(s)
| | - Fabiana Madotto
- Value-based Healthcare Unit, IRCCS MultiMedica, Milan, Italy
| | - Elena Sangalli
- Laboratory of Cardiovascular Pathophysiology-Regenerative Medicine, IRCCS MultiMedica, Milan, Italy
| | - Federica Riccio
- Laboratory of Cardiovascular Pathophysiology-Regenerative Medicine, IRCCS MultiMedica, Milan, Italy
| | | | | | | | | | - Ornella Ludovico
- Diabetic Foot Dpt, IRCCS MultiMedica, Milan, Italy.,Unit of Endocrinology, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Flavio Airoldi
- Interventional Cardiology Unit, IRCCS MultiMedica, Milan, Italy
| | - Davide Tavano
- Interventional Cardiology Unit, IRCCS MultiMedica, Milan, Italy
| | - Laura Giurato
- Diabetic Foot Unit, University of Rome Tor Vergata, Rome, Italy
| | - Marco Meloni
- Diabetic Foot Unit, University of Rome Tor Vergata, Rome, Italy
| | - Luigi Uccioli
- CTO Andrea Alesini Hospital, Division of Endocrinology and Diabetes, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Antonino Bruno
- Laboratory of Immunology and General Pathology, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy.,Laboratory of Innate Immunity, Unit of Molecular Pathology, Biochemistry and Immunology, IRCCS MultiMedica, Milan, Italy
| | - Gaia Spinetti
- Laboratory of Cardiovascular Pathophysiology-Regenerative Medicine, IRCCS MultiMedica, Milan, Italy.
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Bonanni M, Rehak L, Massaro G, Benedetto D, Matteucci A, Russo G, Esperto F, Federici M, Mauriello A, Sangiorgi GM. Autologous Immune Cell-Based Regenerative Therapies to Treat Vasculogenic Erectile Dysfunction: Is the Immuno-Centric Revolution Ready for the Prime Time? Biomedicines 2022; 10:biomedicines10051091. [PMID: 35625828 PMCID: PMC9138496 DOI: 10.3390/biomedicines10051091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 02/04/2023] Open
Abstract
About 35% of patients affected by erectile dysfunction (ED) do not respond to oral phosphodiesterase-5 inhibitors (PDE5i) and more severe vasculogenic refractory ED affects diabetic patients. Innovative approaches, such as regenerative therapies, including stem cell therapy (SCT) and platelet-rich plasma (PRP), are currently under investigation. Recent data point out that the regenerative capacity of stem cells is strongly influenced by local immune responses, with macrophages playing a pivotal role in the injury response and as a coordinator of tissue regeneration, suggesting that control of the immune response could be an appealing approach in regenerative medicine. A new generation of autologous cell therapy based on immune cells instead of stem cells, which could change regenerative medicine for good, is discussed. Increasing safety and efficacy data are coming from clinical trials using peripheral blood mononuclear cells to treat no-option critical limb ischemia and diabetic foot. In this review, ongoing phase 1/phase 2 stem cell clinical trials are discussed. In addition, we examine the mechanism of action and rationale, as well as propose a new generation of regenerative therapies, evolving from typical stem cell or growth factor to immune cell-based medicine, based on autologous peripheral blood mononuclear cells (PBMNC) concentrates for the treatment of ED.
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Affiliation(s)
- Michela Bonanni
- Department of Biomedicine and Prevention, Institute of Cardiology, University of Rome Tor Vergata, 00133 Rome, Italy; (M.B.); (G.M.); (D.B.); (A.M.); (G.R.)
| | - Laura Rehak
- Athena Biomedical Innovations, 50126 Florence, Italy;
| | - Gianluca Massaro
- Department of Biomedicine and Prevention, Institute of Cardiology, University of Rome Tor Vergata, 00133 Rome, Italy; (M.B.); (G.M.); (D.B.); (A.M.); (G.R.)
| | - Daniela Benedetto
- Department of Biomedicine and Prevention, Institute of Cardiology, University of Rome Tor Vergata, 00133 Rome, Italy; (M.B.); (G.M.); (D.B.); (A.M.); (G.R.)
| | - Andrea Matteucci
- Department of Biomedicine and Prevention, Institute of Cardiology, University of Rome Tor Vergata, 00133 Rome, Italy; (M.B.); (G.M.); (D.B.); (A.M.); (G.R.)
- Division of Cardiology San Filippo Neri Hospital, 00135 Rome, Italy
| | - Giulio Russo
- Department of Biomedicine and Prevention, Institute of Cardiology, University of Rome Tor Vergata, 00133 Rome, Italy; (M.B.); (G.M.); (D.B.); (A.M.); (G.R.)
| | | | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Alessandro Mauriello
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Giuseppe Massimo Sangiorgi
- Department of Biomedicine and Prevention, Institute of Cardiology, University of Rome Tor Vergata, 00133 Rome, Italy; (M.B.); (G.M.); (D.B.); (A.M.); (G.R.)
- Correspondence:
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9
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PBMNCs Treatment in Critical Limb Ischemia and Candidate Biomarkers of Efficacy. Diagnostics (Basel) 2022; 12:diagnostics12051137. [PMID: 35626293 PMCID: PMC9139406 DOI: 10.3390/diagnostics12051137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/01/2022] [Accepted: 05/01/2022] [Indexed: 01/27/2023] Open
Abstract
When in critical limb ischemia (CLI) the healing process aborts or does not follow an orderly and timely sequence, a chronic vascular wound develops. The latter is major problem today, as their epidemiology is continuously increasing due to the aging population and a growth in the incidence of the underlying diseases. In the US, the mean annualized prevalence of necrotic wounds due to the fact of CLI is 1.33% (95% CI, 1.32–1.34%), and the cost of dressings alone has been estimated at USD 5 billion per year from healthcare budgets. A promising cell treatment in wound healing is the local injection of peripheral blood mononuclear cells (PBMNCs). The treatment is aimed to induce angiogenesis as well to switch inflammatory macrophages, called the M1 phenotype, into anti-inflammatory macrophages, called M2, a phenotype devoted to tissue repair. This mechanism is called polarization and is a critical step for the healing of all human tissues. Regarding the clinical efficacy of PBMNCs, the level of evidence is still low, and a considerable effort is necessary for completing the translational process toward the patient bed site. From this point of view, it is crucial to identify some candidate biomarkers to detect the switching process from M1 to M2 in response to the cell treatment.
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The Immune-Centric Revolution in the Diabetic Foot: Monocytes and Lymphocytes Role in Wound Healing and Tissue Regeneration-A Narrative Review. J Clin Med 2022; 11:jcm11030889. [PMID: 35160339 PMCID: PMC8836882 DOI: 10.3390/jcm11030889] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 02/04/2023] Open
Abstract
Monocytes and lymphocytes play a key role in physiologic wound healing and might be involved in the impaired mechanisms observed in diabetes. Skin wound macrophages are represented by tissue resident macrophages and infiltrating peripheral blood recruited monocytes which play a leading role during the inflammatory phase of wound repair. The impaired transition of diabetic wound macrophages from pro-inflammatory M1 phenotypes to anti-inflammatory pro-regenerative M2 phenotypes might represent a key issue for impaired diabetic wound healing. This review will focus on the role of immune system cells in normal skin and diabetic wound repair. Furthermore, it will give an insight into therapy able to immuno-modulate wound healing processes toward to a regenerative anti-inflammatory fashion. Different approaches, such as cell therapy, exosome, and dermal substitute able to promote the M1 to M2 switch and able to positively influence healing processes in chronic wounds will be discussed.
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11
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Bellisi M. Autologous peripheral blood mononuclear cells for the treatment of lower extremity lymphedema: a preliminary report. VEINS AND LYMPHATICS 2021. [DOI: 10.4081/vl.2021.10016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Lymphedema is a chronic devastating disease characterized by the accumulation of fluid in the extremities, tissue progressive changes such as adipose tissue deposition and fibrosis. To restore the functionality and structural integrity of the damaged lymphatic vessels, autologous peripheral blood mononuclear cells (PBMNC) was implanted in 3 sessions, 4 weeks apart, in the affected limb. Each patient was followed for 6 months, monitoring changes in the limb volume. Lymphangiogenesis was evaluated by lymphoscintigraphy, and the monitoring of quality of life. A rapid reduction in the volume of the limbs was observed: 24.5% of volume reduction after the first implant, 18.5% after the second, and 15.3% at 6 months after the third (p<0.05 vs baseline).
Lymphoscintigraphy showed a hyper fixation of the tracer along the ipsilateral iliac axis not appreciable at baseline. Implants of autologous PBMNC in patients with primary lower limb lymphedema seems to be a feasible, effective therapy option.
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12
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Hendow EK, Day RM. A facile approach to therapeutic angiogenesis using a platelet concentrate and microsphere composite. NANO SELECT 2021. [DOI: 10.1002/nano.202100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Eseelle K. Hendow
- Centre for Precision Healthcare UCL Division of Medicine University College London London UK
| | - Richard M. Day
- Centre for Precision Healthcare UCL Division of Medicine University College London London UK
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13
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Scala P, Rehak L, Giudice V, Ciaglia E, Puca AA, Selleri C, Della Porta G, Maffulli N. Stem Cell and Macrophage Roles in Skeletal Muscle Regenerative Medicine. Int J Mol Sci 2021; 22:10867. [PMID: 34639203 PMCID: PMC8509639 DOI: 10.3390/ijms221910867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 12/23/2022] Open
Abstract
In severe muscle injury, skeletal muscle tissue structure and functionality can be repaired through the involvement of several cell types, such as muscle stem cells, and innate immune responses. However, the exact mechanisms behind muscle tissue regeneration, homeostasis, and plasticity are still under investigation, and the discovery of pathways and cell types involved in muscle repair can open the way for novel therapeutic approaches, such as cell-based therapies involving stem cells and peripheral blood mononucleate cells. Indeed, peripheral cell infusions are a new therapy for muscle healing, likely because autologous peripheral blood infusion at the site of injury might enhance innate immune responses, especially those driven by macrophages. In this review, we summarize current knowledge on functions of stem cells and macrophages in skeletal muscle repairs and their roles as components of a promising cell-based therapies for muscle repair and regeneration.
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Affiliation(s)
- Pasqualina Scala
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (P.S.); (V.G.); (E.C.); (A.A.P.); (C.S.); (N.M.)
| | - Laura Rehak
- Athena Biomedical innovations, Viale Europa 139, 50126 Florence, Italy;
| | - Valentina Giudice
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (P.S.); (V.G.); (E.C.); (A.A.P.); (C.S.); (N.M.)
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, Largo Città d’Ippocrate 1, 84131 Salerno, Italy
- Clinical Pharmacology, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, Largo Città d’Ippocrate 1, 84131 Salerno, Italy
| | - Elena Ciaglia
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (P.S.); (V.G.); (E.C.); (A.A.P.); (C.S.); (N.M.)
| | - Annibale Alessandro Puca
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (P.S.); (V.G.); (E.C.); (A.A.P.); (C.S.); (N.M.)
- Cardiovascular Research Unit, IRCCS MultiMedica, Via Milanese 300, 20138 Milan, Italy
| | - Carmine Selleri
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (P.S.); (V.G.); (E.C.); (A.A.P.); (C.S.); (N.M.)
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, Largo Città d’Ippocrate 1, 84131 Salerno, Italy
| | - Giovanna Della Porta
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (P.S.); (V.G.); (E.C.); (A.A.P.); (C.S.); (N.M.)
- Interdepartment Centre BIONAM, University of Salerno, Via Giovanni Paolo I, 84084 Fisciano, Italy
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (P.S.); (V.G.); (E.C.); (A.A.P.); (C.S.); (N.M.)
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 275 Bancroft Road, London E1 4DG, UK
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14
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Terlizzese G, Stubinski R, Casini A, Clerici G, Sangiorgi G. A case report of pudendal arteries angioplasty with sirolimus drug-coated balloon and drug-eluting stent associated with intracavernous autologous peripheral blood mononuclear cells injection for untreatable vasculogenic erectile dysfunction. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab244. [PMID: 34409246 PMCID: PMC8364765 DOI: 10.1093/ehjcr/ytab244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/13/2021] [Accepted: 06/03/2021] [Indexed: 11/26/2022]
Abstract
Background Erectile dysfunction (ED) is a prevalent health problem that seriously impacts men's quality of life. The potential treatment of ED by percutaneous approach has emerged with valid angiographic results and a significant improvement in symptoms and quality of life. In addition, cell-based regenerative therapies aiming at enhancing neovascularization have been successfully performed with peripheral blood mononuclear cells (PBMNCs) in diabetic patients affected by critical limb ischaemia. Case summary We report a case of a young insulin dependent (ID) diabetic patients who suffered of severe vasculogenic erectile dysfunction associated with a poor response for more than 1 year to oral phosphodiesterase-5 inhibitors (PDE5i) and intracavernous (IC) phosphodiesterase type 1 (PDE1) therapy. At selective angiography of the pelvic district, a severe atherosclerotic disease of the internal iliac and pudendal artery was evident with absence of distal vascularization of the cavernous bodies. The patient was treated by mechanical revascularization with drug-coated balloon and drug-eluting stent placement associated with IC injection of autologous PBMNCs. Immediate and 1-year clinical and angiographic follow-up are described. Discussion Percutaneous revascularization with drug-coated balloon and drug-eluting stent associated with IC autologous PBMNCs cells injection is a safe and effective procedure to restore normal erectile function in diabetic patients affected by severe vasculogenic ED not responding to conventional oral drug therapies.
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Affiliation(s)
- Giuseppe Terlizzese
- Department of Cardiology, Cardiac Cath Lab, Bolognini Hospital, Bergamo, Italy
| | - Robert Stubinski
- Division of Urology, Istituto Policlinico San Donato, San Donato Milanese, Italy
| | - Andrea Casini
- Diabetic Foot Unit, Division of Vascular Surgery, Clinica San Carlo Paderno Dugnano, Milan, Italy
| | - Giacomo Clerici
- Diabetic Foot Unit, Division of Diabetology, Clinica San Carlo Paderno Dugnano, Milan, Italy
| | - Giuseppe Sangiorgi
- Division of Cardiology, Department of Biomedicine and Prevention, Cardiac Cath Lab, University of Tor Vergata, Rome, Italy
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15
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Magenta A, Florio MC, Ruggeri M, Furgiuele S. Autologous cell therapy in diabetes‑associated critical limb ischemia: From basic studies to clinical outcomes (Review). Int J Mol Med 2021; 48:173. [PMID: 34278463 DOI: 10.3892/ijmm.2021.5006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/30/2020] [Indexed: 01/13/2023] Open
Abstract
Cell therapy is becoming an attractive alternative for the treatment of patients with no‑option critical limb ischemia (CLI). The main benefits of cell therapy are the induction of therapeutic angiogenesis and neovascularization that lead to an increase in blood flow in the ischemic limb and tissue regeneration in non‑healing cutaneous trophic lesions. In the present review, the current state of the art of strategies in the cell therapy field are summarized, focusing on intra‑operative autologous cell concentrates in diabetic patients with CLI, examining different sources of cell concentrates and their mechanisms of action. The present study underlined the detrimental effects of the diabetic condition on different sources of autologous cells used in cell therapy, and also in delaying wound healing capacity. Moreover, relevant clinical trials and critical issues arising from cell therapy trials are discussed. Finally, the new concept of cell therapy as an adjuvant therapy to increase wound healing in revascularized diabetic patients is introduced.
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Affiliation(s)
| | - Maria Cristina Florio
- Laboratory of Cardiovascular Science, National Institute on Aging (NIA), National Institutes of Health (NIH), Baltimore, MD 21224, USA
| | - Massimo Ruggeri
- Department of Vascular Surgery, San Camillo de Lellis Hospital, I‑02100 Rieti, Italy
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16
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Scatena A, Petruzzi P, Maioli F, Lucaroni F, Ambrosone C, Ventoruzzo G, Liistro F, Tacconi D, Di Filippi M, Attempati N, Palombi L, Ercolini L, Bolognese L. Autologous Peripheral Blood Mononuclear Cells for Limb Salvage in Diabetic Foot Patients with No-Option Critical Limb Ischemia. J Clin Med 2021; 10:2213. [PMID: 34065278 PMCID: PMC8161401 DOI: 10.3390/jcm10102213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/21/2023] Open
Abstract
Peripheral blood mononuclear cells (PBMNCs) are reported to prevent major amputation and healing in no-option critical limb ischemia (NO-CLI). The aim of this study is to evaluate PBMNC treatment in comparison to standard treatment in NO-CLI patients with diabetic foot ulcers (DFUs). The study included 76 NO-CLI patients admitted to our centers because of CLI with DFUs. All patients were treated with the same standard care (control group), but 38 patients were also treated with autologous PBMNC implants. Major amputations, overall mortality, and number of healed patients were evaluated as the primary endpoint. Only 4 out 38 amputations (10.5%) were observed in the PBMNC group, while 15 out of 38 amputations (39.5%) were recorded in the control group (p = 0.0037). The Kaplan-Meier curves and the log-rank test results showed a significantly lower amputation rate in the PBMNCs group vs. the control group (p = 0.000). At two years follow-up, nearly 80% of the PBMNCs group was still alive vs. only 20% of the control group (p = 0.000). In the PBMNC group, 33 patients healed (86.6%) while only one patient healed in the control group (p = 0.000). PBMNCs showed a positive clinical outcome at two years follow-up in patients with DFUs and NO-CLI, significantly reducing the amputation rate and improving survival and wound healing. According to our study results, intramuscular and peri-lesional injection of autologous PBMNCs could prevent amputations in NO-CLI diabetic patients.
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Affiliation(s)
- Alessia Scatena
- Diabetology Unit, San Donato Hospital Arezzo, Local Health Authorities South East Tuscany, 52100 Arezzo, Italy;
| | - Pasquale Petruzzi
- Interventional Radiology Unit, San Donato Hospital Arezzo, Local Health Authorities South East Tuscany, 52100 Arezzo, Italy; (P.P.); (N.A.)
| | - Filippo Maioli
- Vascular Surgery Unit, San Donato Hospital Arezzo, Local Health Authorities South East Tuscany, 52100 Arezzo, Italy; (F.M.); (G.V.); (L.E.)
| | - Francesca Lucaroni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Roma, Italy; (F.L.); (C.A.); (L.P.)
| | - Cristina Ambrosone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Roma, Italy; (F.L.); (C.A.); (L.P.)
| | - Giorgio Ventoruzzo
- Vascular Surgery Unit, San Donato Hospital Arezzo, Local Health Authorities South East Tuscany, 52100 Arezzo, Italy; (F.M.); (G.V.); (L.E.)
| | - Francesco Liistro
- Interventional Cardiology Unit, San Donato Hospital Arezzo, Local Health Authorities South East Tuscany, 52100 Arezzo, Italy; (F.L.); (L.B.)
| | - Danilo Tacconi
- Infectious Disease Unit, San Donato Hospital Arezzo, Local Health Authorities South East Tuscany, 52100 Arezzo, Italy;
| | - Marianna Di Filippi
- Diabetology Unit, San Donato Hospital Arezzo, Local Health Authorities South East Tuscany, 52100 Arezzo, Italy;
| | - Nico Attempati
- Interventional Radiology Unit, San Donato Hospital Arezzo, Local Health Authorities South East Tuscany, 52100 Arezzo, Italy; (P.P.); (N.A.)
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Roma, Italy; (F.L.); (C.A.); (L.P.)
| | - Leonardo Ercolini
- Vascular Surgery Unit, San Donato Hospital Arezzo, Local Health Authorities South East Tuscany, 52100 Arezzo, Italy; (F.M.); (G.V.); (L.E.)
| | - Leonardo Bolognese
- Interventional Cardiology Unit, San Donato Hospital Arezzo, Local Health Authorities South East Tuscany, 52100 Arezzo, Italy; (F.L.); (L.B.)
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17
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Groppa E, Colliva A, Vuerich R, Kocijan T, Zacchigna S. Immune Cell Therapies to Improve Regeneration and Revascularization of Non-Healing Wounds. Int J Mol Sci 2020; 21:E5235. [PMID: 32718071 PMCID: PMC7432547 DOI: 10.3390/ijms21155235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 12/20/2022] Open
Abstract
With the increased prevalence of chronic diseases, non-healing wounds place a significant burden on the health system and the quality of life of affected patients. Non-healing wounds are full-thickness skin lesions that persist for months or years. While several factors contribute to their pathogenesis, all non-healing wounds consistently demonstrate inadequate vascularization, resulting in the poor supply of oxygen, nutrients, and growth factors at the level of the lesion. Most existing therapies rely on the use of dermal substitutes, which help the re-epithelialization of the lesion by mimicking a pro-regenerative extracellular matrix. However, in most patients, this approach is not efficient, as non-healing wounds principally affect individuals afflicted with vascular disorders, such as peripheral artery disease and/or diabetes. Over the last 25 years, innovative therapies have been proposed with the aim of fostering the regenerative potential of multiple immune cell types. This can be achieved by promoting cell mobilization into the circulation, their recruitment to the wound site, modulation of their local activity, or their direct injection into the wound. In this review, we summarize preclinical and clinical studies that have explored the potential of various populations of immune cells to promote skin regeneration in non-healing wounds and critically discuss the current limitations that prevent the adoption of these therapies in the clinics.
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Affiliation(s)
- Elena Groppa
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), 34149 Trieste, Italy; (E.G.); (A.C.); (R.V.); (T.K.)
| | - Andrea Colliva
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), 34149 Trieste, Italy; (E.G.); (A.C.); (R.V.); (T.K.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Roman Vuerich
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), 34149 Trieste, Italy; (E.G.); (A.C.); (R.V.); (T.K.)
- Department of Life Sciences, University of Trieste, 34127 Trieste, Italy
| | - Tea Kocijan
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), 34149 Trieste, Italy; (E.G.); (A.C.); (R.V.); (T.K.)
| | - Serena Zacchigna
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), 34149 Trieste, Italy; (E.G.); (A.C.); (R.V.); (T.K.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy
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18
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In-Site Monocyte Implantation in Bone Grafting for Maxillary Atrophy Reconstruction: A Preliminary Observational Proof of Concept Study. IMPLANT DENT 2019; 27:529-541. [PMID: 30239370 DOI: 10.1097/id.0000000000000813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The main objective of this study, involving 11 patients, is to share our experience on an integrated treatment modality, namely, the use of cellular therapy simultaneously with surgical reconstruction. Published works show that the implantation of monocytes in ischemic tissue enhances healing by providing neo-angiogenesis, a key mechanism in tissue regenerative processes. MATERIALS AND METHODS Our approach included the utilization of autologous monocytes and endothelial precursor cells in the bone graft itself to improve the success rate of the integration of the bone graft and its long-term viability/survival by promoting angiogenesis. We compared the standard regenerative procedures, namely sinus lift grafting performed with xenogeneic particle bone graft and posterior mandible grafting performed with on-lay or in-lay autologous cortical/medullary bone-block graft harvested from the iliac crest, with and without the use of cellular implementation. We evaluated results by both radiological and histological assessment. RESULTS Autologous cortical/medullary bone-block graft had a different response to implementation with monocytes, showing a better osteointegration than expected conversely to the xenogeneic particle bone graft. CONCLUSIONS Monocytes seem to improve autologous bone-block graft according to the "Therapeutic Angiogenesis" concept. Implementation with monocytes does not always improve xenogeneic particle bone graft.
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19
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Persiani F, Furgiuele S. Reply to "Peripheral Blood Mononuclear Cells Therapy for Treatment of Lower Limb Ischemia in Diabetic Patient: It Is Really True?". Ann Vasc Surg 2019; 58:387-388. [PMID: 30769074 DOI: 10.1016/j.avsg.2019.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
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20
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Persiani F, Paolini A, Camilli D, Mascellari L, Platone A, Magenta A, Furgiuele S. Peripheral Blood Mononuclear Cells Therapy for Treatment of Lower Limb Ischemia in Diabetic Patients: A Single-Center Experience. Ann Vasc Surg 2018; 53:190-196. [PMID: 30053546 DOI: 10.1016/j.avsg.2018.05.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/18/2018] [Accepted: 05/01/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study is to analyze the effects of peripheral blood mononuclear cells (PBMNCs) therapy in diabetic patients with critical limb ischemia (CLI), with particular regard to its application, as adjuvant therapy in patients underwent endovascular revascularization. METHODS Fifty diabetic patients affected by CLI were enrolled. All patients underwent PBMNCs therapy. Thirty-two patients underwent PBMNCs therapy associated with endovascular revascularization (adjuvant therapy group). In 18 patients, who were considered nonrevascularizable or underwent unsuccessful revascularization, regenerative therapy with PBMNCs was performed as the therapeutic choice (PBMNCs therapy group). RESULTS The median follow-up period was 10 months. The baseline and end point results in adjuvant group were as follows. The mean transcutaneous partial pressure of oxygen (TcPO2) improved from 25 ± 9.2 mmHg to 45.6 ± 19.1 mmHg (P < 0.001), and visual analogue scale (VAS) score means decreased from 8.6 ± 2.1 to 3.8 ± 3.5 (P = 0.001). In PBMNCs therapy group, the mean TcPO2 improved from 16.2 ± 7.2 mmHg to 23.5 ± 8.4 mmHg (P < 0.001), and VAS score means decreased from 9 ± 1.1 to 4.1 ± 3.3 (P = 0.001). Major amputation was observed in 3 cases (9.4%), both in adjuvant therapy group and in PBMNCs therapy one (16.7%) (P = 0.6). CONCLUSIONS The role of cellular therapy with PBMNCs is decisive in the patients that are not susceptible to revascularization. In diabetic patients with CLI and healing resistant ulcers, the adjuvant PBMNCs therapy could represent a valid therapeutic option.
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Affiliation(s)
- Francesca Persiani
- Department of Vascular Surgery, Istituto Dermopatico Dell'Immacolata IDI - IRCCS, Rome, Italy.
| | - Alessandra Paolini
- Department of Vascular Surgery, Istituto Dermopatico Dell'Immacolata IDI - IRCCS, Rome, Italy
| | - Daniele Camilli
- Department of Vascular Surgery, Istituto Dermopatico Dell'Immacolata IDI - IRCCS, Rome, Italy
| | - Luca Mascellari
- Department of Vascular Surgery, Istituto Dermopatico Dell'Immacolata IDI - IRCCS, Rome, Italy
| | - Alessandro Platone
- Department of Vascular Surgery, Istituto Dermopatico Dell'Immacolata IDI - IRCCS, Rome, Italy
| | | | - Sergio Furgiuele
- Department of Vascular Surgery, Istituto Dermopatico Dell'Immacolata IDI - IRCCS, Rome, Italy
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21
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Olivotto E, Merli G, Assirelli E, Cavallo C, Belluzzi E, Ramonda R, Favero M, Filardo G, Roffi A, Kon E, Grigolo B. Cultures of a human synovial cell line to evaluate platelet-rich plasma and hyaluronic acid effects. J Tissue Eng Regen Med 2018; 12:1835-1842. [PMID: 29770602 DOI: 10.1002/term.2704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 04/16/2018] [Accepted: 05/03/2018] [Indexed: 12/26/2022]
Abstract
Synovial inflammation plays an important role in osteoarthritis (OA) pathogenesis. Different biological compounds have been tested mainly on chondrocytes, to treat early stages of OA. However, because OA has been recently defined as "an organ" pathology, investigation on synoviocytes is also needed. Therefore, the aim of the present study was to validate a human fibroblast-like synoviocytes cell line (K4IM) to test the effects of platelet-rich plasma (PRP) and hyaluronan (HA) on anabolic and catabolic gene expression and on HA secretion from cell cultures. In order to determine the effect of PRP and HA, K4IM cells were maintained in culture with or without TNF-α stimulation. In the presence of PRP, unstimulated K4IM cells presented the same expression of IL1B, IL6, CXCL8, VEGF, TIMP1, and hyaluronic synthase isoform HAS3 as primary human synoviocytes, while HA addition did not change their expression pattern, which was similar to control cells. Stimulated cells expressed significantly higher values of IL1B, CXCL8, and VEGF compared with unstimulated ones. PRP did not show any modification, except for VEGF, while HA addition modulated IL1B expression. PRP did not modulate HA release of both stimulated and unstimulated cells. Our study showed the possibility to use K4IM synoviocytes as an in vitro model to test biological compounds useful for the treatment of early OA. Primary cells reflect the phenotype of cells in vivo, but limited recovery from biopsies and restricted lifespan makes experimental manipulation challenging. Therefore, despite cell lines present some limitations, they could be used as an alternative for preliminary experiments.
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Affiliation(s)
- E Olivotto
- RAMSES Laboratory, Research and Innovation Technology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - G Merli
- Nano-Biotechnology Laboratory-NaBi, Research and Innovation Technology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - E Assirelli
- Laboratory of Immunorheumatology and Tissue Regeneration, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - C Cavallo
- RAMSES Laboratory, Research and Innovation Technology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - E Belluzzi
- Rheumatology Unit, University Hospital of Padova, Padova, Italy
| | - R Ramonda
- Rheumatology Unit, University Hospital of Padova, Padova, Italy
| | - M Favero
- RAMSES Laboratory, Research and Innovation Technology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Rheumatology Unit, University Hospital of Padova, Padova, Italy
| | - G Filardo
- Nano-Biotechnology Laboratory-NaBi, Research and Innovation Technology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Roffi
- Nano-Biotechnology Laboratory-NaBi, Research and Innovation Technology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - E Kon
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Humanitas Clinical and Research Center, Milan, Italy
| | - B Grigolo
- RAMSES Laboratory, Research and Innovation Technology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Laboratory of Immunorheumatology and Tissue Regeneration, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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22
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Beji S, Milano G, Scopece A, Cicchillitti L, Cencioni C, Picozza M, D'Alessandra Y, Pizzolato S, Bertolotti M, Spaltro G, Raucci A, Piaggio G, Pompilio G, Capogrossi MC, Avitabile D, Magenta A, Gambini E. Doxorubicin upregulates CXCR4 via miR-200c/ZEB1-dependent mechanism in human cardiac mesenchymal progenitor cells. Cell Death Dis 2017; 8:e3020. [PMID: 28837147 PMCID: PMC5596590 DOI: 10.1038/cddis.2017.409] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 01/06/2023]
Abstract
Doxorubicin (DOXO) treatment is limited by its cardiotoxicity, since it causes cardiac-progenitor-cell depletion. Although the cardioprotective role of the stromal cell-derived factor-1/C-X-C chemokine receptor type 4 (SDF1/CXCR4) axis is well established, its involvement during DOXO-induced cardiotoxicity has never been investigated. We showed that in a mouse model of DOXO-induced cardiomyopathy, CXCR4+ cells were increased in response to DOXO, mainly in human cardiac mesenchymal progenitor cells (CmPC), a subpopulation with regenerative potential. Our in vitro results showed a CXCR4 induction after 24 h of DOXO exposure in CmPC. SDF1 administration protected from DOXO-induced cell death and promoted CmPC migration. CXCR4 promoter analysis revealed zinc finger E-box binding homeobox 1 (ZEB1) binding sites. Upon DOXO treatment, ZEB1 binding decreased and RNA-polymerase-II increased, suggesting a DOXO-mediated transcriptional increase in CXCR4. Indeed, DOXO induced the upregulation of miR-200c, that directly targets ZEB1. SDF1 administration in DOXO-treated mice partially reverted the adverse remodeling, decreasing left ventricular (LV) end diastolic volume, LV ejection fraction and LV anterior wall thickness in diastole, recovering LV end systolic pressure and reducing±dP/dt. Moreover, in vivo administration of SDF1 partially reverted DOXO-induced miR-200c and p53 protein upregulation in mouse hearts. In addition, downmodulation of ZEB1 mRNA and protein by DOXO was significantly increased by SDF1. In keeping, p21 mRNA, that is induced by p53 and inhibited by ZEB1, is induced by DOXO treatment and is decreased by SDF1 administration. This study showed new players of the DOXO-induced cardiotoxicity, that can be exploited to ameliorate DOXO-associated cardiomyopathy.
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Affiliation(s)
- Sara Beji
- Vascular Pathology Laboratory, Istituto Dermopatico dell’Immacolata, IRCCS, Via dei Monti di Creta 104, Rome 00167, Italy
| | - Giuseppina Milano
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan 20138, Italy
- Laboratory of Cardiovascular Research, Department of Surgery and Anesthesiology, University Hospital Lausanne; Rue du Bugnon 46, Lausanne 1011, Switzerland
| | - Alessandro Scopece
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan 20138, Italy
| | - Lucia Cicchillitti
- Department of Research, Advanced Diagnostics and Technological Innovation, Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome 00144, Italy
| | - Chiara Cencioni
- Division of Cardiovascular Epigenetics, Department of Cardiology, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
- National Research Council (CNR), Institute of Cell Biology and Neurobiology, Via del Fosso di Fiorano, 64, Rome 00143, Italy
| | - Mario Picozza
- Vascular Pathology Laboratory, Istituto Dermopatico dell’Immacolata, IRCCS, Via dei Monti di Creta 104, Rome 00167, Italy
| | - Yuri D'Alessandra
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino (CCM), IRCCS, Via Carlo Parea 4, Milan 20138, Italy
| | - Sarah Pizzolato
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan 20138, Italy
| | - Matteo Bertolotti
- Unit of Experimental Cardio-Oncology and Cardiovascular Aging, Centro Cardiologico Monzino (CCM), IRCCS, Via Carlo Parea 4, Milan 20138, Italy
| | - Gabriella Spaltro
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan 20138, Italy
| | - Angela Raucci
- Unit of Experimental Cardio-Oncology and Cardiovascular Aging, Centro Cardiologico Monzino (CCM), IRCCS, Via Carlo Parea 4, Milan 20138, Italy
| | - Giulia Piaggio
- Department of Research, Advanced Diagnostics and Technological Innovation, Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome 00144, Italy
| | - Giulio Pompilio
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan 20138, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, Milan 20122, Italy
| | - Maurizio C Capogrossi
- Vascular Pathology Laboratory, Istituto Dermopatico dell’Immacolata, IRCCS, Via dei Monti di Creta 104, Rome 00167, Italy
| | - Daniele Avitabile
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan 20138, Italy
| | - Alessandra Magenta
- Vascular Pathology Laboratory, Istituto Dermopatico dell’Immacolata, IRCCS, Via dei Monti di Creta 104, Rome 00167, Italy
| | - Elisa Gambini
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan 20138, Italy
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23
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Trignano E, Fallico N, Zingone G, Rubino C, Di Pompeo FS, Campus GV. Combined Treatment of Diabetic Foot Ulcer with Tarsal Tunnel Release and Perilesional Injections of Peripheral Blood Mononuclear Cells. J Am Podiatr Med Assoc 2017; 107:171-174. [PMID: 28394682 DOI: 10.7547/15-098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Emilio Trignano
- Department of Surgery and Microsurgery, University of Sassari, Sassari, Italy
| | - Nefer Fallico
- Department of Plastic Surgery, Sapienza University of Rome, Rome, Italy
| | - Gino Zingone
- Department of Surgery and Microsurgery, University of Sassari, Sassari, Italy
| | - Corrado Rubino
- Department of Plastic Surgery, University of Salerno, Fisciano, Italy
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Perrucci GL, Straino S, Corlianò M, Scopece A, Napolitano M, Berk BC, Lombardi F, Pompilio G, Capogrossi MC, Nigro P. Cyclophilin A modulates bone marrow-derived CD117+ cells and enhances ischemia-induced angiogenesis via the SDF-1/CXCR4 axis. Int J Cardiol 2016; 212:324-35. [DOI: 10.1016/j.ijcard.2016.03.082] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 03/11/2016] [Accepted: 03/19/2016] [Indexed: 12/21/2022]
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