Repeated local implantation of autologous peripheral blood mononuclear cells for the treatment of ischaemic digits in patients with connective tissue diseases.

Objectives: Blood flow in fingers and toes is often impaired in patients with CTDs, mandating amputation in some. Our previous study showed that a single implantation of autologous bone marrow cells is as effective as peripheral blood mononuclear cells (MNCs) to restore impaired blood flow, although neither has long-lasting efficacy. In this study, autologous peripheral blood MNCs were implanted repeatedly to evaluate a better efficacy.

Methods: Three patients with SSc, two with microscopic polyangiitis and one with MCTD were enrolled. All patients had severe RP, ulcers and/or necrosis in the extremities. MNCs were obtained from 400 to 1600 ml of peripheral blood and implanted into 20-80 different sites in the palms and/or soles. This procedure was repeated every 3 months up to 1 year. Humoral factors were measured by ELISAs.

Results: Visual analogue scale scores for pain, coldness and subjective satisfaction were improved after implantation in all patients. Pre-treatment ulcers in five patients were cured after repeated implantations. Angiography showed increased vasculature compared with baseline. Serum levels of VEGF increased after implantation, whereas levels of IL-1β, fibroblast growth factor and endostatin had variable results. None of the patients had any adverse reactions during a follow-up period of up to 3 years.

Conclusions: Repeated implantation of peripheral blood MNCs was effective and safe for the treatment of recalcitrant ulcers developing in ischaemic digits and toes in patients with CTD.