Serena Guiducci, MD; Francesco Porta, MD; Riccardo Saccardi, MD; Stefano Guidi, MD; Lidia Ibba-Manneschi, MD; Mirko Manetti, PhD; Benedetta Mazzanti, BSc; Simone Dal Pozzo, BSc; Anna Franca Milia, PhD; Silvia Bellando-Randone, MD; Irene Miniati, MD; Ginevra Fiori, MD; Rossana Fontana, MD; Laura Amanzi, HP; Francesca Braschi, HP; Alberto Bosi, MD; Marco Matucci-Cerinic, MD, PhD
Acknowledgment: The authors thank the patient for her readiness to help others by allowing her case to be the focus of this article.
Grant Support: By Fondazione Cassa di Risparmio di Pistoia e Pescia (partial funding).
Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1756.
Reproducible Research Statement:Study protocol and statistical code: Not available. Data set: Available from Dr. Guiducci (e-mail, firstname.lastname@example.org) after establishing a written agreement with the authors.
Requests for Single Reprints: Serena Guiducci, MD, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero-Universitaria Careggi, Denothe Center, University of Florence, viale Pieraccini 18, 50139 Florence, Italy; e-mail, email@example.com.
Current Author Addresses: Drs. Guiducci, Porta, Milia, Bellando-Randone, Miniati, Fiori, Fontana, Amanzi, Braschi, and Matucci-Cerinic: Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero-Universitaria Careggi, Denothe Center, University of Florence, viale Pieraccini 18, 50139 Florence, Italy.
Drs. Saccardi, Guidi, and Bosi; Ms. Mazzanti; and Ms. Dal Pozzo: Bone Marrow Transplantation Unit, Azienda Ospedaliero-Universitaria Careggi, viale Morgagni 85, 50134 Florence, Italy.
Drs. Ibba-Manneschi and Manetti: Department of Anatomy, Histology, and Forensic Medicine, University of Florence, viale Morgagni 85, 50134 Florence, Italy.
Author Contributions: Conception and design: S. Guiducci, R. Saccardi, I. Miniati, R. Fontana, A. Bosi, M. Matucci-Cerinic.
Analysis and interpretation of the data: S. Guiducci, F. Porta, R. Saccardi, L. Ibba-Manneschi, M. Manetti, A.F. Milia, M. Matucci-Cerinic.
Drafting of the article: S. Guiducci, F. Porta, L. Ibba-Manneschi, M. Manetti, A.F. Milia.
Critical revision of the article for important intellectual content: S. Guiducci, R. Saccardi, L. Ibba-Manneschi, M. Manetti, M. Matucci-Cerinic.
Final approval of the article: S. Guiducci, F. Porta, R. Saccardi, L. Ibba-Manneschi, M. Manetti, B. Mazzanti, S. Dal Pozzo, A.F. Milia, S. Bellando-Randone, G. Fiori, R. Fontana, L. Amanzi, F. Braschi, A. Bosi, M. Matucci-Cerinic.
Provision of study materials or patients: S. Guidi, B. Mazzanti, S. Bellando-Randone, I. Miniati, F. Braschi.
Obtaining of funding: S. Guiducci, M. Matucci-Cerinic.
Administrative, technical, or logistic support: S. Dal Pozzo, G. Fiori, L. Amanzi, F. Braschi.
Collection and assembly of data: F. Porta, L. Ibba-Manneschi, M. Manetti, B. Mazzanti, S. Dal Pozzo, A.F. Milia, S. Bellando-Randone, L. Amanzi, F. Braschi.
Guiducci S, Porta F, Saccardi R, Guidi S, Ibba-Manneschi L, Manetti M, et al. Autologous Mesenchymal Stem Cells Foster Revascularization of Ischemic Limbs in Systemic Sclerosis: A Case Report. Ann Intern Med. 2010;153:650-654. doi: 10.7326/0003-4819-153-10-201011160-00007
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Published: Ann Intern Med. 2010;153(10):650-654.
Mesenchymal stem cells can differentiate into endothelial cells and participate in angiogenesis in adults. In experimental models of acute myocardial infarction, mesenchymal stem cells led to the recovery of cardiac function through the formation of a new vascular network.
To describe treatment with intravenous infusions of expanded autologous mesenchymal stem cells in 1 patient with critical limb ischemia due to systemic sclerosis.
The rheumatology unit at the University of Florence, Florence, Italy.
A woman, aged 34 years, with systemic sclerosis who developed acute gangrene of the upper and lower limbs.
3 intravenous pulses of expanded autologous mesenchymal stem cells.
Angiography, skin histopathology, and immunohistochemistry.
Areas of necrotic skin were reduced after the first mesenchymal stem-cell infusion. After the third infusion, angiography showed revascularization of the patient's extremities. Skin section analysis revealed cell clusters with tubelike structures, and angiogenic factors were strongly expressed.
Causality cannot be established by a single case.
In patients with systemic sclerosis who have severe peripheral ischemia, intravenous infusion of expanded autologous mesenchymal stem cells may foster the recovery of the vascular network, restore blood flow, and reduce skin necrosis.
Fondazione Cassa di Risparmio di Pistoia e Pescia (partial funding).
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