Interventional radiologists are fitting together the puzzle pieces of how to use stem cells to create new or more blood vessels to treat peripheral arterial disease (PAD) in those individuals with extensively narrowed or clogged arteries.
That puzzle may be closer to being solved in light of recent successful techniques that use simple imaging to view and locate transplanted stem cells and to confirm that they remain alive in the body once injected, notes a study presented at the Society of Interventional Radiology's 34th Annual Scientific Meeting.
PAD, which affects about 10 million Americans, is a chronic disease that progressively restricts blood flow causing poor blood circulation (generally in the legs) and if left untreated can lead to serious medical complications, including heart attack, stroke, amputation and death. Many people can manage the symptoms of PAD and stop its progression through lifestyle changes. If lifestyle changes are not enough, additional medical treatment may be needed, including prescribed medicine to prevent blood clots, lower blood pressure and cholesterol and control pain.
Interventional radiologists treat severe cases of PAD with minimally invasive treatments, including angioplasty and insertion of stents. "However, some patients have extensive disease-with so many blood vessels affected-that they're difficult to treat," said Frank Wacker, M.D., interventional radiologist at Johns Hopkins School of Medicine in Baltimore, Md. That's where stem cells-and image-guided stem cell therapy-come in. "One day, stem cells may enable the targeted delivery of cellular treatments to PAD patients who may be facing amputation and death. It will be important to deliver the right amount of drug treatment to the right place, thus allowing tailored treatment for individual patients," said Wacker. "The use of C-arm CT for image-guided delivery in the angio lab enabled us to precisely target cell delivery in relationship to blood vessels without transferring to a separate CT scanner to obtain the similar information," he added. Stem cell therapy may provide interventional radiologists with a new weapon to fight PAD, a disease that affects 12 to 20 percent of Americans age 65 and older.
"To develop new stem cell treatments for PAD, we need suitable noninvasive methods to track the fate of stem cells clearly inside the body," said veterinary radiologist Dara L. Kraitchman, V.M.D., Ph.D., an associate professor at Johns Hopkins School of Medicine. Transplanting stem cells derived from bone marrow (not embryonic stem cells), accompanied by necessary immune-suppressing drugs, has had mixed results. Rejection by the body's immune system is a likely reason for transplant failure. Because X-ray agents are toxic to stem cells, tracking of stem cell therapy cannot be done by directly labeling the stem cells themselves. Hopkins researchers used a new technique that encloses stem cells in an alginate capsule or "bubble" made from seaweed that contains stem cells to create factors to recruit the building of new vessels along with an X-ray-visible contrast agent. Tested in a rabbit model for the first time, the bubble prevents the body's immune system from reaching and attacking the transplanted cells. "We needed to figure out how to protect transplanted stem cells that are vulnerable to attack by a recipient's immune system and 'see' the cells to determine if they remained alive or not," said Kraitchman. "By making sure our protective covering for stem cells stayed intact, we were able to track where we put the stem cells and confirm whether they could survive," explained Kraitchman.