Gen- und autologe Stammzelltherapie bei pAVK mit chronischer Extremitätenischämie

Zusammenfassung

Die Behandlung mittels Gentransfer exprimierten Wachstumsfaktoren und die autologe Stammzelltransplantation stimulieren die Neovaskularisation. Dies könnte ein neuer Therapieansatz zur Verbesserung der Durchblutung bei der peripheren arteriellen Verschlusserkrankung (pAVK) sein. Vorläufige Ergebnisse der überwiegend unkontrollierten klinischen Untersuchungen deuten auf positive Effekte hin. In einer ersten doppelblinden, randomisierten Untersuchung bei Patienten mit kritischer Extremitätenischämie wurde nach Applikation von FGF (fibroblast growth factor) eine Reduktion der Amputationsrate beobachtet. Wie bei der autologen Stammzelltransplantation sind noch viele Fragen offen, denn die Bestätigung der ersten Ergebnisse durch große randomisierte Studien steht aus.

Summary

Therapeutic angiogenesis is a novel promising strategy that uses angiogenic factors and stem cell transplantation to increase blood perfusion in ischaemic lower limbs. In preliminary studies short term safety and feasibility of gene therapy by recombinant protein administration or gene transfer were proven. Early reports mostly fail to show an convincing efficacy. In the largest placebo-controlled study of therapeutic angiogenesis in severe PAD reported to date, the plasmid-based fibroblast growth factor was safe and significantly reduced amputation rates. The data suggest the efficacy of the angiogenic therapy and provide the basis for further larger trials to confirm these first results.

Schlüsselwörter

Periphere arterielle Verschlusskrankheit - Neovaskularisation - Wachstumsfaktoren - Gentherapie - autologe Stammzelltransplantation

Keywords

Peripheral occlusive disease - therapeutic angiogenesis - angiogenic growth factors - gene therapy - autologous bone marrow stem cell transplantation

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