Stem cell mobilization with plerixafor and healing of diabetic ischemic wounds: A phase IIa, randomized, double‐blind, placebo‐controlled trial

Stem Cells Translational Medicine

Mirko Menegolo¹  Marta Mazzucato²  Mauro Rigato²  Roberta Cappellari²  Angelo Avogaro²  Marco Grasso²  Andrea Bruttocao²  Benedetta Maria Bonora²  Gian Paolo Fadini² 

[1] Department of Cardiothoracic and Vascular Sciences University of Padova Padova Italy;Department of Medicine University of Padova Padova Italy;

关键词: angiogenesis;    CD34+;    clinical translation;    diabetes;    hematopoietic stem cells;    mobilization;   

DOI  :  10.1002/sctm.20-0020

来源: DOAJ

【 摘 要 】

Abstract Bone marrow‐derived cells contribute to tissue repair, but traffic of hematopoietic stem/progenitor cells (HSPCs) is impaired in diabetes. We therefore tested whether HSPC mobilization with the CXCR4 antagonist plerixafor improved healing of ischemic diabetic wounds. This was a pilot, phase IIa, double‐blind, randomized, placebo‐controlled trial (NCT02790957). Patients with diabetes with ischemic wounds were randomized to receive a single subcutaneous injection of plerixafor or saline on top of standard medical and surgical therapy. The primary endpoint was complete healing at 6 months. Secondary endpoints were wound size, transcutaneous oxygen tension (TcO2), ankle‐brachial index (ABI), amputations, and HSPC mobilization. Twenty‐six patients were enrolled: 13 received plerixafor and 13 received placebo. Patients were 84.6% males, with a mean age of 69 years. HSPC mobilization was successful in all patients who received plerixafor. The trial was terminated after a preplanned interim analysis of 50% of the target population showed a significantly lower healing rate in the plerixafor vs the placebo group. In the final analysis data set, the rate of complete healing was 38.5% in the plerixafor group vs 69.2% in the placebo group (chi‐square P = .115). Wound size tended to be larger in the plerixafor group for the entire duration of observation. No significant difference was noted for the change in TcO2 and ABI or in amputation rates. No other safety concern emerged. In conclusion, successful HSPC mobilization with plerixafor did not improve healing of ischemic diabetic wounds. Contrary to what was expected, outside the context of hematological disorders, mobilization of diabetic HSPCs might exert adverse effects on wound healing.

【 授权许可】

Unknown