Vol.1, No.1, 16-19 (201 doi:10.4236/scd.2011.11002 Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/SCD/ 1) Stem Cell Discovery Repeated application of autologous bone marrow-derived stem cell therapy in patients with severe Buerger’s disease Zoltan Boda 1 , K. Razso 1 , M. Szarvas 1 , Zs. Olah 1 , P. Ilonczai 1 , Z. Vereb 2 , E. Rajnavolgyi 2 1 Department of Internal Medicine, University of Debrecen, Debrecen, Hungary; zboda@med.unideb.hu 2 Department of Immunology, University of Debrecen, Debrecen, Hungary Received February 18 2011; revised March 21 2011; accepted March 28 2011. ABSTRACT Stem cell therapy (SCT) is a promising and prospective approach in the treatment of pa- tients with severe peripheral arterial disorders, primarily with Buerger’s disease. However, very little is known about the duration of the effect of SCT, and to our best knowledge no data are available on the efficacy and safety of repeated SCT in patients with Buerger’s disease. Here we report on two patients with severe Buerger’s disease, who received repeated autologous bone marrow-derived stem cell therapy. Our results show that a second SCT, applied to a previously treated leg 30 or 36 months after the first treatment was efficient in both cases. After twelve months, the clinical state of the repeat- edly treated lower limb improved spectacularly and non-healing ulcers healed more rapidly than after the first SCT. No severe adverse events were detected. Thus repeated SCT offers a safe and efficient treatment option for relaps- ing patients at the advanced stage of Buerger’s disease. Keywords: Buerger’s Disease; Non Healing Ulcer; Repeated Bone Marrow-Derived Stem Cell Therapy 1. INTRODUCTION Recent publications have proved the efficacy and safety of stem cell therapy (SCT) in patients with severe Buerger’s disease [1-14]. However, very little informa- tion is available on the duration of the beneficial effect of SCT [12], and according to our best knowledge no data exist on the efficacy and safety of repeated SCT carried out in patients with relapsing or worsening clini- cal states in severe Buerger’s disease. Here we report on two cases, where the lower limb of patients with Buer- ger’s disease, previously treated by autologous bone marrow-derived stem cell therapy (ABMSCT) [9], have been re-treated with freshly isolated autologous bone marrow derived isolated CD34 + cells. Both patients re- lapsed at 30 - 36 months after the first ABMSCT. As they responded to the first treatment, we decided to re- peat ABMSCT with freshly isolated bone marrow de- rived CD34 + cells by using the same method as de- scribed in our previous publication [9]. 2. MATERIALS AND METHODS As it is a repeated stem cell therapy we refer to our previous publication [9]. 3. RESULTS 3.1. Case Reports Patient 1 was a 59-year-old man with Buerger’s dis- ease since 1976. He had rest pain, 50 m walking distance without pain, and 2 large (8 cm 2 ) and deep non-healing ulcers on both feet. He had sympathectomy on both sides (1982, 1983). Amputation of the right toe II and left toe I was carried out in 1991, and the amputation of the left toe III was done in 1995. Disease stage was Ler- ishe/Fontain-IV before ABMSCT. As his left lower limb was in a worse condition, we treated it by ABMSCT in August 2006. The clinical state of this limb is still ex- cellent (rest pain disappeared, the ischaemic ulcer healed and has not relapsed so far), whereas the clinical state of the untreated right limb became worse (rest pain in- Presented at the 54th Annual Meeting of German Society of Throm- bosis Haemostasis (GTH), Nuremberg, February 2010. Fundings: The present study was supported by the EEA/Norway Grants HU-0046/NA/2006-2/ÖP-9 entitled Development of novel stem cell-based therapies for the treatment of advanced peripheral arterial disease and by the TAMOP 4.2.2-08/1-2008-0015 EU supported NFÜ program entitled Establishing a stem cell and gene therapy. Research Centre at the University of Debrecen..