The potential of peripheral blood mononuclear cells in the treatment of patients with diabetes mellitus and critical lower limb ischemia with limited or no possibility of direct revascularization

Diabetes mellitus (DM) is one of the main risk factors for the development of peripheral arterial disease (PAD) with subsequent progression to critical limb ischemia. Despite advances in endovascular technologies in recent years, the risk of technical failure and complications of surgical interventions in patients with DM and critical limb ischemia (CLI) is increased due to the presence of disease complications, and long-term outcomes of arterial patency restoration are significantly worse than those in the healthy population. In the search for therapeutic alternatives in these patients, the role of immune and endothelial cells, keratinocytes, and fibroblasts is increasingly being studied. This review analyzes existing studies on the use of autologous peripheral blood mononuclear cells (PBMNCs) in the treatment of patients with DM and CLI. The positive role of PBMNCs in stimulating angiogenesis and polarizing macrophages from the M1 to M2 phenotype, as well as the relative ease of their use compared to alternative cell therapies, has been convincingly demonstrated. According to the presented data, therapy using autologous PBMNCs is justified and may be effective in real-world clinical practice. However, further research is needed to clarify the production method, frequency of administration, composition of PBMNC-based cell products, and the timing of their use.

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