Intra-arterial Infusion of Autologous Bone Marrow Mononuclear Cells in Non-diabetic Patients With Critical Limb Ischemia.

• Adverse events [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]
  - Adeverse Events and Serious Adverse Events will be recorded since the day of intervention to 12-months follow up
• Changes in arteriography [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  - Any change in the angiographies that will be performed at intervention, at 6 and 12 months follow up

• Ankle-brachial index [ Time Frame: 1 month, 3 months, 6 months ] [ Designated as safety issue: No ]
• Transcutaneous oxygen pressure (TcO2) [ Time Frame: 1 month, 3 months, 6 months ] [ Designated as safety issue: No ]
• Greater ulcer size [ Time Frame: 1 month, 3 months, 6 months ] [ Designated as safety issue: No ]
  Ulcer diameter will be recorded
• Degree of Rutherford-Becker [ Time Frame: 1 month, 3 months, 6 months ] [ Designated as safety issue: No ]
• Perimeter calf muscle [ Time Frame: 1 month, 3 months, 6 months ] [ Designated as safety issue: No ]
• Presence of faster opacity in infrapopliteal vessels at 6 months compared with the basal situation of the patient. [ Time Frame: 1 month, 3 month, 6 month ] [ Designated as safety issue: No ]

• Ankle-brachial index [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• TcO2 [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• Ulcer healing [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  Ulcer diameter will be recorded

Phase II Clinical Trial, a prospective, multicenter, open, randomized, parallel-group controlled with three levels of dose.

The hypothesis of the test we propose is that the mononuclear cells of bone marrow provide progenitor cells with regenerative capacity and besides secrete several angiogenic factors, and their implantation into ischemic tissues with both elements should contribute to angiogenesis and tissue regeneration with recovery of the circulation in the affected limb.

The study population will consist of a total of 88 non-diabetic patients with chronic critical ischemia in at least one of their lower limbs and without possibility of revascularization. In the experimental group will be included a total of 66 patients divided into three levels of dose, 22 patients in each level (increasing dose of mononuclear cells from autologous bone marrow) and other 22 patients in control group.

• 22 patients in group 1 will not receive cell therapy, and they will only receive conventional treatment, acting as a control group.
• 22 patients in group 2 will receive 1x108 autologous bone marrow mononuclear cells.
• 22 patients in group 3 will receive 5x108 autologous bone marrow mononuclear cells.
• 22 patients in group 4 will receive 1x109 autologous bone marrow mononuclear cells.

The cell therapy drug will be administered intra-arterially in all cases Patients will be evaluated by clinical, radiological and angiological methods (ankle / brachial pressure index, oximetry, digital arteriography).

Patients will receive concomitant drug treatment established by the good clinical practice, so undoubtedly it could be possible that some improvement occurs due to drug treatment.

It is estimated that the inclusion period is approximately 24 months, and the follow-up of each patient of six months. Therefore the total duration of the study will be about thirty months from the entry of the first patient to the end of the follow-up period of the last patient included.

The primary variable is the improvement in the vascularisation of the treated limb determined by clinical, angiographic and angiologist parameters.

Study objectives :

• Main objective: To evaluate the safety and feasibility of the autotransplantation of autologous bone marrow mononuclear cells administered intra-arterially in non-diabetic patients with critical chronic ischemia of the lower limbs without possibility of either revascularization or other therapeutic alternatives.

Secondary objectives:

1. To compare the effect of three increasing dose of mononuclear cells from autologous bone marrow in the recovery of clinical, angiographic angiologist parameters in non-diabetic patients with critical chronic ischemia of lower limbs to a control group that will have been applied to a conventional treatment.
2. To analyze complications from regenerative therapy itself, from the route of administration and / or study procedures.

• No Intervention: Control
  No cell therapy
• Experimental: Low dose
  Intraarterial Infusion of Autologous Bone Marrow Mononuclear Cells: 1 x 108
  Intervention: Other: Intraarterial Infusion of Autologous Bone Marrow Mononuclear Cells
• Experimental: Intermediate dose
  Intraarterial Infusion of Autologous Bone Marrow Mononuclear Cells: 5 x 108
  Intervention: Other: Intraarterial Infusion of Autologous Bone Marrow Mononuclear Cells
• Experimental: High dose
  Intraarterial Infusion of Autologous Bone Marrow Mononuclear Cells: 1 x 109
  Intervention: Other: Intraarterial Infusion of Autologous Bone Marrow Mononuclear Cells

Inclusion Criteria:

• Patients of both sexes aged ≥ 18 and ≤ 89 years.
• Non-diabetic.
• Infrapopliteal atherosclerotic vascular disease with severe to severe claudication or Rutherford-Becker grade I-3, II, III, in at least one lower limb. The chronic critical ischemia of the lower limb is defined as persistent / recurring pain requiring analgesia and / or non-healing ulcers present> 4 weeks, with no evidence of improvement with conventional therapies and / or walking test (stress test) between 1-6 minutes two exercise tests separated by at least 2 weeks and / or ankle-brachial index at rest <0.8.
• Inability to endovascular or surgical revascularization as recommended by the TransAtlantic Inter-Society Consensus (TASC).
• Failure of the revascularization surgical performed at least 30 days before, either persistently or entry in critical ischemia phase.
• Life expectancy> 2 years.
• Not expected major amputation in the limb to treat in the next 6 months after inclusion.

• Normal laboratory parameters, defined by:

  1. Leukocytes ≥ 3000
  2. Neutrophils ≥ 1500
  3. Platelets ≥ 100,000
  4. Aspartate aminotransferase AST) / Alanine aminotransferase (ALT) ≤ 2.5 standard range institution.
  5. Creatinine ≤ 2.5 mg / dl
• Patients should give their written informed consent to participate in the study.
• Women of childbearing potential must have negative results on a pregnancy test following standard procedures for each hospital performed at the time of inclusion in the study and agree to use a medically approved method of contraception through the duration of the study.

Exclusion Criteria:

• History of malignancy or hematologic disease (myeloproliferative disease, myelodysplastic syndrome or leukemia)
• Patients with uncontrolled hypertension (defined as blood pressure> 180/110 on more than one occasion).
• Severe heart failure (New York Heart Association IV).
• Patients with malignant ventricular arrhythmias or unstable angina.
• Diagnosis of deep vein thrombosis in the previous 3 months.
• Active infection or gangrene wet day infusion of mononuclear bone marrow cells.
• Corporal mass index (BMI)> 40 kg/m2.
• Patients with a diagnosis of alcoholism at the time of inclusion.
• Proliferative retinopathy.