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Abstract
peripheral vascular disease is a major health care problem in an aging society. An important compensatory response to atherosclerotic obstructive arterial disease is collateral development, a complex process requiring that multiple genes coordinately express their products in an appropriate time-dependent manner.However, the natural capacity of collaterals to remodel and enlarge to compensate for the reduced flow that occurs after occlusion of a major artery is rarely sufficient to restore maximal flow capacity to levels required under various stress-conditions. In the late stages of peripheral vascular disease, progression of tissue hypoperfusion results in ischemic ulceration and gangrene. Unfortunately, amputation is required in more than a third of these patients. Rapid revascularization of injured, ischemic, and regenerating organs is essential for the restoration of their physiological function.Although both surgical bypass and endovascular procedures remain effective in improvement of the blood flow in the ischemic legs, not all the patients are candidates for intervention. The effort in basic science laboratories has showed us the safety of the therapeutic angiogenesis.Stem cell-based regenerative medicine therapies have been touted recently as a noveltherapeutic approach to treat and cure a wide range of diseases. Both adult and stem (ES) cells can serve important sources of precursor cells to derive more mature cell potentially utilized for clinical applications.Therapeutic angiogenesis, the process of growing collateral blood vessels to better perfuse ischemic tissue, has been hailed as an up-and-coming treatment for symptomatic lower-extremity peripheral arterial occlusive disease. A minimally invasive durable treatment would be welcome since current treatment options for this disease carry high risk, limited efficacy or limited durability.Bone marrow is a rich reservoir of tissue-specific stem and progenitor cells. Experimental and clinical studies have shown that endothelial progenitor cells are mobilized from bone marrow, migrate to ischemic tissue, and contribute to the neovascularization process in response to tissue ischemia.In patients suffering from peripheral arterial disease (PAD), such as arteriosclerosis obliterans (ASO) and thrombo-angitis obliterans (Buerger’s disease), the implant-tation of autologous whole bone marrow mononuclear cells into the gastrocnemius muscle resulted in significant improvements of limb blood flow.