#MARKED IMPROVEMENT SKIN#
The Rodnan skin score was reduced from 25 to 11. The resistance index fell, indicating reduced peripheral vascular resistance ( Figure 2). Notably, the transcutaneous partial oxygen pressure (tcpO 2) was enhanced by 20 mm Hg on the left hand and 25 mm Hg on the right hand, now showing physiological values. Vascular ultrasound 6 months after transplantation revealed a marked improvement in the blood circulation of hands and fingers. After 6 months, we detected only 1 ulceration covering a surface of 0.4 cm 2 ( Figure 1). Three months after transplantation, a significant decrease in the patient's painful ulcerations was measured. She felt her tendons and muscles less stiff and her hands more frequently warm. The patient experienced a subjective improvement in her condition. Remarkably, a common cold occurring 6 months after transplantation was resolved without the need for further medical measures. During and after the intravenous administration of 10 6 MSCs per kilogram bodyweight (6 × 10 7 MSCs total), the patient was without subjective complaint or objective organ dysfunction as was the case during further observation (1 year as of 13 September 2007). At the time of transplantation, the patient received a daily dose of 7.5 mg prednisolone and 100 mg azathioprine. The titre of anti-Scl70-antibodies was elevated. The 17 site modified Rodnan skin score was 25. Before transplantation in September 2006, she presented with 6 painful ulcerations (covering a surface of 17 cm 2 in total) at acral localizations (fingertips, knuckles, Figure 1), acral sclerosis (a rapidly progressive massive involvement of the skin, including arms, thighs, the whole trunk and the tendons and joints.
The disease was refractory to methotrexate, steroids, azathioprine, supportive measures and psoralen UVA (PUVA). A 41-year-old female patient first experienced Raynaud's syndrome in 2001.