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4times is a research-stage autologous cell therapy protocol developed by the Royan Institute for the treatment of peripheral artery disease (PAD) and critical limb ischemia (CLI). The therapy involves four repeated transplantations of autologous bone marrow-derived mononuclear cells (BM-MNCs) into the ischemic limbs of patients. These mononuclear cells, which include progenitor endothelial cells and other stem cell populations, are intended to stimulate angiogenesis and arteriogenesis, thereby improving distal limb perfusion and healing ischemic ulcers. A Phase 1/2 clinical trial (NCT01480414) evaluated the safety and efficacy of this repeated dosing regimen in patients with lower limb ischemic ulcers.
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