Safety and Efficacy Study of Autologous Concentrated Bone Marrow Aspirate (cBMA) for Critical Limb Ischemia (CLI)

This is a prospective, randomized, double-blind, placebo controlled, multicenter trial
intended for subjects with critical limb ischemia (CLI) that are unsuitable for
revascularization. The investigational treatment utilizes autologous concentrated bone marrow
aspirate (cBMA) at the point of care. The bone marrow aspirate is obtained from the subject's
hip, concentrated with a bone marrow concentration device, and delivered intramuscularly to
the affected limb. Subjects meeting the inclusion/exclusion criteria will be randomized to
receive either the investigational treatment (cBMA) or a placebo control (sham treatment).

Inclusion Criteria:

- Unilateral or bilateral lower extremity ischemia due to advanced peripheral arterial
disease

- Unsuitable for revascularization

- Minor tissue loss (Rutherford Category 5) or ischemic rest pain (Rutherford Category
4) with ABI ≤ 0.6, or TBI ≤ 0.4, or TcPO2 ≤ 50 mm Hg

- Competent to give consent

- No current malignancy or history of previous malignancy within the last five years,
with the exception of adequately treated non-melanoma skin cancer (evidence of
standard preventative cancer screenings required)

Exclusion Criteria:

- Major tissue loss (Rutherford Category 6)

- Diabetics on oral or insulin therapy with uncontrolled or untreated proliferative
retinopathy (evidence of retinal exam required)

- Poorly controlled diabetes mellitus with HbA1C > 10% (evidence of HbA1C test required)

- Uncompensated congestive heart failure (New York Heart Association Class IV) and/or
other conditions that preclude general anesthesia

- Myocardial infarction or stroke within last 90 days

- Elevated liver function tests (AST or ALT more than twice normal upper limit)

- Renal disease (creatinine > 2.5 mg/dl) or chronic hemodialysis

- White blood cell count < 3,000/µL or > 15,000/µL, platelet count < 100,000/µL, or
hematocrit < 32%

- Topical growth hormone therapy within last 90 days, or injected growth hormone therapy
within last 180 days

- Disease of central nervous system and/or other conditions that impair cognitive
function

- Two or more episodes of pulmonary embolus with a documented DVT in index leg or
history of DVT in index leg without evidence of clot resolution

- Current infection of index leg

- Pregnant women (negative urine pregnancy test required)

- Lower extremity venous disease with pitting edema in index leg

- Recent history (in the 6 months prior to screening) of bone marrow disease or
treatment with any medication or procedure which adversely affects the bone marrow and
would prohibit transplantation

- Current osteomyelitis in index leg

- Existing HIV diagnosis

- Organ transplant recipients

- Known terminal disease process with life expectancy less than one year

- Severe concomitant disease(s) or any additional condition(s) which the investigator
feels constitute(s) criteria for exclusion of a particular subject

- Major amputation required within 30 days

- Inclusion in any other clinical study that may affect the outcome of this study

- Uncorrected stenosis(es) of greater than 50% in the common and/or external iliac
artery and/or common femoral artery of the index leg.