Hypoxia increases mesenchymal stem cell (MSC) migration and enhances functional recovery after hind limb ischemia. The growth area of MSC plated on tissue culture-treated plates was scratched with a sterile pipette tip to create a wound. The borderline of the scratch was immediately marked with a fine-tip marker, and the cultures were incubated in serum-free medium for 24 hr in hypoxia versus normoxia in the presence or absence of 25 ng/ml HGF. Photographs of cell migration were captured with bright-field microscopy at the endpoint. (A): Representative image of three separate experiments. The quantitation of migrated cells demonstrated significant fold increases in MSC motility in samples treated with HGF or combination of hypoxia and HGF, whereas cells cultured in hypoxia alone migrated the most (B). The bar graph (B) summarizes the results of three separate experiments. Hind limb ischemia and sham surgeries were performed on NOD/SCID mice (n = 4). Abductor muscles were harvested at 6, 12, 24, or 48 hr postsurgery, and muscle lysates were analyzed by enzyme-linked immunosorbent assay for the presence of HGF (C). The results show a slight increase in HGF levels in muscles of sham-operated animals starting at 12 hr postsurgery; however, the tissue ischemia caused a significant increase in the HGF levels in the injured muscle, which steadily increased up to 48 hr after surgery (two-way analysis of variance [ANOVA], p < .001). Alternatively, MSC cultured in complete medium were incubated overnight (16–24 hr) in hypoxic or normoxic conditions. Hind limb ischemia was performed on β-2-microglobulin knockout mice, which were then transplanted 1 day after surgery with hypoxic MSC, normoxic MSC, or PBS as a control. The functional recovery was measured by laser Doppler perfusion imaging immediately after the surgery and twice a week for 2 weeks after the transplantation and quantified by Moor LDI image software (D). The y-axis of the graph represents flux (measured in arbitrary units) ratio of injured to uninjured leg, and the three curves are average values for each treatment group (seven animals per group). The results demonstrate a significant improvement (ANOVA, p < .005) in mice transplanted with MSC versus saline control group, whereas the mice transplanted with hypoxic MSC improved significantly faster, as is shown at day 5 (*, p = .011; Student's t-test). Abbreviations: BM-MSC, bone marrow-derived mesenchymal stem cells; HGF, hepatocyte growth factor; hr, hours; PBS, phosphate-buffered saline.