Clinical Cases of Stem Cell Therapy in the Treatment of Diabetic Foot

Diabetic foot disease is the leading cause of lower extremity amputation in diabetic patients. Of the approximately 150 million diabetic patients worldwide, 15% to 20% may develop foot ulcers or gangrene during the course of their disease. The amputation rate of diabetic foot disease is 15 times that of non-diabetic patients. The incidence of diabetic foot disease in China has been increasing year by year, and the medical and social problems caused by diabetic foot disease have begun to attract the attention of many domestic scholars.

1Diabetic Foot Treatment

Systemic treatment

generally includes metabolic control, vasodilation, promoting blood circulation and removing blood stasis, and application of antibiotics (if infection exists)

a. Metabolic control: mainly refers to good control of blood sugar below 11.1mmol/L or as close to normal as possible;

b. Vascular expansion and blood circulation promoting, improving blood supply to tissues: Drugs that expand peripheral blood vessels are often used clinically, and have good adjuvant therapeutic effects on diabetic foot ulcers;

c. Treatment of neuropathy: vitamin B preparations can be applied, and neurotrophic drugs can be used to improve nerve function;

d. The use of antibiotics: Generally, broad-spectrum antibiotics and metronidazole should be given when the pathogenic bacteria are unknown, and the use should be adjusted when necessary after the bacteria and drug susceptibility test results are reported;

e. Hyperbaric oxygen therapy: It can improve blood circulation and lower limb hypoxia, and it can be tried.

Local treatment

mainly including local debridement and wound management

Apply Kanghuier diabetic foot series wound care products (debridement gel, exudate absorption patch and ulcer paste, etc.), which can help remove necrotic and rotten tissues on the wound surface, enhance the exudate absorption of local tissues, promote the growth of granulation tissue, and accelerate the healing of the wound surface. absorb.

surgical treatment

a. Arterial reconstruction: it is an important method to treat extremity ischemia or gangrene caused by blockage of large blood vessels, and can save some patients from amputation;

b. Amputation: It is a last resort method in order to save life after conservative treatment fails. It is best to perform angiography before operation to determine the amputation plane. Under the condition of not affecting the healing of the amputation plane, it is necessary to preserve the postoperative area of ​​the affected limb as much as possible. Functional and conducive to the installation of prosthetics.

stem cell transplant

Stem cells have the function of directed differentiation into various cells needed by the human body. Basic and clinical studies have found that transplanting stem cells into ischemic limbs can locally form vascular endothelial cells and generate new blood vessels without generating other unwanted tissues.

2Case studies of stem cell transplantation in the treatment of diabetic foot

In August 2002, the British Medical Journal first reported the success of autologous bone marrow stem cell transplantation in the treatment of lower limb ischemia. The method is mainly as follows: obtain the bone marrow under local anesthesia, then separate the bone marrow stem cells, and finally transplant the bone marrow stem cells obtained from the separation to the ischemic limb. Early treatment can alleviate or completely relieve intermittent claudication and rest pain, and can promote ulcer healing or shrinkage in patients with diabetic foot ulcers.

In January 2004, enlisted soldier Wang Maosen came to the 463 Hospital to treat diabetic foot with stem cell transplantation. The doctor first extracted a certain amount of stem cells from Xiaowang's peripheral blood through an instrument, and then injected the extracted stem cells into the anesthetized patient. Xiao Wang's legs. One week after the operation, Xiao Wang felt that the original pain in his feet disappeared, and he seemed to walk a lot easier, and the skin color of his feet also improved a lot. About half a year later, in order to further verify the curative effect, the doctor again Xiao Wang underwent an angiography, and it turned out that Xiao Wang's original ischemic lower legs and feet grew a network of capillaries, which greatly improved the blood supply of the lower legs and feet, and Xiao Wang returned to normal. rejoin the team.

In 2008, the First Affiliated Hospital of Zhejiang Wenzhou Medical College performed autologous peripheral blood stem cell transplantation on 21 limbs of 18 patients with severe diabetic foot. The symptoms of pain, coldness and numbness were all improved from 7 days to 6 months after operation. Among the limbs with gangrenous amputation wounds and refractory ulcers, 18 limbs (86%) had wound healing, and none of the extremities suffered plane amputation or required higher plane amputation again. The liver and kidney function, bleeding and coagulation time of all patients were normal, which indicated that the curative effect of autologous peripheral blood stem cell transplantation on severe diabetic foot patients was better.

In 2008, the Hematology Hospital of the Institute of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College published a document stating that they extracted 350 mL of autologous bone marrow from 13 patients with diabetic foot in clinical research, removed red blood cells, and isolated mononuclear cells through density gradient centrifugation. About 40mL of cell suspension was injected locally into the ischemic muscle of the lower extremity. The results showed that the relief rate of calf pain was 100%, the improvement rate of foot pain was 84.6%, the rate of limb salvage was 80%, and the improvement rate of cold and cool sensation was 100%. The walking distance of one patient with intermittent claudication was extended from 50m before operation to 120m. Arteriography of 8 patients in 7 patients showed the formation of new collateral vessels.

From November 2009 to December 2011, 5 patients with type Ⅱ diabetes mellitus complicated with diabetic foot (8 limbs) were hospitalized in Shaanxi Provincial People's Hospital, including 3 males and 2 females, with an average age of 60±9.8 years. Acute and chronic infections, acute complications, malignant tumors and autoimmune diseases were excluded. Insulin was used to control blood sugar before operation, and blood lipids and blood pressure were at normal levels. All patients had foot ulcers and varying degrees of lower extremity arterial stenosis. Under sterile conditions, the umbilical cord mesenchymal stem cell suspension was intramuscularly injected into the affected area at multiple points at intervals of 3cm×3cm. For severe lesions, the foot was injected at intervals of 1cm×1cm, with focus on the area around the ulcer. After the treatment, the pain and numbness of the foot were significantly reduced; the intermittent claudication was significantly improved; all the ulcers were healed.

In October 2011, Chinese and foreign medical research published a document, recording the case of Huainan Dongfang Hospital Group Tumor Hospital applying umbilical cord blood stem cell transplantation technology to treat a 59-year-old male patient who had been ill for 11 years. Healed, the skin temperature was normal, and the numbness disappeared. Half a year later, re-examination of the blood vessels of the lower extremities showed different degrees of new capillary formation.

In 2015, Ningxia Medical Journal reported that 52 patients with diabetic foot disease in Yinchuan First People's Hospital of Ningxia underwent arterial bypass surgery, percutaneous transluminal angioplasty (PTA) below the knee, autologous stem cell transplantation (for 9 Cases of PTA failure patients), and the results of comprehensive treatment were analyzed. Results Postoperatively, 47 patients with diabetic foot disease had complete relief of pain at rest, 9 cases of toe amputation underwent wound healing, 6 cases still had intermittent claudication, and 5 cases underwent below-knee amputation after revascularization failed; Conclusion By arterial bypass The curative effect of comprehensive treatment of diabetic foot disease such as surgery, PTA and autologous stem cell transplantation is affirmed.

In 2015, the Endocrinology Department of Wuhan Central Hospital published a journal to compare autologous stem cell therapy (ASCT) and percutaneous transluminal angioplasty (PTA) in the treatment of ischemic diabetic foot disease (ischemia diabetic foot disease). foot, IDF) effect. Eighty-four IDF patients were included in the study, 28 patients received PTA treatment, 32 patients received autologous stem cell therapy (13 cases of peripheral blood stem cell therapy, 19 cases of bone marrow stem cell therapy), and 24 patients who were unable or unwilling to receive PTA or ASCT therapy were used as The control group, followed for 12 months, was evaluated for amputation rate, transcutaneous partial pressure of oxygen (Tc PO2) and wound healing. Results After 6 months and 12 months of follow-up, the amputation rate of ASCT and PTA groups was significantly lower than that of the control group (P=0.002 and P=0.003). The conclusion showed that both ASCT and PTA treatment could significantly reduce the amputation rate of IDF patients. Healing has a more pronounced effect. The results of this study support ASCT as a potentially promising approach for the treatment of IDF.

epilogue

At present, many hospitals in my country have successfully performed many cases of stem cell transplantation to treat diabetic foot by using stem cells, which significantly improved the symptoms of lower limb pain, numbness, and chills, and the ulcers healed quickly, avoiding amputation or reducing the frequency of amputation. Stem cell transplantation is minimally invasive, safe, effective, and relatively low in price. It is an effective treatment for diabetic foot and lower extremity vascular diseases.