Reduction in Diabetic Foot Ulcers With Stem Cells

April 16, 2020
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Local injection of stem cells derived from autologous bone marrow shows promise in healing recalcitrant neuropathic diabetic foot ulcers.

Presenting the results at the European Association for the Study of Diabetes (EASD), Ahmed Albehairy, MD, from Mansoura University, Egypt, said: “In patients who received the stem cells, ulcer reduction was found to be significantly higher compared with patients on conventional treatment after both 6 weeks and 12 weeks of follow-up. This is despite the fact that initial ulcer size was larger in the stem-cell–treated group.”

After 6 weeks, median ulcer reductions were 49.9% and 7.67% (P = .001) in stem-cell–treated and control groups, respectively, and after 12 weeks, median ulcer reductions were 68.24% and 5.27% (P = .0001). Complete healing was achieved in one case in the stem cell–treated group.

“The healing mechanism may be due to the pure effect of injected stem cells, which is due to the ability of these cells to simulate angiogenesis in the wound bed, decrease excessive inflammation, and suppress scarring,” explained Dr Albehairy.

Nearly 10% to 15% of diabetic foot ulcers remain resistant to treatment, with up to a quarter eventually resulting in limb amputation. He noted that several types of stem cells have previously been used to promote healing in diabetic foot ulcers — broadly categorized into allogenic and autologous stem cells — and the stem cells have been used before to successfully treat diabetic critical limb ischemia.

Fibroblast cell lines derived from diabetic foot ulcer can be reprogrammed to a pluripotent state, which could provide a reservoir of autologous cells to help heal foot ulcers.

Asked whether he thought there was a future in the use of stem cells in healing diabetic foot ulcers, he was cautiously optimistic: “I think we need good properly randomized studies to explore this further.”

By study entry, 20 patients from Mansoura Specialized Medical Hospital, Egypt, with resistant neuropathic diabetic foot ulcers had already received 12 weeks of standard-of-care therapy (conventional treatment and proper offloading modalities) but had failed to respond; they were randomized (1:1) to standard of care (n = 10) or standard of care plus locally injected autologous bone-marrow stem cells (n = 10) for a further 12 weeks. Patients in both groups had a mean HbA1c of 8.3% and a mean body mass index (BMI) of approximately 33 kg/m2, and baseline ulcer sizes were 4.66 cm2 and 3.72 cm2 in the investigational and control arms, respectively.

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