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According to the International Diabetic Foot Working Group, this complication occurs in 2% of diabetic patients each year, which will accrue to 629 million people worldwide by 2045.
 
Stem cells are a new method of tissue repair for a diabetic foot that is still under development. Regardless, it offers hope to many patients with the disease, given the difficulty of its treatment and the high rate of recurrence. Read more in our article.

 

 

Stem cell treatment for diabetic foot – how does it work?

Because of their regenerative properties, stem cells are becoming a useful tool in the treatment of foot ulcers in diabetes, also known as “diabetic foot”. This is an innovative method of cell therapy available as an experimental treatment in a few specialized medical centres around the world.

 

Stem cells are a unique component of the body, capable of “transforming” into almost any tissue of the body and replacing its damaged parts. Because of this, they promote faster healing of wounds and ulcers in diabetic patients, improve the survival prognosis of patients, and in many cases avoid the need for amputation.

    Diabetic foot is one of the most common complications of diabetes mellitus. It is characterized by the formation of a necrotic ulcer on the lower leg, accompanied by neuropathy (nerve damage) and/or peripheral artery disease. The most common cause is arterial thrombosis. The disease does not heal well and can lead to amputation.

 

Because of their versatility, stem cells contribute to the rapid treatment of diabetic foot on several levels at once:

 

    иконка галочкиFormation of new cells involved in wound healing: myofibroblasts, keratinocytes, pericytes and endothelial cells; 

    иконка галочкиRelease of paracrine factors – substances that affect skin tissues and “trigger” skin healing mechanisms; 

    иконка галочкиRemodelling of the extracellular matrix – the process by which wound healing occurs; 

    иконка галочкиFormation of new capillaries; 

    иконка галочкиRegeneration of nerve endings; 

    иконка галочкиImprovement of collagen deposition; 

    иконка галочкиImmunomodulation; 

    иконка галочкиSuppression of inflammatory processes. 

stem cell diabetic foot treatment

 

In most cases, autologous stem cells derived from the patient’s own body are used for cell therapy. They can usually be easily harvested and the treatment process is safe. However, patients with diabetes often have a reduced number of stem cells in the body. Therefore, it may be necessary to take medications that stimulate stem cell production in the bone marrow (G-CSF) or to seek a donor before starting treatment.

 

For each patient who comes to the clinic with diabetic foot, an individual treatment protocol is selected, depending on the characteristics of the course of the disease. Often the best prognosis is observed when stem cell therapy is combined with classical treatment protocols for diabetic foot ulcers:

 

    иконка галочки Balloon angioplasty is a surgical procedure that involves dilating a vessel by inserting an inflatable “balloon” into it to improve blood flow to the affected area of the leg.  

    иконка галочки Stenting is the placement of a small, expandable, mesh-like tube that supports the vessel and helps keep it open.  

    иконка галочки Removal of dead tissue from the ulcer is usually performed with a scalpel.  

    иконка галочкиInfection control. Diabetic patients are 2-4 times more prone to developing infections at the wound site, therefore increased attention is given to preventing them. Antibiotics and various hygienic procedures are implemented.  

    иконка галочкиProper weight distribution on the foot plays a big role in wound healing. Diabetic patients’ shoes should always be comfortable and orthopaedic. Sometimes doctors may put staples or a cast on the foot.  

 

    The European Wound Management Association (EWMA) states that “the emphasis in wound care for the diabetic foot should be on radical and repeated removal of dead tissue, frequent inspection and bacterial control, and a careful balance of moisture.”

 

Also, some novel methods are used in foreign clinics:

    Vacuum wound care

     

    A wound dressing is applied using a special vacuum machine, which automatically removes excess fluid and thereby reduces the risk of infection.

    Hyperbaric Oxygen Therapy

     

    This treatment has an antibacterial effect and also improves local tissue perfusion, stimulates the production of growth factors, collagen synthesis and the formation of new capillaries.

How do I choose a clinic for diabetic foot?

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Why does diabetic foot develop?

быстро вылечить диабетическая стопа

Several factors usually play a role in the development of diabetic foot ulcers, related to the general metabolic dysfunction of the body. Elevated glucose levels often lead to the development of atherosclerosis, which causes the tissues of body parts distant from the heart – most notably the feet and fingertips – to have insufficient blood flow. Diabetes also impairs the immune system, which increases the risk of infections in this group of patients.

 

Hyperglycemia and insulin resistance often leads to bone marrow mobilopathy, a complication in which stem cells are not transported from the bone marrow into the bloodstream. This prevents them from “repairing” blood vessels and capillaries as they do in a healthy body, which increases the risk of vascular disease.

 

Risk factors for the development of diabetic foot include:

 

    иконка галочкиNeuropathy; 

    иконка галочкиNarrowing or thrombosis of arteries in the legs; 

    иконка галочкиPhysical injuries; 

    иконка галочкиUncomfortable/uncomfortable shoes. 

 

    According to the American Diabetes Association (ADA), 25% of patients with this diagnosis will have problems with normal wound healing during their lifetime.

 

The difficulty in treating the diabetic foot is that the natural tissue regeneration processes in patients with diabetes mellitus are damaged. Insufficient blood flow to the foot, neuropathy, and metabolic disorders cause the standard protocols used in medicine to be insufficiently effective.

 

    What are the warning signs of the diabetic foot that patients should look out for?

     

    иконка галочкиChanges in skin and nail colour; 

    иконка галочкиCuts, blisters, blisters and sores on the feet, especially those that secrete fluid or pus; 

    иконка галочкиLoss of sensitivity to temperatures; 

    иконка галочкиPain, numbness, tingling; 

    иконка галочкиUnpleasant odour; 

    иконка галочкиSwelling of the lower extremities.

Comparison of different types of diabetic foot treatment using stem cells

The methods of applying stem cells can be different – injections, sprays, gels, etc. Since the method is still under research, there is no single treatment protocol. The approaches of different clinics may differ from one another, so you need to be careful when choosing a medical institution where the treatment will take place.

 

Most clinics use injections of autologous stem cells into a leg ulcer in the treatment of diabetes.

 

Type of procedureAdvantagesDisadvantages
Source of stem cells
Mesenchymal stem cells taken from bone marrow

иконка галочкиThe need for bone marrow puncture 

иконка галочкиLow concentration of stem cells 

иконка галочкиThe efficiency of treatment is affected by comorbidities 

Mesenchymal stem cells isolated from blood

иконка галочкиSafe procedure

иконка галочкиSimple cell harvesting protocol

иконка галочкиTreatment effectiveness is affected by comorbidities

иконка галочкиG-CSF drugs are necessary

Mesenchymal stem cells derived from adipose tissue

иконка галочкиRelatively safe procedure

иконка галочкиEfficiency is affected by comorbidities

Stem cells derived from cord blood (rarely used)

иконка галочкиThe patient does not need to undergo additional procedures to harvest stem cells

иконка галочкиLow concentration of stem cells

иконка галочкиPossible immune incompatibility

иконка галочкиPre-frozen cord blood or access to the bank is necessary

Donor type
Autologous (the source of stem cells is the patient themselves)

иконка галочкиFull immunocompatibility, no risk of related complications

иконка галочкиLower concentration of stem cells

иконка галочкиLimited treatment potential

Allogeneic (stem cell source is a donor)

иконка галочкиSource of healthy stem cells

иконка галочкиTime required to find a donor

Type of injection
Local injection

иконка галочкиEasy to use

иконка галочкиLow risk of complications

иконка галочкиRelatively inexpensive

иконка галочкиA high percentage of stem cells fail to engraft and die

иконка галочкиUnable to control the location of stem cells

иконка галочкиThe wound may require surgery

Sprays and drops

иконка галочкиPainless

иконка галочкиEasy to use

иконка галочкиLow risk of complications

иконка галочкиRelatively inexpensive

иконка галочкиA high percentage of stem cells fail to engraft and die

иконка галочкиImpossible to control the location of stem cells

иконка галочкиThe wound may require surgery

Hydrogels and scaffolds

иконка галочкиLow risk of complications

иконка галочкиControlling the location of stem cells

иконка галочкиStem cells engraft better

иконка галочкиComplex protocol

иконка галочкиMore expensive procedure

иконка галочкиThe wound may require surgery

Endovascular injection

иконка галочкиConducted during angioplasty

иконка галочкиPositive effect on immunomodulation and glucose optimization

иконка галочкиMore expensive procedure

иконка галочкиStem cells do not engraft well

иконка галочкиRisks associated with vascular surgery


What results can be expected from the treatment?

 

Stem cell therapy improves tissue regeneration abilities and promotes faster and easier wound healing in diabetes.


The effectiveness of this method depends on the body’s response and averages 40-60%.


Studies also show that stem cell therapy combined with angioplasty (stenting or ballooning) has better results than either method on its own. Many patients can avoid leg amputation.


Online medical consultation

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Where to go for treatment of diabetic foot?

When choosing a clinic for diabetic ulcer cell therapy, you need to make sure that it meets international quality standards and has the appropriate certifications. This is the only way to be confident that your doctors will be able to provide you with effective treatment.

 

Among the medical institutions that practice diabetic foot treatment, we can recommend:

    Stembio Laboratory

    The hospital is located in Gebze, Turkey. It has cGMP, EATCB, ISO, Tissue and Cell Center Operating Permit and Cord Blood Bank Work Permit certificates. All kinds of stem cell treatments are performed here.

    Cellthera Clinic

    Cellthera is located in the Czech city of Brno. The hospital is GMP, ISO and EP certified. The clinic uses mesenchymal stem cells derived from adipose or connective tissue to treat patients.

    Summary

    иконка галочкиStem cells are one of the methods of diabetic foot treatment, which allows healing of the wound better and faster, and often – to avoid amputation and prolong the patient’s life. Stem cell therapy in combination with surgical treatment of diabetic foot – angioplasty – shows high effectiveness. 

    иконка галочкиThe effectiveness of the treatment of diabetic foot ulcers averages 40-60%. 

    иконка галочкиThis method of treatment is experimental, so a universal therapy protocol has not yet been developed. The procedures for harvesting and applying stem cells may vary from clinic to clinic. 

    иконка галочкиAmong the hospitals that we recommend contacting for the treatment of diabetic foot with stem cells are the Czech Cellthera and the Turkish Stembio. 

 

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Sources:

  1. 1. Stem cell therapy for diabetic foot ulcers: a review of preclinical and clinical research
  2. 2. Stem Cell-Based Therapy: A Promising Treatment for Diabetic Foot Ulcer
  3. 3. Stem Cell-Based Therapy for Diabetic Foot Ulcers
  4. 4. Stem Cell Therapy for Diabetic Foot Ulcers: Theory and Practice
  5. 5. Enhanced susceptibility to infections in a diabetic wound healing model

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