Autologous peripheral blood stem cells transplantation for the treatment of diabetic vascular disorder in lower extremities and diabetic feet Self-control observation of 89 patients

ABSTRACT

BACKGROUND:

Bone marrow stem cells can be induced to differentiate into vascular endothelial cells and facilitate establishment of compensatory circulation, so as so improve blood supply of ischemic tissues.

Wuhan Central Hospital, Wuban, Hubei Province, China.

A total of 89 patients with type 2 diabetic vascular disorder in the lower extremity were enrolled from Department of Endocrinology in Wuhan Central Hospital from July 2005 to may 2007. All cases matched the criteria of diabetes by WHO in 1999, and complicated with diabetic peripheral angiopathy and diabetic feet. They included 61 males and 28 females, aged 45-90 years, with an average age of 67. Lesion was mainly located in lower extremities, 54 patients with foot ulcers while 8 patients with gangrene. All the patients signed the informed consents, and the experiment was approved by the hospital ethics committee. Recombinant human granulocyte colony stimulating factor was purchased from China Kunpeng Bio-Pharmaceutical Co., Ltd.

Stem cell mobilization 89 patients all received recombinant human granulocyte colony stimulating factor, 500-600 μg per day by hypodermic injection for 5 days to mobilize stem cells. On the fifth day. PBSCs were collected with a total amount of 83-103mL. The number of mononuclear cells was (1.86-3.39)×1011L-1,while the proportion of CD34 positive cells was 0.55%-1.36%. PBSCs transplantation After patients were treated with intravenous anesthesia, PBSCs were injected into the ischemic lower extremity and foot intramuscularly at 3cm×3cm distance. The clinical and laboratory findings were monitored from the first day to the sixth month.MAIN OUTCOME

The patients were evaluated before transplantation, and in the first, third and sixth months after transplantation, including affected limb pain, cool feeling, intermittent claudication, ankle brachial index (ABI), limb skin temperature and deep feeling. Color Doppler. CT and digital subtraction angiography were applied to detect lower extremities morphous.

All 89 included patients were involved in the result analysis. Scores of clinical symptom The affected limb pain, cool feeling, and intermittent claudication were all improved significantly after PBSCs transplantation (P<0.05),and the improvement was more evident with time extension. ABI After PBSCs transplantation, ABI in patients increased significantly by different degrees with the time extension(P0.05). Skin temperature and deep feeling Limb skin temperature increased significantly after transplantation (P<0.05), and deep feeling seemed to be improved, but the change was not significant(P0.05). Imaging determination There was no obvious change after transplantation checking of lower extremity by color Doppler. But CT and digital subtraction angiography results showed lower extremities in 23 patients had new collateral vessels formation with different degrees.

Autologous PBSCs transplantation can increase blood flow of lower extremities in patients with diabetic vascular disorder in the lower extremities and diabetic feet, and promote the angiogenesis in lower extremity of partial patients.