Clinical observation of the application of autologous peripheral blood stem cell transplantation for the treatment of diabetic foot gangrene

Abstract

The aim of the present study was to investigate the optimal mobilization plan in autologous peripheral blood stem cell transplantation for the treatment of diabetic foot and to observe its clinical curative effect. A total of 127 patients with diabetic foot were treated with different doses of granulocyte colony stimulating factor (G-CSF) to mobilize their hematopoietic stem cells. Subsequently, the extracted stem cell suspension was injected into the ischemic lower extremities along the blood vessels in the areas presenting with pathological changes. Following the treatment, the intermittent claudication distance, skin temperature, ankle brachial index and pain scores of the patients were evaluated. In addition, the associations among the mobilization time, doses and peripheral blood CD34⁺ level were analyzed. The collection efficiency of the stem cells was associated with the dose of G-CSF and the mobilization time. Following the injection of the autologous peripheral blood stem cell suspension, the ischemic area of the patients was improved significantly. In conclusion, autologous peripheral blood stem cell transplantation can promote the establishment of collateral circulation in patients with diabetic foot, and the optimal time for gathering stem cells is closely correlated with the peripheral blood CD34⁺ level.

Keywords: CD34+; autologous peripheral blood stem cells; diabetic foot; gangrene; stem cell mobilization.

Figure 1.

Gangrenous wound of a single diabetic foot patient successfully healed following the autologous peripheral blood stem cell transplantation. (A) Preoperative diabetic foot of patient A, showing extensive necrosis and co-infection at left foot. (B) Diabetic foot of patient A at 3 weeks after stem cell transplantation; fresh granulation growth was evident in the wound. (C) Foot of patient A at 4 weeks after transplantation following an in situ dermatoplasty, with the wound healing well.

Figure 2.

Digital subtraction angiography (DSA) images showing changes in the patient's vessels prior to and following stem cell transplantation. (A) Preoperative DSA of patient A showing that the main vessels were occluded and few collateral vessels remained. (B) At 6 weeks after the transplantation, DSA re-examination showed that abundant collateral circulation had been established around the blood vessels in the lesion area.