Indirect revascularization in patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus

Objective. Determination of clinical efficacy of the mesenchymal stem cells transplantation in patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus. Materials and methods. There were examined 11 patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus Type II with purulent-necrotic processes of the foot, in whom conditions for the direct revascularization of extremity were absent. Microbiological monitoring for the wound discharge, determination of the ankle brachial index and transcutaneous oximetry was performed. The technology elaborated have consisted of two stages. On the first of them a purulent focus sanation (in all the patients the distal amputations of the foot, preserving arterial arch) was done. On the second stage the therapy of the wounds was conducted, using negative pressure, injections of cellular suspension (mesenchymal stem cells) while applying long fine cannula under aponeurosis into the muscles along obliterated vessels in the (10 ± 5) ml quantity with subsequent closure of the wound surface, using fibroblastic matrix. Results. In a year after the treatment critical ischemia in 1 patient was noted, the ischemia Grade III - in 3, and in 7 a IIB Grade have persisted. Conclusion. Performance of indirect revascularization, using autologous mesenchymal stem cells, constitutes an effective and secure procedure.

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Cell Technologies in the Treatment of Chronic Wounds in Patients with Diabetes Mellitus

Transplantation and artificial organs ◽

10.30702/transpaorg/10_21.2710/1151-65/4.001.4 ◽

2021 ◽

pp. 51-65

Author(s):

Yu. V. Ivanova ◽

S. M. Gramatiuk ◽

V. O. Prasol ◽

K. V. Miasoiedov ◽

O. O. Zarudnyi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Stem Cells ◽

T Cells ◽

Mesenchymal Stem Cells ◽

Inflammatory Cytokines ◽

Chronic Wounds ◽

Lower Extremities ◽

Wound Surface ◽

Average Hospital ◽

Anti Inflammatory

Materials and methods. The results of treatment of 8 patients with chronic wounds and diabetes mellitus (DM) type 2 and stage IV chronic ischemia of the lower extremities by Fontaine were analyzed, in 2 cases there was a combination of venous and arterial insufficiency. Revascularization of the lower extremities was performed through open (2), endovascular (4) and hybrid surgery (2). In case of venous insufficiency, sclerotherapy of perforator veins was performed. After surgical treatment of the purulent focus, specific bacteriophages were used (after microflora identification). Hydrogel dressings were applied daily, alongside with transplantation of 5,000,000 mesenchymal stem cells (MSC) (CD73+, CD90+, CD105+ and CD45-, CD34-, CD14-, CD79-) by injection into muscle tissue around the wound, then the wound surface was closed with hMSC-fibroblast matrix. Results. After the closure of the wound surface with fibroblast matrix, the patients noted the disappearance of the pain syndrome. The surface area of the wounds averaged 91.3 ± 30.42 cm 2 before the start of treatment, 89.8 ± 34.21 cm 2 on day 5 and – 73.95 ± 21.2 cm 2 on day 12. Spontaneous epithelialization was achieved in the period from 35 to 141 days (depending on the initial state of the wounds). The average hospital stay was 22.6 ± 2.4 days. Discussion. It is known that human epithelial cells (hECs) and human mesenchymal stem cells (hMSCs) suppress proliferation, production of inflammatory cytokines and differentiation of T cells. At the same time, they stimulate the formation of regulatory T cells (Tregs). Soluble factors secreted by hECs, including PGE2, TGF-β, Fas-L, AFP, MIF, TRAIL and HLA-G, block differentiation of dendritic cells and M1 macrophages and promote differentiation of monocytes into the anti-inflammatory M2 phenotype. Moreover, hECs and hMSCs are known to be responsible for modulating the host immune system, mainly by suppressing TNF-α, IFN-γ, MCP-1 and IL-6 and increasing the level of anti-inflammatory cytokines. In vitro and in vivo results show increased cell migration and epithelialization leading to accelerated wound healing.

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Management of Type 1 diabetes mellitus with autologous mesenchymal stem cells

CHRISMED Journal of Health and Research ◽

10.4103/cjhr.cjhr_22_18 ◽

2019 ◽

Vol 6 (1) ◽

pp. 64 ◽

Cited By ~ 2

Author(s):

PradeepV Mahajan ◽

Aabha Morey ◽

Swetha Subramanian ◽

Anurag Bandre ◽

Harshal Ware

Keyword(s):

Diabetes Mellitus ◽

Stem Cells ◽

Type 1 Diabetes ◽

Mesenchymal Stem Cells ◽

Type 1 Diabetes Mellitus ◽

Autologous Mesenchymal Stem Cells

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Autologous mesenchymal stem cells and cutaneous autograft as a treatment for chronic ulcer secondary to diabetes mellitus 2

Cirugía y Cirujanos (English Edition) ◽

10.1016/j.circen.2015.11.010 ◽

2015 ◽

Vol 83 (6) ◽

pp. 532-536

Author(s):

Gamaliel Benítez-Arvízu ◽

Ícela Palma-Lara ◽

René Vazquez-Campos ◽

Raimundo Alfonso Sesma-Villalpando ◽

Alberto Parra-Barrera ◽

...

Keyword(s):

Diabetes Mellitus ◽

Stem Cells ◽

Mesenchymal Stem Cells ◽

Chronic Ulcer ◽

Autologous Mesenchymal Stem Cells ◽

Diabetes Mellitus 2

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Тransplantation of autologous stem cells, obtained from adipose tissue, in complex treatment of chronic ischemia of the lower extremities

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2018.12.30 ◽

2018 ◽

Vol 85 (12) ◽

pp. 30-34

Author(s):

V. G. Mishalov ◽

N. Yu. Litvinova ◽

O. I. Kefeli-Yanovska ◽

V. A. Chernyak ◽

D. E. Dubenko ◽

...

Keyword(s):

Stem Cells ◽

Lower Extremities ◽

Walking Distance ◽

Complex Treatment ◽

Critical Ischemia ◽

Simultaneous Application ◽

Group I ◽

Autologous Mesenchymal Stem Cells ◽

One Year

Objective. To investigate the efficacy of application of autologous mesenchymal stem cells (AMSC) in treatment of patients, suffering critical ischemia of the lower extremities (CILE). Маterials and methods. In 2012 - 2015 yrs there was conducted the treatment of 41 patients, suffering CILE: 22 (53.7%) - men, and 19 (46.3%) - women. In the Group I (the main) 21 (51.2%) patients have had obtained a standard course of treatment, using AMSC. In the Group II (the control one) 20 (49.8%) patients have obtained a standard course of conservative treatment, using prostaglandins of group Е1 (PGЕ1). The results were investigated, measuring ankle-brachial pressure index, and the indices of a laser duplex flowmetry and a walking distance. Results. During a one-year follow-up a trustworthy enhancement of microcirculation index was registered in the patients, who were treated, using AMSC, comparing with the patients, who obtained a course of therapy of PGЕ1 (р=0.037). Positive dynamics of the microcirculation index while a PGЕ1application was observed during (1.8 ± 0.3) mo, аnd while application of AMSC the microcirculation index have been enhanced trustworthily in (2.7 ± 0.4) mo and persisted during one-year of follow-up. Conclusion. Development of therapeutic effect in groups of patients, who were treated with AMSC and PGЕ1, did not occur simultaneously, thus , a complex treatment with simultaneous application of both methods and conduction of a dosed physical training may be considered a rational option.

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