Stem cell therapy for diabetic foot ulcers: a review of preclinical and clinical research

Abstract

BackgroundDiabetic foot ulcer (DFU) is a severe complication of diabetes, preceding most diabetes-related amputations. DFUs require over US$9 billion for yearly treatment and are now a global public health issue. DFU occurs in the setting of ischemia, infection, neuropathy, and metabolic disorders that result in poor wound healing and poor treatment options. Recently, stem cell therapy has emerged as a new interventional strategy to treat DFU and appears to be safe and effective in both preclinical and clinical trials. However, variability in the stem cell type and origin, route and protocol for administration, and concomitant use of angioplasty confound easy interpretation and generalization of the results.MethodsThe PubMed, Google Scholar, and EMBASE databases were searched and 89 preclinical and clinical studies were selected for analysis.ResultsThere was divergence between preclinical and clinical studies regarding stem cell type, origin, and delivery techniques. There was heterogeneous preclinical and clinical study design and few randomized clinical trials. Granulocyte-colony stimulating factor was employed in some studies but with differing protocols. Concomitant performance of angioplasty with stem cell therapy showed increased efficiency compared to either therapy alone.ConclusionsStem cell therapy is an effective treatment for diabetic foot ulcers and is currently used as an alternative to amputation for some patients without other options for revascularization. Concordance between preclinical and clinical studies may help design future randomized clinical trials.

Improved therapeutics of modified mesenchymal stem cells: an update

“…The introduction of cell therapy has made dramatic contribution to science and continue to expand in value and utility in regenerative medicine and disease therapeutics. Experimental and clinical applications of cell therapy has covered many diseases including cardiovascular conditions [1][2][3], Parkinson's disease [4,5], osteoarthritis [6], diabetes [7,8], neurological conditions [9], wounds [10], malignancies [11], among others. The special characteristic properties of MSCs have been exploited in countless research field with fascinating outcomes.…”

The Potential Role of Cycloastragenol in Promoting Diabetic Wound Repair In Vitro

“…Previous research has demonstrated that, compared with exogenous EpSCs, resident EpSCs are more important in tissue remodeling and wound closure; the loss of resident EpSCs, impairment of their migration capacity, and/or excessive differentiation may lead to delay in wound healing. Accordingly, stem cell-based therapy is gaining recognition as a way to improve healing outcomes [6].…”

Photobiomodulation plus Adipose-derived Stem Cells Improve Healing of Ischemic Infected Wounds in Type 2 Diabetic Rats

“…This results in poor wound healing and poor treatment options. In a review article, Lopes et al have stated that existing proof points toward stem cell therapy as a persuasive cure for DFU 32 . Clinical and preclinical research studies have not provided any consensus regarding the optimum category of stem cell that should be used and there is no well-known optimal route or regimen for delivery of the stem cells.…”

“…Differences within preclinical study designs suggest the need for an agreement regarding an optimum animal model that suggests translation to human studies. Variations in the stem cell category and source, route, and regimen for administration also confound easy interpretation and generalization of the results 32 . According to Lopes et al, there is an urgent need for additional experimentation to find a good animal model and persuasive regimens of stem cell therapy for treating severe cases of DFU.…”