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ROLE OF STEM CELLS IN TREATMENT OF UNCORRECTABLE CRITICAL LOWER LIMB ISCHAEMIA IN DIABETIC PATIENTS

Background: Stem cells have the remarkable potential to renew themselves. They can develop into many different cell types in the body during early life and growth. Researchers study many different types of stem cells. There are several main categories: the “pluripotent” stem cells (embryonic stem cells and induced pluripotent stem cells) and nonembryonic or somatic stem cells (commonly called “adult” stem cells). Pluripotent stem cells have the ability to differentiate into all of the cells of the adult body. Adult stem cells are found in a tissue or organ and can differentiate to yield the specialized cell types of that tissue or organ. Objective: This study aims at evaluating the efficacy of autologous injection of bone marrow stem cells concentrates in achieving tissue regeneration, relieving symptoms, improving clinical signs, saving limbs and reducing the level of amputation in cases of critical limb ischemia. Patients and methods: In the present study, 30 patients with diabetic non correctable peripheral arterial diseases were included in study. The study was conducted at Al Hussein University Hospital in the period from January 2019 to June 2020. Results: In this study, 30 patients with diabetic non correctable peripheral arterial diseases had bone marrow stem cells concentrates. Age ranged from 55-76 years with mean value 66.10 ± 5.967 years. 24 patients (80%) were over 60 years. 17 patients (56.7%) were male while 13 patients (43.3%) were female. 18 patients (60%) had urban residency while 12 patients (40%) came from rural areas. The duration of DM ranged from 7 to 31 years. 5 patients (16.6%) had Type I while 25 patients (83.3%) had Type II DM. In this study, 17 patients (56.7%) had ischemic ulcer while 13 patients (43.3%) had neuroischemic ulcer. Ulcer presented in forefoot in 25 patients (83.3%), midfoot in 3 patients (10.0%) and hind foot in 2 patients (6.7%). Mean size of ulcer 2.31 ± 0.649 cm2 with a range of 1.5-3.5 cm2. Tissue regeneration was achieved in 24 patients (80%), relieved symptoms in 25 patients (83.3%), improved clinical signs in 26 patients (86.7%), saved limbs in 28 patients (93.3%) and reduced the level of amputation in 28 patients (93.3%). In this study, 27 patients (90%) were satisfied with the results while 3 patients (10%) were not. Conclusion: Injection of bone marrow mesenchymal stem cells (BMMSC) may provide safety and feasibility for the enhancement of limb salvage in patients with critical ischemic limb.