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.
Highlights
Diabetic foot ulcer (DFU) is a severe complication of diabetes, preceding most diabetes-related amputations
The prevalence of diabetes mellitus has increased precipitously due to worldwide changes in nutrition and lifestyle, and is currently estimated to affect 425 million adults in 2017 and to increase to 629 million patients by 2045 [1]
Diabetic foot ulcer (DFU), a major complication of diabetes, is defined by The International Working Group on the Diabetic Foot as a full-thickness wound located below the ankle in a diabetic patient, and is associated with diabetic neuropathy and peripheral arterial disease [2]
Summary
Diabetic foot ulcer (DFU) is a severe complication of diabetes, preceding most diabetes-related amputations. DFU occurs in the setting of ischemia, infection, neuropathy, and metabolic disorders that result in poor wound healing and poor treatment options. 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. Diabetic foot ulcer (DFU), a major complication of diabetes, is defined by The International Working Group on the Diabetic Foot as a full-thickness wound located below the ankle in a diabetic patient, and is associated with diabetic neuropathy and peripheral arterial disease [2]. More than 2% of the diabetic population develops a new foot ulcer each year leading to US$9.1 billion. Ischemia, infection, neuropathy, and metabolic disorders frequently delay wound healing, a critical challenge for both patients and clinicians [8].
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