Many complications of diabetes seriously threaten the health and even life of patients with diabetes, resulting in serious consequences such as disability and teratogenesis, and even life-threatening.
The reason why diabetes is a disease with high disability rate and mortality rate is largely due to the serious injury of diabetic complications.
Complications of diabetes seriously reduce the quality of life of diabetic patients, and even pose a fatal threat to patients. That's terrible!
Fortunately, there is a law in the world that "everything has its vanquisher". If the bane of diabetic complications is found, diabetic complications are no longer terrible.
With the rise and development of stem cells and regenerative medicine, stem cells have shown great potential in treating diabetic complications, especially diabetic foot.
Stem cells may be the bane of diabetic complications we are looking for, and diabetic complications will become less terrible.
Stem cells stimulate the formation of new blood vessels and regulate inflammation by releasing soluble growth factors and cytokines, which provides a potential treatment for diabetic complications.
At present, there are many reports about the complications of stem cell therapy for diabetes, including diabetic foot, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy and so on.
Stem cell therapy for diabetic foot
Diabetic foot is one of the serious complications of diabetes, which is caused by vascular disease, peripheral neuropathy or infection of lower limbs of diabetic patients.
According to statistics, compared with non-diabetic patients, the incidence of amputation in diabetic patients due to severe ischemic diseases of lower limbs is 40 times higher.
Stem cells can differentiate into vascular endothelial cells and smooth muscle cells in vivo, and secrete a large number of angiogenic factors to form new blood vessels, so stem cells have great potential in treating diabetic feet.
Judging from the effect of current clinical trials, the effect of mesenchymal stem cells (MSC) in treating diabetic foot is better than that of MSC in treating other diabetic complications.
A randomized controlled clinical study was conducted on 20 16 to evaluate the effect of MSC combined with angioplasty on diabetic foot.
Among them, there were 28 people in the human umbilical cord MSC treatment group and 25 people in the control group. The dosage of MSC was (4.8-8.6) x107 per person, and all patients underwent angioplasty. After 3 months of treatment, all patients have improved in different degrees, including ulcer area, local skin temperature, ankle-brachial index (ABI) and other indicators.
However, the improvement in MSC treatment group was more obvious. In the treatment group, Fontaine grade ulcer 19 cases, ulcer surface healing 15 cases, obviously reduced in 2 cases, and ineffective 1 case.
The study also shows that injecting MSC around diabetic foot ulcer is helpful to improve the therapeutic effect of angioplasty.
20 15 Journal of Diabetes Clinical reported the application of autologous stem cell therapy in ischemic diabetic foot disease, and compared the effects of autologous stem cell therapy and percutaneous transluminal angioplasty in the treatment of ischemic diabetic foot disease.
* * * 83 patients with ischemic diabetic foot participated in this clinical trial, of which 365,438+0 patients received autologous stem cell therapy, 28 patients received percutaneous transluminal angioplasty, and 24 patients who were unable or unwilling to receive percutaneous transluminal angioplasty or autologous stem cell therapy served as the control group.
The results show that both autologous stem cell therapy and percutaneous transluminal angioplasty can significantly reduce the amputation rate of patients with ischemic diabetic foot, and autologous stem cell therapy has a more significant effect on ulcer healing.
In a clinical trial, 15 patients with type 2 diabetes (aged 26-72 years) received umbilical cord MSC to treat lower limb ischemia (diabetic foot), and 2× 106 MSCs were injected at multiple points around the ischemic area. The longest observation period was 12 weeks.
The experimental results showed that except insulin dosage and glycosylated hemoglobin (HbA 1c), the concentration of VEGF in patients' peripheral blood reached its peak at 4 weeks, and then decreased continuously. The local skin temperature, ankle-brachial index (ABI) and subcutaneous oxygen partial pressure were significantly improved.
According to a clinical trial of stem cell therapy for severe lower limb ischemia (diabetic foot) published by clinicaltrials.gov website, after 12 months of stem cell therapy, the results showed that the amputation-free survival rate of 1 main limb was 82.4%; (2) Rebuild the blood vessels of lower limbs, increase the number of blood vessels of lower limbs, ankle-brachial index (ABI) and transcutaneous oxygen partial pressure (TcPO2), and all wounds of gangrene or ulcer will heal; 3 pain relief, intermittent claudication pain relief 97%, rest pain relief100%; The walking distance of 4 6 minutes was obviously improved, from/kloc-0 14.5±37.57 meters before treatment to 157 100.92 meters (P = 0.0039).
Stem cell therapy for diabetic retinopathy
Diabetic retinopathy (DR) is the second most common complication of diabetes after diabetic foot, which is caused by ocular vascular diseases caused by various metabolic disorders of diabetes.
Retinopathy is the main cause of blindness among residents in developed countries, and it is more common in patients with type 2 diabetes. It is reported that MSC can improve the vision of animals and patients with retinopathy.
In addition to MSC, intraocular injection of autologous bone marrow hematopoietic stem cells (or bone marrow mononuclear cells) can also improve the vision of patients with retinopathy and edema.
At present, clinical trials have evaluated the effectiveness and safety of hematopoietic stem cell injection in the treatment of retinal vascular diseases. The vision of two patients with diabetic retinopathy was improved after injection of hematopoietic stem cells. After 12 weeks of treatment, the ophthalmic indexes have improved.
The mechanism of hematopoietic stem cells on diabetic retinopathy is not clear, but paracrine signal is considered as a possible mechanism.
Besides hematopoietic stem cells, mesenchymal stem cells, endothelial progenitor cells and adipose stromal cells have also been used in the study of diabetic retinopathy.
Researchers in China published a research paper in the International Journal of Ophthalmology a few years ago, reporting the changes of diabetic retinopathy after autologous stem cell transplantation.
This clinical study found that after autologous stem cell transplantation, the blood sugar level is stable and the islet function is improved, which is helpful to stabilize or delay the progress of retinopathy.
Stem cell therapy for diabetic nephropathy
Diabetic nephropathy is the main complication of 1 type diabetes. Studies have shown that MSC can differentiate into renal cells in vivo, which is expected to repair the damaged part of kidney.
Because of its low immunogenicity, MSC is considered as an ideal graft. A large number of studies show that MSC transplantation can better control blood sugar and prevent the development of nephropathy.
In addition to MSC, induced pluripotent stem cells have also been used in the treatment of diabetic nephropathy in recent years.
Researchers have confirmed that induced pluripotent stem cells can be induced into therapeutic renal cells simply and quickly, which can improve the acute renal injury in mouse models.
The animal experiment conducted by Professor Mu's team found that short-term MSC treatment can significantly improve glomerular basement membrane thickening, renal fibrosis and inflammatory protein expression in diabetic individuals, indicating that this treatment can effectively prevent the occurrence of diabetic nephropathy.
MSC treatment can reduce M 1 macrophages and increase M2 cells in renal tissue.
Animal experiments have proved the effectiveness of MSC in treating diabetic nephropathy. Its mechanism lies in the paracrine effect of cell growth factor secreted by MSC, which inhibits oxidative stress and inflammatory reaction, reduces the apoptosis of renal cells, inhibits the infiltration and activation of macrophages, and even MSC can prevent diabetic nephropathy from progressing to renal failure.
China Journal of Cells and Stem Cells reported the clinical cases of repairing diabetic nephropathy with MSC, which confirmed that umbilical cord MSC was safe and effective in treating diabetic nephropathy through the intervention of dorsal pancreatic artery, bilateral renal arteries and peripheral blood vein transplantation. Compared with the traditional treatment of diabetic nephropathy, MSC transplantation has better clinical effect in improving diastolic blood pressure and renal function.
Stem cell therapy for diabetic neuropathy
Diabetic neuropathy is one of the most obvious complications of diabetes, which means that the nerves are damaged by long-term and persistent hyperglycemia, and 20%-30% patients will have this symptom.
In some cases, neuropathy can lead to ulcers, which may eventually lead to amputation.
It is found that injecting MSC into rats with neuropathy can improve diabetic neuropathic pain, promote vascular regeneration and increase the chances of nerve survival.
In recent years, clinical studies have been carried out at home and abroad to explore the efficacy of stem cell transplantation in the treatment of diabetic peripheral neuropathy.
Chinese researchers observed the curative effect of human umbilical cord MSC transplantation on diabetic peripheral neuropathy, and 32 patients with diabetic peripheral neuropathy participated.
The results show that transplantation of human umbilical cord mesenchymal stem cells can improve the clinical symptoms and neurophysiology of diabetic peripheral neuropathy, and it is a safe and effective new method to treat diabetic peripheral neuropathy.
Diabetes complications have a great influence on the life span and quality of life of diabetic patients.
Fortunately, with the rapid development of medical technology, we are fortunate to welcome stem cell therapy. The great potential of stem cells in treating diabetes and its complications has brought new hope to diabetic patients!
Guangdong Wanhai Group, as the leader of stem cell therapy research, is willing to work hand in hand with colleagues at home and abroad to continuously carry out in-depth research on stem cell therapy for diabetes and its complications for the benefit of the majority of diabetic patients!