Abstract
Diabetes mellitus is the most common chronic disease that can lead to many clinical complications including vision, cardiac, and vascular disorders. Among vascular disorders, Diabetic foot ulcer (DFU) is a severe, fatal, serious and devastating complication and remained major economic consequences for the patients and country and is now a global public health issue. The prevalence of Diabetic foot ulcer in Western countries is 4–10% whereas the prevalence of Diabetic foot ulcer in the world is 15%. It has been reported that the healing rate of DFU is only 10–60% of patients after the first 3 months however the recurrence rate is 40%, 60%, and 71% after 1, 2, and 3 years, respectively. Limited treatment options are available for DFU patients. Stem cell therapy holds a great promise for treating Diabetic foot ulcer (DFU) and recently emerged as a new interventional strategy and appears to be cost-effective safe and effective in both preclinical and clinical trials. The most important characteristic for the successful utilization of mesenchymal stem cell treatments is the conducting of rapid and robust randomized controlled clinical trials. Diabetic foot ulcer remains the most important clinical challenge in the current medical practice and stem cell therapy may be an effective treatment for Diabetic foot ulcers. It is concluded that stem cell therapy is a potential, advanced, and effective treatment for Diabetic foot ulcers and is utilized as an alternative to amputation for T2D patients for revascularization. This therapy is utilizing tissue engineering as well as regenerative medicine.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Gorecka J, Kostiuk V, Fereydooni A, Gonzalez L, Luo J, Dash B, Isaji T, Ono S, Liu S, Lee SR et al (2019) The potential and limitations of induced pluripotent stem cells to achieve wound healing. Stem Cell Res Ther 10(1):87
Kashpur O, Smith A, Gerami-Naini B, Maione AG, Calabrese R, Tellechea A, Theocharidis G, Liang L, Pastar I, Tomic-Canic M et al (2019) Differentiation of diabetic foot ulcer-derived induced pluripotent stem cells reveals distinct cellular and tissue phenotypes. FASEB J 33(1):1262–1277
van Wilgenburg B, Browne C, Vowles J, Cowley SA (2013) Efficient, long term production of monocyte-derived macrophages from human pluripotent stem cells under partly-defined and fully-defined conditions. PLoS One 8(8):e71098
Petrova A, Celli A, Jacquet L, Dafou D, Crumrine D, Hupe M, Arno M, Hobbs C, Cvoro A, Karagiannis P et al (2014) 3D In vitro model of a functional epidermal permeability barrier from human embryonic stem cells and induced pluripotent stem cells. Stem Cell Rep 2(5):675–689
Kim JS, Choi HW, Choi S, Do JT (2011) Reprogrammed pluripotent stem cells from somatic cells. Int J Stem Cells 4(1):1–8
Morgan HD, Santos F, Green K, Dean W, Reik W (2005) Epigenetic reprogramming in mammals. Human Mol Genet 14(Spec No 1):R47–R58
Freberg CT, Dahl JA, Timoskainen S, Collas P (2007) Epigenetic reprogramming of OCT4 and NANOG regulatory regions by embryonal carcinoma cell extract. Mol Biol Cell 18(5):1543–1553
Hochedlinger K, Jaenisch R (2006) Nuclear reprogramming and pluripotency. Nature 441(7097):1061–1067
Kulcenty K, Wroblewska J, Mazurek S, Liszewska E, Jaworski J (2015) Molecular mechanisms of induced pluripotency. Contemp Oncol 19(1A):A22–A29
Telpalo-Carpio S, Aguilar-Yanez J, Gonzalez-Garza M, Cruz-Vega D, Moreno-Cuevas J (2013) iPS cells generation: an overview of techniques and methods. J Stem Cells Regenerat Med 9(1):2–8
Ma X, Kong L, Zhu S (2017) Reprogramming cell fates by small molecules. Protein Cell 8(5):328–348
Zhang Y, Li W, Laurent T, Ding S (2012) Small molecules, big roles—the chemical manipulation of stem cell fate and somatic cell reprogramming. J Cell Sci 125(Pt 23):5609–5620
Bhat AA, Younes SN, Raza SS, Zarif L, Nisar S, Ahmed I, Mir R, Kumar S, Sharawat SK, Hashem S et al (2020) Role of non-coding RNA networks in leukemia progression, metastasis and drug resistance. Mol Cancer 19(1):57
Zuberi M, Mir R, Khan I, Javid J, Guru SA, Bhat M, Sumi MP, Ahmad I, Masroor M, Yadav P et al (2020) The promising signatures of circulating microRNA-145 in epithelial ovarian cancer patients. MicroRNA 9(1):49–57
Garwood CS, Steinberg JS (2016) What’s new in wound treatment: a critical appraisal. Diabetes Metab Res Rev 32(Suppl 1):268–274
Houreld NN (2014) Shedding light on a new treatment for diabetic wound healing: a review on phototherapy. ScientificWorldJournal 2014:398412
Ruthenborg RJ, Ban JJ, Wazir A, Takeda N, Kim JW (2014) Regulation of wound healing and fibrosis by hypoxia and hypoxia-inducible factor-1. Mol Cells 37(9):637–643
Duscher D, Maan ZN, Whittam AJ, Sorkin M, Hu MS, Walmsley GG, Baker H, Fischer LH, Januszyk M, Wong VW et al (2015) Fibroblast-specific deletion of hypoxia inducible factor-1 critically impairs murine cutaneous neovascularization and wound healing. Plast Reconstr Surg 136(5):1004–1013
Tavakkoly-Bazzaz J, Amoli MM, Pravica V, Chandrasecaran R, Boulton AJ, Larijani B, Hutchinson IV (2010) VEGF gene polymorphism association with diabetic neuropathy. Mol Biol Rep 37(7):3625–3630
Elfaki I, Mir R, Abu-Duhier FM, Khan R, Sakran M (2019) Phosphatidylinositol 3-kinase Glu545Lys and His1047Tyr mutations are not associated with T2D. Curr Diabet Rev. https://doi.org/10.2174/1573399815666191015142201
Lai WH, Ho JC, Chan YC, Ng JH, Au KW, Wong LY, Siu CW, Tse HF (2013) Attenuation of hind-limb ischemia in mice with endothelial-like cells derived from different sources of human stem cells. PLoS One 8(3):e57876
Mulyasasmita W, Cai L, Dewi RE, Jha A, Ullmann SD, Luong RH, Huang NF, Heilshorn SC (2014) Avidity-controlled hydrogels for injectable co-delivery of induced pluripotent stem cell-derived endothelial cells and growth factors. J Controlled Release 191:71–81
Rufaihah AJ, Huang NF, Jame S, Lee JC, Nguyen HN, Byers B, De A, Okogbaa J, Rollins M, Reijo-Pera R et al (2011) Endothelial cells derived from human iPSCS increase capillary density and improve perfusion in a mouse model of peripheral arterial disease. Arterioscler Thromb Vasc Biol 31(11):e72–e79
Dar A, Domev H, Ben-Yosef O, Tzukerman M, Zeevi-Levin N, Novak A, Germanguz I, Amit M, Itskovitz-Eldor J (2012) Multipotent vasculogenic pericytes from human pluripotent stem cells promote recovery of murine ischemic limb. Circulation 125(1):87–99
Brouwer M, Zhou H, Nadif Kasri N (2016) Choices for induction of pluripotency: recent developments in human induced pluripotent stem cell reprogramming strategies. Stem Cell Rev Rep 12(1):54–72
Seki T, Fukuda K (2015) Methods of induced pluripotent stem cells for clinical application. World J Stem Cells 7(1):116–125
Ding DC, Shyu WC, Lin SZ (2011) Mesenchymal stem cells. Cell Transplant 20(1):5–14
Huang Y, Li Q, Zhang K, Hu M, Wang Y, Du L, Lin L, Li S, Sorokin L, Melino G et al (2019) Single cell transcriptomic analysis of human mesenchymal stem cells reveals limited heterogeneity. Cell Death Dis 10(5):368
Rodriguez-Menocal L, Shareef S, Salgado M, Shabbir A, Van Badiavas E (2015) Role of whole bone marrow, whole bone marrow cultured cells, and mesenchymal stem cells in chronic wound healing. Stem Cell Res Ther 6:24
Walter MN, Wright KT, Fuller HR, MacNeil S, Johnson WE (2010) Mesenchymal stem cell-conditioned medium accelerates skin wound healing: an in vitro study of fibroblast and keratinocyte scratch assays. Exp Cell Res 316(7):1271–1281
Smith AN, Willis E, Chan VT, Muffley LA, Isik FF, Gibran NS, Hocking AM (2010) Mesenchymal stem cells induce dermal fibroblast responses to injury. Exp Cell Res 316(1):48–54
Jeon YK, Jang YH, Yoo DR, Kim SN, Lee SK, Nam MJ (2010) Mesenchymal stem cells’ interaction with skin: wound-healing effect on fibroblast cells and skin tissue. Wound Repair Regenerat 18(6):655–661
Lee SH, Jin SY, Song JS, Seo KK, Cho KH (2012) Paracrine effects of adipose-derived stem cells on keratinocytes and dermal fibroblasts. Ann Dermatol 24(2):136–143
Schlosser S, Dennler C, Schweizer R, Eberli D, Stein JV, Enzmann V, Giovanoli P, Erni D, Plock JA (2012) Paracrine effects of mesenchymal stem cells enhance vascular regeneration in ischemic murine skin. Microvasc Res 83(3):267–275
Volarevic V, Arsenijevic N, Lukic ML, Stojkovic M (2011) Concise review: mesenchymal stem cell treatment of the complications of diabetes mellitus. Stem Cells 29(1):5–10
Wu Y, Chen L, Scott PG, Tredget EE (2007) Mesenchymal stem cells enhance wound healing through differentiation and angiogenesis. Stem Cells 25(10):2648–2659
Sasaki M, Abe R, Fujita Y, Ando S, Inokuma D, Shimizu H (2008) Mesenchymal stem cells are recruited into wounded skin and contribute to wound repair by transdifferentiation into multiple skin cell type. J Immunol 180(4):2581–2587
Si YL, Zhao YL, Hao HJ, Fu XB, Han WD (2011) MSCs: biological characteristics, clinical applications and their outstanding concerns. Ageing Res Rev 10(1):93–103
Xu YX, Chen L, Hou WK, Lin P, Sun L, Sun Y, Dong QY, Liu JB, Fu YL (2009) Mesenchymal stem cells treated with rat pancreatic extract secrete cytokines that improve the glycometabolism of diabetic rats. Transplant Proc 41(5):1878–1884
Horie M, Choi H, Lee RH, Reger RL, Ylostalo J, Muneta T, Sekiya I, Prockop DJ (2012) Intra-articular injection of human mesenchymal stem cells (MSCs) promote rat meniscal regeneration by being activated to express Indian hedgehog that enhances expression of type II collagen. Osteoarthr Cartil 20(10):1197–1207
Hocking AM, Gibran NS (2010) Mesenchymal stem cells: paracrine signaling and differentiation during cutaneous wound repair. Exp Cell Res 316(14):2213–2219
Chen L, Tredget EE, Wu PY, Wu Y (2008) Paracrine factors of mesenchymal stem cells recruit macrophages and endothelial lineage cells and enhance wound healing. PLoS One 3(4):e1886
Zhang QZ, Su WR, Shi SH, Wilder-Smith P, Xiang AP, Wong A, Nguyen AL, Kwon CW, Le AD (2010) Human gingiva-derived mesenchymal stem cells elicit polarization of m2 macrophages and enhance cutaneous wound healing. Stem Cells 28(10):1856–1868
Liu L, Yu Y, Hou Y, Chai J, Duan H, Chu W, Zhang H, Hu Q, Du J (2014) Human umbilical cord mesenchymal stem cells transplantation promotes cutaneous wound healing of severe burned rats. PLoS One 9(2):e88348
Hajjar AM, Lewis PF, Endeshaw Y, Ndinya-Achola J, Kreiss JK, Overbaugh J (1998) Efficient isolation of human immunodeficiency virus type 1 RNA from cervical swabs. J Clin Microbiol 36(8):2349–2352
Couture P, Paradis-Massie J, Oualha N, Thibault G (2009) Adhesion and transcellular migration of neutrophils and B lymphocytes on fibroblasts. Exp Cell Res 315(13):2192–2206
Sorrell JM, Caplan AI (2010) Topical delivery of mesenchymal stem cells and their function in wounds. Stem Cell Res Ther 1(4):30
Anderson SB, Lin CC, Kuntzler DV, Anseth KS (2011) The performance of human mesenchymal stem cells encapsulated in cell-degradable polymer-peptide hydrogels. Biomaterials 32(14):3564–3574
Steck AK, Rewers MJ (2011) Genetics of type 1 diabetes. Clin Chem 57(2):176–185
Almutairi FM, Mir R, Abu-Duhier F, Khan R, Harby K, Elfaki I (2019) SLC2A2 gene (glucose transporter 2) variation is associated with an increased risk of developing T2d in an ethnic population of Saudi Arabia. Indian J Public Health Res Dev 10(1):600–605
Elfaki I, Mir R, AbuDuhier FM, Babakr AT, Barnawi J (2019) Potential impact of microRNA gene polymorphisms in the pathogenesis of diabetes and atherosclerotic cardiovascular disease. J Pers Med 9(4):E51
Elfaki I, Mir R, Almutairi FM, Duhier FMA (2018) Cytochrome P450: polymorphisms and roles in cancer, diabetes and atherosclerosis. Asian Pac J Cancer Prev 19(8):2057–2070
Chawla A, Chawla R, Jaggi S (2016) Microvasular and macrovascular complications in diabetes mellitus: distinct or continuum? Indian J Endocrinol Metab 20(4):546–551
American Diabetes Association (2017) 10. Microvascular complications and foot care. Diabetes Care 40(Suppl 1):S88–S98
Tindong M, Palle JN, Nebongo D, Aminde LN, Mboue-Djieka Y, Mbarga NTF, Dehayem MY, Choukem SP (2018) Prevalence, clinical presentation, and factors associated with diabetic foot ulcer in two regional hospitals in Cameroon. Int J Low Extrem Wounds 17(1):42–47
Lopes L, Setia O, Aurshina A, Liu S, Hu H, Isaji T, Liu H, Wang T, Ono S, Guo X et al (2018) Stem cell therapy for diabetic foot ulcers: a review of preclinical and clinical research. Stem Cell Res Ther 9(1):188
Cao Y, Gang X, Sun C, Wang G (2017) Mesenchymal stem cells improve healing of diabetic foot ulcer. J Diabetes Res 2017:9328347
Wong VW, Sorkin M, Gurtner GC (2013) Enabling stem cell therapies for tissue repair: current and future challenges. Biotechnol Adv 31(5):744–751
Hass R, Kasper C, Bohm S, Jacobs R (2011) Different populations and sources of human mesenchymal stem cells (MSC): a comparison of adult and neonatal tissue-derived MSC. Cell Commun Signal 9:12
Wan J, Xia L, Liang W, Liu Y, Cai Q (2013) Transplantation of bone marrow-derived mesenchymal stem cells promotes delayed wound healing in diabetic rats. J Diabetes Res 2013:647107
Hua J, Gong J, Meng H, Xu B, Yao L, Qian M, He Z, Zou S, Zhou B, Song Z (2013) Comparison of different methods for the isolation of mesenchymal stem cells from umbilical cord matrix: proliferation and multilineage differentiation as compared to mesenchymal stem cells from umbilical cord blood and bone marrow. Cell Biol Int. https://doi.org/10.1002/cbin.10188
Dash NR, Dash SN, Routray P, Mohapatra S, Mohapatra PC (2009) Targeting nonhealing ulcers of lower extremity in human through autologous bone marrow-derived mesenchymal stem cells. Rejuvenation Res 12(5):359–366
Amin AH, Abd Elmageed ZY, Nair D, Partyka MI, Kadowitz PJ, Belmadani S, Matrougui K (2010) Modified multipotent stromal cells with epidermal growth factor restore vasculogenesis and blood flow in ischemic hind-limb of type II diabetic mice. Lab Investig 90(7):985–996
Jin HJ, Bae YK, Kim M, Kwon SJ, Jeon HB, Choi SJ, Kim SW, Yang YS, Oh W, Chang JW (2013) Comparative analysis of human mesenchymal stem cells from bone marrow, adipose tissue, and umbilical cord blood as sources of cell therapy. Int J Mol Sci 14(9):17986–18001
Xia N, Xu JM, Zhao N, Zhao QS, Li M, Cheng ZF (2015) Human mesenchymal stem cells improve the neurodegeneration of femoral nerve in a diabetic foot ulceration rats. Neurosci Lett 597:84–89
You HJ, Namgoong S, Han SK, Jeong SH, Dhong ES, Kim WK (2015) Wound-healing potential of human umbilical cord blood-derived mesenchymal stromal cells in vitro—a pilot study. Cytotherapy 17(11):1506–1513
Li XY, Zheng ZH, Li XY, Guo J, Zhang Y, Li H, Wang YW, Ren J, Wu ZB (2013) Treatment of foot disease in patients with type 2 diabetes mellitus using human umbilical cord blood mesenchymal stem cells: response and correction of immunological anomalies. Curr Pharm Des 19(27):4893–4899
Moon KC, Suh HS, Kim KB, Han SK, Young KW, Lee JW, Kim MH (2019) Potential of allogeneic adipose-derived stem cell-hydrogel complex for treating diabetic foot ulcers. Diabetes 68(4):837–846
Ahmed EM (2015) Hydrogel: preparation, characterization, and applications: a review. J Adv Res 6(2):105–121
O’Loughlin A, Kulkarni M, Creane M, Vaughan EE, Mooney E, Shaw G, Murphy M, Dockery P, Pandit A, O’Brien T (2013) Topical administration of allogeneic mesenchymal stromal cells seeded in a collagen scaffold augments wound healing and increases angiogenesis in the diabetic rabbit ulcer. Diabetes 62(7):2588–2594
Badillo AT, Redden RA, Zhang L, Doolin EJ, Liechty KW (2007) Treatment of diabetic wounds with fetal murine mesenchymal stromal cells enhances wound closure. Cell Tissue Res 329(2):301–311
Kwon DS, Gao X, Liu YB, Dulchavsky DS, Danyluk AL, Bansal M, Chopp M, McIntosh K, Arbab AS, Dulchavsky SA et al (2008) Treatment with bone marrow-derived stromal cells accelerates wound healing in diabetic rats. Int Wound J 5(3):453–463
Falanga V, Iwamoto S, Chartier M, Yufit T, Butmarc J, Kouttab N, Shrayer D, Carson P (2007) Autologous bone marrow-derived cultured mesenchymal stem cells delivered in a fibrin spray accelerate healing in murine and human cutaneous wounds. Tissue Eng 13(6):1299–1312
Zonta S, De Martino M, Bedino G, Piotti G, Rampino T, Gregorini M, Frassoni F, Dal Canton A, Dionigi P, Alessiani M (2010) Which is the most suitable and effective route of administration for mesenchymal stem cell-based immunomodulation therapy in experimental kidney transplantation: endovenous or arterial ? Transplant Proc 42(4):1336–1340
Ho JH, Tseng TC, Ma WH, Ong WK, Chen YF, Chen MH, Lin MW, Hong CY, Lee OK (2012) Multiple intravenous transplantations of mesenchymal stem cells effectively restore long-term blood glucose homeostasis by hepatic engraftment and beta-cell differentiation in streptozocin-induced diabetic mice. Cell Transplant 21(5):997–1009
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Mir, R., Elfaki, I., Waza, A.A., AbuDuhier, F.M. (2021). Stem Cells in the Treatment of Diabetic Foot Ulcers. In: Zubair, M., Ahmad, J., Malik, A., Talluri, M.R. (eds) Diabetic Foot Ulcer. Springer, Singapore. https://doi.org/10.1007/978-981-15-7639-3_16
Download citation
DOI: https://doi.org/10.1007/978-981-15-7639-3_16
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-15-7638-6
Online ISBN: 978-981-15-7639-3
eBook Packages: MedicineMedicine (R0)