Rapid healing of a therapy-refractory diabetic foot after transplantation of autologous bone marrow stem cells

Background: The diabetic foot mainly depends on painless pressure lesions, which are based on diabetic polyneuropathy and microangiopathy. In these cases the regenerative potential of adult autologous mononuclear stem cells could serve as causal therapy. History and Clinical Findings: A 63-year-old patient with long-lasting type 2 diabetes mellitus suffers from a reduced walking distance of 200 in and a therapy-refractory ulcer at the right ball of the great toe. Therefore, the authors have decided to perforin a combined intraarterial and intramuscular transplantation of stem cells into the right limb for the first time on this disease. Therapy and Results: After harvesting of bone marrow the mononuclear cell fraction was separated (157 x 10(6) cells). Thereafter, the fractional intraarterial and intramuscular transplantation of the cell suspension was performed (10 nil each). Already 8 weeks later, the ulcer healed completely, after 6 months the walking distance increased by > 100%, on venous occlusion plethysmography the arterial blood circulation at rest increased by 23% and the reactive hyperemia by 56%. Conclusion: The combined intraarterial and intramuscular transplantation of autologous bone marrow stem cells could constitute a novel, clinically feasible and safe therapy for patients with diabetic foot syndrome. The success of this approach may be ascribed to microangiogenesis and to an anti-inflammatory effect of the transplanted stem cells.