Diabetes and its many complications, including diabetic foot ulcers, the most common reason for amputation of the foot next only to road accidents, are the focus of many health campaigns and medical research worldwide.
Diabetic foot ulcers develop in patients are triggered by nerve damage or obstruction of arteries causing either lack of sensation in the foot or poor blood circulation. Amputation is adopted to avoid the ulcer from spreading to the rest of the body. But not all diabetic ulcers heal quickly, for which stem cell therapy is becoming a popular option.
A team of city doctors claim to have pioneered therapy for foot ulcers using dental pulp stem cells rather than the conventional stem cells taken from the bone marrow. An unhealed ulcer in a 72 year-old diabetic with an anterior foot amputation was healed after 35 million dental pulp stem cells were injected, the team claims. The patient has 18 years of diabetic history and had undergone a coronary artery bypass surgery.
Dental pulp stem cells are extracted from the milk tooth, says S.Sankaranarayanan, dental laser surgeon, whose initiative with V.R.Ravi, orthopaedic surgeon, and P.Ramachandran, plastic surgeon, under the banner of Mother Cell Regeneration Centre, Tiruchi, was published in the October-December issue of the Journal of Tamil Nadu Indian Dental Association (JIDAT). “Almost 50,000 amputations are reported in India each year according to a study by a Chennai facility. If left untreated, patients with diabetic foot ulcer may develop serious cardiac and renal complications,” says Dr. Sankaranarayanan.
Ideal for older patients
The team has successfully used stem cells from bone marrow to treat oral sub mucous fibrosis, a non-cancerous stage preceding oral cancer, says Dr. V.R. Ravi. “As a patient ages, the number of stem cells in the bone marrow reduce. Besides, older patients may find the extraction of stem cells by surgery painful. Dental pulp stem cells are ideal for diabetic ulcer patients advanced in age.”
Dental pulp cells can be sourced from the same person or from stem cell banks. Each milk tooth may hold ten to fifteen cells which when cultured in a lab for three to four weeks may produce up to 100 million stem cells.
Initial investigations are conducted to determine blockage of blood vessels in patient and stem cells are injected along the course of the blocked arteries from the top to the toe with one cm gap. “Dental pulp stem cell restore nerve sensation and blood vessel regeneration that help the ulcer to heal fast,” says Dr. Sankaranarayanan. The procedure can be used to heal unhealed ulcers caused by one digit amputation, anterior foot amputation. “The goal is to heal the wound and avoid further amputation.”
Only 15 per cent of patients with diabetic foot ulcers may require stem cell therapy. If the wound shows no sign of healing even after four to six months, investigations reveal severe blockade of main arteries and no benefits from conventional therapy.
Dental pulp stem cells cause around Rs.1,500 per million and a patient may require an average of 35 million stem cells. As there are few stem cell storage banks in India, the popularity of the therapy hinges on infrastructure development. In this case, the stem cells were cultured at a bank in Hyderabad.
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