Autologous Bone Marrow Transplant for Human Diabetes Mellitus.

Background: stem cells have tha capacity of both self-renewal and multilineage differentiation. They have the ability to proliferate and differentiate into any type of cell. Bernat Soria and coworkers showed how to guide stem cells in animals to differentiate in specific cell lineages as neurons,cardiomyocytes an insulin-secreting cells (

Aims: to study the bahaviour in glucose metabolism in a group of patients receiving autologous bone marrow transplantation for arterial ischaemic limb disease and prior mobilization with G-CSF. To evaluate the safety of the procedure.

Methods: from july 2004 to july 2007, 71 patients developing severe arterial limb ischaemia (candidates to amputation) were included in this study. 40 men and 31 women. Median age 66 years old (44–86). Mobilized with filgrastim (Neupogen) 5 ug/kg weight daily (5 days). Bone marrow harvest at 6^th day. Local anaesthesia was performed in all the patients. Unmanipulated cells, concentrated by gradient of density, were injected in the affected limb in 2 ml aliquots into the gastrocnemius muscle. Mean volume 40 ml. Follop up of each patient was done regularly evaluating: amputation, rest pain, frequency of analgesics intake, healing of the ulcers, peak walking time, insulin or oral antidiabetic drugs required. Doppler and angiographic test were also performed. The mean number of injected mononuclear cells was 1,9 x10⁹/kg. All the patients received low molecular weight heparin (nadroparin, Fraxiparine)3800–5600 IU anti-Xa subcutaneously, aspirin 81 mg and pentoxifiline 400 mg daily, as medical treatment after the procedure for at least 60 to 90 days. A control population of 67 patients affected by severe arterial limb ischaemia was considered. They didn’t receive angiogenic treatment.

Results: there was no treatment related mortality. In the control group 65 patients were amputated. In the “ABMT Group” 3 patients received amputation of the lower limb. The statistical difference between the two groups was highly significant in favor of the angiogenic group. They were evaluated by the chi square test and log rank test with a p value < 0,05. In the ABMT Group, 33% of type 1 diabetes and 74% of type 2 diabetes, discontinued their antidiabetic treatment for more than 3 months after ABMT.

Conclusions: autologous bone marrow transplantatioan can be performed safely and appears to be a benefical therapy for selected patients with severe peripheral arterial occlusive disease and diabetes mellitus. novoa.je@gmail.com