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Diabetic foot ulcers are a serious complication of diabetes and require advanced therapies to promote wound healing. Human amnion-derived mesenchymal stem cells(hAMSCs) have gained attention due to their regenerative properties and potential therapeutic applications. This study aims to evaluate the effectiveness of hAMSCs in the treatment of diabetic foot ulcers in a female uremic patient.
We reported a case of a 35-years-old female patient with diabetic foot ulcers on her right foot. The ulcers are large, painful, and have a mummified appearance. This patient has a history of type 2 diabetes mellitus for 20 years. She was diagnosed with uremia and hypertension in 2018 and underwent peritoneal dialysis(PD) for 4 years. After experiencing COVID-19 in January 2023, her right foot lesions began to deteriorate, causing blackening and pain in her fourth digit. The dry gangrene in her foot gradually expanded to the second to fifth digits, the heel, and the instep, along with suppuration and infection. Then, she was admitted to our hospital with a lower extremity arteriogram showing occlusion of the right inferior femoral artery. A computerized tomography angiography(CTA) performed at a local hospital showed atherosclerosis in both the abdominal aorta and lower limb arteries. A lower extremity arteriogram showed occlusion of the right inferior femoral artery. She underwent percutaneous lower limb arteriography, balloon dilation, and intravascular stent implantation in March, 2023. The patient had been switched to hemodialysis and continuous kidney replacement therapy(CKRT). She received compassionate treatment with hAMSCs for the first time in April, 2023, which was approved by the Ethics Committee of our hospital. The hAMSCs were administered intravenously to the patient at a dosage of 1.0 × 106 cells/kg body weight, combined with a local intramuscular injection along the wound edge (2.0 × 104 cells/cm2) and topical application on the ulcer. Until Oct 2023, the patient was administered with eight hAMSC treatments.
Throughout the 6-month treatment period, the patient had no adverse reactions and experienced a notable improvement in the condition of her foot ulcers. The ulcers showed a reduction in size, increased formation of granulation tissue, and enhanced wound closure(Fig 1 and Fig 2). Moreover, the patient reported a decrease in pain and an improvement in overall quality of life.
The intravenous and local administration of hAMSCs represents a promising treatment strategy for diabetic foot ulcers in individuals with uremia. Further research and clinical trials are necessary to validate these findings and establish the optimal dosage, treatment duration, and long-term outcomes of this therapeutic approach.