NEW FRONTIER IN MEDICINE: Regenerative cells derived from bone marrow for treating diabetic foot

It is a known fact that our body has its own repair system which works efficiently when we have a cut in our skin or a broken bone. This repair system is made up of regenerative cells which are responsible for repairing almost any damage to any tissue of the human body.
These cells have two distinct properties that separate them from other types of cells. Firstly, they can divide to make more of themselves and secondly, they can turn into any other type of cell in the body. These cells are stored in abundance in different tissues in our body such as fat tissue, blood and bone marrow (the red substance inside our bones). Since the 60s until today bone marrow transplant is the most common medical procedure used to treat some types of blood cancer, such as leukemia due to the properties of cells in restoring normal blood cells.  
Since then scientists have been discovering new and safe clinical applications for these cells. One of the applications, introduced in Mauritius and the Sub Saharan region by Apollo Bramwell Hospital, concerns the treatment of diabetic foot using bone marrow-derived cells from the same patient.
Before talking about this treatment we must first look at the prevalence of in Mauritius. Diabetes is a group of metabolic diseases in which a person has high HYPERLINK ""blood sugar, either because the body does not produce enough HYPERLINK ""insulin (Type1), or because cells do not respond to the insulin that is produced naturally in the body (Type 2). About 99% of diabetic patients in Mauritius suffer from Type 2 diabetes. Mauritius has one of the highest prevalence rates of Type 2 diabetes in the world.
In 2009, the Baker IDI Heart and Diabetes Institute of Australia in Collaboration with the Ministry of Health and Quality of Life (MoHQoL), doctors and scientists from Sweden, UK and Finland conducted a comprehensive survey about the trend in diabetes in Mauritius. The group reported 26.9% prevalence rate in Mauritius in people aged 30-75 years up from 19.5% in 2004, and for every case diagnosed there is one still undiagnosed. The report indicated that 50% of deaths in 2009 were caused by diabetes.
In addition to all other complications related to diabetes such as cardiovascular diseases, kidney and blindness or deteriorated vision, there were over 400 amputations of lower limbs in public hospitals each year due to diabetes.The situation is alarming. The MoHQoL with other private health care institutions and NGOs are doing what they can to tackle the problem of diabetes but there is still a lot to be done.
The rising prevalence of diabetes is associated with rapid cultural and social changes, ageing populations, increasing urbanization, dietary changes, reduced physical activity and other unhealthy lifestyle and behavioral patterns. On the other hand factors that contribute to the rapid progress of the diabetes symptoms are the poor control of blood sugar, lack of exercise, obesity, smoking and alcohol.
One of the complications associated with diabetes is the restriction of blood flow due to the blockage or narrowing of the blood vessels (arteries) that supply blood to the limbs. This can result in diabetic foot symptoms. The symptoms can be recognized by pain, numbness, aching and heaviness in the legs and buttocks during exercise, cramping, slow healing and painful sores, and a weak pulse, or no pulse in the legs and feet. Symptoms can also include poor nail and hair growth on toes and legs, different temperatures in each leg and pale or blue skin (indicating tissue death) that could eventually lead to gangrene and limb amputation.
Treatment of diabetic foot can be achieved in some patients through open surgical procedure to remove part of the artery that is blocked or by performing a bypass of the blocked segment to insure good blood flow. Alternatively, catheter-based intervention to unblock artery and restore blood might be employed. Unfortunately, the majority of diabetic foot patients are not eligible for one or both of these procedures and they were left to face amputation.
In the past decade scientists in Europe used autologous (the patient's own) bone marrow derived cells to treat a variety of conditions such as cardiovascular, orthopedic and sports-related injuries in addition to diabetic foot. Bone marrow-derived cells became an alternative to traditional medical care in such hard to treat cases that are not responsive to advanced clinical treatment approaches. This form of treatment is now available in Mauritius due to a collaboration with European counterparts to transfer these approved treatments in an effort to provide high quality medical care to the Mauritian people.
Unfortunately most patients are not well informed about the consequences of delaying treatment after having diabetic foot symptoms, especially when they have a wound in the lower limb that won't heal. Scientists have found out that in diabetic patients, the release of cells from bone marrow to blood stream to repair damages tissue is impaired. This means that with poor blood circulation, the problem will be magnified and the wound will not be repaired. Bone marrow derived  cells  can contribute significantly to wound healing through regeneration of the blood capillary system and formation of the collateral blood vessels to bypass blocked segments which then sufficiently increases blood circulation, and can ultimately save the patient’s limb.
This new medical approach, which is now available in Mauritius, could effectively tackle the problem of limb amputation and reduce the burden of having a large number of amputees each year, as well as the burden on the health system and society. The procedure is safe and has hardly any side effects. The patient's bone marrow is usually taken from the hips, the major bone marrow reservoir, under anesthesia and cells will be concentrated within a few minutes using special equipment and tools, then given back to the patients. The patient will be required to spend about two days in the hospital for observation. This treatment can help patients where classical medical interventions have failed.
Patients with diabetes must also take certain precautions to avoid any health complications. They should have regular checkups especially when any member in the family has also been previously diagnosed with the disease. If they were positively diagnosed, then they must strictly follow the treatment suggested by their physician to control their blood sugar. Changes in lifestyle include a healthy diet, exercise, giving up on smoking and other unhealthy factors, which would significantly reduce diabetes-related complications.

Dr Salah Aljanabi
Deputy Chief Medical Officer
Apollo Bramwell Hospital