An Alternative for Lower-Extremity Amputations – Another Ray of Hope for Diabetics
Introduction to Peripheral arterial disease or PAD
Foot and leg problems are commonly associated with diabetics, as the arteries within the limbs of these patients tend to get clogged at a higher rate. Not surprising that the rate of limb amputations in these patients is also very high. The problem of clogging of blood vessels arises due to the deposition of fat and is also known as Peripheral arterial disease or PAD. During the initial stages, the fat deposition or plaques block the arteries, creating a situation called atherosclerosis. But as time proceeds, the plaques get hardened and block the supply of oxygen rich blood to vital organs like heart, brain, limbs etc. Hence, PAD also increases the chances of cardiovascular and cerebrovascular diseases.
Alarming Symptoms of PAD
A persistent pain accompanied by cramps in the limbs during mild exercise is an alarming signal. Sometimes, even thighs, buttocks start to ache and the patient finds relief after sufficient rest. In advanced cases, patients suffer from acute tissue loss and gangrene . A person who is diabetic, hypertensive or obese is at a higher risk for PAD.
Why is the risk of PAD more in diabetics?
Diabetes impairs the metabolic balance as a result of which the structure and functions of the arteries are also hampered. Diabetes creates proatherogenic modifications like inflammation of the vasculature. This in turn, increases the chances of PAD. With the advancement in science, lots of preventive measures like intense medication, surgery and exercise programs have come up. But in some rare cases, when these measures fail, doctors have to amputate the effected limb. The rate of amputation within diabetics has fallen down during past few years, but doctors of the modern world do not consider it as a significant achievement. This led to the discovery of novel therapies.
Upcoming Therapies Which Promise the Treatment for PAD
Gene therapy: According to Willyard C, a gene therapy product which targets to replace the mutated gene has come up with the promise of treating PAD.
Cell Therapy: Another line of research targets the synthesis of cell therapy products like Ixmyelocel-T. This particular product has been produced by Aastrom Biosciences. This product introduces new cells into the damaged tissues and is presently undergoing its final stages of clinical evaluation. When ixmyelocel-T was administered along with bone marrow derived mesenchymal stem cells and mixture of macrophages, the rate of limb amputations and gangrene was found to be reduced by 62% .
Stimulation of angiogenesis: Angiogenesis is the process of formation of new blood vessels from the older ones. The signaling pathway involving vascular endothelial growth factors (VEGFs) and their receptors plays a primary role in this. Modern research is oriented towards designing a gene therapy which can promote the complex process of angiogenesis.
Research on traditional medication: Scientists are also simultaneously struggling to discover new traditional medicines, which can act as anticoagulants.
Summary of Ixmyelocel-T based Cell Therapy
Individual’s Efforts to Reduce the Chances of PAD
An awareness of factors which increase the risk of PAD helps to minimize its rate. Smoking and lack of physical activity increase the chances of PAD. Reduced intake of oily foods helps to maintain balanced cholesterol levels. People who have a family history of PAD or cardiovascular problems should be very careful and watchful about the symptoms. A combination of healthy life style habits, proper diet and medication may reduce the chances of limb amputation in diabetic patients.
1. American Diabetes Association, Peripheral Arterial Disease in People With Diabetes, Diabetes Care, 2003 Dec, 26(12), 3333-41.
2. Willyard C, Limb-saving medicines sought to prevent amputations, Nature Medicine, 2012, 18, 328.