The treatment was done by Dr S.R Subrammaniyan, Chief Vascular surgeon assisted by a team comprising of Dr Amalorpavanathan, Dr Rajkumar and Dr Shankar. The bone marrow stem cell isolation and suspension as per proven international protocols was done at the Nichi-In Centre for Regenerative Medicine (NCRM) situated inside the Vijaya Health Centre Premises. The outcome of the patients status were presented at a Symposium on regenerative medicine held on the 17^th of October 2006 and well accepted by the scientific community.

Posterior Tibial Artery, Anterior Tibial Artery and Peroneal Artery are the three major blood vessels supplying the foot and leg. The Posterior Tibial Artery which supplies major part of the foot and the backside of the calf was totally occluded in this patient and she had been advised for an amputation of the affected area, because there was no possibility of performing a bypass surgery to salvage the limb as the distal portion of the vessel was occluded. At this juncture the Vijaya Vascular team after going through publications in international journals resorted to this new treatment which we hope is the first time in the state of Tamilnadu. Though for other kinds of diseases such as TAO such treatments have been done in other institutes in India, for diabetes this has not been reported and in that sense, this could be the first time in India.

In this treatment, the patient’s bone marrow was tapped under general anesthesia and 100 ml of bone marrow was taken. The bone marrow stem cells were isolated and suspended for injection as per cGMP protocols at NCRM. They were injected to the calf muscle affected portion two times at an interval of one month. Then from the time of the injection the healing started very rapidly and healthy granulation started covering the previously ischemic portion of the limb and close to 40% of the foot area, 20% of calf area and 100% of the lateral wound region were covered by skin. The remaining portion was treated with skin grafting and could successfully heal and now the patient is able to use her left lower limb as much as the right side.

When she was investigated by ABI (Ankle-Brachial Index) and CT scan, it has been found that (i) The blood circulation has improved as proven by ABI index and (ii) The Posterior Tibial Artery which was previously occluded has become patent due to fine network of new vessel formation following the bone marrow stem cell therapy.

Incidence of Diabetes is very rapidly increasing in India and we are likely to have more number of similar patients. In such patients when there is no feasibility of a revascularization by bypass surgery, and when amputation is the only option left, with this experience we would say that the autologous bone marrow stem cell therapy would be suitable and safe.

Comments by Prof. Geoffrey Gurtner

Publication of the presentation in the Journal of Stem cells and Regenerative Medicine