Regenerative Medicine and the Diabetic Foot

New discoveries in the field of stem cell biology point toward the next frontier in treatment of the diabetic foot. Stem cell populations persist in most adult tissues, providing limited regenerative potential over the course of life. It is these resident mesenchymal stem cells that allow under normal circumstances for the healing of cutaneous wounds. The greatest impact of diabetes is on the vascular system, and cardiovascular complications are the most common cause of death in diabetic patients. The main pathophysiologic mechanism underlying these complications seems to be dysfunctional neovascularization in response to ischemia, as evidenced by the reduced growth of collateral coronary vessels after acute myocardial infarction and the poor clinical outcomes associated with diabetic peripheral arterial disease as seen in the diabetic foot. Neovascularization occurs by two distinct processes: angiogenesis and vasculogenesis.