Bone marrow cellular profile in patients with diabetes: association of statin therapy with CD34+ cells

Diabetes is associated with alterations in bone marrow (BM) cellularity beyond its acute and chronic complications in both type 1 and type 2 diabetes. These changes may be amplified in patients with advanced disease, such as CLTI. Key alterations include imbalance of the BM microenvironment and shifts in hematopoietic cell populations, particularly the CD34+ subpopulation.

This retrospective observational study analyzed patients treated with autologous cell therapy (ACT) for chronic limb-threatening ischemia over 16 years. Patients on immunosuppressive therapy or corticoids, with stage 4-5 chronic kidney disease, repeated ACT were excluded. Harvested BM underwent hematological analysis (leucocytes, monocytes, lymphocytes) and immunophenotyping (percentage and absolute count of CD34). Outcomes were evaluated in relation to diabetes parameters (type, duration, glycated hemoglobin, diabetic complications score index - DCSI) and medications (oral antidiabetics, statins). Wilcoxon rank test and Spearman correlation were used.

Seventy-four patients were included from 167 in the ACT database. Statin therapy was significantly associated with higher CD34 percentage (β = 0.256, p< 0.001), while simultaneously being associated with lower lymphocyte counts, suggesting that statins may modify BM cellular composition rather than directly increase absolute progenitor cell numbers.

Statins appear to optimize the BM microenvironment rather than increase absolute hematopoietic cell numbers in a non-hematological diabetic population with severe limb ischemia. In addition, higher DCSI scores were associated with increased CD34+ cell percentage, suggesting a link between diabetes severity and BM cellular composition.