Interview | Professor Bi Sheng of Jianjia Healthcare: Can Regenerative Rehabilitation Become the “Golden Key” to Alter Amputation Outcomes for Diabetic Foot Patients
Prolonged hyperglycemia in people with diabetes continuously damages vascular endothelial cells, triggers platelet aggregation and thrombus formation, and impairs systemic blood circulation. Such vascular lesions are particularly prominent in the feet. As the body part farthest from the heart, feet are the hardest to recover once blood supply is compromised.
Roughly one‑in‑five patients hospitalized for diabetic foot will eventually undergo partial limb amputation. In China, more than 50 million people suffer from diabetic foot and peripheral arterial disease, with 3‑3.5 million new‑onset diabetic foot ulcers reported annually.
Traditional vascular surgery can reopen major lower‑limb blood vessels (“main roads”), yet offers limited solutions for occluded microcirculatory “side roads”. This clinical bottleneck drives many patients toward amputation.
Professor Bi Sheng, Chairman of the Rehabilitation Medicine Committee under the Chinese Association of Non‑public Medical Institutions, Chief Expert in Rehabilitation Specialties at Jianjia Healthcare, Chief Physician and doctoral supervisor, is one of China’s earliest advocates for the concept of regenerative rehabilitation. Leading his team, he has developed the autologous blood‑cell combined PRP implantation technique for lower‑limb microcirculation reconstruction, aiming to tackle diabetic‑foot‑related amputation.
Recently, Medical World interviewed Professor Bi Sheng to explore a critical question: when major vessels are patent yet microcirculation remains blocked, can regenerative rehabilitation serve as the golden key to reverse diabetic‑foot amputation?
“Main Roads Opened, Side Roads Remain Blocked”
“Endovascular interventions in conventional vascular surgery, such as balloon angioplasty and stent implantation, can effectively open large blood vessels — what we call ‘main roads’. However, these instruments cannot reach small arterioles within the microcirculation. Even if main vessels are reopened, insufficient blood perfusion persists at wound sites, so wounds cannot heal,” Professor Bi pointed out an unmet long‑standing clinical need.
According to the 10th edition of the IDF Diabetes Atlas released by the International Diabetes Federation (IDF), the number of people with diabetes aged 20‑79 in China will rise to approximately 164 million by 2030. Diabetic foot is among diabetes’ most severe complications, and patient numbers keep growing alongside the expanding diabetic population. Domestic multi‑center clinical surveys show that among Chinese diabetic patients aged above 50 years, the annual incidence of diabetic foot ulcers reaches 8.1 %; among diabetic‑foot patients, the amputation rate stands as high as 19.3 %.
Regenerative rehabilitation follows an alternative technical pathway built on re‑defined therapeutic targets. For severely calcified and occluded native vessels, instead of repeatedly attempting recanalization, clinicians generate a brand‑new blood‑supply network within ischemic tissue.
“Building Side Lanes Next to Urban Main Highways”
“The essence of our technology lies in constructing new side roads,” Professor Bi offered a metaphor. “Just as cities rely not only on arterial highways but also capillary‑like branch lanes and alleys, we reconstruct occluded microcirculation to deliver blood flow to wounds and nerve endings.”
How are these “side roads” generated? Drawing on international Platelet‑Rich Plasma (PRP) therapy, Professor Bi’s team made key improvements: implanting combined autologous blood cells and PRP to achieve in‑situ vascular regeneration.
“In‑situ vascular regeneration does not depend on pre‑existing native vessels. New vessels grow ‘from scratch’. Much like sowing seeds into muscle and fascia tissue, a fine vascular network forms and connects to major vessels to restore tissue perfusion.”
Professor Bi compared alternative approaches to justify using only patients’ own blood. One option requires harvesting 200‑400 mL bone marrow for concentration and implantation, which causes substantial trauma and high costs and is poorly accepted by patients. A second approach uses mobilizing agents to draw immature bone‑marrow cells into circulating blood, requiring 4‑5 consecutive injections, carrying high costs plus potential adverse events including bone pain and even cerebral infarction.
“Our technique isolates cells directly from peripheral blood, combines them with PRP, and implants the mixture into the ischemic lower limbs. Fully autologous material eliminates rejection risks while delivering comparably excellent therapeutic outcomes.”
Mr. Fu, 62 years old, suffered severe diabetic foot disease with left‑foot pain, non‑healing infected ulcers and prior amputation of two toes. Angiography demonstrated multi‑segment occlusion and severe stenosis of the left anterior tibial artery, with no improvement after multiple prior treatments. After two cycles of this therapy, microcirculatory “side roads” were reconstructed. His wounds healed completely, lower‑limb pain vanished, and he regained full capacity for walking and driving, returning fully to daily life.
Another patient, Mr. Fang aged 37, lived with thromboangiitis obliterans. Within two‑years he underwent three lower‑limb endovascular interventions plus toe amputation. He still presented with skin defects and exposed bone on his left great toe; calf distressing pain forced him to stop walking after fewer than 140 steps. CTA confirmed complete occlusion from the mid‑segment of his left superficial femoral artery to the distal popliteal artery, leaving conventional therapies powerless over microcirculatory damage.
Mr. Fang received two sessions of the autologous blood‑cell plus PRP regenerative therapy in February and April 2026. Follow‑up showed his pain‑free walking distance improved from less than 150 meters to roughly one hour of continuous walking.
“Interventions open main arteries, yet microcirculatory side roads stay blocked,” said Professor Bi Sheng. “We create de‑novo perfusion networks within ischemic tissue, opening new pathways for patients who previously had no therapeutic options.”
“This procedure requires specialized equipment beyond standard PRP separation systems. Implantation is performed under ultrasound guidance. Cell isolation plus implantation takes approximately four‑to‑five hours in total.”
A Rehabilitation Medicine Pioneer on the Road of Regenerative Rehabilitation
Professor Bi Sheng is one of few Chinese scholars with cross‑disciplinary expertise spanning rehabilitation medicine and regenerative medicine. Before taking office as Chief Rehabilitation Expert at Jianjia Healthcare, he served as Director of the Rehabilitation Medicine Center at a top‑tier domestic hospital.
The concept of regenerative rehabilitation did not emerge out of nowhere. Around 2010, international scholars began advocating deeper integration between regenerative and rehabilitation medicine. In 2014, Columbia University established the world’s first combined department of rehabilitation and regenerative medicine under Dr. Joel Stein, Chair of Rehabilitation Medicine.
Professor Bi ranks among China’s earliest promoters of this interdisciplinary fusion. In 2024, he put forward the viewpoint that “regenerative rehabilitation represents the future of rehabilitation medicine”.
“Both disciplines address intractable diseases, and their interventions can be combined. Physical therapy can boost regenerative treatment efficacy.” In Professor Bi’s view, rehabilitation medicine is inherently designed for hard‑to‑cure disorders; regenerative medicine offers potential to reverse pathological processes, hence regenerative rehabilitation defines the future of the specialty.
At Wuhan Jianjia Rehabilitation Hospital, Professor Bi is refining conventional rehabilitation frameworks while implementing regenerative rehabilitation in clinical practice. “Our earliest attempts date back to around 2018, and we kept advancing through the pandemic.” Nearly six‑years passed from initial exploration to full clinical deployment at Wuhan Jianjia Rehabilitation Hospital.
Through continuous technical iteration, the current combined “autologous blood‑cells + PRP” protocol was finalized.
According to Professor Bi Sheng, rehabilitation departments treating diabetic foot are not “encroaching on other specialties”. Classic international rehabilitation textbooks contain chapters on vascular rehabilitation covering exercise‑induced collateral circulation formation as physical therapy. His work builds upon this foundation by adding biological regenerative technologies to achieve geometric improvements in clinical outcomes.
Rehabilitation teams bring distinct strengths: ultrasound‑guided precise injection, long‑term follow‑up management and comprehensive pain control. Most critically: after limb salvage, rehabilitation specialists ensure patients regain walking ability and functional independence.
“Rather than competing with vascular surgery, we complement each other. They build the highway; we construct auxiliary access roads. When the highway gets blocked, the side lanes still reach the destination.”
Early Intervention Is Critical
Professor Bi wants to correct a widespread misconception: many believe diabetic foot only requires treatment once open ulcers develop.
“Early‑stage diabetic foot frequently manifests not as ulcers but peripheral neuropathy: numb, cold feet and blunted sensation. These symptoms essentially stem from ischemia.
Using ultrasound‑guided techniques, we can intervene during the neuropathic phase, improve neural blood supply and reverse disease progression before ulcers form.”
This early‑intervention mindset differentiates regenerative rehabilitation from traditional management approaches.
Professor Bi emphasizes that in‑situ vascular regeneration is not suitable for every patient.
“Patients with long‑segment occlusion above the knee tend to show poorer responses.
Apart from that group, most patients benefit well. Careful evaluation remains essential for elderly individuals and those with poor overall physical status.”
This technology is currently available at Wuhan Jianjia Rehabilitation Hospital, which hosts one of China’s few specialized wound‑rehabilitation wards to support such clinical work.
“While short‑term treatment costs may be relatively high, overall expenditure drops in the long run. Hospital stays can be drastically shortened — conditions that once required two‑month admission may be resolved within days. Limb‑salvage success rates far exceed those of conventional protocols.”
Professor Bi hopes regenerative‑medicine applications within rehabilitation will accelerate further.
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