Abstract
IntroductionChronic wounds are a major health-care issue, but research is limited by the complexity and heterogeneity in terms of wound etiology as well as patient-related factors. A suitable animal model that replicates the situation in humans is not available. Therefore, the aim of the present work is to present a standardized human wound model and the data of a pilot study of topically applied progenitor cells in a sacral pressure sore.MethodsThree patients underwent cell harvest from the iliac crest at the time of the initial debridement. Forty-eight hours after bone marrow harvest and debridement, the CD34+ selected cell suspension was injected into the wound. With the aid of a laser scanner, three-dimensional analyses of wound morphometry were performed until the defect was reconstructed with a local flap 3 weeks after debridement.ResultsDecreases in volume to 60% ± 6% of baseline on the sham side and to 52% ± 3% of baseline on the cell side were measured. Histologic work-up revealed no signs of metaplastic, dysplastic, or neoplastic proliferation/differentiation after progenitor cell treatment. CD34+ cells were detected in the biopsies of day 0.ConclusionsThe pressure sore wound model allows investigation of the initial 3 weeks after cell-based therapy. Objective outcome analysis in terms of wound volume and histology can be performed without, or with, minimal additional morbidity, and the anatomy of the sacral area allows a control and study side in the same patient. Therefore, this model can serve as a standard for wound-healing studies.Trial registrationClinicalTrials.gov NCT00535548.
Highlights
Chronic wounds are a major health-care issue, but research is limited by the complexity and heterogeneity in terms of wound etiology as well as patient-related factors
Promising results have been reported in the treatment of small series of mainly chronic lower-extremity wounds with bone marrow-derived stem cells [2,3,4,5,6,7,8,9]
Patients Of a total of 35 patients presenting with sacral pressure sores between January 2007 and December 2008, three male patients met the restrictive inclusion criteria
Summary
Chronic wounds are a major health-care issue, but research is limited by the complexity and heterogeneity in terms of wound etiology as well as patient-related factors. The rationale behind the use of cell-based therapies—besides the presence of macro- and microvascular disease leading to ischemia and hypoxia or hyperglycemia, infection, and inflammatory reactions and so on—is the fact that cells in chronic wounds are phenotypically altered or senescent or both [10,11]. They have a limited capacity to divide and are less responsive to stimulation by growth factors. The multimodal properties of stem and progenitor cells that create a local environment conductive to wound healing are lacking
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