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Daneste H, Mohammadzadeh Boukani L, Ramezani N, Asadi F, Zaidan HK, Sadeghzade A, Ehsannia M, Azarashk A, Gholizadeh N. Combination therapy along with mesenchymal stem cells in wound healing; the state of the art. Adv Med Sci 2023; 68:441-449. [PMID: 37924749 DOI: 10.1016/j.advms.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/23/2023] [Accepted: 10/17/2023] [Indexed: 11/06/2023]
Abstract
Mesenchymal stem cells (MSCs) are being increasingly used in various therapeutic applications including skin tissue repair and wound healing. The positive effects of the MSCs therapy are largely elicited by immunomodulation, increasing angiogenesis, supporting extracellular matrix (ECM) and thus favoring skin structure. However, the therapeutic competences of MSC-based therapies are somewhat hindered by their apparent modest clinical merits, conferring the need for methods that would rise the efficacy of such therapies. A plethora of reports have shown that therapeutic properties of MSCs could be enhanced with other strategies and compounds like biomaterial and platelet-rich plasma (PRP) to target key possessions of MSCs and properties of adjacent tissues concurrently. Manipulation of cellular stress-response mechanisms to improve cell resistance to oxidative stress prior to or during MSC injection could also improve therapeutic efficacy of MSCs. In the current review, we shed light on the recent advances in MSCs combination therapy with other ingredients and procedures to sustain MSCs-mediated effects in wound healing.
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Affiliation(s)
- Hossein Daneste
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Narges Ramezani
- Department of Biology, Damghan Branch, Islamic Azad University, Damghan, Iran
| | - Fatemeh Asadi
- Department of Genetics, Izeh Branch, Islamic Azad University, Izeh, Iran
| | - Haider Kamil Zaidan
- Department of Medical Laboratories Techniques, Al-Mustaqbal University College, Hillah, Babylon, Iraq
| | - Azita Sadeghzade
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maedeh Ehsannia
- Faculty of Basic Sciences, Islamic Azad University, Tehran East Branch, Tehran, Iran
| | - Ali Azarashk
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Nasim Gholizadeh
- Department of Dermatology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
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Iacopetti I, Perazzi A, Patruno M, Contiero B, Carolo A, Martinello T, Melotti L. Assessment of the quality of the healing process in experimentally induced skin lesions treated with autologous platelet concentrate associated or unassociated with allogeneic mesenchymal stem cells: preliminary results in a large animal model. Front Vet Sci 2023; 10:1219833. [PMID: 37559892 PMCID: PMC10407250 DOI: 10.3389/fvets.2023.1219833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/13/2023] [Indexed: 08/11/2023] Open
Abstract
Regenerative medicine for the treatment of skin lesions is an innovative and rapidly developing field that aims to promote wound healing and restore the skin to its original condition before injury. Over the years, different topical treatments have been evaluated to improve skin wound healing and, among them, mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) have shown promising results for this purpose. This study sought to evaluate the quality of the healing process in experimentally induced full-thickness skin lesions treated with PRP associated or unassociated with MSCs in a sheep second intention wound healing model. After having surgically created full-thickness wounds on the back of three sheep, the wound healing process was assessed by performing clinical evaluations, histopathological examinations, and molecular analysis. Treated wounds showed a reduction of inflammation and contraction along with an increased re-epithelialization rate and better maturation of the granulation tissue compared to untreated lesions. In particular, the combined treatment regulated the expression of collagen types I and III resulting in a proper resolution of the granulation tissue contrary to what was observed in untreated wounds; moreover, it led to a better maturation and organization of skin adnexa and collagen fibers in the repaired skin compared to untreated and PRP-treated wounds. Overall, both treatments improved the wound healing process compared to untreated wounds. Wounds treated with PRP and MSCs showed a healing progression that qualitatively resembles a restitutio ad integrum of the repaired skin, showing features typical of a mature healthy dermis.
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Affiliation(s)
- Ilaria Iacopetti
- Department of Animal Medicine, Production and Health, University of Padua, Padova, Italy
| | - Anna Perazzi
- Department of Animal Medicine, Production and Health, University of Padua, Padova, Italy
| | - Marco Patruno
- Department of Comparative Biomedicine and Food Science, University of Padua, Padova, Italy
| | - Barbara Contiero
- Department of Animal Medicine, Production and Health, University of Padua, Padova, Italy
| | - Anna Carolo
- Department of Comparative Biomedicine and Food Science, University of Padua, Padova, Italy
| | | | - Luca Melotti
- Department of Comparative Biomedicine and Food Science, University of Padua, Padova, Italy
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Adipose-Derived Stem Cell Extracellular Vesicles Improve Wound Closure and Angiogenesis in Diabetic Mice. Plast Reconstr Surg 2023; 151:331-342. [PMID: 36696316 DOI: 10.1097/prs.0000000000009840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Currently, there is a lack in therapy that promotes the reepithelialization of diabetic wounds as an alternative to skin grafting. Here, the authors hypothesized that extracellular vesicles from adipose-derived stem cells (ADSC-EVs) could accelerate wound closure through rescuing the function of keratinocytes in diabetic mice. METHODS The effect of ADSC-EVs on the biological function of human keratinocyte cells was assayed in vitro. In vivo, 81 male severe combined immune deficiency mice aged 8 weeks were divided randomly into the extracellular vesicle-treated diabetes group (n = 27), the phosphate-buffered saline-treated diabetes group (n = 27), and the phosphate-buffered saline-treated normal group (n = 27). A round, 8-mm-diameter, full-skin defect was performed on the back skin of each mouse. The wound closure kinetics, average healing time, reepithelialization rate, and neovascularization were evaluated by histological staining. RESULTS In vitro, ADSC-EVs improved proliferation, migration, and proangiogenic potential, and inhibited the apoptosis of human keratinocyte cells by suppressing Fasl expression with the optimal dose of 40 μg/mL. In vivo, postoperative dripping of ADSC-EVs at the dose of 40 μg/mL accelerated diabetic wound healing, with a 15.8% increase in closure rate and a 3.3-day decrease in average healing time. ADSC-EVs improved reepithelialization (18.2%) with enhanced epithelial proliferation and filaggrin expression, and suppressed epithelial apoptosis and Fasl expression. A 2.7-fold increase in the number of CD31-positive cells was also observed. CONCLUSION ADSC-EVs improve diabetic wound closure and angiogenesis by enhancing keratinocyte-mediated reepithelialization and vascularization. CLINICAL RELEVANCE STATEMENT ADSC-EVs could be developed as a regenerative medicine for diabetic wound care.
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Barakat M, DiPietro LA, Chen L. Limited Treatment Options for Diabetic Wounds: Barriers to Clinical Translation Despite Therapeutic Success in Murine Models. Adv Wound Care (New Rochelle) 2021; 10:436-460. [PMID: 33050829 PMCID: PMC8236303 DOI: 10.1089/wound.2020.1254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/12/2020] [Indexed: 12/15/2022] Open
Abstract
Significance: Millions of people worldwide suffer from diabetes mellitus and its complications, including chronic diabetic wounds. To date, there are few widely successful clinical therapies specific to diabetic wounds beyond general wound care, despite the vast number of scientific discoveries in the pathogenesis of defective healing in diabetes. Recent Advances: In recent years, murine animal models of diabetes have enabled the investigation of many possible therapeutics for diabetic wound care. These include specific cell types, growth factors, cytokines, peptides, small molecules, plant extracts, microRNAs, extracellular vesicles, novel wound dressings, mechanical interventions, bioengineered materials, and more. Critical Issues: Despite many research discoveries, few have been translated from their success in murine models to clinical use in humans. This massive gap between bench discovery and bedside application begs the simple and critical question: what is still missing? The complexity and multiplicity of the diabetic wound makes it an immensely challenging therapeutic target, and this lopsided progress highlights the need for new methods to overcome the bench-to-bedside barrier. How can laboratory discoveries in animal models be effectively translated to novel clinical therapies for human patients? Future Directions: As research continues to decipher deficient healing in diabetes, new approaches and considerations are required to ensure that these discoveries can become translational, clinically usable therapies. Clinical progress requires the development of new, more accurate models of the human disease state, multifaceted investigations that address multiple critical components in wound repair, and more innovative research strategies that harness both the existing knowledge and the potential of new advances across disciplines.
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Affiliation(s)
- May Barakat
- Center for Wound Repair and Tissue Regeneration, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Luisa A. DiPietro
- Center for Wound Repair and Tissue Regeneration, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lin Chen
- Center for Wound Repair and Tissue Regeneration, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
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5
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Kuffler DP. Eliminating non-healing wounds: a review. Regen Med 2021; 16:391-404. [PMID: 33876695 DOI: 10.2217/rme-2020-0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Non-healing cutaneous wounds, including pressure, diabetic and venous ulcers, are wounds where the skin and underlying tissues die due to ischemia, infection, metabolic conditions, immunosuppression or radiation. Some can be eliminated with relatively straightforward techniques, although they may continue to grow in diameter and depth, becoming increasingly painful and never heal. Others respond more slowly or poorly to treatment, while others are recalcitrant to treatments. This review examines the etiology of non-healing wounds and different wound management treatments. In addition, it examines the efficacy of platelet-rich plasma in promoting wound healing and its potential mechanisms of action. It is concluded that platelet-rich plasma alone, but more effectively when combined with another technique(s), has the greatest potential for promoting complete wound healing. However, further studies are required to determine whether the efficacy of wound healing induced by each of these techniques is enhanced by applying the techniques simultaneously.
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Affiliation(s)
- Damien P Kuffler
- Institute of Neurobiology, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico 00901, USA
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Navarro R, Pino A, Martínez-Andrés A, Garrigós E, Sánchez ML, Gallego E, Anitua E. Combined therapy with Endoret-Gel and plasma rich in growth factors vs Endoret-Gel alone in the management of facial rejuvenation: A comparative study. J Cosmet Dermatol 2020; 19:2616-2626. [PMID: 32757356 DOI: 10.1111/jocd.13661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Skin suffers progressive decrement. An endogenous regenerative technology has been developed that has the versatility to provide an autologous injectable gel (Endoret-Gel) or a liquid plasma rich in growth factors (PRGF) based on the patient´s own platelet-rich plasma. AIMS To compare the efficacy of the combined therapy with Endoret-Gel and PRGF versus Endoret-Gel alone in the management of facial rejuvenation. METHODS Twenty clinically diagnosed patients with aged skin received either Endoret-Gel monotherapy or Endoret-Gel + PRGF combined therapy. Patients underwent three sessions at one-month intervals and were clinically assessed for six months. Corneometry, sebumetry, and high-resolution topographic analysis were carried out. Patient self-assessment questionnaires and clinical improvement scores were also performed. RESULTS The combined therapy showed to promote a higher hydration index. These results were also significant for spot improvement at three months, while conversely, monotherapy with Endoret-Gel demonstrated higher UV spot improvement. A significant decrease of sebum production and wrinkle development was observed for both treatment groups. Red areas also improved in a similar way at the end of the follow-up period. After Endoret-Gel or Endoret-Gel + PRGF therapy, 30% and 70% of patients referred to be very satisfied, respectively. Accordingly, 40% and 80% showed a "very improved" esthetic performance. None of the patients reported a negative change and no adverse events were recorded. CONCLUSION Both Endoret-Gel monotherapy and the combined treatment with PRGF were shown to promote facial rejuvenation and to palliate the age-related cutaneous atrophy. The combined therapy may exert a synergistic effect that addresses both skin quality improvement and soft tissue restoration in a shorter period.
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Affiliation(s)
| | - Ander Pino
- BTI Biotechnology Institute, Vitoria, Spain
| | | | | | | | | | - Eduardo Anitua
- BTI Biotechnology Institute, Vitoria, Spain.,Eduardo Anitua Foundation, Vitoria, Spain
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Anitua E, Pino A, Zalduendo M. Long-term stability of a novel platelet-rich plasma-based topical serum for cutaneous applications. J Cosmet Dermatol 2020; 20:854-861. [PMID: 32654407 DOI: 10.1111/jocd.13617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Skin alterations are usually related to chronic diseases that demand sustained and long-term dosages; hence, it is pivotal that the stability of treatments is preserved. A novel storable and endogenous topical serum (ES) based on the patient's own blood has been recently developed. AIMS To investigate the long-term stability of the formulation and to provide preliminary data of its biologic potential. METHODS Samples from six donors were obtained and either used as fresh samples or cold-stored for 6 months. Physicochemical, rheological, and biological stability of the formulation was determined. RESULTS Endogenous topical serum maintained unaltered its organoleptic properties, viscosity, pH, spreadability index, and sterility. The growth factor content including TGFβ-I, EGF, PDGF-AB, HGF, and Ang-I showed no decrease. In contrast, ES showed lower levels of IGF-I once stored. Dermal fibroblasts showed no change in their proliferative activity. CONCLUSION Endogenous topical serum showed to maintain its physicochemical and biological properties after six months of storage. ES might reduce the frequency of blood extractions and would enable patients with chronic disorders to maintain a daily use of the product in a minimally invasive way.
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Affiliation(s)
| | - Ander Pino
- BTI Biotechnology Institute, Vitoria, Spain
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8
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Black L, Zorina T. Cell-based immunomodulatory therapy approaches for type 1 diabetes mellitus. Drug Discov Today 2020; 25:380-391. [DOI: 10.1016/j.drudis.2019.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/11/2019] [Accepted: 11/30/2019] [Indexed: 12/14/2022]
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A Human Umbilical Cord Mesenchymal Stem Cell-Conditioned Medium/Chitosan/Collagen/ β-Glycerophosphate Thermosensitive Hydrogel Promotes Burn Injury Healing in Mice. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5768285. [PMID: 31886229 PMCID: PMC6915016 DOI: 10.1155/2019/5768285] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/24/2019] [Indexed: 01/02/2023]
Abstract
We investigated the effects of a human umbilical cord mesenchymal stem cell-conditioned medium (MSC-CM)/chitosan/collagen/β-glycerophosphate (β-GP) thermosensitive hydrogel (MSC-CM/hydrogel) on mice with third-degree burns. MSC-CM was collected and mixed with chitosan, collagen, and β-GP to generate the thermosensitive MSC-CM/hydrogel, which was stored in the liquid phase at 4°C. The wounds of established third-degree burned mice were then externally covered with the MSC-CM/hydrogel, which formed a gel when placed on the wounds at physiological temperature. Injured mice in three additional groups were treated with unconditioned MSC medium (UM), MSC-CM, or UM/chitosan/collagen/β-GP thermosensitive hydrogels. Skin wound samples were obtained 4, 14, and 28 days after burning for further analysis by hematoxylin and eosin and Ki-67 staining. Wound healing rates and times, in addition to immunohistochemical results, were then compared and analyzed among the four groups. Application of the MSC-CM/hydrogel shortened healing time, limited the area of inflammation, enhanced reepithelialization, promoted the formation of high-quality, well-vascularized granulation tissue, and attenuated the formation of fibrotic and hypertrophic scar tissue. In summary, MSC-CM/hydrogel effectively promotes wound healing in third-degree burned mice.
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10
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Anitua E, Troya M, Pino A. A novel protein-based autologous topical serum for skin regeneration. J Cosmet Dermatol 2019; 19:705-713. [PMID: 31397540 DOI: 10.1111/jocd.13075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/06/2019] [Accepted: 03/18/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND As skin ages, a functional decrement occurs. To avoid future vulnerability to dermatologic diseases, an optimal cutaneous regeneration is mandatory. Biological therapies based on blood-derived autologous proteins are gaining attention of scientists and dermatologists. OBJECTIVES A novel 100% autologous topical serum has been developed using plasma rich in growth factors technology. The physicochemical characterization and the biologic potential of the novel formulation have been studied. METHODS Rheological and mechanical properties and the biological capacity of the formulation were characterized. Human dermal fibroblast culture and 3D organotypic skin explants were used as in vitro and ex vivo cutaneous models, respectively. RESULTS The autologous topical serum presented an optimal spreadability index and appropriate shear thinning behavior that allowed an easy handling and rapid integration within the cutaneous tissue. The formulation has a high growth factor load with the ability to progressively penetrate into the dermal/epidermal layers of the skin. It is biocompatible and promotes cell proliferation and chemotactic activity. The autologous topical serum promotes the biosynthetic activity of cells by the stimulation of collagen and hyaluronic acid expression. CONCLUSIONS These findings present an in situ and easy to prepare autologous topical serum based on the patient's own blood with physicochemical and bioactive properties that may be used for skin regeneration purposes.
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Affiliation(s)
- Eduardo Anitua
- Eduardo Anitua Foundation, Vitoria, Spain.,BTI - Biotechnology Institute, Vitoria, Spain
| | - María Troya
- BTI - Biotechnology Institute, Vitoria, Spain
| | - Ander Pino
- BTI - Biotechnology Institute, Vitoria, Spain
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Huber SC, Junior JLRC, Silva LQ, Montalvão SAL, Annichino-Bizzacchi JM. Freeze-dried versus fresh platelet-rich plasma in acute wound healing of an animal model. Regen Med 2019; 14:525-534. [PMID: 31115259 DOI: 10.2217/rme-2018-0119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Aim: To compare freeze-dried and fresh platelet-rich plasma (PRP) preparations, in a pre-clinical study. Materials & methods: 30 Wistar male rats were used to compare and characterize human PRP which was applied at the perilesional area in an acute wound model, evaluated by macroscopical and histological analysis. Results: Despite the increased growth factor concentration after the freeze-drying process, no change in the healing kinetics was observed in vivo. Nevertheless, a significant increased number of myofibroblasts was demonstrated in comparison with the fresh PRP group. We also demonstrated a significant increased percentage of blood vessels in comparison with controls in both the superficial and deep epidermis. Conclusion: These results encourage randomized clinical trials to evaluate the effectiveness of freeze-dried PRP for skin ulcer treatment.
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Affiliation(s)
- Stephany C Huber
- Hemocentro, Haemostasis Laboratory, State University of Campinas - UNICAMP, 13083-970, Campinas, São Paulo, Brazil
| | - José Luiz R C Junior
- Hemocentro, Haemostasis Laboratory, State University of Campinas - UNICAMP, 13083-970, Campinas, São Paulo, Brazil
| | - Letícia Q Silva
- Hemocentro, Haemostasis Laboratory, State University of Campinas - UNICAMP, 13083-970, Campinas, São Paulo, Brazil
| | - Silmara A L Montalvão
- Hemocentro, Haemostasis Laboratory, State University of Campinas - UNICAMP, 13083-970, Campinas, São Paulo, Brazil
| | - Joyce M Annichino-Bizzacchi
- Hemocentro, Haemostasis Laboratory, State University of Campinas - UNICAMP, 13083-970, Campinas, São Paulo, Brazil
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Combined plasma rich in growth factors and adipose-derived mesenchymal stem cells promotes the cutaneous wound healing in rabbits. BMC Vet Res 2018; 14:288. [PMID: 30241533 PMCID: PMC6151009 DOI: 10.1186/s12917-018-1577-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 08/16/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The use of Plasma Rich in Growth Factors (PRGF) and Adipose Derived Mesenchymal Stem Cells (ASCs) are today extensively studied in the field of regenerative medicine. In recent years, human and veterinary medicine prefer to avoid using traumatic techniques and choose low or non-invasive procedures. The objective of this study was to evaluate the efficacy of PRGF, ASCs and the combination of both in wound healing of full-thickness skin defects in rabbits. With this purpose, a total of 144 rabbits were used for this study. The animals were divided in three study groups of 48 rabbits each depending on the administered treatment: PRGF, ASCs, and PGRF+ASCs. Two wounds of 8 mm of diameter and separated from each other by 20 mm were created on the back of each rabbit: the first was treated with saline solution, and the second with the treatment assigned for each group. Macroscopic and microscopic evolution of wounds was assessed at 1, 2, 3, 5, 7 and 10 days post-surgery. With this aim, 8 animals from each treatment group and at each study time were euthanized to collect wounds for histopathological study. RESULTS Wounds treated with PRGF, ASCs and PRGF+ASCs showed significant higher wound healing and epithelialization rates, more natural aesthetic appearance, significant lower inflammatory response, significant higher collagen deposition and angiogenesis compared with control wounds. The combined treatment PRGF+ASCs showed a significant faster cutaneous wound healing process. CONCLUSIONS The combined treatment PRGF+ASCs showed the best results, suggesting this is the best choice to enhance wound healing and improve aesthetic results in acute wounds.
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Lopes L, Setia O, Aurshina A, Liu S, Hu H, Isaji T, Liu H, Wang T, Ono S, Guo X, Yatsula B, Guo J, Gu Y, Navarro T, Dardik A. Stem cell therapy for diabetic foot ulcers: a review of preclinical and clinical research. Stem Cell Res Ther 2018; 9:188. [PMID: 29996912 PMCID: PMC6042254 DOI: 10.1186/s13287-018-0938-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/15/2018] [Accepted: 06/20/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Diabetic foot ulcer (DFU) is a severe complication of diabetes, preceding most diabetes-related amputations. DFUs require over US$9 billion for yearly treatment and are now a global public health issue. DFU occurs in the setting of ischemia, infection, neuropathy, and metabolic disorders that result in poor wound healing and poor treatment options. Recently, stem cell therapy has emerged as a new interventional strategy to treat DFU and appears to be safe and effective in both preclinical and clinical trials. However, variability in the stem cell type and origin, route and protocol for administration, and concomitant use of angioplasty confound easy interpretation and generalization of the results. METHODS The PubMed, Google Scholar, and EMBASE databases were searched and 89 preclinical and clinical studies were selected for analysis. RESULTS There was divergence between preclinical and clinical studies regarding stem cell type, origin, and delivery techniques. There was heterogeneous preclinical and clinical study design and few randomized clinical trials. Granulocyte-colony stimulating factor was employed in some studies but with differing protocols. Concomitant performance of angioplasty with stem cell therapy showed increased efficiency compared to either therapy alone. CONCLUSIONS Stem cell therapy is an effective treatment for diabetic foot ulcers and is currently used as an alternative to amputation for some patients without other options for revascularization. Concordance between preclinical and clinical studies may help design future randomized clinical trials.
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Affiliation(s)
- Lara Lopes
- Vascular Biology and Therapeutics Program and Department of Surgery , Yale School of Medicine, Yale University, New Haven, CT USA
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ocean Setia
- Vascular Biology and Therapeutics Program and Department of Surgery , Yale School of Medicine, Yale University, New Haven, CT USA
| | - Afsha Aurshina
- Vascular Biology and Therapeutics Program and Department of Surgery , Yale School of Medicine, Yale University, New Haven, CT USA
| | - Shirley Liu
- Vascular Biology and Therapeutics Program and Department of Surgery , Yale School of Medicine, Yale University, New Haven, CT USA
| | - Haidi Hu
- Vascular Biology and Therapeutics Program and Department of Surgery , Yale School of Medicine, Yale University, New Haven, CT USA
| | - Toshihiko Isaji
- Vascular Biology and Therapeutics Program and Department of Surgery , Yale School of Medicine, Yale University, New Haven, CT USA
| | - Haiyang Liu
- Vascular Biology and Therapeutics Program and Department of Surgery , Yale School of Medicine, Yale University, New Haven, CT USA
| | - Tun Wang
- Vascular Biology and Therapeutics Program and Department of Surgery , Yale School of Medicine, Yale University, New Haven, CT USA
| | - Shun Ono
- Vascular Biology and Therapeutics Program and Department of Surgery , Yale School of Medicine, Yale University, New Haven, CT USA
| | - Xiangjiang Guo
- Vascular Biology and Therapeutics Program and Department of Surgery , Yale School of Medicine, Yale University, New Haven, CT USA
| | - Bogdan Yatsula
- Vascular Biology and Therapeutics Program and Department of Surgery , Yale School of Medicine, Yale University, New Haven, CT USA
| | - Jianming Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tulio Navarro
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Alan Dardik
- Vascular Biology and Therapeutics Program and Department of Surgery , Yale School of Medicine, Yale University, New Haven, CT USA
- VA Connecticut Healthcare System, West Haven, CT USA
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Mahmoudian-Sani MR, Rafeei F, Amini R, Saidijam M. The effect of mesenchymal stem cells combined with platelet-rich plasma on skin wound healing. J Cosmet Dermatol 2018; 17:650-659. [PMID: 29504236 DOI: 10.1111/jocd.12512] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Mesenchymal stem cells (MSCs) are multipotent stem cells that have the potential of proliferation, high self-renewal, and the potential of multilineage differentiation. The differentiation potential of the MSCs in vivo and in vitro has caused these cells to be regarded as potentially appropriate tools for wound healing. After the burn, trauma or removal of the tumor of wide wounds is developed. Although standard treatment for skin wounds is primary healing or skin grafting, they are not always practical mainly because of limited autologous skin grafting. EVIDENCE ACQUISITIONS Directory of Open Access Journals (DOAJ), Google Scholar, PubMed (NLM), LISTA (EBSCO), and Web of Science have been searched. EVIDENCE SYNTHESIS For clinical use of the MSCs in wound healing, two key issues should be taken into account: First, engineering biocompatible scaffolds clinical use of which leads to the least amount of side effects without any immunologic response and secondly, use of stem cells secretions with the least amount of clinical complications despite their high capability of healing damage. CONCLUSION In light of the MSCs' high capability of proliferation and multilineage differentiation as well as their significant role in modulating immunity, these cells can be used in combination with tissue engineering techniques. Moreover, the MSCs' secretions can be used in cell therapy to heal many types of wounds. The combination of MSCs and PRP aids wound healing which could potentially be used to promote wound healing.
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Affiliation(s)
| | - Fatemeh Rafeei
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Razieh Amini
- Department of Genetics and Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Massoud Saidijam
- Department of Genetics and Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Yan W, Liu H, Deng X, Jin Y, Wang N, Chu J. Acellular dermal matrix scaffolds coated with connective tissue growth factor accelerate diabetic wound healing by increasing fibronectin through PKC signalling pathway. J Tissue Eng Regen Med 2017; 12:e1461-e1473. [DOI: 10.1002/term.2564] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 07/31/2017] [Accepted: 08/25/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Wenxia Yan
- College of BiophotonicsSouth China Normal University Guangzhou China
| | - Hanping Liu
- College of BiophotonicsSouth China Normal University Guangzhou China
| | - Xiaoyuan Deng
- College of BiophotonicsSouth China Normal University Guangzhou China
| | - Ying Jin
- College of BiophotonicsSouth China Normal University Guangzhou China
| | - Ning Wang
- College of BiophotonicsSouth China Normal University Guangzhou China
| | - Jing Chu
- College of BiophotonicsSouth China Normal University Guangzhou China
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16
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Rocha MADC, Silva LMC, Oliveira WAD, Bezerra DDO, Silva GCD, Silva LDS, Medeiros BLDN, Baêta SDAF, Carvalho MAMD, Argôlo NM. Allogeneic mesenchymal stem cells and xenogenic platelet rich plasma, associated or not, in the repair of bone failures in rabbits with secondary osteoporosis. Acta Cir Bras 2017; 32:767-780. [PMID: 29019594 DOI: 10.1590/s0102-865020170090000009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/18/2017] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To assess the efficacy of allogeneic mesenchymal stem cells and xenogenic platelet rich plasma in the treatment of bone failure of osteoporotic rabbits secondary to estrogenic deprivation and iatrogenic hypercortisolism. METHODS Eight female rabbits underwent ovarian resection and corticoid therapy to induce clinical status of osteoporosis. Four failures were produced in the tibiae, with each failure being treated with hemostatic sponge, allogenic mesenchymal stem cells, xenogenic platelet-rich plasma and the association between both. The animals were divided into two groups, evaluated radiographically and histopathologically at 30 and 60 days post treatment. RESULTS A radiographically confirmed consolidation of bone failures treated with allogeneic mesenchymal stem cells, associated with the histopathological image of mature and immature bone tissue, without evidence of osteopenia, was compared with the other groups, in which radiolucent failures with osteopenia and fibrosis were still present, denoting the satisfactory effect of the first treatment in detriment to the others. CONCLUSION The treatment of bone failures of rabbits with secondary osteoporosis with allogeneic mesenchymal stem cells induced greater bone consolidation with mature and immature bone tissue production (p<0.01), when compared to the other treatments.
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Affiliation(s)
- Mariá Andrade de Carvalho Rocha
- Fellow Master degree, Postgraduate Program in Animal Science, Universidade Federal do Piauí (UFPI), Teresina-PI, Brazil. Radiography, technical procedures, obtaining platelet-rich plasma
| | - Laís Meireles Costa Silva
- Fellow Master degree, Postgraduate Program in Animal Science, Universidade Federal do Piauí (UFPI), Teresina-PI, Brazil. Radiography, technical procedures, obtaining platelet-rich plasma
| | - Wellson Andrade de Oliveira
- Fellow Master degree, Postgraduate Program in Animal Science, Universidade Federal do Piauí (UFPI), Teresina-PI, Brazil. Radiography, technical procedures, obtaining platelet-rich plasma
| | - Dayseanny de Oliveira Bezerra
- Fellow PhD degree, Postgraduate Program in Animal Science, UFPI, Teresina-PI, Brazil. Anesthetic, technical procedures
| | - Gustavo Cardoso da Silva
- Fellow PhD degree, Northeast Network of Biotechnology, UFPI, Teresina-PI, Brazil. Computerized image analysis
| | - Lucilene Dos Santos Silva
- Fellow Postdoctoral degree, National Postdoctoral Program (PNPD/CNPq), UFPI, Teresina-PI, Brazil. Photomicrographs and histopathological examinations
| | | | - Sílvia de Araújo França Baêta
- PhD, Associate Professor, Department of Clinical and Veterinary Surgery, UFPI, Teresina-PI, Brazil. Histopathological examinations, supervised all phases of the study
| | | | - Napoleão Martins Argôlo
- PhD, Associate Professor, Department of Clinical and Veterinary Surgery, UFPI, Teresina-PI, Brazil. Design of the study, supervised all phases of the study
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17
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Liu H, Liu H, Deng X, Chen M, Han X, Yan W, Wang N. CXCR4 antagonist delivery on decellularized skin scaffold facilitates impaired wound healing in diabetic mice by increasing expression of SDF-1 and enhancing migration of CXCR4-positive cells. Wound Repair Regen 2017; 25:652-664. [PMID: 28783870 DOI: 10.1111/wrr.12552] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/25/2017] [Indexed: 01/07/2023]
Abstract
C-X-C chemokine receptor type 4 (CXCR4) is an alpha-chemokine receptor specific for stromal cell-derived factor 1 (SDF-1 also called CXCL12). The antagonist of CXCR4 can mobilize CD34+ cells and hematopoietic stem cells from bone marrow within several hours, and it has an efficacy on diabetes ulcer through acting on the SDF-1/CXCR4 axis. In this study, we investigated for the first time whether the antagonist of CXCR4 (Plerixafor/AMD3100) delivered on acellular dermal matrix (ADM) may accelerate diabetes-impaired wound healing. ADM scaffolds were fabricated from nondiabetic mouse skin through decellularization processing and incorporated with AMD3100 to construct ADM-AMD3100 scaffold. Full-thickness cutaneous wound in streptozotocin (STZ)-induced diabetic mice were treated with ADM, AMD3100, or ADM-AMD3100. 21 days after treatment, wound closure in ADM-AMD3100-treated mice was more complete than ADM group and AMD3100 group, and it was accompanied by thicker collagen formation. Correspondingly, diabetic mice treated with ADM-AMD3100 demonstrated prominent neovascularization (higher capillary density and vascular smooth muscle actin), which were accompanied by up-regulated mRNA levels of SDF-1 and enhanced migration of CXCR4 in the granulation tissue. Our results demonstrate that ADM scaffold provide perfect niche for loading AMD3100 and ADM-AMD3100 is a promising method for diabetic wound healing mainly by increasing expression of SDF-1 and enhancing migration of CXCR4-positive cells.
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Affiliation(s)
- Hao Liu
- College of Biophotonics, South China Normal University, Guangzhou, China
| | - Hanping Liu
- College of Biophotonics, South China Normal University, Guangzhou, China
| | - Xiaoyuan Deng
- College of Biophotonics, South China Normal University, Guangzhou, China
| | - Maosheng Chen
- College of Biophotonics, South China Normal University, Guangzhou, China
| | - Xue Han
- College of Biophotonics, South China Normal University, Guangzhou, China
| | - Wenxia Yan
- College of Biophotonics, South China Normal University, Guangzhou, China
| | - Ning Wang
- College of Biophotonics, South China Normal University, Guangzhou, China
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18
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van de Vyver M. Intrinsic Mesenchymal Stem Cell Dysfunction in Diabetes Mellitus: Implications for Autologous Cell Therapy. Stem Cells Dev 2017; 26:1042-1053. [DOI: 10.1089/scd.2017.0025] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mari van de Vyver
- Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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19
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Raman spectroscopy enables noninvasive biochemical identification of the collagen regeneration in cutaneous wound healing of diabetic mice treated with MSCs. Lasers Med Sci 2017; 32:1131-1141. [DOI: 10.1007/s10103-017-2218-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
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20
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Zorzopulos J, Opal SM, Hernando-Insúa A, Rodriguez JM, Elías F, Fló J, López RA, Chasseing NA, Lux-Lantos VA, Coronel MF, Franco R, Montaner AD, Horn DL. Immunomodulatory oligonucleotide IMT504: Effects on mesenchymal stem cells as a first-in-class immunoprotective/immunoregenerative therapy. World J Stem Cells 2017; 9:45-67. [PMID: 28396715 PMCID: PMC5368622 DOI: 10.4252/wjsc.v9.i3.45] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/12/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023] Open
Abstract
The immune responses of humans and animals to insults (i.e., infections, traumas, tumoral transformation and radiation) are based on an intricate network of cells and chemical messengers. Abnormally high inflammation immediately after insult or abnormally prolonged pro-inflammatory stimuli bringing about chronic inflammation can lead to life-threatening or severely debilitating diseases. Mesenchymal stem cell (MSC) transplant has proved to be an effective therapy in preclinical studies which evaluated a vast diversity of inflammatory conditions. MSCs lead to resolution of inflammation, preparation for regeneration and actual regeneration, and then ultimate return to normal baseline or homeostasis. However, in clinical trials of transplanted MSCs, the expectations of great medical benefit have not yet been fulfilled. As a practical alternative to MSC transplant, a synthetic drug with the capacity to boost endogenous MSC expansion and/or activation may also be effective. Regarding this, IMT504, the prototype of a major class of immunomodulatory oligonucleotides, induces in vivo expansion of MSCs, resulting in a marked improvement in preclinical models of neuropathic pain, osteoporosis, diabetes and sepsis. IMT504 is easily manufactured and has an excellent preclinical safety record. In the small number of patients studied thus far, IMT504 has been well-tolerated, even at very high dosage. Further clinical investigation is necessary to demonstrate the utility of IMT504 for resolution of inflammation and regeneration in a broad array of human diseases that would likely benefit from an immunoprotective/immunoregenerative therapy.
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21
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Anitua E, Pino A, Orive G. Plasma rich in growth factors promotes dermal fibroblast proliferation, migration and biosynthetic activity. J Wound Care 2016; 25:680-687. [DOI: 10.12968/jowc.2016.25.11.680] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- E. Anitua
- Eduardo Anitua Foundation, Vitoria, Spain
- BTI Biotechnology Institute, Vitoria, Spain
| | - A. Pino
- Eduardo Anitua Foundation, Vitoria, Spain
| | - G. Orive
- Eduardo Anitua Foundation, Vitoria, Spain
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22
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Mesenchymal Stem Cells as a Prospective Therapy for the Diabetic Foot. Stem Cells Int 2016; 2016:4612167. [PMID: 27867398 PMCID: PMC5102750 DOI: 10.1155/2016/4612167] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 09/28/2016] [Accepted: 10/10/2016] [Indexed: 12/14/2022] Open
Abstract
The diabetic foot is a serious complication of diabetes. Mesenchymal stem cells are an abundant source of stem cells which occupy a special position in cell therapies, and recent studies have suggested that mesenchymal stem cells can play essential roles in treatments for the diabetic foot. Here, we discuss the advances that have been made in mesenchymal stem cell treatments for this condition. The roles and functional mechanisms of mesenchymal stem cells in the diabetic foot are also summarized, and insights into current and future studies are presented.
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23
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Gelatin and galactomannan-based scaffolds: Characterization and potential for tissue engineering applications. Carbohydr Polym 2015; 133:8-18. [DOI: 10.1016/j.carbpol.2015.06.039] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 06/10/2015] [Accepted: 06/12/2015] [Indexed: 11/18/2022]
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24
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Picard F, Hersant B, Bosc R, Meningaud JP. The growing evidence for the use of platelet-rich plasma on diabetic chronic wounds: A review and a proposal for a new standard care. Wound Repair Regen 2015; 23:638-43. [PMID: 26019054 DOI: 10.1111/wrr.12317] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 05/22/2015] [Indexed: 01/29/2023]
Abstract
Nonhealing chronic wounds and exposed tendons, bones and joints are very challenging to cure specially for diabetic patients. Plastic surgeons have a new weapon to enhance wound healing with the use of autologous growth factors. Recently, the process of fabrication of platelet-rich plasma (PRP) has been simplified. The goal of this literature review is to summarize the evidenced-based body of knowledge regarding the treatment of diabetic chronic wounds by PRP. A PubMed and Cochrane search (1978-2015) was performed and all studies assessing the clinical effect of PRP on the healing of diabetic chronic wounds were included. The screening retrieved 7,555 articles and 12 studies were included. On six randomized studies included, five found significant benefits for the use of PRP on diabetic chronic foot ulcers and the sixth randomized study did not publish a statistical analysis but found favorable outcomes. The two other controlled studies included found significant benefits regarding the healing rate and the four uncontrolled studies included showed high rates of healing with the adjunction of PRP. Regarding the method of use, PRP was applied on the wound as a gel twice a week (41.7% of studies) or once a week (33.3% of studies). In conclusion, 87.5% of controlled studies found a significant benefit for the adjunction of PRP to treat chronic diabetic wounds. As PRP may be beneficial, we suggest using PRP on diabetic ulcers which remain unhealed after standard treatment.
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Affiliation(s)
- Frédéric Picard
- Department of Plastic & Reconstructive Surgery, Henri Mondor Hospital, Créteil, France
| | - Barbara Hersant
- Department of Plastic & Reconstructive Surgery, Henri Mondor Hospital, Créteil, France
| | - Romain Bosc
- Department of Plastic & Reconstructive Surgery, Henri Mondor Hospital, Créteil, France
| | - Jean-Paul Meningaud
- Department of Plastic & Reconstructive Surgery, Henri Mondor Hospital, Créteil, France
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25
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Li M, Zhao Y, Hao H, Han W, Fu X. Mesenchymal stem cell-based therapy for nonhealing wounds: today and tomorrow. Wound Repair Regen 2015; 23:465-82. [PMID: 25877885 DOI: 10.1111/wrr.12304] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 03/09/2015] [Accepted: 03/30/2015] [Indexed: 12/31/2022]
Abstract
Although advancements have been made with traditional therapies, the treatment of chronic nonhealing wounds still remains a tough challenge. In the past two decades, mesenchymal stem cell (MSC)-based therapy has emerged as a promising therapeutic strategy for nonhealing wounds because of their characteristics including self-renewal and a multidirectional differentiation ability and their easy collection and weak immunogenicity. There is a growing body of basic scientific studies that shed light on the functional mechanism of MSCs in modulating nonhealing wounds. Furthermore, critical advances have been achieved using MSC-based therapy in preclinical animal models as well as in clinics trials. In this present review, we summarize the mechanisms of MSCs and highlight the important preclinical and clinical trials of MSC therapy for nonhealing wounds. In particular, the combination of MSCs transplantation and tissue-engineered skin is addressed as a new strategy to optimize the delivery efficiency and therapeutic potential. Additionally, the current drawbacks of MSC therapy and the potential to further optimize the use of MSCs are implied.
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Affiliation(s)
- Meirong Li
- Wound Healing and Cell Biology Laboratory, Institute of Basic Medical Science, Chinese PLA General Hospital, Beijing, Peoples Republic of China.,Trauma Treatment Center, Central Laboratory, Chinese PLA General Hospital Hainan Branch, Sanya, Peoples Republic of China
| | - Yali Zhao
- Wound Healing and Cell Biology Laboratory, Institute of Basic Medical Science, Chinese PLA General Hospital, Beijing, Peoples Republic of China.,Trauma Treatment Center, Central Laboratory, Chinese PLA General Hospital Hainan Branch, Sanya, Peoples Republic of China
| | - Haojie Hao
- Wound Healing and Cell Biology Laboratory, Institute of Basic Medical Science, Chinese PLA General Hospital, Beijing, Peoples Republic of China
| | - Weidong Han
- Wound Healing and Cell Biology Laboratory, Institute of Basic Medical Science, Chinese PLA General Hospital, Beijing, Peoples Republic of China
| | - Xiaobing Fu
- Wound Healing and Cell Biology Laboratory, Institute of Basic Medical Science, Chinese PLA General Hospital, Beijing, Peoples Republic of China
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26
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Kuffler DP. Platelet-Rich Plasma Promotes Axon Regeneration, Wound Healing, and Pain Reduction: Fact or Fiction. Mol Neurobiol 2015; 52:990-1014. [PMID: 26048672 DOI: 10.1007/s12035-015-9251-x] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Indexed: 11/25/2022]
Abstract
Platelet-rich plasma (PRP) has been tested in vitro, in animal models, and clinically for its efficacy in enhancing the rate of wound healing, reducing pain associated with injuries, and promoting axon regeneration. Although extensive data indicate that PRP-released factors induce these effects, the claims are often weakened because many studies were not rigorous or controlled, the data were limited, and other studies yielded contrary results. Critical to assessing whether PRP is effective are the large number of variables in these studies, including the method of PRP preparation, which influences the composition of PRP; type of application; type of wounds; target tissues; and diverse animal models and clinical studies. All these variables raise the question of whether one can anticipate consistent influences and raise the possibility that most of the results are correct under the circumstances where PRP was tested. This review examines evidence on the potential influences of PRP and whether PRP-released factors could induce the reported influences and concludes that the preponderance of evidence suggests that PRP has the capacity to induce all the claimed influences, although this position cannot be definitively argued. Well-defined and rigorously controlled studies of the potential influences of PRP are required in which PRP is isolated and applied using consistent techniques, protocols, and models. Finally, it is concluded that, because of the purported benefits of PRP administration and the lack of adverse events, further animal and clinical studies should be performed to explore the potential influences of PRP.
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Affiliation(s)
- Damien P Kuffler
- Institute of Neurobiology, University of Puerto Rico, Medical Sciences Campus, 201 Blvd. Del Valle, San Juan, 00901, Puerto Rico,
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27
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Isakson M, de Blacam C, Whelan D, McArdle A, Clover AJP. Mesenchymal Stem Cells and Cutaneous Wound Healing: Current Evidence and Future Potential. Stem Cells Int 2015; 2015:831095. [PMID: 26106431 PMCID: PMC4461792 DOI: 10.1155/2015/831095] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/07/2015] [Indexed: 01/09/2023] Open
Abstract
Human skin is a remarkable organ that sustains insult and injury throughout life. The ability of skin to expeditiously repair wounds is paramount to survival. With an aging global population, coupled with a rise in the prevalence of conditions such as diabetes, chronic wounds represent a significant biomedical burden. Mesenchymal stem cells (MSC), a progenitor cell population of the mesoderm lineage, have been shown to be significant mediators in inflammatory environments. Preclinical studies of MSC in various animal wound healing models point towards a putative therapy. This review examines the body of evidence suggesting that MSC accelerate wound healing in both clinical and preclinical studies and also the possible mechanisms controlling its efficacy. The delivery of a cellular therapy to the masses presents many challenges from a safety, ethical, and regulatory point of view. Some of the issues surrounding the introduction of MSC as a medicinal product are also delineated in this review.
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Affiliation(s)
- M. Isakson
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - C. de Blacam
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - D. Whelan
- Centre for Research in Vascular Biology, University College Cork, Cork, Ireland
| | - A. McArdle
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - A. J. P. Clover
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
- Centre for Research in Vascular Biology, University College Cork, Cork, Ireland
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28
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Moroz A, Deffune E. Platelet-rich plasma and chronic wounds: remaining fibronectin may influence matrix remodeling and regeneration success. Cytotherapy 2013; 15:1436-9. [DOI: 10.1016/j.jcyt.2013.05.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/09/2013] [Accepted: 05/27/2013] [Indexed: 11/17/2022]
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29
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What Is New in the Understanding of Non Healing Wounds Epidemiology, Pathophysiology, and Therapies. ACTA ACUST UNITED AC 2013. [DOI: 10.1155/2013/625934] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chronic wounds are a growing socioeconomic problem in the western world. Knowledge on recalcitrant wounds relies on in vitro studies or clinical observations, and there is emerging evidence on the clinical impact of bacterial biofilm on skin healing. Chronic wounds are locked in the inflammatory state of wound healing, and there are multiple explanations for this arrest with the theory of exaggerated proteolysis as the most commonly accepted. Previously, there has not been enough focus on the different etiologies of chronic wounds compared to acute, healing wounds. There is an urgent need to group chronic wounds by its cause when searching for possible diagnostic or therapeutic targets. Good wound management should therefore consist of recognition of basic wound etiology, irrigation, and debridement in order to reduce microbial and necrotic load, frequently changed dressings, and appropriate antimicrobial and antibiofilm strategies based on precise diagnosis. Representative sampling is required for diagnosis and antimicrobial treatment of wounds. The present review aims at describing the impact of biofilm infections on wounds in relation to diagnosing, treatment strategies, including experimentally adjuvant approaches and animal models.
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30
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Current world literature. Curr Opin Organ Transplant 2013; 18:111-30. [PMID: 23299306 DOI: 10.1097/mot.0b013e32835daf68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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