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Singh K, Maity P, Koroma AK, Basu A, Pandey RK, Beken SV, Haas P, Krug L, Hainzl A, Sindrilaru A, Pfeiffer C, Wlaschek M, Frank NY, Frank MH, Ganss C, Bánvölgyi A, Wikonkál N, Eming S, Pastar I, Tomic-Canic M, Kluth MA, Scharffetter-Kochanek K. Angiogenin Released from ABCB5 + Stromal Precursors Improves Healing of Diabetic Wounds by Promoting Angiogenesis. J Invest Dermatol 2021; 142:1725-1736.e10. [PMID: 34808236 DOI: 10.1016/j.jid.2021.10.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 01/07/2023]
Abstract
Severe angiopathy is a major driver for diabetes associated secondary complications. Knowledge on underlying mechanisms essential for advanced therapies to attenuate these pathologies is limited. Injection of ABCB5+ stromal precursors (SPs) at the edge of non-healing diabetic wounds in a murine db/db model, closely mirroring human type II diabetes, profoundly accelerates wound closure. Strikingly, enhanced angiogenesis was substantially enforced by the release of the ribonuclease angiogenin from ABCB5+ SPs. This compensates for the profoundly reduced angiogenin expression in non-treated murine chronic diabetic wounds. Silencing of angiogenin in ABCB5+ SPs prior to injection significantly reduced angiogenesis and delayed wound closure in diabetic db/db mice implying an unprecedented key role for angiogenin in tissue regeneration in diabetes. These data hold significant promise for further refining SPs-based therapies of non-healing diabetic foot ulcers and other pathologies with impaired angiogenesis.
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Affiliation(s)
- Karmveer Singh
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Pallab Maity
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | | | - Abhijit Basu
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Rajeev Kumar Pandey
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Seppe Vander Beken
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Philipp Haas
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Linda Krug
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Adelheid Hainzl
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Anca Sindrilaru
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Christiane Pfeiffer
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Meinhard Wlaschek
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Natasha Y Frank
- Transplantation Research Center, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Boston VA Healthcare System, West Roxbury, MA, USA; Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Markus H Frank
- Transplantation Research Center, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, USA; Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Transplantation Research Center, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, USA; Harvard Stem Cell Institute, Harvard University, Cambridge, Massachusetts, USA; School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Christoph Ganss
- TICEBA GmbH, Heidelberg, Germany; RHEACELL GmbH & Co. KG, Heidelberg, Germany
| | - András Bánvölgyi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Norbert Wikonkál
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Sabine Eming
- Department of Dermatology and Venereology, University of Cologne, Cologne, Germany
| | - Irena Pastar
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Marjana Tomic-Canic
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Mark A Kluth
- TICEBA GmbH, Heidelberg, Germany; RHEACELL GmbH & Co. KG, Heidelberg, Germany
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Russell D, Atkin L, Betts A, Dowsett C, Fatoye F, Gardner S, Green J, Manu C, McKenzie T, Meally H, Mitchell L, Mullings J, Odeyemi I, Sharpe A, Yeowell G, Devlin N. Using a modified Delphi methodology to gain consensus on the use of dressings in chronic wounds management. J Wound Care 2019; 27:156-165. [PMID: 29509111 DOI: 10.12968/jowc.2018.27.3.156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Managing chronic wounds is associated with a burden to patients, caregivers, health services and society and there is a lack of clarity regarding the role of dressings in improving outcomes. This study aimed to provide understanding on a range of topics, including: the definition of chronicity in wounds, the burden of illness, clinical outcomes of reducing healing time and the impact of early interventions on clinical and economic outcomes and the role of matrix metalloproteinases (MMPs) in wound healing. METHOD A systematic review of the literature was carried out on the role of dressings in diabetic foot ulcer (DFU), and venous leg ulcer (VLU) management strategies, their effectiveness, associated resource use/cost, and quality of life (QoL) impact on patients. From this evidence-base statements were written regarding chronicity in wounds, burden of illness, healing time, and the role of MMPs, early interventions and dressings. A modified Delphi methodology involving two iterations of email questionnaires followed by a face-to-face meeting was used to validate the statements, in order to arrive at a consensus for each. Clinical experts were selected, representing nurses, surgeons, podiatrists, academics, and policy experts. RESULTS In the first round, 38/47 statements reached or exceeded the consensus threshold of 80% and none were rejected. According to the protocol, any statement not confirmed or rejected had to be modified using the comments from participants and resubmitted. In the second round, 5/9 remaining statements were confirmed and none rejected, leaving 4 to discuss at the meeting. All final statements were confirmed with at least 80% consensus. CONCLUSION This modified Delphi panel sought to gain clarity from clinical experts surrounding the use of dressings in the management of chronic wounds. A full consensus statement was developed to help clinicians and policy makers improve the management of patients with these conditions.
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Affiliation(s)
- David Russell
- Consultant Vascular Surgeon and Honorary Clinical Associate Professor, Leeds Teaching Hospitals NHS Trust
| | - Leanne Atkin
- Vascular Nurse Specialist, Mid Yorkshire Hospitals NHS Trust
| | - April Betts
- Health Technology Assessment Project Manager, Manchester Metropolitan University
| | - Caroline Dowsett
- Nurse Consultant Tissue Viability, East London NHS Foundation Trust, London
| | - Francis Fatoye
- Professor of Health Economics and Outcomes, Manchester Metropolitan University
| | - Sarah Gardner
- Clinical Lead, Tissue Viability, Oxford Health NHS Foundation Trust
| | - Julie Green
- Senior Lecturer in Nursing, Director of Postgraduate Programmes, Keele University, School of Nursing and Midwifery
| | - Chris Manu
- Consultant Diabetologist and Clinical Researcher in Diabetic Foot, King's College Hospital, London
| | - Tracey McKenzie
- Head of Tissue Viability Services, Torbay and Southern Devon NHS Foundation Trust
| | - Helena Meally
- Hospital Podiatrist, Leeds Teaching Hospitals NHS Trust
| | | | - Julie Mullings
- Lead Tissue Viability Nurse, University Hospital of South Manchester, NHS Foundation Trust
| | - Isaac Odeyemi
- Visiting Professor of Health Technology Assessment and Health Policy, Manchester Metropolitan University
| | - Andrew Sharpe
- Advanced Podiatrist and Lecturer Practitioner, West Lancashire Community Service, Virgin Care and University of Huddersfield
| | - Gillian Yeowell
- MSc Advanced Physiotherapy Programme Leader, Manchester Metropolitan University
| | - Nancy Devlin
- Director of Research, Professor, Office of Health Economics, Victoria Street, London
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Abstract
BACKGROUND One of the most significant, and growing, challenges in modern medicine, i.e. the treatment of chronic wounds, is marked by nonuniform data. This concerns both prevalence and incidence of chronic dermatosis, in particular venous ulcers (ulcus cruris), as well as the impact on the health-related quality of life, and practical and economic parameters of the success of different therapies. PURPOSE The aim of this work is to examine the epidemiology of chronic wounds, in particular age-associated venous ulcers, their impact on health-related quality of life, the treatment regimen, and practical and economic parameters of the success of different therapies. MATERIALS AND METHODS Performed were analysis of data on the care of venous ulcers in Germany, based on secondary data of Barmer GEK from 2009 and 2012, comparison with data of a NHS Kent Community Health Trust study, and analysis of studies concerning structures, processes and critical success factors for the treatment of chronic wounds, including economic effects. CONCLUSION Early causal therapy with treatment based on the stage of the wound, consequent goal-oriented interdisciplinary care, and relapse prophylaxis is critical for successful healing of venous ulcers. The costs of treatment significantly correlate with the duration of treatment which can be reduced by up to 60% using guideline-based concepts for the treatment of chronic wounds. Treatment success, in particular with regard to cost-benefit considerations, can be optimized by telemedicine networks of key players who treat chronic wounds.
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Benítez-Arvízu G, Palma-Lara Í, Vazquez-Campos R, Sesma-Villalpando RA, Parra-Barrera A, Gutiérrez-Iglesias G. [Autologous mesenchymal stem cells and cutaneus autograft as a treatment for chronic ulcer secondary to diabetes mellitus 2]. CIR CIR 2015; 83:532-6. [PMID: 26164137 DOI: 10.1016/j.circir.2015.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 10/31/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND Diabetes mellitus 2 has become a global problem. It is estimated that 15% to 25% of patients could develop a chronic ulcer in their life, and nearly 33% of direct care costs of the diabetes mellitus 2 is spent on treating these ulcers. Mesenchymal stem cells have emerged as a promising cell source for the treatment of these ulcers. CLINICAL CASE The case is presented of a 67 year-old male with a history of diabetes mellitus, acute myocardial infarction, and food ulcer chronic involving right foot and part of his leg. He was treated with mesenchymal stem cell management, resulting in skin graft integration and full coverage of the lesion. CONCLUSION The implementation of mesenchymal stem cell techniques for treatment of chronic ulcer is feasible. The impact on the population would lead to a significant improvement in their quality of life and reduce healthcare spending.
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Affiliation(s)
- Gamaliel Benítez-Arvízu
- Departamento de Laboratorio de Morfología Celular, Escuela Superior de Medicina, Instituto Politécnico Nacional, México D.F., México.
| | - Ícela Palma-Lara
- Departamento de Laboratorio de Morfología Celular, Escuela Superior de Medicina, Instituto Politécnico Nacional, México D.F., México
| | - René Vazquez-Campos
- Servicio de Ortopedia, Hospital General de Puebla, Secretaria de Salud del estado de Puebla, Puebla, Puebla, México
| | | | - Alberto Parra-Barrera
- Departamento de Laboratorio de Medicina Regenerativa y Cáncer, Escuela Superior de Medicina, Instituto Politécnico Nacional, México D.F., México
| | - Gisela Gutiérrez-Iglesias
- Departamento de Laboratorio de Medicina Regenerativa y Cáncer, Escuela Superior de Medicina, Instituto Politécnico Nacional, México D.F., México
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Jimenez F, Poblet E, Izeta A. Reflections on how wound healing-promoting effects of the hair follicle can be translated into clinical practice. Exp Dermatol 2014; 24:91-4. [DOI: 10.1111/exd.12521] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 12/20/2022]
Affiliation(s)
| | - Enrique Poblet
- Department of Pathology; Hospital Universitario Reina Sofía; Murcia Spain
| | - Ander Izeta
- Tissue Engineering Laboratory; Instituto Biodonostia; Hospital Universitario Donostia; San Sebastián Spain
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Harding K, Aldons P, Edwards H, Stacey M, Finlayson K, Gibb M, Jenkins L, Shooter G, Lonkhuyzen DV, Lynam E, Heinrichs E, Upton Z. Effectiveness of an acellular synthetic matrix in the treatment of hard-to-heal leg ulcers. Int Wound J 2014; 11:129-37. [PMID: 23834253 PMCID: PMC7950675 DOI: 10.1111/iwj.12115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Hard-to-heal leg ulcers are a major cause of morbidity in the elderly population. Despite improvements in wound care, some wounds will not heal and they present a significant challenge for patients and health care providers. A multi-centre cohort study was conducted to evaluate the effectiveness and safety of a synthetic, extracellular matrix protein as an adjunct to standard care in the treatment of hard-to-heal venous or mixed leg ulcers. Primary effectiveness criteria were (i) reduction in wound size evaluated by percentage change in wound area and (ii) healing assessed by number of patients healed by end of the 12 week study. Pain reduction was assessed as a secondary effectiveness criteria using VAS. A total of 45 patients completed the study and no difference was observed between cohorts for treatment frequency. Healing was achieved in 35·6% and wound size decreased in 93·3% of patients. Median wound area percentage reduction was 70·8%. Over 50% of patients reported pain on first visit and 87·0% of these reported no pain at the end of the study. Median time to first reporting of no pain was 14 days after treatment initiation. The authors consider the extracellular synthetic matrix protein an effective and safe adjunct to standard care in the treatment of hard-to-heal leg ulcers.
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Affiliation(s)
- Keith Harding
- Wound Healing Research Unit, Institute for Translation, Innovation, Methodologies and Engagement (TIME)Cardiff UniversityCardiffUK
| | - Pat Aldons
- The Prince Charles HospitalChermsideAustralia
| | - Helen Edwards
- School of Nursing and MidwiferyQueensland University of TechnologyBrisbaneAustralia
| | - Michael Stacey
- Department of SurgeryFremantle Hospital, The University of Western AustraliaFremantleAustralia
| | - Kathleen Finlayson
- School of Nursing and MidwiferyQueensland University of TechnologyBrisbaneAustralia
| | - Michelle Gibb
- School of Nursing and MidwiferyQueensland University of TechnologyBrisbaneAustralia
| | - Liz Jenkins
- The Prince Charles HospitalChermsideAustralia
| | - Gary Shooter
- Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia
| | - Derek Van Lonkhuyzen
- Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia
| | - Emily Lynam
- Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia
| | | | - Zee Upton
- Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia
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Augustin M, Herberger K, Kroeger K, Muenter KC, Goepel L, Rychlik R. Cost-effectiveness of treating vascular leg ulcers with UrgoStart(®) and UrgoCell(®) Contact. Int Wound J 2014; 13:82-7. [PMID: 24618370 DOI: 10.1111/iwj.12238] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/20/2013] [Accepted: 01/07/2014] [Indexed: 11/30/2022] Open
Abstract
Although chronic wounds have a high socio-economic impact, data on comparative effectiveness of treatments are rare. UrgoStart(®) is a hydroactive dressing containing a nano-oligosaccharide factor (NOSF). This study aimed at evaluating the cost-effectiveness of this NOSF-containing wound dressing in vascular leg ulcers compared with a similar neutral foam dressing (UrgoCell(®) Contact) without NOSF. Cost-effectiveness analysis from the perspective of the German statutory health care system was performed using a decision tree model for a period of 8 weeks. Cost and outcome data were derived from the clinical study 'Challenge' suggesting a response rate (≥40% wound size reduction) of UrgoStart(®) of 65·6% versus 39·4% for the comparator. In the treatment model, effect-adjusted costs of €849·86 were generated after 8 weeks for treatment with UrgoStart(®) versus €1335·51 for the comparator resulting in an effect-adjusted cost advantage of €485·64 for UrgoStart(®) . In linear sensitivity analyses, the outcomes were stable for varying assumptions on prices and response rates. In an 8-week period of treatment for vascular leg ulcers, UrgoStart(®) shows superior cost-effectiveness when compared with the similar neutral foam dressing without any active component (NOSF). As demonstrated within a randomised, double-blind clinical trial, UrgoStart(®) is also more effective in wound area reduction than the neutral foam dressing. Wound healing was not addressed in this clinical trial. Follow-up data of 12 months to allow for reulceration assessment were not generated.
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Affiliation(s)
- Matthias Augustin
- Institute and German Center for Health Services Research in Dermatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Herberger
- Institute and German Center for Health Services Research in Dermatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Lisa Goepel
- Institute and German Center for Health Services Research in Dermatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Rehder J, Bosnardo CAF, Kraft MBDPL, Frade MAC, Guillaumon AT, Batista FRX, Puzzi MB. A Comparative Study of Cell Therapy and Fibrin Glue Applied to Chronic Venous Ulcers. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.proeng.2013.05.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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