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Montague C, Holt Y, Vlok M, Dhanraj P, Boodhoo K, Maartens M, Buthelezi K, Niesler CU, van de Vyver M. Combined therapeutic use of umbilical cord blood serum and amniotic membrane in diabetic wounds. Biochimie 2024:S0300-9084(24)00171-8. [PMID: 39043358 DOI: 10.1016/j.biochi.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/21/2024] [Accepted: 07/18/2024] [Indexed: 07/25/2024]
Abstract
Diabetic wounds are hard-to-heal due to complex multifactorial dysregulation within the micro-environment, necessitating the development of novel regenerative approaches to stimulate healing. This study investigated whether the combined therapeutic application of two novel cellular tissue products, namely a decellularized collagen-rich amniotic membrane (AmR) and growth factor-rich umbilical cord blood serum (UCBS) could have a positive synergistic effect on long-term healing outcomes by stimulating both superficial wound closure and wound bed regeneration. Full thickness excisional wounds were induced on obese diabetic mice (B6.Cg-lepob/J, ob/ob, n = 23) and treated with either: 1) Standard wound care (control); 2) UCBS; 3) AmR or 4) UCBS + AmR. Macroscopic wound closure was assessed on days 0, 3, 7, 10 and 14 post wounding. To determine the potential impact on wound recurrence, endpoint analysis was performed to determine both the overall quality of healing histologically as well as the molecular state of the wounds on day 14 via proteomic analysis. The data demonstrated the presence of both healers and non-healers. Re-epithelization took place in the healers of all treatment groups, but underlying tissue regeneration was far more pronounced following application of the combined treatment (UCBS + AmR), suggesting improved quality of healing and potentially a reduced change of recurrence long term. In non-healers, wounds failed to heal due to excessive slough formation and a reduction in LTB4 expression, suggesting impaired antimicrobial activity. Care should thus be taken since the cellular tissue product therapy could pose an increased risk for infection in some patients.
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Affiliation(s)
| | - Y Holt
- Next Biosciences, Midrand, South Africa
| | - M Vlok
- Central Analytical Facility, Stellenbosch University, Cape Town, South Africa
| | - P Dhanraj
- Experimental Medicine Research Group, Department of Medicine, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - K Boodhoo
- Experimental Medicine Research Group, Department of Medicine, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Maartens
- Experimental Medicine Research Group, Department of Medicine, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - C U Niesler
- Next Biosciences, Midrand, South Africa; Discipline of Biochemistry, School of Life Sciences, University of KwaZulu-Natal (UKZN), Pietermaritzburg, South Africa
| | - M van de Vyver
- Experimental Medicine Research Group, Department of Medicine, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Chen P, Vilorio NC, Dhatariya K, Jeffcoate W, Lobmann R, McIntosh C, Piaggesi A, Steinberg J, Vas P, Viswanathan V, Wu S, Game F. Effectiveness of interventions to enhance healing of chronic foot ulcers in diabetes: A systematic review. Diabetes Metab Res Rev 2024; 40:e3786. [PMID: 38507616 DOI: 10.1002/dmrr.3786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND It is critical that interventions used to enhance the healing of chronic foot ulcers in diabetes are backed by high-quality evidence and cost-effectiveness. In previous years, the systematic review accompanying guidelines published by the International Working Group of the Diabetic Foot performed 4-yearly updates of previous searches, including trials of prospective, cross-sectional and case-control design. AIMS Due to a need to re-evaluate older studies against newer standards of reporting and assessment of risk of bias, we performed a whole new search from conception, but limiting studies to randomised control trials only. MATERIALS AND METHODS For this systematic review, we searched PubMed, Scopus and Web of Science databases for published studies on randomised control trials of interventions to enhance healing of diabetes-related foot ulcers. We only included trials comparing interventions to standard of care. Two independent reviewers selected articles for inclusion and assessed relevant outcomes as well as methodological quality. RESULTS The literature search identified 22,250 articles, of which 262 were selected for full text review across 10 categories of interventions. Overall, the certainty of evidence for a majority of wound healing interventions was low or very low, with moderate evidence existing for two interventions (sucrose-octasulfate and leucocyte, platelet and fibrin patch) and low quality evidence for a further four (hyperbaric oxygen, topical oxygen, placental derived products and negative pressure wound therapy). The majority of interventions had insufficient evidence. CONCLUSION Overall, the evidence to support any other intervention to enhance wound healing is lacking and further high-quality randomised control trials are encouraged.
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Affiliation(s)
- Pam Chen
- Joondalup Health Campus, Ramsay Healthcare Australia, Joondalup, Western Australia, Australia
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Nalini Campillo Vilorio
- Department of Diabetology, Diabetic Foot Unit, Plaza de la Salud General Hospital, Santo Domingo, Dominican Republic
| | - Ketan Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Ralf Lobmann
- Clinic for Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Alberto Piaggesi
- Diabetic Foot Section, Department of Medicine, University of Pisa, Pisa, Italy
| | - John Steinberg
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Prash Vas
- King's College Hospital NHS Foundation Trust, London, UK
| | - Vijay Viswanathan
- MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Center, Chennai, India
| | - Stephanie Wu
- Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Fran Game
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Chen P, Vilorio NC, Dhatariya K, Jeffcoate W, Lobmann R, McIntosh C, Piaggesi A, Steinberg J, Vas P, Viswanathan V, Wu S, Game F. Guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev 2024; 40:e3644. [PMID: 37232034 DOI: 10.1002/dmrr.3644] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023]
Abstract
AIMS Principles of wound management, including debridement, wound bed preparation, and newer technologies involving alternation of wound physiology to facilitate healing, are of utmost importance when attempting to heal a chronic diabetes-related foot ulcer. However, the rising incidence and costs of diabetes-related foot ulcer management necessitate that interventions to enhance wound healing of chronic diabetes-related foot ulcers are supported by high-quality evidence of efficacy and cost effectiveness when used in conjunction with established aspects of gold-standard multidisciplinary care. This is the 2023 International Working Group on the Diabetic Foot (IWGDF) evidence-based guideline on wound healing interventions to promote healing of foot ulcers in persons with diabetes. It serves as an update of the 2019 IWGDF guideline. MATERIALS AND METHODS We followed the GRADE approach by devising clinical questions and important outcomes in the Patient-Intervention-Control-Outcome (PICO) format, undertaking a systematic review, developing summary of judgements tables, and writing recommendations and rationale for each question. Each recommendation is based on the evidence found in the systematic review and, using the GRADE summary of judgement items, including desirable and undesirable effects, certainty of evidence, patient values, resources required, cost effectiveness, equity, feasibility, and acceptability, we formulated recommendations that were agreed by the authors and reviewed by independent experts and stakeholders. RESULTS From the results of the systematic review and evidence-to-decision making process, we were able to make 29 separate recommendations. We made a number of conditional supportive recommendations for the use of interventions to improve healing of foot ulcers in people with diabetes. These include the use of sucrose octasulfate dressings, the use of negative pressure wound therapies for post-operative wounds, the use of placental-derived products, the use of the autologous leucocyte/platelet/fibrin patch, the use of topical oxygen therapy, and the use of hyperbaric oxygen. Although in all cases it was stressed that these should be used where best standard of care was not able to heal the wound alone and where resources were available for the interventions. CONCLUSIONS These wound healing recommendations should support improved outcomes for people with diabetes and ulcers of the foot, and we hope that widescale implementation will follow. However, although the certainty of much of the evidence on which to base the recommendations is improving, it remains poor overall. We encourage not more, but better quality trials including those with a health economic analysis, into this area.
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Affiliation(s)
- Pam Chen
- Joondalup Health Campus, Ramsay Healthcare Australia, Joondalup, Western Australia, Australia
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Nalini Campillo Vilorio
- Department of Diabetology, Diabetic Foot Unit, Plaza de la Salud General Hospital, Santo Domingo, Dominican Republic
| | - Ketan Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Ralf Lobmann
- Clinic for Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart, Stuttgart, Germany
| | - Caroline McIntosh
- Podiatric Medicine, School of Health Sciences, University of Galway, Galway, Ireland
| | - Alberto Piaggesi
- Diabetic Foot Section, Department of Medicine, University of Pisa, Pisa, Italy
| | - John Steinberg
- Georgetown University School of Medicine, Georgetown, Washington DC, USA
| | - Prash Vas
- King's College Hospital NHS Foundation Trust, London, UK
| | - Vijay Viswanathan
- MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Center, Chennai, India
| | - Stephanie Wu
- Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Fran Game
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Kafili G, Niknejad H, Tamjid E, Simchi A. Amnion-derived hydrogels as a versatile platform for regenerative therapy: from lab to market. Front Bioeng Biotechnol 2024; 12:1358977. [PMID: 38468689 PMCID: PMC10925797 DOI: 10.3389/fbioe.2024.1358977] [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: 12/20/2023] [Accepted: 02/09/2024] [Indexed: 03/13/2024] Open
Abstract
In recent years, the amnion (AM) has emerged as a versatile tool for stimulating tissue regeneration and has been of immense interest for clinical applications. AM is an abundant and cost-effective tissue source that does not face strict ethical issues for biomedical applications. The outstanding biological attributes of AM, including side-dependent angiogenesis, low immunogenicity, anti-inflammatory, anti-fibrotic, and antibacterial properties facilitate its usage for tissue engineering and regenerative medicine. However, the clinical usage of thin AM sheets is accompanied by some limitations, such as handling without folding or tearing and the necessity for sutures to keep the material over the wound, which requires additional considerations. Therefore, processing the decellularized AM (dAM) tissue into a temperature-sensitive hydrogel has expanded its processability and applicability as an injectable hydrogel for minimally invasive therapies and a source of bioink for the fabrication of biomimetic tissue constructs by recapitulating desired biochemical cues or pre-defined architectural design. This article reviews the multi-functionality of dAM hydrogels for various biomedical applications, including skin repair, heart treatment, cartilage regeneration, endometrium regeneration, vascular graft, dental pulp regeneration, and cell culture/carrier platform. Not only recent and cutting-edge research is reviewed but also available commercial products are introduced and their main features and shortcomings are elaborated. Besides the great potential of AM-derived hydrogels for regenerative therapy, intensive interdisciplinary studies are still required to modify their mechanical and biological properties in order to broaden their therapeutic benefits and biomedical applications. Employing additive manufacturing techniques (e.g., bioprinting), nanotechnology approaches (e.g., inclusion of various bioactive nanoparticles), and biochemical alterations (e.g., modification of dAM matrix with photo-sensitive molecules) are of particular interest. This review article aims to discuss the current function of dAM hydrogels for the repair of target tissues and identifies innovative methods for broadening their potential applications for nanomedicine and healthcare.
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Affiliation(s)
- Golara Kafili
- Center for Nanoscience and Nanotechnology, Institute for Convergence Science and Technology, Sharif University of Technology, Tehran, Iran
| | - Hassan Niknejad
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elnaz Tamjid
- Department of Nanobiotechnology, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Abdolreza Simchi
- Center for Nanoscience and Nanotechnology, Institute for Convergence Science and Technology, Sharif University of Technology, Tehran, Iran
- Department of Materials Science and Engineering, Sharif University of Technology, Tehran, Iran
- Center for Bioscience and Technology, Institute for Convergence Science and Technology, Sharif University of Technology, Tehran, Iran
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Chen ACY, Lu Y, Hsieh CY, Chen YS, Chang KC, Chang DH. Advanced Biomaterials and Topical Medications for Treating Diabetic Foot Ulcers: A Systematic Review and Network Meta-Analysis. Adv Wound Care (New Rochelle) 2024; 13:97-113. [PMID: 37395488 DOI: 10.1089/wound.2023.0024] [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] [Indexed: 07/04/2023] Open
Abstract
Significance: With the increasing diabetic population worldwide, diabetic foot ulcers (DFUs) are a significant concern. This study aimed to compare the efficacy of skin substitutes, biomaterials, and topical agents with standard care. Recent Advances: A meta-analysis was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, EMBASE, and Web of Science were searched using the following keywords: diabetes mellitus AND skin graft OR tissue replacement OR dressing OR drug. Two independent reviewers performed data collection and quality assessment of the eligible studies. The primary outcome was the 12- to 16-week healing rates and the secondary outcome was recurrence rates. Critical Issues: Thirty-eight randomized controlled trials, including 3,862 patients, were analyzed. The studies exhibited low heterogeneity (τ2 = 0.10) without significant asymmetry (Egger's test, p = 0.8852). After pooling direct and indirect estimates, placenta-based tissue products exhibited the best wound healing probability (p-score = 0.90), followed by skin substitutes with living cells (p-score = 0.70), acellular skin substitutes (p-score = 0.56), and advanced topical dressings (p-score = 0.34) compared with standard of care. The recurrence analysis showed significant improvement in the intervention group compared with the control group (11.21% vs. 15.15%). Future Directions: This network meta-analysis provides the relative effectiveness and rank of biomaterials and topical dressings in DFU healing. The results could help clinical decision making.
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Affiliation(s)
| | - Yi Lu
- Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Chi-Ying Hsieh
- Division of Plastic and Esthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yo-Shen Chen
- Division of Plastic and Esthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ke-Chung Chang
- Division of Plastic and Esthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Dun-Hao Chang
- Division of Plastic and Esthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Information Management, Yuan Ze University, Taoyuan, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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6
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Vecin NM, Kirsner RS. Skin substitutes as treatment for chronic wounds: current and future directions. Front Med (Lausanne) 2023; 10:1154567. [PMID: 37711741 PMCID: PMC10498286 DOI: 10.3389/fmed.2023.1154567] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/21/2023] [Indexed: 09/16/2023] Open
Abstract
Chronic wounds such as diabetic foot ulcers and venous leg ulcers place a significant burden on the healthcare system and in some cases, have 5-year mortality rates comparable to cancer. They negatively impact patients' quality of life due to pain, odor, decreased mobility, and social isolation. Skin substitutes are an advanced therapy recommended for wounds that fail to show decrease in size with standard care. The choice of substitute used should be based on evidence, which often differs based on wound etiology. There are more than 75 skin substitutes currently available, and that number is rising. In this review, we discuss current management and future directions of chronic wounds while providing a review of available randomized control trial data for various skin substitutes.
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Affiliation(s)
- Nicole M. Vecin
- Departments of Medical Education and Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Robert S. Kirsner
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
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Protzman NM, Mao Y, Long D, Sivalenka R, Gosiewska A, Hariri RJ, Brigido SA. Placental-Derived Biomaterials and Their Application to Wound Healing: A Review. Bioengineering (Basel) 2023; 10:829. [PMID: 37508856 PMCID: PMC10376312 DOI: 10.3390/bioengineering10070829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Chronic wounds are associated with considerable patient morbidity and present a significant economic burden to the healthcare system. Often, chronic wounds are in a state of persistent inflammation and unable to progress to the next phase of wound healing. Placental-derived biomaterials are recognized for their biocompatibility, biodegradability, angiogenic, anti-inflammatory, antimicrobial, antifibrotic, immunomodulatory, and immune privileged properties. As such, placental-derived biomaterials have been used in wound management for more than a century. Placental-derived scaffolds are composed of extracellular matrix (ECM) that can mimic the native tissue, creating a reparative environment to promote ECM remodeling, cell migration, proliferation, and differentiation. Reliable evidence exists throughout the literature to support the safety and effectiveness of placental-derived biomaterials in wound healing. However, differences in source (i.e., anatomical regions of the placenta), preservation techniques, decellularization status, design, and clinical application have not been fully evaluated. This review provides an overview of wound healing and placental-derived biomaterials, summarizes the clinical results of placental-derived scaffolds in wound healing, and suggests directions for future work.
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Affiliation(s)
- Nicole M Protzman
- Healthcare Analytics, LLC, 78 Morningside Dr., Easton, PA 18045, USA
| | - Yong Mao
- Laboratory for Biomaterials Research, Department of Chemistry and Chemical Biology, Rutgers University, 145 Bevier Rd., Piscataway, NJ 08854, USA
| | - Desiree Long
- Research & Development, Degenerative Diseases, Celularity Inc., 170 Park Ave., Florham Park, NJ 07932, USA
| | - Raja Sivalenka
- Research & Development, Degenerative Diseases, Celularity Inc., 170 Park Ave., Florham Park, NJ 07932, USA
| | - Anna Gosiewska
- Research & Development, Degenerative Diseases, Celularity Inc., 170 Park Ave., Florham Park, NJ 07932, USA
| | - Robert J Hariri
- Research & Development, Degenerative Diseases, Celularity Inc., 170 Park Ave., Florham Park, NJ 07932, USA
| | - Stephen A Brigido
- Research & Development, Degenerative Diseases, Celularity Inc., 170 Park Ave., Florham Park, NJ 07932, USA
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Mohammed YA, Farouk HK, Gbreel MI, Ali AM, Salah AA, Nourelden AZ, Gawad MMAE. Human amniotic membrane products for patients with diabetic foot ulcers. do they help? a systematic review and meta-analysis. J Foot Ankle Res 2022; 15:71. [PMID: 36104736 PMCID: PMC9472416 DOI: 10.1186/s13047-022-00575-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Diabetic foot ulcer (DFU) is one of the most serious diabetic complications. DFU is an open wound that usually occurs in the foot sole due to poor blood glucose control, peripheral neuropathy, and poor circulation. The human amniotic allograft membrane is a biological wound dressing derived from the amniotic membrane. It contains amino acids, nutrients, cytokines, and growth factors that make the growth process easier. Objective To compare dehydrated human amnion and chorion allograft (DHACA) plus the standard of wound care (SOC) with the SOC alone. Methods We searched for randomized clinical trials (RCTs) on PubMed, Scopus, Cochrane, and Web of Science till April 2021 using relevant keywords. All search results were screened for eligibility. We extracted the data from the included trials and pooled them as mean difference (MD) or risk ratio (RR) with the 95% confidence interval (CI) using Review Manager software (ver. 5.4). Results The pooled effect estimate from 11 RCTs showed that DHACA was superior to SOC regarding the complete wound healing in both 6th and 12th week (RR = 3.78; 95% CI: [2.51, 5.70]; P < 0.00001) and (RR = 2.00; 95% CI: [1.67, 2.39], P < 0.00001 respectively). Also, the analysis favored the DHACA regarding the mean time to heal in the 12th-week (MD = -12.07, 95%CI: [-19.23, -4.91], P = 0.001). The wound size reduction was better with DHACA (MD = 1.18, 95%CI: [-0,10, 2.26], P = 0.03). Conclusion Using DHACA with SOC is safer and more effective than using SOC alone for DFU patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00575-y.
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Magana A, Giovanni R, Essien E, Epel B, Kotecha M, Liu S, Mathew MT, Hagarty SE, Bijukumar D. Amniotic growth factors enhanced human pre-adipocyte cell viability and differentiation under hypoxia. J Biomed Mater Res B Appl Biomater 2022; 110:2146-2156. [PMID: 35384274 PMCID: PMC9283253 DOI: 10.1002/jbm.b.35068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/25/2022] [Accepted: 03/22/2022] [Indexed: 11/10/2022]
Abstract
One of the major drawbacks associated with autologous fat grafting is unpredictable graft retention. Various efforts to improve the survivability of these cells have been explored, but these methods are time‐consuming, complex, and demand significant technical skill. In our study, we examine the use of cryopreserved amniotic membrane as a source of exogenous growth factors to improve adipocyte survivability under normal and hypoxic conditions. Human primary preadipocytes were cultured in a gelatin‐ferulic acid (Gtn‐FA) hydrogel with variable oxygen concentration and treated with amniotic membrane‐derived condition medium (CM) for 7 days. This hydrogel provides a hypoxic environment and also creates a 3D cell culture to better mimic recipient site conditions. The O2 concentration in the hydrogel was measured by electron paramagnetic resonance oxygen imaging (EPROI). The conjugation of FA was confirmed by FTIR and NMR spectroscopy. The cell viability and adipocyte differentiation were analyzed by alamarBlue™ assay, Oil Red O staining, and RT‐qPCR. The expression of genes: Pref‐1, C/EBP β, C/EBP α, PPAR‐ƴ, SLC2A4, and VEGF‐A were quantified. The cell viability results show that the 50% CM showed significantly higher cell pre‐adipocyte cell viability. In addition, compared to normal conditions, hypoxia/CM provided higher PPAR‐ƴ (p < .05), SLC2A4, and VEGF‐A (p < .05) (early and terminal differentiating markers) mRNA expression. This finding demonstrates the efficacy of amniotic CM supplementation as a novel way to promote adipocyte survival and retention via the expression of key gene markers for differentiation and angiogenesis.
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Affiliation(s)
- Alejandro Magana
- Department of Biomedical Science, University of Illinois College of Medicine at Rockford, Rockford, Illinois, USA
| | - Regina Giovanni
- Department of Biomedical Science, University of Illinois College of Medicine at Rockford, Rockford, Illinois, USA
| | - Edidiong Essien
- Department of Biomedical Science, University of Illinois College of Medicine at Rockford, Rockford, Illinois, USA
| | - Boris Epel
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois, USA
| | | | - Songyun Liu
- Department of Orthopedics, Rush University of Medical Center, Chicago, Illinois, USA
| | - Mathew T Mathew
- Department of Biomedical Science, University of Illinois College of Medicine at Rockford, Rockford, Illinois, USA
| | - Sarah E Hagarty
- Department of Biomedical Science, University of Illinois College of Medicine at Rockford, Rockford, Illinois, USA.,Departments of Surgery and Biomedical Science, University of Illinois College of Medicine at Rockford, Illinois, USA
| | - Divya Bijukumar
- Department of Biomedical Science, University of Illinois College of Medicine at Rockford, Rockford, Illinois, USA
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10
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Oropallo A, Goodwin A, Morrissey M, Del Pin C, Rao A. Human Amnion Chorion Membrane Allografts in the Treatment of Chronic Diabetic Foot Ulcers: A Literature Review. Adv Skin Wound Care 2021; 34:1-7. [PMID: 33739952 DOI: 10.1097/01.asw.0000734388.08779.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To discuss human amnion chorion (placental) membrane allograft (HACMA) use for the treatment of chronic diabetic foot ulcers (DFUs) and to evaluate the effectiveness, cost, and product waste of this therapy. DATA SOURCES PubMed, Cochrane, and OVID databases. STUDY SELECTION Twenty-four articles pertaining to HACMA and DFUs published from 2016 to 2020 were selected. DATA EXTRACTION The data collected included type of wound care product, study design, study size, baseline size of DFU, cost, product wastage, number of applications, and wound healing outcomes. DATA SYNTHESIS Human amnion chorion membrane allografts in the treatment of chronic DFUs have led to a reduction in healing time and increased the overall percentage of healing, making them more effective in treating DFUs compared with standard of care. These products are offered in multiple sizes with various shelf lives and methods of storage, making them accessible, easy to use, less wasteful, and lower in cost compared with other commercially available products. Promising evidence demonstrates that HACMAs are beneficial in treating complex, high-grade DFUs with exposed tendon or bone. CONCLUSIONS Human amnion chorion membrane allografts are effective in treating chronic DFUs with a greater percentage of complete wound closure and a reduction in healing time versus standard of care.
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Affiliation(s)
- Alisha Oropallo
- At Northwell Health, Lake Success, New York, Alisha Oropallo, MD, FACS, is Director, Northshore/LIJ Wound Healing Center and Hyperbarics; Ashley Goodwin, MD, is Visiting Scholar, Department of Surgery; MaKenzie Morrissey, MD, is Visiting Scholar, Department of Surgery; Christina Del Pin, MD, FACS, is Attending Surgeon, Department of Surgery; and Amit Rao, MD, is Research Coordinator, Department of Surgery. The authors have disclosed no financial relationships related to this article. Submitted March 2, 2020; accepted in revised form May 4, 2020
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11
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Lakmal K, Basnayake O, Hettiarachchi D. Systematic review on the rational use of amniotic membrane allografts in diabetic foot ulcer treatment. BMC Surg 2021; 21:87. [PMID: 33588807 PMCID: PMC7885244 DOI: 10.1186/s12893-021-01084-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 02/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background Diabetic foot ulcer is a complication with multiple aetiological factors which has a significant impact to patients’ lives and costs to the healthcare system. The potential of human amniotic membrane to act as an allograft has been studied in relation to this condition. Aim of this study is to evaluate the current scientific evidence on its effectiveness in healing diabetic foot ulcers. Methods Pubmed, Cochrane library, and Google scholar were searched using the search terms, “Amnion” OR “Placenta” AND “Diabetic foot”. (MeSH terms) in the title or the abstract field from 1st of January 2000 to 30th March 2020. The quality of published reports was assessed using standard methods. We searched for experimental and observational studies in terms of randomized control trials, prospective cohort, retrospective cohort studies and case series. Results When searched with Mesh terms, 12 citations in PubMed, 22 citations in Cochrane library and 30 in other data bases were found. After screening the studies and their reference lists, 12 studies met the inclusion criteria and the others were excluded. There were 8 randomized control trials (RCTs), 2 prospective studies and 2 retrospective studies employing different preparation methods of the amniotic membranes. A wide variation in study end points were noted. Majority of the RCTs (n = 7) were concluded with significantly higher wound closure rate compared to the conventional treatment groups. In prospective and retrospective studies, it was shown that large chronic ulcers which were resistant to closure with standard therapy achieved wound closure with amniotic membrane allografts. A meta-analysis could not be performed due to study heterogeneity, and publication bias was not assessed due to the small number of available studies which was not sufficient for accurate comparison. Conclusion Even though, the studies had some inherent heterogeneity due to different preparation methods, different study end points and outcome measurements. According to our review the current studies using amniotic membrane allografts give reliable evidence of reduction in healing time over conventional methods.
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Affiliation(s)
- Kasun Lakmal
- Department of Anatomy, Faculty of Medicine, University of Colombo, 25, Kynsey Place 8, Colombo, Sri Lanka
| | - Oshan Basnayake
- Department of Anatomy, Faculty of Medicine, University of Colombo, 25, Kynsey Place 8, Colombo, Sri Lanka
| | - D Hettiarachchi
- Department of Anatomy, Faculty of Medicine, University of Colombo, 25, Kynsey Place 8, Colombo, Sri Lanka.
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Marston WA, Lantis JC, Wu SC, Nouvong A, Clements JR, Lee TD, McCoy ND, Slade HB, Tseng SC. One-year safety, healing and amputation rates of Wagner 3-4 diabetic foot ulcers treated with cryopreserved umbilical cord (TTAX01). Wound Repair Regen 2020; 28:526-531. [PMID: 32386343 PMCID: PMC7383512 DOI: 10.1111/wrr.12809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/09/2020] [Accepted: 03/10/2020] [Indexed: 12/14/2022]
Abstract
An open label, multicenter 16‐week trial of cryopreserved human umbilical cord (TTAX01) was previously undertaken in 32 subjects presenting with a Wagner grade 3 or 4 diabetic foot ulcer, with 16 (50%) of these having confirmed closure following a median of one product application (previous study). All but two subjects (30/32; 94%) consented to participate in this follow‐up study to 1‐year postexposure. No restrictions were placed on treatments for open wounds. At 8‐week intervals, subjects were evaluated for adverse events (AEs) and wound status (open or closed). Average time from initial exposure to end of follow‐up was 378 days (range 343‐433), with 29 of 30 (97%) subjects completing a full year. AEs were all typical for the population under study, and none were attributed to prior exposure to TTAX01. One previously healed wound re‐opened, one previously unconfirmed closed wound remained healed, and nine new wound closures occurred, giving 25 of 29 (86.2%) healed in the ITT population. Three of the new closures followed the use of various tissue‐based products. Three subjects whose wounds were healed required subsequent minor amputations due to osteomyelitis, one of which progressed to a major amputation (1/29; 3.4%). One additional subject underwent two minor amputations prior to healing. Overall, the study found TTAX01 to be safe in long‐term follow‐up and associated with both a low rate of major amputation and a higher than expected rates of healing.
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Affiliation(s)
- William A Marston
- Division of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - John C Lantis
- Mt Sinai West and St Luke's Hospitals, New York, New York, USA
| | - Stephanie C Wu
- Rosalind Franklin University, North Chicago, Illinois, USA
| | - Aksone Nouvong
- Department of Surgery, UCLA, Los Angeles, California, USA
| | | | | | | | - Herbert B Slade
- TissueTech, Inc., Miami, Florida, USA.,Department of Pediatrics, University of North Texas Health Sciences Center, Fort Worth, Texas, USA
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Su YN, Zhao DY, Li YH, Yu TQ, Sun H, Wu XY, Zhou XQ, Li J. Human amniotic membrane allograft, a novel treatment for chronic diabetic foot ulcers: A systematic review and meta-analysis of randomised controlled trials. Int Wound J 2020; 17:753-764. [PMID: 32119765 DOI: 10.1111/iwj.13318] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/18/2020] [Accepted: 01/27/2020] [Indexed: 02/05/2023] Open
Abstract
To evaluate the efficacy and safety of human amniotic membrane (HAM) allograft in treating chronic diabetic foot ulcers (DFUs), a comprehensive search of randomised controlled trials in MEDLINE, EMBASE, PubMed, CENTRAL and Web of Science was conducted to December 7, 2019. Two reviewers independently screened the studies, extracted data, and evaluated the quality of studies. The primary outcome was the proportion of complete healing. The secondary outcomes were mean time to complete healing and adverse events. Statistical analyses were performed using RevMan 5.3. We identified 257 articles, of which 7 articles (465 participants) were included in the meta-analysis. The proportion of complete wound healing in HAM plus standard of care (SOC) group was 3.88 times as high as that in SOC alone (RR: 3.88 [95% CI: 2.34, 6.44]) at 6 weeks, and 2.01 times at 12 weeks (RR: 2.01 [95%CI: 1.45, 2.77]). The intervention group had a significantly shorter time to complete healing (MD: -30.33 days, [95% CI: -37.95, -22.72]). The number needed to treat within 6 weeks was 2.3 ([95% CI: 1.8, 3.1]). No significant difference was shown in adverse events. Results were consistent in a sensitivity analysis. Hence, HAM plus SOC is effective and safe in treating chronic DFUs.
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Affiliation(s)
- Ya-Na Su
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Ding-Yun Zhao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Yong-Hong Li
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Tian-Qi Yu
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Huan Sun
- Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu City, Sichuan Province, China
| | - Xin-Yu Wu
- Chengdu Fifth People's Hospital, Chengdu City, Sichuan Province, China
| | - Xiao-Qin Zhou
- Department of Cardiothoracic Surgery, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Jing Li
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.,The Chinese Cochrane Center, Chengdu City, Sichuan Province, China
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