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Palackic A, Jay JW, Duggan RP, Branski LK, Wolf SE, Ansari N, El Ayadi A. Therapeutic Strategies to Reduce Burn Wound Conversion. Medicina (B Aires) 2022; 58:medicina58070922. [PMID: 35888643 PMCID: PMC9315582 DOI: 10.3390/medicina58070922] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/02/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
Burn wound conversion refers to the phenomenon whereby superficial burns that appear to retain the ability to spontaneously heal, convert later into deeper wounds in need of excision. While no current treatment can definitively stop burn wound conversion, attempts to slow tissue damage remain unsatisfactory, justifying the need for new therapeutic interventions. To attenuate burn wound conversion, various studies have targeted at least one of the molecular mechanisms underlying burn wound conversion, including ischemia, inflammation, apoptosis, autophagy, generation of reactive oxygen species, hypothermia, and wound rehydration. However, therapeutic strategies that can target various mechanisms involved in burn wound conversion are still lacking. This review highlights the pathophysiology of burn wound conversion and focuses on recent studies that have turned to the novel use of biologics such as mesenchymal stem cells, biomaterials, and immune regulators to mitigate wound conversion. Future research should investigate mechanistic pathways, side effects, safety, and efficacy of these different treatments before translation into clinical studies.
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Affiliation(s)
- Alen Palackic
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, A-8036 Graz, Austria
| | - Jayson W. Jay
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Robert P. Duggan
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Ludwik K. Branski
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Steven E. Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Naseem Ansari
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
- Correspondence:
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An update on stem cells applications in burn wound healing. Tissue Cell 2021; 72:101527. [PMID: 33756272 DOI: 10.1016/j.tice.2021.101527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 12/21/2022]
Abstract
Burn wounds have proven to be capable of having a long lasting devastating effects on human body. Conventional therapeutic approaches are not up to the mark as they are unable to completely heal the burn wound easily and effectively. Major pitfalls of these treatments include hypertrophic scarring, contracture and necrosis. Presence of these limitations in the current therapies necessitate the search for a better and more efficient cure. Regenerative potency of stem cells in burn wound healing outweigh the traditional treatment procedures. The use of multiple kinds of stem cells are gaining interest due to their enhanced healing efficiency. Distinctions of stem cells include better and faster burn wound healing, decreased inflammation levels, less scar progression and fibrosis on site. In this review, we have discussed the wound-healing process, present methods used for stem cells administration, methods of enhancing stem cells potency and human studies. Pre-clinical and the clinical studies focused on the treatment of thermal and radiation burns using stem cells from 2003 till the present time have been enlisted. Studies shows that the use of stem cells on burn wounds, whether alone or by the help of a scaffold significantly improves healing. Homing of the stem cells at the wound site results in the re-epithelialization, angiogenesis, granulation, inhibition of apoptosis, and regeneration of skin appendages together with reduced infection rate in the human studies. Several studies on animals have shown that stem cells can effectively promote wound healing. Although more research is needed to find out the effectiveness of this treatment in patients with severe burn wounds.
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Smith RD, Carney BC, Garg G, Monger KW, Prindeze NJ, Shupp JW, Moffatt LT. Modeling Burn Progression Using Comb Burns: The Impact of Thermal Contact Duration on Model Outcomes. J Surg Res 2020; 260:155-162. [PMID: 33340869 DOI: 10.1016/j.jss.2020.11.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/02/2020] [Accepted: 11/15/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Burn progression is a phenomenon that remains poorly characterized. The mechanisms of burn conversion are not completely understood, and consequently, both predictive diagnostic tools and interventions are limited. The rat comb burn model is a commonly used approach to study horizontal burn conversion. However, there is significant variability in how the model is performed. Skin contact duration, comb device heating method, comb heating duration, amount of pressure applied, the weight of the comb, and associated depth of burn are all variables that are heterogeneous in studies utilizing the model. MATERIALS AND METHODS Here, contact duration was examined to determine the impact the duration of burn delivery has on the conversion of interspaces in this model. Data from multiple experiments consisting of 10, 15, 20, 30, 40, and 45 s comb burns were compiled and assessed. Burns were made using combs heated in a 100°C dry bath and then monitored for 2 d. Interspace viability was assessed by digital and laser doppler imaging and biopsy procurement. RESULTS Laser Doppler Imaging and viable interspace measurements showed that as burn duration increased, the percentage of the viable interspace and interspace perfusion decreased. Additionally, a contact time of 30 s or greater was required to result in 100% interspace conversion. CONCLUSIONS These results demonstrate a need to better characterize and potentially standardize the rat comb burn model to reduce variation and maintain it as a valuable tool for controlled studies of the pathophysiology of burn wound progression.
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Affiliation(s)
- Robert D Smith
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia
| | - Bonnie C Carney
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Biochemistry and Molecular Biology, Georgetown University, Washington, District of Columbia
| | - Gaurav Garg
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Surgery, MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Kyle W Monger
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia
| | - Nicholas J Prindeze
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Surgery, MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Biochemistry and Molecular Biology, Georgetown University, Washington, District of Columbia; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia.
| | - Lauren T Moffatt
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Biochemistry and Molecular Biology, Georgetown University, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
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Henriksen JL, Sørensen NB, Fink T, Zachar V, Porsborg SR. Systematic Review of Stem-Cell-Based Therapy of Burn Wounds: Lessons Learned from Animal and Clinical Studies. Cells 2020; 9:cells9122545. [PMID: 33256038 PMCID: PMC7761075 DOI: 10.3390/cells9122545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022] Open
Abstract
Treatment of severe burn wounds presents a daunting medical challenge, and novel approaches promoting healing and reducing scarring are highly desirable. The application of mesenchymal stem/stromal cells (MSCs) has been suggested as a novel treatment. In this paper, we present systematic reviews of pre-clinical and clinical studies of MSC therapy for second- or third-degree thermal burn wounds. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, the PubMed and Embase databases were searched, and interventional studies of MSC therapy using rodent models (21 studies) or human burn patients (three studies) were included in the pre-clinical and clinical reviews, respectively, where both overall outcome and wound-healing-phase-specific methodologies and effects were assessed. The pre-clinical studies demonstrated a promising effect of the application of MSCs on several wound healing phases. The clinical studies also suggested that the MSC treatment was beneficial, particularly in the remodeling phase. However, the limited number of studies, their lack of homogeneity in study design, relatively high risk of bias, lack of reporting on mode of action (MOA), and discontinuity of evidence restrict the strength of these findings. This comprehensive review presents an overview of available methodologies to assess the MOA of MSC treatment for distinct wound healing phases. Furthermore, it includes a set of recommendations for the design of high-quality clinical studies that can determine the efficacy of MSCs as a therapy for burn wounds.
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Affiliation(s)
- Josefine Lin Henriksen
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, 9220 Aalborg, Denmark; (J.L.H.); (N.B.S.)
| | - Nana Brandborg Sørensen
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, 9220 Aalborg, Denmark; (J.L.H.); (N.B.S.)
| | - Trine Fink
- Regenerative Medicine Group, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 3B, 9220 Aalborg, Denmark; (T.F.); (V.Z.)
| | - Vladimir Zachar
- Regenerative Medicine Group, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 3B, 9220 Aalborg, Denmark; (T.F.); (V.Z.)
| | - Simone Riis Porsborg
- Regenerative Medicine Group, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 3B, 9220 Aalborg, Denmark; (T.F.); (V.Z.)
- Correspondence: ; Tel.: +45-99407567
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Mesenchymal stem cell therapy of acute thermal burns: A systematic review of the effect on inflammation and wound healing. Burns 2020; 47:270-294. [PMID: 33218945 DOI: 10.1016/j.burns.2020.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/25/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022]
Abstract
AIM Mesenchymal stem cell (MSC) therapies are emerging as a promising strategy to promote tissue repair, and may extend their utility to burn care. This comprehensive review of the extant literature, evaluated all in vivo studies, to elucidate the potential protective and therapeutic effect of MSCs in acute thermal skin burns. METHODS PubMed was systematically searched, according to PRISMA guidelines, and all relevant preclinical and clinical studies were included according to pre-specified eligibility criteria. RESULTS Forty-two studies were included in a qualitative synthesis, of which three were human and 39 were animal studies. The preclinical studies showed that MSCs can significantly reduce inflammation, burn wound progression and accelerate healing rate of acute burns. The underlying mechanisms are complex and not fully understood but paracrine modulators, such as immunomodulatory, antioxidative and trophic factors, seem to play important roles. Allogeneic MSC therapy has proved feasible in humans, and could allow for prompt treatment of acute burns in a clinical setting. CONCLUSION MSC therapy show positive results, regarding improved burn wound healing and immunologic response. However, most findings are based on small animal studies. Randomized clinical trials are warranted to investigate the regenerative effects in human burns before translating the findings into clinical practice.
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Homing and Engraftment of Intravenously Administered Equine Cord Blood-Derived Multipotent Mesenchymal Stromal Cells to Surgically Created Cutaneous Wound in Horses: A Pilot Project. Cells 2020; 9:cells9051162. [PMID: 32397125 PMCID: PMC7290349 DOI: 10.3390/cells9051162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 12/15/2022] Open
Abstract
Limb wounds on horses are often slow to heal and are prone to developing exuberant granulation tissue (EGT) and close primarily through epithelialization, which results in a cosmetically inferior and non-durable repair. In contrast, wounds on the body heal rapidly and primarily through contraction and rarely develop EGT. Intravenous (IV) multipotent mesenchymal stromal cells (MSCs) are promising. They home and engraft to cutaneous wounds and promote healing in laboratory animals, but this has not been demonstrated in horses. Furthermore, the clinical safety of administering >1.00 × 108 allogeneic MSCs IV to a horse has not been determined. A proof-of-principle pilot project was performed with two horses that were administered 1.02 × 108 fluorescently labeled allogeneic cord blood-derived MSCs (CB-MSCs) following wound creation on the forelimb and thorax. Wounds and contralateral non-wounded skin were sequentially biopsied on days 0, 1, 2, 7, 14, and 33 and evaluated with confocal microscopy to determine presence of homing and engraftment. Results confirmed preferential homing and engraftment to wounds with persistence of CB-MSCs at 33 days following wound creation, without clinically adverse reactions to the infusion. The absence of overt adverse reactions allows further studies to determine effects of IV CB-MSCs on equine wound healing.
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Tobalem M, Wettstein R, Tschanz E, Plock J, Lindenblatt N, Harder Y, Rezaeian F. The burn comb model revisited. Burns 2020; 46:675-681. [DOI: 10.1016/j.burns.2019.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/15/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
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Nazempour M, Mehrabani D, Mehdinavaz-Aghdam R, Hashemi SS, Derakhshanfar A, Zare S, Zardosht M, Moayedi J, Vahedi M. The effect of allogenic human Wharton's jelly stem cells seeded onto acellular dermal matrix in healing of rat burn wounds. J Cosmet Dermatol 2019; 19:995-1001. [PMID: 31556227 DOI: 10.1111/jocd.13109] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/20/2019] [Accepted: 07/23/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Various methods were introduced to overcome the autograft shortage in burn wound care, including cell transplantation and tissue engineering. AIMS To evaluate the healing effect of allogenic human Wharton's jelly stem cells (hWJSCs) seeded onto acellular dermal matrix (ADM) in rat burn injuries. PATIENTS AND METHODS Human Wharton's jelly stem cells provided from umbilical cord tissue were characterized before transplantation, and the growth kinetic was determined. Skin samples from cosmetic surgeries were used for preparation of ADM. Forty male Sprague Dawley rats were randomly divided into 4 equal groups. Third-degree burn was induced for all animals by exposing to hot water using a 2 cm ring for 10 seconds. Group 1 was burned rats that did not receive any treatment. After burn injury, the second group received silver sulfadiazine (SSD), the third group was treated just by using ADM, and the fourth group received 2 × 106 hWJSCs seeded onto ADM. The animals were euthanized for histologic evaluation after 7, 14, and 21 days. RESULTS Human Wharton's jelly stem cells were characterized to be spindle shape and positive for osteogenic and adipogenic induction and for mesenchymal markers but lacked hematopoietic markers. Population doubling time (PDT) was 40.1 hours with an increasing growth trend until day 6th. Macro- and microscopically, the healing was mild in ADM group and moderate in ADM + hWJSCs group after 21 days. CONCLUSION Allogenic hWJSCs seeded onto ADM improved the healing process in burn wounds denoting to their therapeutic and anti-inflammatory effects in burn wounds that can be added to the literature.
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Affiliation(s)
- Mehra Nazempour
- Department of Biomedical and Tissue Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Davood Mehrabani
- Stem cell Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Comparative and Experimental Medicine Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pathology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Seyedeh-Sara Hashemi
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Derakhshanfar
- Comparative and Experimental Medicine Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrokh Zare
- Stem cell Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Zardosht
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Moayedi
- Comparative and Experimental Medicine Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahjoob Vahedi
- Comparative and Experimental Medicine Center, Shiraz University of Medical Sciences, Shiraz, Iran
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The effects of mesenchymal stem cells with platelet-rich fibrin membrane to the wound healing of 2nd degree burns in rats. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abbas OL, Özatik O, Gönen ZB, Öğüt S, Entok E, Özatik FY, Bahar D, Bakir ZB, Musmul A. Prevention of Burn Wound Progression by Mesenchymal Stem Cell Transplantation: Deeper Insights Into Underlying Mechanisms. Ann Plast Surg 2018; 81:715-724. [PMID: 30260837 DOI: 10.1097/sap.0000000000001620] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Burns are dynamic wounds that may present a progressive expansion of necrosis into the initially viable zone of stasis. Therefore, salvage of this zone is a major subject of focus in burn research. The beneficial effects of mesenchymal stem cells (MSCs) on the survival of the zone of stasis have been previously documented. However, many gaps still exist in our knowledge regarding the underlying protective mechanisms. Hence, this study was designed to evaluate the pathophysiological basis of MSCs in the prevention of burn wound progression. METHODS Wistar rats received thermal trauma on the back according to the "comb burn" model. Animals were randomly divided into sham, control, and stem cell groups with sacrifice and analysis at 72 hours after the burn. The stasis zones were evaluated using histochemistry, immunohistochemistry, biochemistry, real-time polymerase chain reaction assay, and scintigraphy to evaluate the underlying mechanisms. RESULTS Gross evaluation of burn wounds revealed that vital tissue percentage of the zone of stasis was significantly higher in the stem cell group. Semiquantitative grading of the histopathologic findings showed that MSCs alleviated burn-induced histomorphological alterations in the zone of stasis. According to CC3a staining and expression analysis of Bax (B-cell leukemia 2-associated X) and Bcl-2 (B-cell leukemia 2) genes, MSCs attenuated increases in apoptosis postburn. In addition, these transplants showed an immunomodulatory effect that involves reduced neutrophilic infiltration, down-regulation of proinflammatory cytokines (tumor necrosis factor α, interleukin 1β [IL-1β], and IL-6), and up-regulation of the anti-inflammatory cytokine IL-10 in the zone of stasis. Burn-induced oxidative stress was significantly relieved with MSCs, as shown by increased levels of malondialdehyde, whereas the expression and activity of the antioxidant enzyme superoxide dismutase were increased. Finally, MSC-treated interspaces had enhanced vascular density with higher expression levels for vascular endothelial growth factor A, platelet-derived growth factor, fibroblast growth factor, and transforming growth factor β. Gamma camera images documented better tissue perfusion in animals treated with MSCs. CONCLUSIONS The protective effects of MSCs are mediated by the inhibition of apoptosis through immunomodulatory, antioxidative, and angiogenic actions.
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Affiliation(s)
- Ozan Luay Abbas
- From the Departments of Plastic, Reconstructive and Aesthetic Surgery and
| | - Orhan Özatik
- Histology and Embryology, Faculty of Medicine, Ahi Evran University, Kirşehir
| | | | - Serdal Öğüt
- Department of Nutrition and Dietetics, Faculty of Health Science, Adnan Menderes University, Aydin
| | - Emre Entok
- Department of Nuclear Medicine, Faculty of Medicine, Osmangazi University, Eskişehir
| | | | - Dilek Bahar
- Gen Kök Genome and Stem Cell Center, Erciyes University, Kayseri
| | | | - Ahmet Musmul
- Department of Biostatistics, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
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Ahmadi AR, Chicco M, Huang J, Qi L, Burdick J, Williams GM, Cameron AM, Sun Z. Stem cells in burn wound healing: A systematic review of the literature. Burns 2018; 45:1014-1023. [PMID: 30497816 DOI: 10.1016/j.burns.2018.10.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/11/2018] [Accepted: 10/19/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Severe burns are often associated with high morbidity and unsatisfactory functional and esthetic outcomes. Over the last two decades, stem cells have generated great hopes for the treatment of numerous conditions including burns. The aim of this systematic review is to evaluate the role of stem cell therapy as a means to promote burn wound healing. METHODS Comprehensive searches in major databases were carried out in March 2017 for articles on stem cell therapy in burn wound healing. In total 2103 articles were identified and screened on the basis of pre-determined inclusion and exclusion criteria. RESULTS Fifteen experimental and two clinical studies were included in the review. The majority of studies reported significant improvement in macroscopic burn wound appearance as well as a trend toward improved microscopic appearance, after stem cell therapy. Other parameters evaluated, such as re-vascularization, collagen formation, level of pro- and anti-inflammatory mediators, apoptosis and cellular infiltrates, yielded heterogeneous results across studies. CONCLUSION Stem cell therapy appears to exert a positive effect in burn wound healing. There is, therefore, justification for continued efforts to evaluate the use of stem cells as an adjunct to first-line therapies in burns.
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Affiliation(s)
- Ali R Ahmadi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Maria Chicco
- Department of Surgery, St. Mary's Hospital, Imperial College London, London, United Kingdom
| | - Jinny Huang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Le Qi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - James Burdick
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - George M Williams
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew M Cameron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zhaoli Sun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Revilla G, Afriani N, Rusnita D. Effects of Bone Marrow Mesenchymal Stem Cell to Transforming Grow Factor-β3 and Matrix Metalloproteinase-9 Expression in Burns. JOURNAL OF MEDICAL SCIENCES 2018. [DOI: 10.3923/jms.2018.164.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Xue M, Zhao R, Lin H, Jackson C. Delivery systems of current biologicals for the treatment of chronic cutaneous wounds and severe burns. Adv Drug Deliv Rev 2018; 129:219-241. [PMID: 29567398 DOI: 10.1016/j.addr.2018.03.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/08/2018] [Accepted: 03/13/2018] [Indexed: 12/15/2022]
Abstract
While wound therapy remains a clinical challenge in current medical practice, much effort has focused on developing biological therapeutic approaches. This paper presents a comprehensive review of delivery systems for current biologicals for the treatment of chronic wounds and severe burns. The biologicals discussed here include proteins such as growth factors and gene modifying molecules, which may be delivered to wounds free, encapsulated, or released from living systems (cells, skin grafts or skin equivalents) or biomaterials. Advances in biomaterial science and technologies have enabled the synthesis of delivery systems such as scaffolds, hydrogels and nanoparticles, designed to not only allow spatially and temporally controlled release of biologicals, but to also emulate the natural extracellular matrix microenvironment. These technologies represent an attractive field for regenerative wound therapy, by offering more personalised and effective treatments.
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Hosni Ahmed H, Rashed LA, Mahfouz S, Elsayed Hussein R, Alkaffas M, Mostafa S, Abusree A. Can mesenchymal stem cells pretreated with platelet-rich plasma modulate tissue remodeling in a rat with burned skin? Biochem Cell Biol 2017; 95:537-548. [PMID: 28314112 DOI: 10.1139/bcb-2016-0224] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Our aim was to study the effect of platelet-rich plasma (PRP) on the proliferation of bone-marrow-derived mesenchymal stem cells (BM-MSCs) and to investigate their roles in the healing of experimental burn injury and the possible mechanism of action. Our work was divided into in-vitro and in-vivo studies. The in-vitro study included untreated MSCs and MSCs treated with PRP. Levels of TGF-β and cell proliferation were assessed. In the in-vivo study, 72 rats were distributed equally among 6 groups: control, burn, burn with MSCs, burn with PRP, burn with both MSCs and PRP, and burn with MSCs pretreated with PRP. On the 7th and 20th day after injury, the serum levels of transforming growth factor beta (TGF-β) and tumor necrosis factor alpha (TNF-α), as well as interleukin-10 (IL-10) levels in skin tissue were measured by ELISA; histopathology and gene expression of MMP-1, TIMP-2, Ang-1, Ang-2, and vimentin by real-time PCR were performed in all groups. In vitro: proliferation of MSCs and TGF-β increased in the PRP-treated group compared with the control group. In vivo: Ang-1, Ang-2, and vimentin were upregulated, whereas MMP-1 and TIMP-2 were downregulated. TGF-β and IL-10 were increased, whereas TNF-α was decreased in all treated groups with more significance in MSCs and PRP on day 20. Histopathology of burn skin was improved in all treated groups, particularly in MSCs pretreated with PRP 20 days post-burn.
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Affiliation(s)
- Hanan Hosni Ahmed
- a Department of Medical Biochemistry and Molecular Biology, Unit of Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Laila Ahmed Rashed
- a Department of Medical Biochemistry and Molecular Biology, Unit of Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sohair Mahfouz
- b Department of Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rania Elsayed Hussein
- a Department of Medical Biochemistry and Molecular Biology, Unit of Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa Alkaffas
- a Department of Medical Biochemistry and Molecular Biology, Unit of Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shaimaa Mostafa
- c Plastic Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Azza Abusree
- a Department of Medical Biochemistry and Molecular Biology, Unit of Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
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15
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Importance of homogeneity between groups in the study of therapeutic efficacy. Cytotherapy 2016; 19:327-328. [PMID: 27769638 DOI: 10.1016/j.jcyt.2016.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 11/22/2022]
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Salibian AA, Rosario ATD, Severo LDAM, Nguyen L, Banyard DA, Toranto JD, Evans GRD, Widgerow AD. Current concepts on burn wound conversion-A review of recent advances in understanding the secondary progressions of burns. Burns 2016; 42:1025-1035. [PMID: 26787127 DOI: 10.1016/j.burns.2015.11.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/16/2015] [Accepted: 11/24/2015] [Indexed: 01/27/2023]
Abstract
Burn wound conversion describes the process by which superficial partial thickness burns convert into deeper burns necessitating surgical intervention. Fully understanding and thus controlling this phenomenon continues to defy burn surgeons. However, potentially guiding burn wound progression so as to obviate the need for surgery while still bringing about healing with limited scarring is the major unmet challenge. Comprehending the pathophysiologic background contributing to deeper progression of these burns is an essential prerequisite to planning any intervention. In this study, a review of articles examining burn wound progression over the last five years was conducted to analyze trends in recent burn progression research, determine changes in understanding of the pathogenesis of burn conversion, and subsequently examine the direction for future research in developing therapies. The majority of recent research focuses on applying therapies from other disease processes to common underlying pathogenic mechanisms in burn conversion. While ischemia, inflammation, and free oxygen radicals continue to demonstrate a critical role in secondary necrosis, novel mechanisms such as autophagy have also been shown to contribute affect significantly burn progression significantly. Further research will have to determine whether multiple mechanisms should be targeted when developing clinical therapies.
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Affiliation(s)
- Ara A Salibian
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, 200 S. Manchester Avenue, Orange, CA, 92868-3298, United States
| | - Angelica Tan Del Rosario
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, 200 S. Manchester Avenue, Orange, CA, 92868-3298, United States
| | - Lucio De Almeida Moura Severo
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, 200 S. Manchester Avenue, Orange, CA, 92868-3298, United States
| | - Long Nguyen
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, 200 S. Manchester Avenue, Orange, CA, 92868-3298, United States
| | - Derek A Banyard
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, 200 S. Manchester Avenue, Orange, CA, 92868-3298, United States
| | - Jason D Toranto
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, 200 S. Manchester Avenue, Orange, CA, 92868-3298, United States
| | - Gregory R D Evans
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, 200 S. Manchester Avenue, Orange, CA, 92868-3298, United States
| | - Alan D Widgerow
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, 200 S. Manchester Avenue, Orange, CA, 92868-3298, United States.
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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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The Use of Stem Cells in Burn Wound Healing: A Review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:684084. [PMID: 26236731 PMCID: PMC4508388 DOI: 10.1155/2015/684084] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 01/15/2023]
Abstract
Burn wound healing involves a series of complex processes which are subject to intensive investigations to improve the outcomes, in particular, the healing time and the quality of the scar. Burn injuries, especially severe ones, are proving to have devastating effects on the affected patients. Stem cells have been recently applied in the field to promote superior healing of the wounds. Not only have stem cells been shown to promote better and faster healing of the burn wounds, but also they have decreased the inflammation levels with less scar progression and fibrosis. This review aims to highlight the beneficial therapeutic effect of stem cells in burn wound healing and to discuss the involved pathways and signaling molecules. The review covers various types of burn wound healing like skin and corneal burns, along with the alternative recent therapies being studied in the field of burn wound healing. The current reflection of the attitudes of people regarding the use of stem cells in burn wound healing is also stated.
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Ozturk S, Karagoz H. Experimental stem cell therapies on burn wound: do source, dose, timing and method matter? Burns 2015; 41:1133-9. [PMID: 25716759 DOI: 10.1016/j.burns.2015.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 12/15/2014] [Accepted: 01/13/2015] [Indexed: 12/11/2022]
Abstract
Stem cell therapy has been introduced as a new and promising modality of wound covering in recent decade. It has been used for improvement of burn wound, post burn scar and saving stasis zone of burn with good results. However, there have been some differences between the various experimental burn wound trials in stem cell source, therapeutic dose, delivery method and timing of stem cell delivery. In our study, we aimed to review stem cell biology and investigate discrepancies in animal trials of use of stem cells in burn wound account for the variation in, stem cell source, therapeutic dose, delivery method and timing of stem cell delivery.
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Affiliation(s)
- Sinan Ozturk
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Plastic and Reconstructive Surgery Department, Turkey.
| | - Huseyin Karagoz
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Plastic and Reconstructive Surgery Department, Turkey
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20
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Treatment of Secondary Burn Wound Progression in Contact Burns—A Systematic Review of Experimental Approaches. J Burn Care Res 2015; 36:e176-89. [DOI: 10.1097/bcr.0000000000000131] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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