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Efficacy of adipose derived stem cells in management of chronic ulcers - Comment

Description: About the use of adipose derived stem cells in management of chronic ulcers.

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1. Efficacy of adipose derived stem cells in management of chronic ulcers: clinical and laboratory study By Emil Sabry
2. Normal Wound healing It is an elaborate process that occurs in distinct, yet overlapping phases of well orchestrated cascade of biological and molecular processes: • Hemostasis • Inflammation • Proliferation • Remodeling
3. Abnormal wound healing •Chronic wounds occur when there is failure of injured skin to proceed through an orderly and timely process to produce anatomic and functional integrity. •This mostly caused by conditions like DM, malnutrition, venous insufficiency, ischemia and/or immunosuppression.
4. Impaired wound healing in DM: • Impaired cellular activity • Impaired Extracellular matrix (ECM) synthesis and deposition • Impaired growth factors release • Impaired neovascularization
5. Cell therapy •Despite the huge advances in medical care, chronic non-healing wounds still represent a challenge in our practice. •New therapies are required to optimize wound healing like cell therapies. •Cell therapy is defined as a set of strategies to use living cells as a regenerative therapy to repair, replace or restore biological function.
6. Stem cells •The term stem cells refers to a myriad of different cell types that share two key characteristics: Self- renewal and the potential for differentiation into different cell types. •In 2001, Zuk et al. demonstrated that human fat obtained from human lipoaspirates contained multilineage stem cells, which have the potential to undergo adipogenesis, osteogenesis, chondrogenesis and myogenesis in vitro and in vivo.
7. Role of stem cells in chronic wound healing •Stem cells enhance cutaneous wound healing through trophic and paracrine activity, providing: 1 - Ability to differentiate into various types of cells. 2 - Biological pump secreting growth factors. •Resulting in: - Enhancing growth factors availability for wound healing. - Promoting angiogenesis. - Regulation of inflammatory process. - Differentiation into target tissue cells.
8. Aims of our work •Evaluation of the efficacy of ASCs therapy in treatment of non-healing ulcers(both by clinical & histological parameters. •Estimation the amount of stem cells yield of adipose tissue and the stem cell requirements for non-healing ulcer in relation to ulcer surface area by flowcytometry.
9. Methodology 1. Aspiration of fat by standard liposuction methods. 2. Treatment of fat tissue obtained enzymatically for freeing cellular content. 3. Estimation of stem cell yield by immunophenotypic characters; CD45, CD31, CD34+, CD105+. 4. Injection of the yielded cellular contents into the ulcer using blunt cannulas no. 2. 5. Injection will be for successive times 20-30 day apart until healing occurs.
10. Methodology 6. Evaluation of results by: •Anthropometric measures before and after injection documented by photography. •Comparing histologic features in ulcer before and after injection regarding cellular recruitment, angiogenesis and restoration of cell appendages. •Preparation of ulcer for further intervention. •Overall aesthetic healing results.
11. Histological parameters of assessment: 1. Wound reepithelialization: migration of keratinocytes, bridging of cells, keratinization 2. Inflammatory cells: absence/ presence (mild/moderate/marked) 3. Fibroblasts: absence/presence (mild/moderate/marked) 4. New vessels: absence/presence (mild/moderate/marked) 5. Collagen: absence/presence (mild/moderate/marked)
12. Clinical cases
13. Diabetic ulcer right heel – Healed after 2 injections
14. Diabetic ulcer left forefoot – Healed after 2 injections
15. Trophic ulcer left forefoot – Healed after 2 injections
16. Diabetic ulcer right forefoot – Healed after 2 injections
17. Trophic ulcer right heel – Healed after 2 injections
18. Diabetic ulcer left big toe – Healed after 2 injections
19. Conclusion: Adipose derived stem cell is an effective method in treating chronic ulcers alongside with other lines of treatment like offloading and optimization of patient’s general condition
20. Thank you

Posted by :  peter88 Post date :  2020-01-13 13:15
Category :  Health & Medicine Views :  73

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