Tissue therapy with autologous dermal and epidermal culture cells for diabetic foot ulcers

Abstract

A great part of diabetic ulcers on the lower extremities have difficult healing and represent the most common cause of non-traumatic amputation In case of patients unresponsive to the classical therapy with debridement, dressings and systemic antibiotic therapy, cell therapy may be an excellent indication. The objective of this study was to assess the efficacy of autologous skin cell (fibroblasts and keratinocytes) implants cultivated ex vivo and applied to long-standing (9-34 years) skin ulcers of five diabetic patients (4 DM2 and 1 DM1) with autologous fibrin glue. There were six ulcers of onset between 4 months and 20 years before and from 4.0 to 36.62 cm(2) in size, located on the lower limbs and unresponsive to the several conventional treatments. Complete healing was observed in five ulcers (83.3%), after 21-120 days. The patient who presented the largest ulcer had partial improvement in 40 days. It is believed that the more distal ulcer location is, the worse is its prognosis. There probably is a correlation between healing time, ulcer size and prior duration. No adverse reactions derived from the treatment occurred. It is concluded that this method is an excellent therapeutic option for diabetic ulcers, allowing faster healing. Its great advantage is being a minimally invasive procedure that can be carried out in an outpatient clinic.

Development and Characterization of an Engraftable Tissue-Cultured Skin Autograft: Alternative Treatment for Severe Electrical Injuries?

“…After wound bed conditioning -approximately after 7 days -these dermal substitutes are removed and autografting can be performed. Autologous cell-containing fibrin glues [Marcelo et al, 2012] or Integra ® [Pauchot et al, 2013] are alternatives that are permanent and do not have to be removed from the wound. Their healing times range from 21 days to 18 weeks.…”

Sickle cell disease: Classification of clinical complications and approaches to preventive and therapeutic management

“…Certain modalities for the management of leg ulcers that are not commonly used in SCD include topical application of platelet-derived growth factor prepared either autologously (Procuren) [50] or by recombinant technology (Regranex) [51], topical sodium nitrite for chronic leg ulcers [52], and the use of cultured skin grafts [53]. In addition, mānuka honey from New Zealand has been reported to heal diabetic foot ulcers [54,55].…”

Alteration of Skin Properties with Autologous Dermal Fibroblasts

“…Another delivery method is direct application of fibroblasts suspended in matrix to the wound or ulcer site. In diabetic foot ulcers a proprietary mixture of cultured keratinocytes and fibroblasts are suspended in fibrin glue and applied to the wound before the area is covered with a dressing [44]. Another approach is grafting a composite bandage with cells incorporated in a matrix.…”

“…This product could be improved by the use of autologous skin constituents consisting of fibroblasts and keratinocytes to generate a “custom” bi-layered skin substitutes for skin repair and regeneration. Along these lines, proof of principle experiments have shown that long standing diabetic ulcers treated with a mixture of autologous fibroblast and keratinocytes in a fibrin suspension resulted in faster healing of ulcers with no adverse effect [44]. …”