Use of dehydrated human amniotic membrane allografts to promote healing in patients with refractory non healing wounds

Sheikh, Emran; Sheikh, Ednan; Fetterolf, Donald

doi:10.1111/iwj.12035

Cited by 78 publications

(58 citation statements)

References 14 publications

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“…In one small series, patients with a variety of wound types refractory to traditional therapies demonstrated improved healing after dHACM allografts treatment. 19 Sheikh et al 20 also reported a case series demonstrating that refractory, nonhealing wounds treated FIGURE 5. Elution of growth factors over 96 h into normal saline.…”

Section: Discussionmentioning

confidence: 99%

Properties of dehydrated human amnion/chorion composite grafts: Implications for wound repair and soft tissue regeneration

Koob¹,

Lim²,

Massee³

et al. 2014

J Biomed Mater Res

199

160

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PURIONV R processed dehydrated human amnion/chorion membrane (dHACM; MiMedx Group, Marietta, GA) tissue products were analyzed for the effectiveness of the PURION V R process in retaining the native composition of the amniotic membrane and preserving bioactivity in the resulting products. dHACM was analyzed for extracellular matrix (ECM) composition through histological staining and for growth factor content via multiplex ELISA arrays. Bioactivity was assessed by evaluating endogenous growth factor production by human dermal fibroblasts in response to dHACM and for thermal stability by mechanical tests and in vitro cell proliferation assays. Histology of dHACM demonstrated preservation of the native amnion and chorion layers with intact, nonviable cells, collagen, proteoglycan, and elastic fibers distributed in the individual layers. An array of 36 cytokines known to regulate processes involved in inflammation and wound healing were identified in dHACM. When treated with dHACM extracts, bioactivity was demonstrated through an upregulation of basic fibroblast growth factor, granulocyte colony-stimulating factor, and placental growth factor biosynthesis, three growth factors involved in wound healing, by dermal fibroblasts in vitro. After conditioning at temperatures ranging from 278.7 to 173.5 C, dHACM retained its tensile strength and ability to promote proliferation of dermal fibroblasts in vitro. Elution experiments demonstrated a soluble fraction of growth factors that eluted from the tissue and another fraction sequestered within the matrix. The PURION V R process retains the native composition of ECM and signaling molecules and preserves bioactivity. The array of cytokines preserved in dHACM are in part responsible for its therapeutic efficacy in treating chronic wounds by orchestrating a "symphony of signals" to promote healing.

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Section: Discussionmentioning

confidence: 99%

Properties of dehydrated human amnion/chorion composite grafts: Implications for wound repair and soft tissue regeneration

Koob¹,

Lim²,

Massee³

et al. 2014

J Biomed Mater Res

199

160

View full text Add to dashboard Cite

show abstract

“…Data suggests that a balance of stem cell secreted immunoregulatory proteins in a chronic wound may be crucial to transition the wound out of this sustained inflammatory phase and into a normal acute healing phase to achieve wound re‐epithelialization. In prospective, randomized, controlled clinical trials, dHACM tissue has demonstrated the ability to resolve chronic inflammation and accelerate healing in a variety of refractory wounds;29, 30, 31, 48, 49, 50 however, the mechanisms of action remain somewhat unclear. Data from preclinical wound models in mice has additionally shown that dHACM implanted subcutaneously leads to the recruitment of circulating host MSCs and HSCs, suggesting that adult stem cells may contribute to the mechanism by which dHACM promotes healing 3, 33.…”

Section: Discussionmentioning

confidence: 99%

Dehydrated human amnion/chorion membrane regulates stem cell activity in vitro

Massee

Chinn

Lei³

et al. 2015

J Biomed Mater Res

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Human‐derived placental tissues have been shown in randomized clinical trials to be effective for healing chronic wounds, and have also demonstrated the ability to recruit stem cells to the wound site in vitro and in vivo. In this study, PURION® Processed dehydrated human amnion/chorion membrane allografts (dHACM, EpiFix®, MiMedx Group, Marietta, GA) were evaluated for their ability to alter stem cell activity in vitro. Human bone marrow mesenchymal stem cells (BM‐MSCs), adipose derived stem cells (ADSCs), and hematopoietic stem cells (HSCs) were treated with soluble extracts of dHACM tissue, and were evaluated for cellular proliferation, migration, and cytokine secretion. Stem cells were analyzed for cell number by DNA assay after 24 h, closure of an acellular zone using microscopy over 3 days, and soluble cytokine production in the medium of treated stem cells was analyzed after 3 days using a multiplex ELISA array. Treatment with soluble extracts of dHACM tissue stimulated BM‐MSCs, ADSCs, and HSCs to proliferate with a significant increase in cell number after 24 h. dHACM treatment accelerated closure of an acellular zone by ADSCs and BM‐MSCs after 3 days, compared to basal medium. BM‐MSCs, ADSCs, and HSCs also modulated endogenous production of a number of various soluble signals, including regulators of inflammation, mitogenesis, and wound healing. dHACM treatment promoted increased proliferation and migration of ADSCs, BM‐MSCs, and HSCs, along with modulation of secreted proteins from those cells. Therefore, dHACM may impact wound healing by amplifying host stem cell populations and modulating their responses in treated wound tissues. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1495–1503, 2016.

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“…Of 12 patients, 4 had surgical dehiscence, 3 patients had neuropathic DFUs, and 5 other patients had venous leg ulcers (VLU), scleroderma, snake bite, or traumatic or arterial insufficiency wounds. [62][63][64] Three patients with neuropathic chronic DFUs were described in the Shah study. The initial wound sizes were 0.42, 3.42, and 1.32 cm 2 with a duration of 4, 7-8, and 3 months, respectively.…”

Section: Commercial Placental Membrane Productsmentioning

confidence: 99%

Use of Placental Membranes for the Treatment of Chronic Diabetic Foot Ulcers

Brantley

Verla

2015

Advances in Wound Care

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Significance: Chronic diabetic foot ulcers (DFUs) remain a challenge for physicians to treat. High mortality rates for DFU patients have pointed to the low effectiveness of standard care and lack of quality wound care products. The composition (collagen-rich tissue matrix and endogenous growth factors and cells) and functional properties (anti-inflammatory, anti-bacterial, and angiogenic) of placental membranes are uniquely suited to address the needs of chronic wounds. This led to the commercialization of placental membranes, which are now widely available to physicians as a new advanced wound treatment option.Recent Advances: Progress in tissue processing and preservation methods has facilitated the development of placental products for wounds. Currently, a variety of commercial placental products are available to physicians for the treatment of chronic DFUs and other wounds. This review summarizes the key factors that negatively impact DFU healing (including social factors, such as smoking, vascular deficiencies, hyperglycemia, and other metabolic abnormalities), describes the structure and biology of placental membranes, and overviews commercially available placental products for wounds and data from the most recent DFU clinical trials utilizing commercial placental membranes.Critical Issues: Although the effects of diabetes on wound healing are complex and not fully understood, some of the key factors and pathways that interfere with healing have been identified. However, a multidisciplinary approach for the assessment of patients with chronic DFUs and guidelines for selection of appropriate treatment modalities remain to be implemented.Future Directions: The biological properties of placental membranes show benefits for the treatment of chronic DFUs, but scientific and clinical data for commercially available placental products are limited. Therefore, we need (1) more randomized, controlled clinical trials for commercial placental products; (2) studies that help to understand the timing of placental products' application and criteria for patient selection; and (3) studies comparing the functional properties of different commercially available placental products.

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Use of dehydrated human amniotic membrane allografts to promote healing in patients with refractory non healing wounds

Cited by 78 publications

References 14 publications

Properties of dehydrated human amnion/chorion composite grafts: Implications for wound repair and soft tissue regeneration

Properties of dehydrated human amnion/chorion composite grafts: Implications for wound repair and soft tissue regeneration

Dehydrated human amnion/chorion membrane regulates stem cell activity in vitro

Use of Placental Membranes for the Treatment of Chronic Diabetic Foot Ulcers

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