Autologous stem cell‐based therapy for sickle cell leg ulcer: a pilot study

Abstract

Recurrent chronic leg ulcers are among the most severe vasculopathic complications of sickle cell disease (SCD). Their treatment remains a challenge. Stem cell therapy with bone marrow mononuclear cells (BMMC) is a promising new therapeutic option for other forms of chronic ulcers. This prospective pilot study was performed to evaluate safety and feasibility of BMMC implantation in patients with SCD and chronic leg ulcers (SCLU). Ulcer closure, recurrence and local pain were evaluated. BMMC were successfully administered to 23 SCLU patients and no serious adverse events occurred. During the 6-month follow-up period, 91·3% of patients had improved ulcer pain compared with baseline and 29·2% of the treated ulcers achieved total healing. The frequency of progenitor stem cells (CD34CD45 and fibroblast colony-forming units) in BMMC was found to be significantly reduced in SCLU patients and compared to SCD patients without ulcers (P < 0·004 and P < 0·01, respectively). No relationship was observed between treatment outcome and the number of implanted BM progenitor stem cells. In conclusion, BMMC implantation is a feasible and safe procedure, showing favourable outcomes for the treatment of SCLU, and encouraging further controlled clinical trials.

To learn more about sickle cell ulcers

“…In these mice, we confirmed that skin healing was delayed due to a reduced migration of marrow endothelial progenitor cells in wounds in relation with a defect in skin SDF1 production . In accordance with our study, another group has shown that autologous marrow progenitors injected into patient's ulcers were able to allow significant healing of ulcers . Therefore, local cutaneous as well as distant – mainly marrow‐occurring mechanisms related to wound angiogenesis – appear altered in affected patients.…”

Leg Ulcers in Sickle-Cell Disease: Treatment Update

“…A pilot study in 2016 used cellular therapy: stem cells from bone marrow mononuclear cells (BMMC) were injected locally in 23 patients with SCLUs. 63 During the 6-month follow-up period, 29.2% of the ulcers treated achieved total healing, which does not appear different from results obtained using standard wound care. The rationale behind using these autologous cells was that progenitor stem cells (CD34CD45low and fibroblast colony-forming units) in BMMC were found to be significantly reduced in SCLU patients when compared with SCD patients without ulcers.…”

Uso de Células Tronco Mesenquimais na Medicina Regenerativa e Rejuvenescimento

“…Plaquetas, linfócitos 22 Ortopedia A terapia com células tronco mesenquimais vem se tornando um procedimento clínico muito aplicado no tratamento de patologias relacionadas com a cartilagem e com o menisco, incluindo a osteoartrite. 23 Corroborando com isso, o Dr. Roberto Dórea e o Prof. Ricardo Ribeiro dos Santos, fizeram um trabalho que usou o Plasma rico em fatores de crescimento e células mesenquimais para tratar degeneração condral grau IV na articulação do joelho.…”