Dallas Stem Cell Researchers Use Amniotic Tissue To Successfully Treat Non-Healing Surgical Wound


The founders of the Riordan-McKenna Institute, Neil Riordan, PhD and orthopedic surgeon, Wade McKenna, DO, have announced that the use of sterile, dehydrated amniotic tissue AlphaPATCH™, which was developed by Amniotic Therapies in Dallas, Texas, resulted in complete healing of an otherwise non-healing surgical knee wound.

The case involved a 78-year-old male who had a non-healing surgical wound from a total right knee replacement that had been performed six weeks earlier. The patient had not responded after 6 weeks of conservative wound care and the wound showed no signs of healing.

Dr. McKenna irrigated the wound in the operating room and then placed two AlphaPATCH dry amniotic membranes (4 cm x 4 cm) over the wound before dressing it.

At the two-week follow-up visit, a central scab had formed over the wound. At four-weeks, the wound had completely scabbed over, and by eight-weeks, the scab had just fallen off and the wound was healing well, covered by a patch of immature skin about the size of a penny. At the ten-week follow-up visit, the wound was completely healed.

The case report, entitled “Case Report Of Non-Healing Surgical Wound Treated With Dehydrated Amniotic Membrane” is published in the July issue of the Journal of Translational Medicine. This milestone in Dr. Riordan and Dr. McKenna’s ongoing study of the use of amniotic tissue products and stem cells to stimulate or augment wound healing is the third peer-reviewed journal article on regenerative medicine published by the Riordan McKenna Institute.

Dehydrated amniotic membrane products like AlphaPATCH is thought by most people to contain live stem cells, which is not the case. However, dehydrated amniotic membrane does contain several growth factors that promote healing and stimulate the body’s own stem cells to behave more similar to stem cells in a younger person.

“It’s gratifying to have this new tool in my toolbox. I treated conservatively and was getting nowhere. Even in a patient with a significant smoking history and decreased blood flow to his legs, we were able to achieve this result. Chronic wounds can be very frustrating for both the patient and the caregiver,” remarked Troy Chandler, PA-C, who participated in the patient’s treatment.

Wound Healing and Human Umbilical Cord Mesenchymal Stem Cells


Previous studies have shown that human bone marrow–derived mesenchymal stromal cells have potential to accelerate and augment wound healing. However, in the clinic, it is difficult to properly culture and then use bone marrow stem cells. Human umbilical cord blood–derived mesenchymal stromal cells (hUCB-MSCs) recently have been commercialized for cartilage repair as a cell-based therapy product that uses allogeneic stem cells.

Presently, current cell therapy products for wound healing utilize fibroblasts. Is it possible that hUCB-MSCs are superior to fibroblasts for wound healing? Seung-Kyu Han and his colleagues from the Department of Plastic Surgery at the Korea University College of Medicine in Seoul, South Korea used a cell culture system to compare the ability of hUCB-MSCs and fibroblasts to heal wounds.

For their study, Han and others used diabetic mice and isolated fibroblasts from normal and diabetic mice. Then they tested the ability of these cells to heal skin wounds in the very mice from which they were isolated. A third group of diabetic mice with skin wounds were treated with hUCB-MSCs. A comparison of all three groups examined the cell proliferation, collagen synthesis and growth factor (basic fibroblast growth factor, vascular endothelial growth factor and transforming growth factor-β) production and compared them among the three groups.

The results showed that hUCB-MSCs produced significantly higher amounts of vascular endothelial growth factor and basic fibroblast growth factor in comparison to both fibroblast groups. Human UCB-MSCs were better than diabetic fibroblasts but healthy fibroblasts in collagen synthesis, and there were no significant differences in cell proliferation and transforming growth factor-β production. Human UCB-MSCs produced significantly higher amounts of VEGF and bFGF when compared with both fibroblasts.

These results suggest that Human UCB-MSCs might be a better source for diabetic wound healing than either allogeneic or autologous fibroblasts. Larger animal studies will be needed, but this particular study seems like a good start.

A New Way to Prepare Fat-Based Stem Cells to Treat Wounds


An Italian laboratory headed by Dr. Raposio at the University of Parma has designed a simple and fast technique for preparing fat-based stem cells for use in the clinic.

Fat contains an alternative source of mesenchymal stem cells with characteristics similar to those found in bone marrow, but the fat-based stem cells are easier to isolate and have been shown to be effective enhancers of wound healing.

Raposio and his colleagues used fat contributed by liposuction patients. Each patient provided about 80 cubic centimeters of fat in liposuction procedures that were collected under anesthesia. Once the cells from this fat were isolated, they were mixed with platelet-rich plasma (PRP) that had been previously collected. Mixing PRP with stem cells enhances the capabilities of the fat-based stem cells and generates a concoction called “e-PRP.”  This simple procedure that consisted of fat collection, stem cell collection and mixing the cells with PRP to make e-PRP quickly made a produce that was ready for grafting onto wounds on the skin.

Detailed analyses of the cells isolated from the fat showed that they consisted of about 50,000 fat-based mesenchymal stem cells or ASCs. They represented about 5% of all cells in the sample. The remaining cells were blood-derived cell and blood vessel-making endothelial cells.

The significance of this procedure lies in the fact that most of the protocols used to isolate stem cells from fat take about two hours and require animal-derived reagents. However, the number of ASCs isolated with this new procedure is sufficient for application to wounds without the need of expanding the cells in culture. Also, this new procedure does not require serum or animal-derived reagents, and it takes only 15 minutes.

Thus this method of ASC isolation is innovative, feasible, and represents an advance in the stem cell-based treatment of chronic wounds.

Mesenchymal Stem Cells Make Blood Vessel Cells and Improve Wound Healing


Mesenchymal stem cells from umbilical cord have the ability to differentiate into cartilage cells, fat cells, bone cells, and blood vessels cells. These cells also are poorly recognized by the immune system of the patient and are at a low risk of being rejected by the patient’s immune system.

Valeria Aguilera and her colleagues from the laboratory of Claudio AguayoWe at the University of Concepción, Chilee have evaluated the use of mesenchymal stem cells from umbilical cord in the formation of new blood vessels in damaged tissues. Wharton’s jelly mesenchymal stem cells of hWMSCs were used to potentially accelerate tissue repair in living animals.

Aguilera and her co-workers began by isolating mesenchymal stem cells from human Wharton’s jelly (a connective tissue in umbilical cord). Then they grew these cells in culture for 14 or 30 days. Interestingly, the longer the WMSCs grew in culture, the more they looked like blood vessel cells. They began to express blood vessel-specific genes and proteins. WMSCs cultured for 30 days were even more like blood vessels than those grown in culture for 14 days.

When these cells were injected in the mice with damaged skin, the results showed that the WMSCs cultured for 30 days significantly accelerated wound healing compared with animals injected with either undifferentiated hWMSCs or with no cells.

Effect of hWMSCs and endothelial-differentiated hWMSC transplantation in a wound-healing model. A) Representative images of wounds at day 1 (top panels) and 12 (lower panels) after injury and subcutaneous injection of hWMSCs, hWMSC trans-differentiated into endothelial cells for 14 days (hWMSC-End14d) or 30 days (hWMSC-End30d), or control (PBS). B) Wound healing quantified in PBS (○), hWMSC (•), hWMSC-End14d (□) or hWMSC-End30d (▪) treated mice (n = 5 independent experiments, in duplicate). Values are expressed as mean±S.E.M, +P<0.05 in hWMSC-End30d v/s hWMSC, hWMSC-End14d, at the corresponding time; **P<0.03 in hWMSC-End30d v/s PBS; *P<0.001 in hWMSC-End30d v/s PBS; # P<0.01 in hWMSC-End30d v/s PBS.
Effect of hWMSCs and endothelial-differentiated hWMSC transplantation in a wound-healing model.
A) Representative images of wounds at day 1 (top panels) and 12 (lower panels) after injury and subcutaneous injection of hWMSCs, hWMSC trans-differentiated into endothelial cells for 14 days (hWMSC-End14d) or 30 days (hWMSC-End30d), or control (PBS). B) Wound healing quantified in PBS (○), hWMSC (•), hWMSC-End14d (□) or hWMSC-End30d (▪) treated mice (n = 5 independent experiments, in duplicate). Values are expressed as mean±S.E.M, +P

 

 

The wounds of mice treated with the WMSCs cultured for 30 days looked healthier, but they had many more blood vessels.

Histologic analysis of wounds in the wound-healing model. A) Representative photographs of wounds (hematoxilin/eosin staining) 12 days after injury and subcutaneous injection of PBS, hWMSCs, hWMSC-End14d or hWMSC-End30d. Quantification of histological images, for blood vessels area (B) and histological score (C) for each group of mice. Values are mean ± S.E.M (n = 5 independent experiments, in duplicate), *P<0.001 in hWMSC-End30d or hWMSC-End14d v/s MSC; +P<0.05 in hWMSC-End30d or hWMSC-End14d v/s hWMSC. Magnification x40 (-). Ep, epidermis; D, dermis; H, hypodermis.
Histologic analysis of wounds in the wound-healing model.
A) Representative photographs of wounds (hematoxilin/eosin staining) 12 days after injury and subcutaneous injection of PBS, hWMSCs, hWMSC-End14d or hWMSC-End30d. Quantification of histological images, for blood vessels area (B) and histological score (C) for each group of mice. Values are mean ± S.E.M (n = 5 independent experiments, in duplicate), *P

When laboratory animals received the culture medium from the WMSCs cultured for 30-days also showed significant acceleration of their healing, which suggests that these cells secrete a host of healing molecules that induced the formation of new blood vessels.  One might also conclude that the implanted WMSCs did not contribute to the formation of new blood vessels, but simply directed the formation of new blood vessels by secreting healing molecules.  However, when WMSCs were detected in the healed tissue, they were predominantly found in the walls of new blood vessels.

Immunohistochemical detection of human mesenchymal cells in a wound-healing model. A. Immunohistochemical staining of human mitochondria was performed in permeabilized tissue sections obtained after 12 days of subcutaneous injection of PBS, hWMSCs, hWMSC-End14d or hWMSC-End30d in mice. Cell nuclei were stained with hematoxyline. In B. Number of positive cells per vessel. Representative images of 5 independent experiments, in duplicate. Magnification x40 and insert 100x. Bars 50 µm.
Immunohistochemical detection of human mesenchymal cells in a wound-healing model.
A. Immunohistochemical staining of human mitochondria was performed in permeabilized tissue sections obtained after 12 days of subcutaneous injection of PBS, hWMSCs, hWMSC-End14d or hWMSC-End30d in mice. Cell nuclei were stained with hematoxyline. In B. Number of positive cells per vessel. Representative images of 5 independent experiments, in duplicate. Magnification x40 and insert 100x. Bars 50 µm.

These results, which were published in PLOS ONE, demonstrate that mesenchymal stem cells isolated from umbilical cord connective tissue or Wharton’s jelly can be successfully grown in culture in the laboratory and trans-differentiated into blood vessels-forming cells (endothelial cells).  These differentiated hWMSC-derived endothelial cells seem to promote the formation of new networks of blood vessels, which augments tissue repair in laboratory animals through the secretion of soluble pro-blood vessel-making molecules and, occasionally, by contributing to the formation of new vessels, themselves.

Scar-less Healing in the Fetus


In early fetal development, skin wounds undergo regeneration and healing without scar formation. Unfortunately, this wound healing mechanism later disappears, but by studying the fetal stem cells capable of this scarless wound healing, researchers may be able to apply these mechanisms to develop cell-based approaches able to minimize scarring in adult wounds.

Michael Longaker, Peter Lorenz, and co-authors from Stanford University School of Medicine and John A. Burns School of Medicine, University of Hawaii, Honolulu, describe a new stem cell that has been identified in fetal skin and blood that may have a role in scarless wound healing. In the article “The Role of Stem Cells During Scarless Skin Wound Healing,” the authors propose future directions for research to characterize the differences in wound healing mechanisms between fetal and adult skin-specific stem cells.

“This work comes from the pioneers in the field and delineates the opportunities towards scarless healing in adults,” says Editor-in-Chief Chandan K. Sen, PhD, Professor of Surgery and Director of the Comprehensive Wound Center and the Center for Regenerative Medicine and Cell-Based Therapies at The Ohio State University Wexner Medical Center, Columbus, OH.

Sweat Glands Are A Source of Stem Cells for Wound Healing


Stem Cells from human sweat glands serve as a remarkable source for wound healing treatments according to a laboratory in Lübeck, Germany.

Professor Charli Kruse, who serves as the head of the Fraunhofer Research Institute for Marine Biotechnology EMB, Lübeck, Germany, and his colleagues isolated cultured pancreatic cells in the course of their research to look into the function of a protein called Vigilin. When the pancreatic cells were grown in culture, they produced, in addition to other pancreatic cells, nerve and muscle cells. Thus the pancreas contains a stem cell population that can differentiate into different cell types.

Kruse and his group decided to investigate other glands contained a similar stem cell population that could differentiate into other cell types.

Kruse explained: “We worked our way outward from the internal organs until we got to the skin and the sweat glands. Again, this yielded the same result: a Petri dish full of stem cells.”

Up to this point, sweat glands have not received much attention from researchers. Mice and rats only have sweat glands on their paws, which makes them rather inaccessible. Human beings, on the other hand, have up to three million sweat glands, predominantly on the soles of out feet, palms of the hand, armpits, and forehead.

Ideally, a patient could have stem cells taken from her own body to heal an injury, wound, or burn, Getting to these endogenous stem cell populations, however, represents a challenge, since it requires bone marrow biopsies or aspirations, liposuction, or some other invasive procedure.

Sweat glands, however, are significantly easier to find, and a short inpatient visit to your dermatologist that extracts three millimeters of underarm skin could provide enough stem cells to grow in culture for treatments.

Stem cells from sweat glands have the capacity to aid wound healing. Kruse and his group used sweat gland-based stem cells in laboratory animals. The Kruse group used skin biopsies from human volunteers and separated out the sweat gland tissues under a dissecting scope. Then the sweat gland stem cells were grown in culture and induced to differentiate into a whole host of distinct cell types.

Then Kruse’s team grew these sweat gland stem cells in a skin-like substrate that were applied to wounds on the backs of laboratory animals. Those animals that had received stem cell applications healed faster than those that received no stem cells.

If the stem cells were applied to the mice with the artificial substrate, the cells moved into the bloodstream and migrated away from the site of the injury. In order to help heal the wound the cells had to integrate into the skin and participate in the healing process.

“Not only are stem cells from sweat glands easy to cultivate, they are extremely versatile, too,” said Kruse.

Kruse and his team are already in the process of testing a treatment for macular degeneration using sweat gland-based stem cells. “In the long-term, we could possibly set up a cell bank for young people to store stem cells from their own sweat glands/ They would then be available for use should the person need new cells, following an illness,l perhaps, or in the event of an accident,” Kruse said.

Adding One Gene to Cells can Regrow Hair, Cartilage, Bone and Soft Tissues


The reactivation of a gene called Lin28a, which is active in embryonic stem cells, can regrow hair and repair cartilage, bone, skin, and other soft tissues in mice.

This study comes from scientists at the Stem Cell Program at Boston Children’s Hospital who found that the Lin28a promotes tissue repair by enhancing metabolism in mitochondria, which are the energy-producing engines in cells. These data suggest that upregulation of common “housekeeping” functions might provide new ways to develop regenerative treatments.

George Q. Daley, the director of Boston Children’s Hospital Stem Cell Transplantation Program, said, “Efforts to improve wound healing and tissue repair have mostly failed, but altering metabolism provides a new strategy which we hope will prove successful.”

One of the first authors of this paper, Shyh-Chang Ng, added, “Most people would naturally think that growth factors are the major players in wound healing, but we found that the core metabolism of cells is rate-limiting in terms of tissue repair. The enhanced metabolic rate we saw when we reactivated Lin28a is typical of embryos during their rapid growth phase.”

Lin28a was first discovered in worms, but the Lin28a gene is found in all animals. It is abundantly expressed in embryonic stem cells and during early embryonic development. Stem cell scientists have even used Lin28a to help reprogram adult cells into induced pluripotent stem cells. Lin28a encodes an RNA-binding protein that regulates the translation of messenger RNAs into protein.

To express more of this protein in mice, Daley and his colleagues attached the Lin28a gene to a piece of DNA that would drive expression when the mice were fed the drug doxycycline. Ng and others noticed that one of the targets of Lin28a was a small RNA molecule called Let-7, which is known to promote aging and cell maturation. Let-7 is a member of a class of non-coding RNA molecules called micro-RNAs that bind to messenger RNAs and prevent their translation.  Let-7 is made as a larger precursor molecule that is processed to a smaller molecule that is functional.  LIN28 binds specifically to the primary and precursor forms of Let-7, and inhibits Let-7 processing.

Lin28a function

Ng said, “We were confident that Let-7 would be the mechanism, but there was something else involved.”

Let-28a is known to activate the translation of several different genes that play a role in basic energy metabolism (e.g., Pfkp, Pdha1, Idh3b, Sdha, Ndufb3, and Ndufb8), Activation of these genes enhances oxidative metabolism and promotes an embryonic bioenergetic state.

In their Lin28a transgenic mice, Daley, Ng and others noticed that Lin28a definitively enhanced the production of metabolic enzymes in mitochondria, and that these “revved up” the mitochondria so that they generated the energy needed to stimulate and grow new tissues.

PIIS0092867413012786.fx1.lrg

“We already know that accumulated defects in mitochondria can lead to aging in many cells and tissues,” said Ng. We are showing the converse: enhancement of mitochondrial metabolism can boost tissue repair and regeneration, recapturing the remarkable repair capacity of juvenile animals. ”

Further experiments showed that bypassing Lin28a and directly activating mitochondrial metabolism with small molecules had the same effect on wound healing. This suggests that pharmaceuticals might induce regeneration and enhance tissue repair.

“Since Lin28 itself is difficult to introduce into cells, the fact that we were able to activate mitochondrial metabolism pharmacologically gives us hope,” said Ng.

Lin28a did not cause universal regeneration of all tissues. Heart tissue, for example, was poorly aided by Lin28a. Also, Lin28a induced the regeneration of severed finger tips in newborn mice, but not in adult mice.

Nevertheless, Lin28a could be a key factor in constituting a kind of healing cocktail, in combination with other embryonic factors yet to be found.