ReviewNovel trends in application of stem cells in skin wound healing
Introduction
A chronic wound is a loss of skin or other tissues that do not heal during the time normally needed to heal others wounds. Treatment of these wounds can be long-lasting, requires specific medical skills and constitute a great challenge for contemporary medicine. The problem affects an estimated twenty million people around the world. This number may significantly increase due to ageing population and escalating incidence of civilization diseases such as obesity and diabetes (Bumpus and Maier, 2013). Globally, by 2020 the wound care market is projected to surpass 22 billion USD per year (Tricco et al., 2015). Impaired wound healing increases the number of operative procedures, lengthens hospital stays and worsens a patient's susceptibility to infection (Butler et al., 2010). Thus, many scientists focus on determining different factors affecting the process of wound healing, among others those related to the use of certain drugs, improper diet and exposure to environmental pollution. It is also possible to identify specific diseases that increase the risk of developing non-healing ulcers and to determine the effect of hypoxia on the healing process (Burns et al., 2003).
The methods that are currently used in the treatment of chronic wounds are multifactorial and include several steps. First and foremost, direct causes are sought that have made the treatment process difficult and attempts are being made to eliminate them. If, despite this, healing is still very slow or does not progress, the specific methods are used to support the process. However, traditional wound care procedures using debridement, infection control and typical dressings have limited efficacy, especially for treatment of chronic wounds, which is still a challenging task for healthcare experts.
The development of biomedical engineering has increased the interest in working out new therapeutic approaches for wounds difficult to heal. These include for example gene therapy, cell therapy, biological dressings, growth factors delivery and engineered skin equivalents. Among these new treatment modalities, stem cell-based therapies have gained interest as a part of regenerative medicine.
Currently, a rising number of stem cell therapies has been tested in clinical and preclinical trials in the context of their impact on wound healing (Leavitt et al., 2016, Tsai et al., 2018). The use of stem cells in the treatment of chronic wounds is a novel approach that uses processes that naturally occur in wound healing such as the action of growth factors, stimulation of immune processes and regulation of the inflammatory process, as well as improving the blood supply to developing tissue, which speeds up epidermis growth (Kolle et al., 2013).
The aim of this review is to summarize mechanisms by which different stem cells influence wound healing process and to describe latest strategies used to improve their therapeutic potential in the context of non-healing wounds. Moreover, we will mention some clinical trials and experiments on animal models, that support the use of stem cells, especially mesenchymal stem cells (MSCs), in chronic wound treatment. Finally, we will discuss limits and benefits of stem cell therapy in comparison to traditional ones.
Section snippets
Adult stem cells related to wound healing process
Stem cells, due to their properties - differentiation into other cell types and the potential for unlimited proliferation - are one of the most popular issues of contemporary medicine and biological sciences. According to their ability to differentiate, they can be divided into toti-, pluri-, multi- and unipotent, while according to their source - into embryonic (isolated from the blastocyst), adult (isolated from the mature organism, also known as somatic stem cells) and obtained from the
Stem cells application in wound healing
In larger burns and chronic wounds, the number and function of stem cells may be impaired. For example, it was shown, that chronic wound environment inhibits ADSCs proliferation rate and changes expression of some genes crucial for wound healing in these cells (Koenen et al., 2015). Moreover, EPCs derived from diabetic patients (that often suffer from non-healing ulcers) demonstrated decreased adherence to human umbilical vein endothelial cells, impaired proliferation and less involvement in
Discussion
Human skin is the largest organ of the human body and its main function is to provide proper protection against external factors and the penetration of pathogens into the body. Its continuity is of the greatest importance and any damage may be a potential gateway to infection. Wounds created within the skin are the result of the impact of various damaging and irritating factors leading to disruption of the skin's continuity, while the process of their treatment is multistage and can be
Declaration of interest
None.
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