Adult bone-marrow derived stem cells produce good results in curing severe pressure sores in spinal cord injured people
Among the most exasperating and potentially fatal complications of spinal cord injury are pressure ulcers (also referred to decubitus ulcers or bedsores). Pressure ulcers most often occur where a bony prominence repeatedly puts pressure on the skin and intervening tissue. Two of the most vulnerable regions for paralyzed people are the bottom of the buttocks and the sacral area. People with impaired sensation and those that must lye or sit for long periods are very susceptible to pressure sores. There is some debate about the precise chain of events that lead to pressure sores but there is unanimous agreement that once they occur healing is difficult and prolonged. In fact, some pressure sores take years to heal, or do not completely heal at all.
In many instances pressure sores become infected. If they are sufficiently deep this often leads to bone infection and possibly sepsis. Pressure sores can be lethal even in the presence of expert medical care as demonstrated by death of Christopher Reeve. Once the wound becomes chronic it often becomes refractory to healing. The reasons for this are not clear but it is fair to say that the balance between building tissue and breaking down tissue becomes skewed towards the latter. Research has shown that there is an abnormally enhanced presence of tissue destroying enzymes (those that break down extracellular matrix) in the wound fluid along with colonizing bacteria.
Treatment for severe pressure sores in wealthy countries include hospitalization, avoiding pressure on the affected area (prolonged bed rest), special high-protein diet, prolonged treatment with antibiotics, using continuous vacuum to remove debris and fluid from the wound, administration of a variety of topical ointments include silver impregnated dressings, medical grade honey etc. and the surgical grafting of skin and muscle from an adjacent region into the cavity produced by the wound.
Once a pressure sore has occurred and healed the area becomes much more vulnerable to breakdown again despite the method used to close the wound. The depression and complications related to pressure sores have a major impact on the quality-of-life of the patient and often the family, especially if they become charged with long-term home care.
In developing poor countries pressure sores or complications due to pressure sores limit the lifespan of paraplegics or quadriplegics to an average of about 2 years. In developed countries pressure sores are a major source of iatrogenic mortality for spinal cord injured people, following only adverse drug interactions. There is a dire need to improve the rate of healing of these dreadful sores. Although the life span of a paralyzed individual may be near normal in wealthy countries pressure sores are predictive of a reduction of life span regardless of the location in the world.
Pressure sores have probably been with us throughout human history. Some Egyptian mummies show evidence of pressure sores. Among all hospital patients in the US it is estimated that as many as 20% regularly have pressure sores. The cost to the US economy is about 8 billion dollars a year in total. Clearly there is a dire need to find an improved method of curing this dreadful affliction from both an economic as well as a quality-of-life perspective.
In the following abstract published in the Journal of Spinal Cord Medicine a group in Spain (Sarasúa et al) have used autologous mesenychmal stem cells from bone marrow to cure severe pressure ulcers within a reasonable amount of time. This study is very welcome news for all of us with spinal cord injury, because most paralyzed people will experience pressure ulcers during their lifetime. A separate clinical trial is also being planned in Switzerland essentially repeating the work done in Spain. The sooner this methodology is widely available to better address these sores-the better.
Abstract:
J Cord Med. 2011;34(3):301-7.
Treatment of pressure ulcers with autologous bone marrow nuclear cells in patients with spinal cord injury.
Sarasúa JG, López SP, Viejo MA, Basterrechea MP, Rodríguez AF, Gutiérrez AF, Gala JG, MenéndezYM, Augusto DE, Arias AP, Hernández JO.
Servicio de Cirugía Plástica, Hospital Universitario Central de Asturias, Oviedo, Spain.
Pressure ulcers are especially difficult to treat in patients with spinal cord injury (SCI) and recurrence rates are high. Prompted by encouraging results obtained using bone marrow stem cells to treat several diseases including chronic wounds, this study examines the use of autologous stem cells from bone marrow to promote the healing of pressure ulcers in patients with SCI.
OBJECTIVE:
To obtain preliminary data on the use of bone marrow mononuclear cells (BM-MNCs) to treat pressure ulcers in terms of clinical outcome, procedure safety, and treatment time.
PARTICIPANTS:
Twenty-two patients with SCI (19 men, 3 women; mean age 56.41 years) with single type IV pressure ulcers of more than 4 months duration.
INTERVENTIONS:
By minimally invasive surgery, the ulcers were debrided and treated with BM-MNCs obtained by Ficoll density gradient separation of autologous bone marrow aspirates drawn from the iliac crest.
RESULTS:
In 19 patients (86.36%), the pressure ulcers treated with BM-MNCs had fully healed after a mean time of 21 days. The number of MNCs isolated was patient dependent, although similar clinical outcomes were observed in each case. Compared to conventional surgical treatment, mean intra-hospital stay was reduced from 85.16 to 43.06 days. Following treatment, 5 minutes of daily wound care was required per patient compared to 20 minutes for conventional surgery. During a mean follow-up of 19 months, none of the resolved ulcers recurred.
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