Treatment of pressure ulcers with autologous bone marrow nuclear cells in patients with spinal cord injury

Abstract

Context: 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.

Conclusions: Our data indicate that cell therapy using autologous BM-MNCs could be an option to treat type IV pressure ulcers in patients with SCI, avoiding major surgical intervention.

Figures

Figure 1

Flow cytometry image obtained after gating with 7-actynomicin D in order to eliminate non-viable cells.

Figure 2

Pressure ulcers before and after autologous MNC therapy. (A) Patient 2, images taken before (left) and after treatment (right). (B) Patient 4, images taken before (left) and after (right) treatment.

Figure 3

RNM images obtained before and after autologous MNC therapy. Patient 2, images taken before (A) and 6 months after (B) treatment. Arrows point to the pressure ulcer.

Figure 4

RNM images obtained before and after autologous MNC therapy. Patient 4, images taken before (A) and 6 months after (B) treatment. Arrows point to the pressure ulcer.