A Narrative Review on Efficacy of Cell- and Tissue-Based Therapies for Diabetic Foot Ulcer

IF 3.7 4区 医学 Q2 PHARMACOLOGY & PHARMACY
Behnaz Niroomand, Ibrahim Mohammadzadeh, Maryam Tabarzad, Elham Mohit
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Abstract

Diabetic foot ulcers (DFUs) are complex, making conventional treatments challenging in restoring skin tissue. Stem cell therapy (SCT) and skin replacement therapy (SRT) offer promising solutions by addressing prolonged inflammation, impaired cell proliferation, and reduced extracellular support. Here, based on the origin of cells, SCTs are categorized into embryonic, induced pluripotent, fetal, and adult stem cells (ASCs). Mesenchymal stem cells are among the most employed types of ASCs in clinical trials for treating DFUs. Furthermore, their delivery routes, and stem-cell-derived products are also discussed. However, the lack of phase III/V clinical trials limits their clinical use. SRTs are classified by tissue origin (human or animal) and product cellularity. Clinical trials and systematic reviews indicate that placenta-based grafts (e.g., EpiFix), acellular dermal matrices from human cadaver skin (e.g., DermACell and Graftjacket), and bioengineered cell-based products (e.g., Apligraf and Dermagraft) are the most effective and safe for SRT. Both SCT and SRT are evolving fields with ongoing challenges, including injection barriers, cell reprogramming risks, ethical concerns, foreign body reactions, and a lack of long-term follow-up studies.

Abstract Image

以细胞和组织为基础的治疗糖尿病足溃疡的疗效综述
糖尿病足溃疡(DFUs)是复杂的,使得传统的治疗方法在恢复皮肤组织方面具有挑战性。干细胞疗法(SCT)和皮肤替代疗法(SRT)通过解决长期炎症、细胞增殖受损和细胞外支持减少提供了有希望的解决方案。根据细胞来源,sct可分为胚胎干细胞、诱导多能干细胞、胎儿干细胞和成体干细胞。间充质干细胞是临床试验中用于治疗DFUs的最常用的ASCs类型之一。此外,还讨论了它们的传递途径和干细胞衍生产品。然而,缺乏III/V期临床试验限制了它们的临床应用。srt按组织来源(人或动物)和产品细胞划分。临床试验和系统综述表明,基于胎盘的移植物(如EpiFix)、来自人尸体皮肤的脱细胞真皮基质(如DermACell和Graftjacket)和生物工程细胞产品(如Apligraf和Dermagraft)是SRT最有效和最安全的。SCT和SRT都是不断发展的领域,面临着持续的挑战,包括注射障碍、细胞重编程风险、伦理问题、异物反应以及缺乏长期随访研究。
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来源期刊
Advanced Therapeutics
Advanced Therapeutics Pharmacology, Toxicology and Pharmaceutics-Pharmaceutical Science
CiteScore
7.10
自引率
2.20%
发文量
130
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