Role of cord blood and bone marrow mesenchymal stem cells in recent deep burn: a case-control prospective study.

Abstract

Rationale: Burn injuries represent one of the major worldwide public health problems causing more severe physiological stress than other traumas. Effective treatment of burn injuries is mandatory to prevent the numerous life-threatening complications and possible disabilities. Stem cells, a population of multipotent cells retaining the properties of self-renewal and differentiation, are the main player in tissue regeneration after major trauma. Thus, they are thought to play a key role in wound healing inducing efficient and physiological skin regeneration. Stem cell-based regeneration is quickly gaining scientific grounds.

Objective: This study was designed as a comparative prospective study to evaluate and compare the regenerative effect of bone marrow derived mesenchymal stem cells (BM-MSCs) and umbilical cord blood derived mesenchymal stem cells (UC-MSCs) compared to conventional early excision and graft (EE&G) in recent thermal full thickness burned patients.

Subject & methods: Recruited burned patients were randomly divided into three groups (20 patients on each group) having recent thermal full thickness percentage ranging from 10% to 25% total body surface area (TBSA). After receiving allocated treatment, they were assessed as regards: rate of burn healing, presence of post-burn complications both early (such as loss of graft and infections) and late (as hypertrophic scars, keloid, hypo- or hyperpigmentation or contracture of the wound), hospitalization time and cost.

Results: This study showed significantly improved rate of healing in both BM-MSC and UC-MSC groups as compared to EE&G group with no significant difference between bone marrow and umbilical cord groups. Comparing the incidence of early complications, partial and total loss of graft occurred in 50% patients in (EE&G) group, while infection complication appeared in 25% of patients of (BM-MSCs) group and in 70% of patients in (UC-MSCS) group. The late complications (hypertrophic scars) were observed in 40% of (EE&G) patients group, in 15% of (BM-MSCs) treated patients group and 20% of (UC-MSCS) patients group. Contractured scars were present in 15% in (EE&G) group, 10% in (BM-MSCs) group, 10% in (UC-MSCS) group. Hypopigmentation occurred in 20% of patients in (EE&G) group, 20% in (BM-MSCs) group and 10% in (UC-MSCS) group. Hyperpigmentation was present in 20% of patient in (EE&G) group, 30% in (UC-MSCS) group but no hyperpigmentation occurred in (BM-MSCs) group. There was no late complication in 5% of patient in (EE&G) group, 55% in (BM-MSCs) group and 30% in (UC-MSCS) group. The results of this study revealed that the hospitalization period was significantly reduced in both (BM-MSCs) group and (UC-MSCS) group as compared to (EE&G) group.

Conclusion: this study proves that mesenchymal stem cells, both from bone marrow and cord blood origin, can effectively improve healing of burn injuries.