Mastrogiacomo Maddalena, Nardini Marta, Collina Maria Chiara, Di Campli Cristiana, Filaci Gilberto, Cancedda Ranieri, Odorisio Teresa
Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università degli Studi di Genova, Genova, Italy.
Unità Operativa Semplice Piede Diabetico e Ulcere Cutanee, IDI-IRCCS, Roma, Italy.
Front Bioeng Biotechnol. 2022 May 2;10:869408. doi: 10.3389/fbioe.2022.869408. eCollection 2022.
Cutaneous chronic wounds are a major global health burden in continuous growth, because of population aging and the higher incidence of chronic diseases, such as diabetes. Different treatments have been proposed: biological, surgical, and physical. However, most of these treatments are palliative and none of them can be considered fully satisfactory. During a spontaneous wound healing, endogenous regeneration mechanisms and resident cell activity are triggered by the released platelet content. Activated stem and progenitor cells are key factors for ulcer healing, and they can be either recruited to the wound site from the tissue itself (resident cells) or from elsewhere. Transplant of skin substitutes, and of stem cells derived from tissues such as bone marrow or adipose tissue, together with platelet-rich plasma (PRP) treatments have been proposed as therapeutic options, and they represent the today most promising tools to promote ulcer healing in diabetes. Although stem cells can directly participate to skin repair, they primarily contribute to the tissue remodeling by releasing biomolecules and microvesicles able to stimulate the endogenous regeneration mechanisms. Stem cells and PRP can be obtained from patients as autologous preparations. However, in the diabetic condition, poor cell number, reduced cell activity or impaired PRP efficacy may limit their use. Administration of allogeneic preparations from healthy and/or younger donors is regarded with increasing interest to overcome such limitation. This review summarizes the results obtained when these innovative treatments were adopted in preclinical animal models of diabetes and in diabetic patients, with a focus on allogeneic preparations.
由于人口老龄化以及糖尿病等慢性疾病发病率的上升，皮肤慢性伤口已成为一个持续增长的重大全球健康负担。人们提出了不同的治疗方法：生物治疗、手术治疗和物理治疗。然而，这些治疗方法大多只是姑息性的，没有一种能被认为是完全令人满意的。在伤口自然愈合过程中，内源性再生机制和驻留细胞活性由释放的血小板成分触发。活化的干细胞和祖细胞是溃疡愈合的关键因素，它们可以从组织本身（驻留细胞）或其他地方被招募到伤口部位。皮肤替代物以及源自骨髓或脂肪组织等组织的干细胞移植，连同富血小板血浆（PRP）治疗已被提议作为治疗选择，它们代表了当今促进糖尿病患者溃疡愈合最有前景的工具。尽管干细胞可以直接参与皮肤修复，但它们主要通过释放能够刺激内源性再生机制的生物分子和微泡来促进组织重塑。干细胞和PRP可以从患者自身获取作为自体制剂。然而，在糖尿病状态下，细胞数量减少、细胞活性降低或PRP疗效受损可能会限制它们的使用。越来越多的人关注使用来自健康和/或年轻供体的同种异体制剂来克服这种限制。本综述总结了在糖尿病临床前动物模型和糖尿病患者中采用这些创新治疗方法时所取得的结果，重点是同种异体制剂。
