Emerging therapy for improving wound repair of severe radiation burns using local bone marrow-derived stem cell administrations.
The therapeutic management of severe radiation burns remains a challenging issue today. Conventional surgical treatment including excision, skin autograft, or flap often fails to prevent unpredictable and uncontrolled extension of the radiation-induced necrotic process. In a recent very severe accidental radiation burn, we demonstrated the efficiency of a new therapeutic approach combining surgery and local cellular therapy using autologous mesenchymal stem cells (MSC), and we confirmed the crucial place of the dose assessment in this medical management. The patient presented a very significant radiation lesion located on the arm, which was first treated by several surgical procedures: iterative excisions, skin graft, latissimus muscle dorsi flap, and forearm radial flap. This conventional surgical therapy was unfortunately inefficient, leading to the use of an innovative cell therapy strategy. Autologous MSC were obtained from three bone marrow collections and were expanded according to a clinical-grade protocol using platelet-derived growth factors. A total of five local MSC administrations were performed in combination with skin autograft. After iterative local MSC administrations, the clinical evolution was favorable and no recurrence of radiation inflammatory waves occurred during the patient's 8-month follow-up. The benefit of this local cell therapy could be linked to the "drug cell" activity of MSC by modulating the radiation inflammatory processes, as suggested by the decrease in the C-reactive protein level observed after each MSC administration. The success of this combined treatment leads to new prospects in the medical management of severe radiation burns and more widely in the improvement of wound repair.
Bey
Eric
E
Hôpital d'Instruction des Armées Percy, Service de Chirurgie Plastique, BP 410, 92141 Clamart Cedex, France.
Prat
Marie
M
Duhamel
Patrick
P
Benderitter
Marc
M
Brachet
Michel
M
Trompier
François
F
Battaglini
Pierre
P
Ernou
Isabelle
I
Boutin
Laetitia
L
Gourven
Muriel
M
Tissedre
Frédérique
F
Créa
Sandrine
S
Mansour
Cédric Ait
CA
de Revel
Thierry
T
Carsin
Hervé
H
Gourmelon
Patrick
P
Lataillade
Jean-Jacques
JJ
D000328:Adult; D001134:Arm Injuries / Q000209:etiology / Q000628:therapy*; D002056:Burns / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000628:therapy*; D018788:Radioactive Hazard Release; D019651:Plastic Surgery Procedures; D016038:Skin Transplantation