title: Effect of combination therapy with alginate dressing and mouse epidermal growth factor on epidermal stem cells in patients with refractory wounds.
abstract: BACKGROUND
  The aim of this research was to determine the efficacy of combination therapy using an alginate dressing and mouse epidermal growth factor (mEGF) on proliferation and differentiation of epidermal stem cells (ESCs) in patients with refractory wounds.
  
  
  METHODS
  Eighteen patients (12 males and 6 females, aged from 18 to 61 years (mean 36.4 years)) with various skin wounds, were treated by dressing changing for one month. The wounds were located in the foot (11), calf (3), thigh (2) and forearm (2). The patients were randomly divided into 3 groups: alginate dressing and mEGF (group A; n = 6), mEGF (group B; n = 6) and control (group C; n = 6). Wound closure indexes were measured at 7, 14, 21 and 28 days. Samples were harvested for pathologic examination, at 7 and 14 days following treatment. Cytokeratin 10 (CK10) and cytokeratin 15 (CK15) positive cells were evaluated using the super-sensitivity (SP) immunohistochemical staining technique.
  
  
  RESULTS
  Wound healing was promoted in groups A and B. In group A, the wound closure index was increased significantly (P < 0.05), and in one case the maximum cure area reached 102 cm(2). Pathological examination identified a thicker epidermis, active angiogenesis and enhanced granulation in group A compared with groups B and C. Using the SP immunohistochemical staining technique, we showed that ESCs in group A were bigger in size and larger in number than in groups B and C. Overall, there was a significant difference in ESCs proliferation and differentiation between group A and group B (or C).
  
  
  CONCLUSIONS
  Combination therapy using an alginate dressing and mEGF shows increased proliferation and differentiation of ESCs in patients with refractory wounds compared with those treated with mEGF alone.
authors.affiliation: Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Bi
authors.forename: Qiong
authors.initials: Q
authors.lastname: Zhang
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
authors.forename: Ming
authors.initials: M
authors.lastname: Xu
authors.forename: Shui-Jun
authors.initials: SJ
authors.lastname: Zhang
authors.forename: Bin-Song
authors.initials: BS
authors.lastname: Qiu
authors.forename: Bing
authors.initials: B
authors.lastname: Xia
authors.forename: Hai-Feng
authors.initials: HF
authors.lastname: Gu
authors.forename: Jian-Fei
authors.initials: JF
authors.lastname: Hong
authors.forename: Chen
authors.initials: C
authors.lastname: Zhao
authors.forename: Dan-Jie
authors.initials: DJ
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000328:Adult; D000464:Alginates / Q000627:therapeutic use*; D000818:Animals; D001458:Bandages; D002454:Cell Differentiation / Q000187:drug effects; D049109:Cell Proliferation / Q000187:drug effects; D004815:Epidermal Growth Factor / Q000627:therapeutic use*; D004847:Epithelial Cells / Q000166:cytology*; D005260:Female; D020723:Glucuronic Acid / Q000627:therapeutic use; D006603:Hexuronic Acids / Q000627:therapeutic use; D006801:Humans; D007150:Immunohistochemistry; D053569:Keratin-15 / Q000378:metabolism; D008297:Male; D051379:Mice; D008875:Middle Aged; D013234:Stem Cells / Q000166:cytology* / Q000187:drug effects; D014945:Wound Healing / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000464:Alginates; D006603:Hexuronic Acids; D053569:Keratin-15; D004815:Epidermal Growth Factor; D020723:Glucuronic Acid