Measurements of CD34+/CD45-dim Stem Cells Predict Healing of Diabetic Neuropathic Wounds.
Management of neuropathic foot ulcers in patients with diabetes (DFUs) has changed little over the past decade, and there is currently no objective method to gauge probability of successful healing. We hypothesized that studies of stem/progenitor cells (SPCs) in the early weeks of standard wound management could predict who will heal within 16 weeks. Blood and debrided wound margins were collected for 8 weeks from 100 patients undergoing weekly evaluations and treatment. SPC number and intracellular content of hypoxia-inducible factors (HIFs) were evaluated by flow cytometry and immunohistochemistry. More SPCs entered the bloodstream in the first 2 weeks of care in patients who healed (n = 37) than in those who did not (n = 63). Logistic regression demonstrated that the number of blood-borne SPCs and the cellular content of HIFs at study entry and the first-week follow-up visit predicted healing. Strong correlations were found among week-to-week assessments of blood-borne SPC HIF factors. We conclude that assays of SPCs during the first weeks of care in patients with DFUs can provide insight into how well wounds will respond and may aid with decisions on the use of adjunctive measures.
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD sthom@smail.umaryland.edu.
Stephen R
SR
Thom
Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Michelle
M
Hampton
Podiatric Surgery and Medicine, Penn Presbyterian Medical Center, Philadelphia, PA.
Michael A
MA
Troiano
Department of Medicine, Greater Baltimore Medical Center, Baltimore, MD.
Ziad
Z
Mirza
Podiatric Surgery and Medicine, Penn Presbyterian Medical Center, Philadelphia, PA.
D Scot
DS
Malay
Podiatric Surgery and Medicine, Penn Presbyterian Medical Center, Philadelphia, PA.
Steven
S
Shannon
Podiatric Surgery and Medicine, Penn Presbyterian Medical Center, Philadelphia, PA.
Nathan B
NB
Jennato
Podiatric Surgery, Roxborough Memorial Hospital, Philadelphia, PA.
Cornelius M
CM
Donohue
Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Ole
O
Hoffstad
Department of Medicine, Greater Baltimore Medical Center, Baltimore, MD.
Diana
D
Woltereck
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
Ming
M
Yang
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
Kevin
K
Yu
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
Veena M
VM
Bhopale
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
Svitlana
S
Kovtun
Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
David J
DJ
Margolis
D053687:Adult Stem Cells; D018952:Antigens, CD34 / Q000097:blood*; D017719:Diabetic Foot / Q000097:blood*; D003929:Diabetic Neuropathies / Q000097:blood*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D017493:Leukocyte Common Antigens / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013997:Time Factors; D014945:Wound Healing
D018952:Antigens, CD34; D017493:Leukocyte Common Antigens