The application of human umbilical cord blood mononuclear cells in the management of deep partial thickness burn
Background: Wound healing in burn is a complex process and early complete wound closure still enfaces many problems. Application of stem cells is found to be the future method of wound healing. Among the available sources of allogenic stem cells, umbilical cord blood is quite easy to be obtained, has less ethical issue, and contain multipotent stem cells, which are characterized by low immunogenicity. The study aims to evaluate the potential of human umbilical cord blood mononuclear cells (hUCBMNCs) treatment in the management of deep partial thickness burns.
Methods: Twenty patients with deep partial thickness burns were treated with topical application of 2 x 107 hUCBMNCs and silver sulfadiazine (SSD) cream on the comparable wound size in the other sites. The treatments were applied for six times in every two consecutive days. Wound surface area was measured with Visitrak® on day 0, 7, and 11. Pain intensity was evaluated using Wong Baker’s faces scale on each wound dressing change. Histology examination was performed in some samples of collected skin biopsy of the newly re-epithelialized area of hUCBMNCs and SSD-treated wound at the end of treatment. HLA typing is used to evaluate the issue of safety. Wilcoxon signed rank test was used to compare the rate of wound healing.
Results: Sixteen patients of hUCBMNCs-treated showed a significant wound closure in faster than SSD-treated; measured on day 7 (p = 0.041) and day 11 (p = 0.021). Number of patients with reduced pain intensity, from approximately scale 3 to 1/0 on day 7 and 11, were higher in hUCBMNCs-treated compared to SSD-treated wound. In spite of the HLA-mismatch, no allergic reaction, rejection, and infection found on hUCBMNCs-treated wound suggested the safety of this therapy. Histology examination found the formation of dermal-epidermal junction and rete ridges equal to the normal skin on hUCBMNCs-treated wounds.
Conclusion: hUCBMNCs are effective and safe to promote re-epithelialization in deep partial thickness burns. (Med J Indones. 2013;22:92-9)
Keywords: Deep partial thickness burn, mononuclear cells, re-epithelialization, umbilical cord blood
Benson A, Dickson WA, Boyce DE. Burns. BMJ. 2006;332(7542):649-52.
Hanumadass ML, Ramakrishnan M, Ramakrihnan MK, Babu M. The art and science of burn wound management. Turnbridge Wells, Kent: Anshan; 2005.
Benson A, Dickson WA, Boyce DE. Burns. BMJ. 2006;332(7542):649-52.
Lineen E, Namias N. Biologic dressing in burns. J Craniofac Surg. 2008;19(4):923-8.
Loss M, Wedler V, Künzi W, Meuli-Simmen C, Meyer VE. Artificial skin, split-thickness autograft and cultured autologous keratinocytes combined to treat a severe burn injury of 93% of TBSA. Burns 2000;26(7):644-52.
Atiyeh BS, Costagliola M. Cultured epithelial autograph (CEA) in burn treatment: Three decades later. Burns. 2007;33(4):405-13.
Caruso DM, Schuh WH, Al-Kasspooles MF, Chen MC, Schiller WR. Cultured composite autografts as coverage for an extensive body surface area burn: Case report and review of the technology. Burns 1999;25(8):771-9.
Kamolz LP, Kolbus A, Wick N, et al. Cultured human epithelium: Human umbilical cord blood stem cells differentiate into keratinocytes under invitro conditions. Burns 2006;32(1):16-9.
Dai Y, Li J, Li J, et al. Skin epithelial cells in mice from umbilical cord mesenchymal stem cells. Burns 2007;33(4):418-28.
Lansdown, AB. Silver: Its antibacterial properties and mechanism of action. J Wound Care. 2002;11:125-30.
Heggers JP, Hawkins H, Edgar P, Villarreal C, Herndon DN. Treatment of infections in burns. In: Herndon DN, editor. Total burn care. London: Saunders; 2002. p.120-69.
Wright JB, Lam K, Hansen D, Burrell RE. Efficacy of topical silver against fungal burn wound pathogens. Am J Infect Control. 1999;27:344-50.
Choban PS, Marshall WJ. Leukopenia secondary to silver sulfadiazine: Frequency, characteristics and clinical consequences. Am Surg. 1987;53:515-7.
Herruzo-Cabrera R, Garcia-Torres V, Rey-Calero J, Vizcaino-Alcaide MJ. Evaluation of the penetration strength, bactericidal efficacy and spectrum of action of several antimicrobial creams against isolated microorganisms in a burn centre. Burns 1992;18:39-44.
Chularojmontri L, Wattanapittayakul SK. Isolation and characterization of umbilical cord blood hematopoietic stem cells. J Med Assoc Thai. 2009;92(Suppl.3):S88-94.
Yu M, Xiao Z, Shen L, Li L. Mid-trimester fetal bloodderived adherent cells share characteristics similar to mesenchymal stem cells but full-term umbilical cord blood does not. Br J Haematol. 2004;124(5):666-75.
Jonsson CE, Holmsten A, Dahlström L, Jonsson K. Background pain in burn patients: Routine measurement and recording of pain intensity in a burn unit. Burns 1998; 24(5):448-54.
Sasazuki T, Juji T, Morishima Y, et al. Effect of matching class I HLA alleles on clinical outcome after transplantation of hematopoietic stem cells from an unrelated donor. N Engl J Med. 1998;339:1177-85.
Anasetti C, Amos D, Beatty PG, et al. Effect of HLA compatibility on engraftment of bone marrow transplants in patients with leukemia or lymphoma. N Eng J Med. 1989;320:197-204.
Morishima Y, Sasazuki T, Inoko H, et al. The clinical significance of human leukocyte antigen (HLA) allele compatibility in patients receiving a marrow transplant from serologically HLA-A, HLA-B, and HLA-DR matched unrelated donors. Blood 2002;99:4200-6.
Rocha V, Wagner Jr. JE, Sobocinski KA, et al. Graft versus host disease in children who have received a cord-blood or bone marrow transplant from an HLA identical sibling. N Engl J Med. 2000;342(25):1846-54.
Kurtzberg J, Laughlin M, Graham ML, et al. Placental blood as a source of hematopoietic stem cells for transplantation into unrelated recipients. N Engl J Med. 1996;335:157-66.
Laughlin MJ, Baker J, Bambach B, et al. Hematopoietic engraftment and survival in adult recipients of umbilical-cord blood from unrelated donors. N Engl J Med. 2001;344:1815-22.
Barker JN. 2007. Umbilical cord blood (UCB) transplantation: An alternative to the use of unrelated volunteer donors. Hematol Am Soc Hematol Educ Progr. 2007;1:55-61.
Heng T, Dudakov J, Khong D, Chidgey A, Boyd R. Stem cells meet immunity. J Mol Med. 2009;87:1061-9.
Gluckman E, Rocha V. Cord blood transplantation: State of the art. Haematologica 2009;94(4):451-4.
Copyright (c) 2013 Yefta Moenadjat, Maurin Merlina, Camy F. Surjadi, Caroline T. Sardjono, Yuyus Kusnadi, Ferry Sandra
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.