11 April 2023

Advances in burns treatment open up new possibilities for healing other complicated wounds. For the first time, stem cells are now being tested as a treatment for hard-to-heal leg ulcers.

Using stem cells in the treatment of hard-to-heal wounds and burns is a new method under development. Its success depends on close collaboration between researchers and health care staff. The objective is clear: meeting health care needs.

“I recall a man in his 40s, this was a couple of months after I came to LiU as a researcher, who was fighting for his life. I’m sad to say he died. If we’d had the technologies we have now, we might have been able to help him. I still think about him,” says Ahmed Elserafy, who was recruited to LiU as a researcher to find the right type of cells to treat wounds.

One of Sweden’s two national Burn Centres is located at Linköping University Hospital. Here, near-clinical and internationally recognised research is carried out next to advanced burns care. One important task is developing the burn care of the future.Folke Sjöberg Photo credit Emma Busk Winquist

“Burn treatment has been the same for a very long time and is based on taking skin grafts from the patient for transplant to the wound area. Our research focuses on finding other ways to cover open wounds,” says Folke Sjöberg, professor at LiU and consultant at the Linköping national Burn Centre (Brännskadecentrum).

But not only burns cause serious open wounds. A very large group of wounds identified as ‛hard-to-heal wounds’, cause extensive suffering and present a difficult health care challenge.

There are significant differences between burns and hard-to-heal wounds. Burns occur suddenly. Burn patients do not normally have underlying diseases adversely affecting the healing of wounds. A hard-to-heal wound, however, is caused by underlying conditions that impair healing, such as diabetes, or multimorbidity in the case of elderly people.

Want to improve grim prognosis

The prognosis is grim for the around 100,000 people in Sweden with hard-to heal wounds. In more than half of the cases, such wounds lead to amputation of the limb affected. Hard-to-heal wounds are most often treated with dressings and wound care products. It is also possible to transplant the patient’s own skin to the wound.researcher in operating theatre.The equipment that Ahmed Elserafy needs to work with the cells is moved into the operating theatre when needed. Photo credit Ahmed Elserafy

The team of researchers and care staff have developed a model for growing new skin cells from a tissue sample from the patient. The cells are administered to the wound area in the form of a solution. The team has shown that the wound heals from the edges to the centre, just like it would naturally. Most wounds have shrunk to only half the size after 15 days.

This model forms the basis for the researchers’ next step, where they investigate the viability of using cells from another person instead of the patient’s own.

“Cells from elderly patients are not optimal for transplantation. What we’re doing now is that we use cells from younger individuals with much better healing potential,” says Folke Sjöberg.

The first clinical study

Specialist nurse Matilda Karlsson and consultant Moustafa Elmasry are working on a clinical study at the Burn Centre’s wound clinic. It is the first study in the world where stem cells, produced in compliance with the regulations governing the manufacture of medicinal products, are tested on patients with hard-to-heal leg ulcers.two researchers in operating theatre.Matilda Karlsson and Moustafa Elmasry getting the necessary dressings while Ahmed Elserafy prepares the cells. Photo credit Brännskadecentrum, Region Östergötland

“It’s a revolutionising, active treatment compared with traditional treatment using dressings or transplantation of the patient’s own skin, which is a very invasive procedure,” says Moustafa Elmasry.

The cells used are derived from fat harvested from plastic surgery patients. The researchers collaborate with the company Xintela in Lund, which purifies a well-defined group of stem cells. What is unique about stem cells is that they can be developed into any type of cell in the body. Studies have shown that even if the cells come from another person, the body’s immune defence system does not react to them.

The study, which will comprise eight patients, is in its start-up phase. As with all clinical studies, the first step is to find out whether the treatment is safe. The researchers hope that the stem cells will also have a positive effect on wound healing. Should this turn out to be the case, it will be interesting to develop the process to ensure a sufficiently large amount of cells at a reasonable cost, to enable broad application in health care. The larger the wound, the more cells are required.

If the treatment proves successful, the researchers hope that, in the long term, it can also be used to cover extensive burns. Matilda Karlsson does not hesitate for a second when asked what they hope their research will eventually lead to:

“A product that can heal all types of hard-to-heal wounds, with no need for skin grafts from the patient. This could hopefully save people from amputation of the limbs affected and, in the case of severe burns, save lives.”

Translation: Anneli Mosell

Stem cells as medicinal products

What is it?

• Stem cells are immature cells that can be developed into any type of cell.
• Stem cells belong to what is called advanced therapy medicinal products, ATMP. About a dozen ATMPs are approved in Europe today and much research is being done in this field.
• Stem cells are currently used mainly to treat blood diseases.
• The cells used can be the patient’s own (autologous transplant) or they may come from another person (allogeneic transplant).

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