Emerging therapy for improving wound repair of severe radiation burns using local bone marrow-derived stem cell administrations

TLDR

Severe radiation burns are difficult to treat, and conventional surgical approaches such as excision, skin grafts, or flaps often fail to halt the progressive necrotic process. The authors expanded autologous bone‑marrow mesenchymal stem cells with platelet‑derived growth factors and delivered five local injections in combination with skin autografts after multiple surgical debridements. This combined surgical and cellular therapy prevented recurrence of radiation inflammation over an eight‑month follow‑up, lowered C‑reactive protein levels, and suggests a drug‑cell effect, indicating a promising strategy for severe radiation burn wound repair.

Abstract

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.