Stem Cell-Based and Stem Cell-Related Regenerative Therapies for Pure Venous Ulcers: A Systematic Review.
Baiqiang Zhang, Jinghe Zhu, Sijing Wang et al.
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In 30 seconds
This systematic review assessed the efficacy and safety of stem cell-based or related regenerative therapies for strictly defined pure venous ulcers. It included three comparative studies involving 43 patients: two randomised controlled trials and one non-randomised comparative study. Interventions varied, including bone marrow-derived mesenchymal stem cells, hair follicle-containing punch grafts and antlerogenic stem cell extract. In one randomised trial, hair follicle-treated areas had greater ulcer area reduction at 18 weeks than control areas (75.15% [SD 23.03] vs. 33.07% [SD 46.17], p = 0.002). Overall findings suggest potential benefit, but remain preliminary.
Key findings
- In a randomised double-blind pilot trial, mesenchymal stem cells in fibrin spray accelerated linear healing by approximately 10-fold versus saline spray and fibrin spray alone (p < 0.01).
- At 18 weeks, ulcer area reduction was greater in hair follicle-treated areas than control areas (75.15% [SD 23.03] vs. 33.07% [SD 46.17], p = 0.002).
- The non-randomised study reported significant improvements in wound area, circumference and healing-related indices, but Ki-67 expression did not differ significantly.
- No major treatment-related safety concerns were reported, although adverse-event data were limited.
Why it matters
Pure venous ulcers are distinct from arterial, diabetic and mixed-aetiology ulcers, so evidence from those populations may not apply directly. This review brings together comparative evidence specific to pure venous ulcers and identifies promising healing outcomes, while showing how little evidence is currently available. The varied interventions and outcome measures make the results difficult to generalise.
What to keep in mind
Only three studies involving 43 patients were included. The review notes small samples, heterogeneous interventions and variable outcome definitions; adverse-event data were also limited.