Management of pressure injury with autologous bone marrow-mononuclear cells (BM-MNCs) in patients with spinal cord injury (SCI) patients- A pilot study

Rajeshwar Nath Srivastava1, Mukesh Kumar Dwivedi1, Amit Kumar Bhagat2 and Saloni Raj3, (1)Department of Orthopaedic Surgery, King George’s Medical University, Lucknow, U.P., India, Lucknow, India, (2)Department of Surgical Gastroenterology, King George’s Medical University, Lucknow, U.P., India, Lucknow, India, (3)MS Ramiyah Medical College, Bangalore, India, Bangalore, India
Introduction: Pressure injury (PI) is devastating co morbidity in SCI subjects and difficult to treat. Some studies shows mixed results using bone marrow stem cells to treat several diseases including chronic wounds. Aim of this pilot study was to assess the safety, efficacy of bone marrow derived stem cell therapy to promote the healing of pressure injury in patients with SCI.

Material and Methods: Ten patients having stage IV PI were enrolled and equally divided into two groups: Group 1 patients (5) were given BM-MNCs followed by dry gauze daily dressing and Group 2 patients (5) were given only dry gauze dressing as standard wound care. Among group 1 patients, 100 ml bone marrow (BM) was harvested from the posterior iliac crest. BM-MNCs suspension was separated from BM immediately after harvesting. BM-MNCs were injected by insulin syringe after the wound was subdivided with a grid into small areas of 1 cm2. Wound assessment for healing outcome measures in both the groups was done at week 0, 3, 6 and 9. Wound biopsy was done at every 3 week to assess the matastatis.

Results: Pressure injury treated with BM-MNCs had fully healed after 6 week. When compared to group 2 patients, significant reduced surface area was observed in BM-MNCs treated PI at week 6 (p=0.001). Conversion of slough into red granulation tissue was significantly higher in BM-MNC group after week 6 (p=0.001). None of the biopsies showed signs of metaplastic roliferation/differentiation after BM-MNCs therapy. 

Conclusions: This pilot study indicate that autologous BM-MNCs therapy is safe and could be an option to treat type IV pressure ulcers in patients with SCI. A larger study may help to test the efficacy of this therapy to treat pressure injury.