Эффективность стромальных сосудистых фракций жировой ткани

Еремин П С; Деев Р В; Хохлов И В; Гильмутдинова И Р

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ЭФФЕКТИВНОСТЬ СТРОМАЛЬНЫХ СОСУДИСТЫХ ФРАКЦИЙ ЖИРОВОЙ ТКАНИ

Журнал: ВЕСТНИК ВОССТАНОВИТЕЛЬНОЙ МЕДИЦИНЫ Том 2019 № 3 , 2019

Рубрики: НАУЧНАЯ ЖИЗНЬ

УДК 614.2 Организация здравоохранения

Еремин П С ¹

Деев Р В ²

Хохлов И В ³

Гильмутдинова И Р ⁴

Информация об авторах и публикации

Авторы:

1. Национальный медицинский исследовательский центр реабилитации и курортологии Минздрава России

2. Рязанский государственный медицинский университет им. академика И.П. Павлова

3. Донецкий национальный университет

4. Национальный медицинский исследовательский центр реабилитации и курортологии Минздрава России

Тип:

Статья

Страницы:

с 73 по 75

Статус:

Опубликован

Получено:

27.07.2019

Одобрено:

27.07.2019

Опубликовано:

27.07.2019

Классификаторы:

УДК 614.2 Организация здравоохранения

Язык материала:

английский

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Currently, local radiation injuries of skin and underlying tissues are the most frequently occurring consequences of a human contact with an ionizing radiation source [4]. Most cases of radiation injuries result from the X-ray therapy of tumors and non-tumor diseases [5]. However, this treatment method has significant side effects along with positive results of application. For example, after radiation therapy 41 % of patients have radiation injuries of skin and underlying tissues, in 3,5 % of clinical cases these injuries lead to long-term non-healing radiation ulcers (RU) [6]. The RU are hard to treat due to disorders in metabolic and proliferative processes in tissues, pathological changes of microcirculatory boodstream’s condition in a damaged area [7,8]. The main method for treating late radiation injuries and severe and very severe injuries is a surgery, including necrectomy along with non-surgical measures. However, this method is not efficient enough, as it allows to achieve complete healing only among 21 % of patients [9]. Clinical studies of using autologous bone marrow MMSC in the therapy of patients with RU revealed positive results [10]. Still, despite positive results, this method has a number of flaws: painful and complicated procedure of bone marrow sampling and a mandatory long period of cell culture. Now that cell technologies get developed, adipose-derived minimum manipulated autologous cell products (stromal vascular fractions SVF in particular) gain popularity [11]. Article goal. The goal is to assess efficiency of using SVF in regeneration of skin after deep radiation injuries in early and late periods after irradiation. Materials and methods. We used a test model of non-healing severe RUs [12] to conduct the experiment. Sampling of a stromal vascular fraction. We sampled biomaterial from the animal that later on we injected with cell products. To reduce stress and pain, we used intravenous anesthesia to sample biomaterial from animals. We sampled subcutaneous adipose tissue by method of syringe liposuction in abdominal and inguinal areas. Sampling of a stromal vascular fraction was done in accordance with standard protocol for enzymatic treatment of adipose tissue. Cell products. In order to assess efficiency of different cell products and clarify mechanism of their action, we conducted therapy of severe local radiation injuries on the 21st day after irradiation - in the beginning of ulcer formation and on the 160th day - chronic 4-month non-healing ulcers. Statistical data processing. We applied planimetric methods to assess changes. We processed statistical data with IBM SPSS Statistics 19 statistical package. Results. Morphofunctional changes of skin tissues after local irradiation of 110 Gy dose. Skin radiation injuries of rats after 110 Gy irradiation are developed similarly to clinical picture of a human pathological process in severe cases. The latent period, when skin injury was not visually detected, lasted 7-9 days. After that, we observed hyperemia and a disrupted normal skin tone. In 12-13 after irradiation, rats were observed to have dry dermatitis. By 14-16 days dry dermatitis became moist dermatitis. Major processes during this period are epithelial desquamation, leukocytic infiltration of dead and dying tissues, destruction of collagenous framework of derm. In 17-25 days after irradiation, we observed formation of ulcers on skin of 60 % of rats. In 29-36 days ulcers were completely formed, after that we observed progression of necrotic process. Treatment of radiation injuries in certain periods after irradiation. 40 animals were irradiated during preparation for the experiment. By 160th day after irradiation (the first day of injection of cell products), only 36 rats survived, 4 of them had their ulcers completely healed by the 50th day. The treatment was carried once on the 160th day after irradiation. Planimetry results revealed that by 14th day after SVF injection, the damaged area diminished by 50 %, compared to initial size, and made 1,36 ± 0,63 cm2. By the end of observation, dynamics in healing of radiation injuries remained stable in test groups and ulcer areas diminished up to 33 % (0,87 ± 0,47 cm2) by the 34th day of observation. We presented results for key points, having chosen the moment of cell products’ injection as a zero point. Treatment of radiation injuries in early periods after irradiation. The treatment of RU was carried once on the 21st day after irradiation. In the test group we noticed active recovery in defected area. By the end of observation, animals revealed no inclination for worsening course, they had no wound suppuration and no inflammatory response, atrophic scars began to form in areas of radiation injuries. In control group, we noted remaining considerably sized injuries, as well as signs of inflammatory response and suppurating wounds during the whole observation period. Planimetry results revealed that by the 5th day after SVF injection, there was an insignificant positive effect, and on the 13th day (32th day after irradiation) there were more distinctive differences: the damaged area was reduced up to 1,6 ± 0,6 cm2. By the 62nd day of the therapy, results reached statistical significance, the defect area was reduced up to 0,83 ± 0,3 cm2. By the final period of observation, epithelial integrity was not fully recovered, still, there was no ulcer defect of tissues and this local area was filled with granulation tissue. Conclusions. The obtained results indicate that application of SVF for skin regeneration after severe RU has a positive therapeutic effect regardless of the period of treatment beginning after irradiation.

Список литературы

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