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Burn Injury Wound Healing Improved with Adipose Stem Cell-laden Hydrogels

Review of  “Delivery of Allogeneic Adipose Stem Cells in PEG-Fibrin Hydrogels as an Adjunct to Meshed Autografts After Sharp Debridement of Deep Partial Thickness Burns” from STEM CELLS Translational Medicine by Stuart P. Atkinson

Extensive and deep burn injuries require the excision of necrotic tissue before treatment with a meshed split-thickness skin autograft with the aim of covering a large area with a small amount of graftable material [1]. However, cosmetic concerns, especially when the burns affect regions such as the face, neck, and hands, as well as the need to improve the grafting process and enhance wound healing have prompted the search for new approaches.

Novel approaches for enhanced wound healing include the application of immunosuppressive and pro-angiogenic mesenchymal stem cells derived from adipose tissue (ASCs) alongside a biomaterial carrier [2, 3]. Now, a team led by Robert J. Christy (United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA) has assessed a combination of meshed autografts and ASC-laden hydrogels to promote wound healing in a porcine model [4]. Can this new STEM CELLS Translational Medicine study provide improved burn injury wound healing with the help of ASCs?

Burmeister et al. employed deep partial thickness burns on the dorsum of Yorkshire pigs as a model system to assess the efficacy of their new ASC-based approach, as this clinically-relevant large animal represents the best surrogate for human skin [5]. Following the removal of dead/damaged tissue at day 4, the authors treated the wounds with split-thickness skin grafts (STSG) or meshed STSG (mSTSG) and compared these to mSTSG accompanied by a polyethylene-glycol-fibrin-based hydrogel laden with increasing concentrations of in vitro expanded porcine ASCs. 

Encouragingly, the study established that while the hydrogel prevented the unwanted wound contraction that can lead to physical deformity, it also supported the continued proliferation of ASCs. Furthermore, ASCs secreted high levels of vascular endothelial growth factor (VEGF) into the wound site, thereby promoting accelerated angiogenesis and encouraging higher levels of wound healing.

While the authors point to the small size of the wounds assessed and the lack of the complex pathophysiology/pain that occurs during instances of extensive burns and scarring as limitations to their study, this promising approach could be adapted to a point-of-care application [6] to provide a rapid and completely autologous strategy for burn injury wound repair in human patients.

For more on adipose stem cells and burn injury wound healing, stay tuned to the Stem Cells Portal!


  1. Vandeput J, Nelissen M, Tanner JC, et al., A review of skin meshers. Burns 1995;21:364-370.
  2. Natesan S, Zamora DO, Wrice NL, et al., Bilayer Hydrogel With Autologous Stem Cells Derived From Debrided Human Burn Skin for Improved Skin Regeneration. Journal of Burn Care & Research 2013;34:18-30.
  3. Zamora DO, Natesan S, Becerra S, et al., Enhanced wound vascularization using a dsASCs seeded FPEG scaffold. Angiogenesis 2013;16:745-757.
  4. Burmeister DM, Stone R, Wrice N, et al., Delivery of Allogeneic Adipose Stem Cells in Polyethylene Glycol‐Fibrin Hydrogels as an Adjunct to Meshed Autografts After Sharp Debridement of Deep Partial Thickness Burns. STEM CELLS Translational Medicine 2018;7:360-372.
  5. Sullivan TP, Eaglstein WH, Davis SC, et al., THE PIG AS A MODEL FOR HUMAN WOUND HEALING. Wound Repair and Regeneration 2001;9:66-76.
  6. Natesan S, Wrice NL, Baer DG, et al., Debrided Skin as a Source of Autologous Stem Cells for Wound Repair. STEM CELLS 2011;29:1219-1230.