On 2015 Apr 20, Gunalp Uzun commented:

In this article, Marino and coworkers investigated the effectiveness of autologous adipose tissue derived regenerative cells in the treatment of chronic lower extremity ulcers in patients with severe arterial obstruction. Adipose tissue, recently, has gained significant attention as a stem cell source and the contribution of adipose tissue derived stem cells (ADSC) to wound healing has been shown in several experimental studies (Cherubino M, 2011). However, the number of studies that use ADSC to accelerate wound healing in a clinical setting is low (Cherubino M, 2011, Uzun G, 2014). The article by Marino et al., in this regard, is an important contribution to this field. We, therefore, read the article with great interest, yet would like to express some of our reservations.

First, the outcome of patients in the control group was not given in the article (Marino G, 2013). Marino et al. included twenty patients, whose ulcers have not healed despite several months of traditional and advanced wound care methods. Of the 20 patients, 10 have been treated surgically with ADSC and others have been used as ‘controls’. In the Results, they also state that patients who were treated with ADSC and who did not were monitored at days 4, 10, 20, 60, and 90. At the end of the study, ulcers of the 6 (60%) patients in the treatment group completely healed, however, there is no mention about ulcer healing rate in the control group. If the authors have provided this information, the reader would be able to compare the outcomes in the treatment and control groups and to reach a better conclusion on the effectiveness of ADSC.

Second, there is a discrepancy between the information provided in the text and in the tables. Identification of a factor that predicts those who would benefit from ADSC would be very useful. The authors propose baseline ankle brachial index (ABI) value as a predictor of treatment outcome. In the Results, it is stated that ‘Patients who recovered completely had an ABI between 0.8-0.9, whereas others with a reduction in the diameter of the ulcer had an ABI between 0.5-0.6.’ (Marino G, 2013). Baseline characteristics and ABI values of patients in the treatment and control groups were presented in Table 1 and Table 2, respectively (Marino G, 2013). It is seen on this tables that none of the patients had an ABI higher than 0.39. This issue needs clarification.

There is a need for more clinical studies that tests ADSC as a potential treatment for non-healing lower extremity ulcers in patients with peripheral arterial disease. We applaud the efforts of Maroni et al., and acknowledge the importance of their study, however, we think that two points mentioned above needs to be clarified.

Gunalp Uzun & Abdul Kerim Yapici

References

1. Marino G, Moraci M, Armenia E, Orabona C, Sergio R, De Sena G, Capuozzo V, Barbarisi M, Rosso F, Giordano G, Iovino F, Barbarisi A. Therapy with autologous adipose-derived regenerative cells for the care of chronic ulcer of lower limbs in patients with peripheral arterial disease. J Surg Res. 2013;185:36-44.

2. Cherubino M, Rubin JP, Miljkovic N, Kelmendi-Doko A, Marra KG. Adipose-derived stem cells for wound healing applications. Ann Plast Surg. 2011;66(2):210-5.

3. Uzun G, Yapici AK, Ilgaz Y. Adipose derived mesenchymal stem cells in wound healing: a clinical review. Dis Mol Med. 2014;2:57-64. doi: 10.5455/dmm.20150120123357

On 2015 Apr 20, Gunalp Uzun commented:

In this article, Marino and coworkers investigated the effectiveness of autologous adipose tissue derived regenerative cells in the treatment of chronic lower extremity ulcers in patients with severe arterial obstruction. Adipose tissue, recently, has gained significant attention as a stem cell source and the contribution of adipose tissue derived stem cells (ADSC) to wound healing has been shown in several experimental studies (Cherubino M, 2011). However, the number of studies that use ADSC to accelerate wound healing in a clinical setting is low (Cherubino M, 2011, Uzun G, 2014). The article by Marino et al., in this regard, is an important contribution to this field. We, therefore, read the article with great interest, yet would like to express some of our reservations.

First, the outcome of patients in the control group was not given in the article (Marino G, 2013). Marino et al. included twenty patients, whose ulcers have not healed despite several months of traditional and advanced wound care methods. Of the 20 patients, 10 have been treated surgically with ADSC and others have been used as ‘controls’. In the Results, they also state that patients who were treated with ADSC and who did not were monitored at days 4, 10, 20, 60, and 90. At the end of the study, ulcers of the 6 (60%) patients in the treatment group completely healed, however, there is no mention about ulcer healing rate in the control group. If the authors have provided this information, the reader would be able to compare the outcomes in the treatment and control groups and to reach a better conclusion on the effectiveness of ADSC.

Second, there is a discrepancy between the information provided in the text and in the tables. Identification of a factor that predicts those who would benefit from ADSC would be very useful. The authors propose baseline ankle brachial index (ABI) value as a predictor of treatment outcome. In the Results, it is stated that ‘Patients who recovered completely had an ABI between 0.8-0.9, whereas others with a reduction in the diameter of the ulcer had an ABI between 0.5-0.6.’ (Marino G, 2013). Baseline characteristics and ABI values of patients in the treatment and control groups were presented in Table 1 and Table 2, respectively (Marino G, 2013). It is seen on this tables that none of the patients had an ABI higher than 0.39. This issue needs clarification.

There is a need for more clinical studies that tests ADSC as a potential treatment for non-healing lower extremity ulcers in patients with peripheral arterial disease. We applaud the efforts of Maroni et al., and acknowledge the importance of their study, however, we think that two points mentioned above needs to be clarified.

Gunalp Uzun & Abdul Kerim Yapici

References

1. Marino G, Moraci M, Armenia E, Orabona C, Sergio R, De Sena G, Capuozzo V, Barbarisi M, Rosso F, Giordano G, Iovino F, Barbarisi A. Therapy with autologous adipose-derived regenerative cells for the care of chronic ulcer of lower limbs in patients with peripheral arterial disease. J Surg Res. 2013;185:36-44.

2. Cherubino M, Rubin JP, Miljkovic N, Kelmendi-Doko A, Marra KG. Adipose-derived stem cells for wound healing applications. Ann Plast Surg. 2011;66(2):210-5.

3. Uzun G, Yapici AK, Ilgaz Y. Adipose derived mesenchymal stem cells in wound healing: a clinical review. Dis Mol Med. 2014;2:57-64. doi: 10.5455/dmm.20150120123357