Background/Purpose

Fingertip digital ulcers (DUs) are a rather frequent and invalidating complication in the course of systemic sclerosis (SSc), often showing a very slow or null tendency to heal, and causing intense local pain. Furthermore, most of the commonly used systemic and local therapeutic procedures have demonstrated to be scarcely or totally inadequate to induce a rapid healing in the SSc-related DUs. Recently stem cell therapy has emerged as a new approach to accelerate wound healing, and some case reports have been published where local or regional transfer of bone marrow stem cells (BMSCs) was effective in improving or healing SSc-related ischemic lesions. Adipose-derived stem cells (ASCs) are considered another source of multipotent stem cells potentially able to induce angiogenesis and tissue repair.In the present study we have tentatively treated long lasting and poorly responsive to traditional therapy SSc-related DUs by the implantation of autologous adipose-tissue derived cells (ATDCs) fraction, that it know to contains both the ASCs and the stromal/vascular cell (SV) component.

Methods

Fifteen patients with SSc having a long lasting DU in only one fingertip, unresponsive  to intensive systemic and local treatment, were enrolled into the study. The grafting procedure consisted in the injection, at the basis of the corresponding finger, of 0.5-1 ml of ATDCs fraction, separated by centrifugation of adipose tissue collected through liposuction from subcutaneous abdominal fat. Time to healing after the procedure was the primary end point of the study, while reduction of pain intensity (measured by visual analogue scale), and of analgesic consumption represented secondary end point. Furthermore, the after therapy variation of the number of capillaries, observed in the nailfold video-capillaroscopy (NVC) exam, and of the resistivity in the digit arteries, measured by high resolution echo-color doppler were also taken into account.

Results

A rather speed healing of the DUs was reached in all of the enrolled patients (mean time to healing 4.23 weeks; range 3-8 weeks).  A significant reduction of pain intensity was observed after few weeks (p<0.001), while the number of capillaries was significantly increased at second (3 months) and third (6 months) NVC assessment (p<0.0001 in both cases, with respect to the basal examination). Finally, a significant after treatment reduction of digit artery resistivity was also recorded (p<0.0001).

Conclusion

Even with the limitations related to the small number of patients included, and to the open-label design of the study, the strongly favourable outcome we observed suggests that the local grafting with ATDC, containing both ASCs and SV fraction, could represent a promising option for the treatment of SSc-related DUs unresponsive to more consolidated therapies.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/regional-implantation-of-adipose-tissue-derived-cells-induces-a-prompt-healing-of-long-lasting-indolent-digital-ulcers-in-patients-with-systemic-sclerosis/