Advancements in cell-based therapies for the treatment of pressure injuries: A systematic review of interventional studies

Camesi, Alianda; Wettstein, Reto; Valido, Ezra; Nyfeler, Nicole; Stojic, Stevan; Glisic, Marija; Stoyanov, Jivko; Bertolo, Alessandro (2023). Advancements in cell-based therapies for the treatment of pressure injuries: A systematic review of interventional studies. Journal of tissue engineering, 14, p. 20417314231201071. Sage 10.1177/20417314231201071

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The high recurrence and complications associated with severe pressure injuries (PI) necessitate the exploration of advanced treatments, such as cell-based therapies, to facilitate wound healing. Such techniques harness the ability of different cell types to promote angiogenesis, re-epithelialization of the skin, and tissue regeneration. This systematic review explores the efficacy of cell-based therapies and tissue engineering in treating deep PI. We searched for interventional studies using cells in the treatment of PI in adults in four online libraries (PubMed, Embase, Ovid Medline, and Cochrane; latest search 10th June 2023). We found one randomized clinical trial (RCT), two non-RCT, and three pre-post studies, comprising 481 study participants with PI (253 intervention/228 controls). The risk of bias was categorized as moderate due to minimal bias in outcome measurements, or high owing to unclear patient randomization methods, as assessed by the ROBINS-I, NIH, and RoB-2 tools. Four cell types were identified in the context of cell-based therapies of PI: bone marrow mononuclear stem cells (BM-MNCs, n = 2); hematopoietic derived stem cells (HSC, n = 1); macrophages and activated macrophage suspensions (AMS, n = 2); and cryopreserved placental membrane containing viable cells (vCPM, n = 1). Wound healing outcomes were observed in patients undergoing cell-based therapies, including complete wound closure (AMS, vCPM; n = 142), faster healing rate (BM-MNCs, AMS; n = 146), improved granulation tissue formation (HSC, n = 3) and shorter hospitalization time (BM-MNCs; n = 108) compared to standard of care, with no adverse reactions. PI healing rate decreased only in one study with BM-MNC therapy, compared to control (n = 86). Based on the available data, though with limited evidence, it seems that macrophage deployment showed the most favorable outcomes. The results indicate that cell-based therapies offer a potential avenue for enhancing wound healing and tissue repair in PI; however, more extensive research is needed in this domain.

Item Type:

Journal Article (Review Article)


04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Glisic, Marija, Stoyanov, Jivko, Bertolo, Alessandro


500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health
600 Technology > 620 Engineering






[223] Swiss Paraplegic Foundation = Schweizer Paraplegiker-Stiftung ; [222] Horizon 2020 ; [226] Swiss School of Public Health Global P3HS




Alessandro Bertolo

Date Deposited:

29 Nov 2023 09:07

Last Modified:

07 Dec 2023 16:06

Publisher DOI:


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