Breakfast Symposium 1: Wound Care
Thursday, July 27
Managing foot ulcers, particularly in patients with diabetes, is one of the great challenges facing podiatric physicians. Cellular senescence is the major barrier to the healing process for these wounds, but the use of Mesenchymal stem cell grafts has the potential to overcome that barrier for better outcomes.
During Thursday’s Breakfast Symposium presentation, “Cellular Senescence,” Matthew J. Regulski, DPM, medical director of the Wound Institute of Ocean County, Toms River, NJ, will provide a better understanding of cellular senescence’s role in chronic diseases.
“Cellular senescence is a key factor in the development of every age-related chronic disease from head to toe—Parkinson’s, Alzheimer’s, atherosclerosis, and chronic wounds,” Dr. Regulski said. “There are disease states that cause chronic inflammation that results in the production of reactive oxygen species.
“One of the most devastating diseases is diabetes, which causes premature aging and rapid cellular dysfunction. That is why patients with diabetes have wounds that are harder to heal and harder to regenerate. It’s harder for them to fight infection because the cells are aged, senesced, and tired.”
Other causes of cellular senescence are DNA damage, telomere erosion, oncogene activation, infection, radiation, and medications.
“Oncogenes are genes that are activated to prevent tumor formation. Therefore, cellular senescence is evolutionarily an anti-tumor mechanism that activates tumor suppression,” Dr. Regulski said. “Cellular senescence is a state of proliferation arrest. Therefore, cells do not grow because they are metabolically active in a pro-inflammatory way.”
The production of these pro-inflammatory proteins can lead to the induction of chronic, sterile, low-grade inflammation and, in the context of obesity, they can lead to the initiation of type 2 diabetes and its deleterious comorbidities. Understanding cellular senescence and chronic inflammation can lead to recognizing one of the contributors to the non-healing diabetic ulcer, he said.
“Because of cellular senescence and non-proliferating cells, the use of living placental stem cell grafts, which have three living cell lines and hundreds of proteins, can have tremendous impact on restoring, repairing, and up-regulating the endogenous regenerative capacity of human tissue,” Dr. Regulski said. “Mesenchymal stem cells could be called ‘medicinal signaling cells’ because they secrete factors as dictated by the inflamed and diseased microenvironment. Therefore, they are able to repair, regenerate, and reconstitute the abnormal cellular component as well as the dysfunctional protein library being secreted by senescent cells.”
Dr. Regulski predicts that these types of cells are the wave the future.
“There are more than 700 clinical trials going on right now with Mesenchymal stem cells for all age-related chronic diseases. Foot and ankle specialists should understand why we are applying a cellular component to this diseased tissue. My hope is that everyone will understand why we are doing these types of applications and the power that can come from using stem cells,” he said.