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Chapter 1

Pilot Study: The Effects of Stem Cells and Platelet Rich Plasma on Recovery from Laser Resurfacing

Robert Bowen M.D., FCCP, FASLMS

Clinical Associate Professor of Medicine, WVU-East;

Medical Director, The Center for Positive Aging, Martinsburg, WV

ABSTRACT

This paper presents the results of a pilot study into whether stem cells or cellular growth factors would improve the efficacy of fractional laser resurfacing of the skin and/or reduce recovery time.

Keywords: laser resurfacing, fractional laser, adipose derived stem cells, platelet rich plasma, platelet derived growth factors, facial aging, burn scars, acne scars

INTRODUCTION

The development of fractional laser resurfacing has allowed effective treatments with shorter recovery than after full-field resurfacing.^1,2 This technique has been applied to the process of the aging face (wrinkles, texture irregularities, skin laxity, and sun damage), as well as treatment of surgical, acne, and burn scars.^2-4 A variety of infrared wavelengths, each with a different absorption coefficient (affinity for water) has been used successfully (1319 nm, 1320 nm, 1440 nm, 1450 nm, 2750 nm, 2940 nm, 10,600 nm). The 2940 nm Er:YAG laser and the 10,600 nm CO₂ laser have a high coefficient for absorption for water and are capable of complete ablation of tissue. These wavelengths have been effective for treating aging skin with reduced recovery times and approach but may not often achieve the results of full field resurfacing. The recent discovery of the regenerative properties of adult stem cells and platelet-derived growth factors (PDGFs) has raised questions as to whether stem cells or cellular growth factors would improve the efficacy or reduce the recovery time of these procedures.

PILOT STUDY

Stem Cells

Stem cells have the characteristics of both being able to replicate themselves and differentiate into a variety of other cells.⁵ Embryonic stem cells (ESCs) are truly pluripotent, meaning that they can become any type of human cell. Significant scientific and ethical issues still surround the use of ESCs, thus limiting their application. Fortunately, adult mesenchymal stem cells are multipotent and are plentiful in both bone marrow and adipose tissue.⁶ Adipose derived mesenchymal stem cells (ADSCs) can differentiate into vascular tissue, bone, cartilage, and adipoctyes among others. In addition to their cellular regenerative potential, these cells also exhibit chemotaxis and the ability to modulate inflammation via cytokines.^6-8

Subcutaneous fat is a rich source of ADSCs, is available in sufficient quantities and can be harvested under local anesthesia.⁸ PDGFs can also be obtained by simple procedures of phlebotomy and centrifugation and also hold regenerative potential.

Materials and Methods

Three volunteers, skin type two and three, were tested in separate one-centimeter square areas with the ER:Yag laser (Sciton, Palo Alto, CA). Three 1 cm² squares were treated at 100 microns depth with a 100% coverage (full field) and three 1 cm² squares at 300 microns depth with 11% coverage (fractional) in each subject. Each treated area had topical application of; 1) gel vehicle only 2) gel and platelet rich plasma (PRP) 3) gel, PRP,and ADSCs. ADSCs were obtained from a “mini-liposuction” procedure using tumescent anesthesia and PRP was obtained from peripheral blood. The biologic agents were then topically applied to the wounds with a pipette and allowed to dry for 5 minutes. The treated skin was dressed with a gel to maintain the cells in an anaerobic environment. Sequential photographs were obtained and evaluated.

Results

Fractional wounds under all conditions healed rapidly. Epithelialization occurred within 24 hours or less in all 9 fractional wounds. 100 micron full field wounds healed more slowly. The surface area that had re-epithelialized was measured and compared to the total area of the wound and a percent healing was calculated. Mean time 50% epithelialization in the vehicle only group was 10 days, compared with 6 days in the PRP group, and 4 days in the PRP plus ADSCs group. Full re-epithelialization was achieved in a mean of 14 days with PRP and 7 days with PRP plus ADSCs. None of the areas treated with the gel vehicle alone were fully healed at the end of the 14 day observation period.

Figure 1. 5 days post-treatment: 100 micron full field resurfacing (top), 300 micron 11% fractional resurfacing (bottom), vehicle dressing only (left), vehicle + PRP (center), vehicle+ PRP+ ADSCs (right)

Figure 2. 7 days post-treatment: 100 micron full field resurfacing (top), 300 micron 11% fractional resurfacing (bottom), vehicle dressing only (left), vehicle + PRP (center), vehicle+ PRP+ ADSCs (right)

Figure 3. 8 days post-treatment: 100 micron full field resurfacing (top), 300 micron 11% fractional resurfacing (bottom), vehicle dressing only (left), vehicle + PRP (center), vehicle+ PRP+ ADSCs (right)

CONCLUDING REMARKS

This pilot study showed faster healing times compared to a vehicle dressing only of laser wounds treated with PRP and PRP plus ADSCs. These results suggest the possibility of reduced recovery times from full field laser resurfacing treatment.

The PRP and PRP plus ADSCs were applied topically using a pipette to the forearm and abdominal skin of volunteers. Facial skin heals more quickly than abdominal and forearm skin and thus healing after treatment with PRP and ADSCs is likely to be more rapid than that observed in the forearm and abdominal skin treated in this study. Administration of the PRP and cells with a pipette, as was done in this study, is not likely to be practical when treating facial skin and further work is planned using a canula or a needle to implant these biological agents in the subcutaneous space and/or dermis of subjects just prior to treatment with the laser. A split face study using ADSCs and PRP applied in a thin coat with a brush following treatment or with subcutaneous/dermal injection prior to treatment is recommended.

REFERENCES

1.Manstein D, Heron GS, Sink RK, Tanner H. Fractional thermolysis: A new concept for cutaneous remodeling using microoscopic patterns of injury. Laser Surg Med. 2004;34:426-428.

2.Geronemus R. Fractional thermolysis: current and future applications. Laser Surg Med. 2006;38:169-176.

3.Bowen R. A novel approach to ablative fractional resurfacing of mature thermal burn scars. J Drugs Dermatol. 2010;9:389-393.

4.Waibel J, Beer K. Ablative fractional laser resurfacing for the treatment of a third-degree burn. J Drugs Dermatol. 2009;8:294-297.

5.Plant-Bernard V, Silvertre JS, Cousin B, et al. Plasticity of human adipose lineage cells toward endothelial cells; physiological and therapeutic perspectives. Circulation 2004;109:656-663.

6.Zuk PA, Zhu M, Ashjian P, et al. Human adipose tissue is a source of multipotent stem cells. Mol Biol Cell. 2002;13:4279-4294.

7.Moseley TA, Zhu M, Hedrick MH. Adipose derived stem and progenitor cells as fillers in plastic and reconstructive surgery. Plast Reconstr Surg. 2006;118 (3 suppl):121s-128s.

8.Strawford A, Autelo F, asured with 2 H2O. AmJ Physiol Endocrinol Metab. 2004;256:E577-E588.

9.Matsumoto D, Sato K, Gonda R, et al. Cell assisted lipotransfer: Supportive use of human adipose derived cells for soft tissue augmentation. Tissue Engineering. 2006;12:3375-3382.

ABOUT THE AUTHOR

Dr. Robert Bowen is an Internal Medicine and Pulmonary specialist, Board Certified in Cosmetic Laser Surgery by the American Board of Laser Surgery. He is a Fellow of the American Society of Laser Medicine and Surgery and has published research articles on laser medicine. Dr. Bowen is a Diplomate of the American Board of Anti-Aging Medicine and a graduate of the Aesthetic Medicine Fellowship.