Snyder RJ, Schultz G, Wachuku C, Rashid AM, Ead JKK, et al.
Journal of the American Podiatric Medical Association. Date of publication 2020 Oct 13;volume ():.
1. J Am Podiatr Med Assoc. 2020 Oct 13. pii: 20-140. doi: 10.7547/20-140. [Epub
ahead of print]
Proposed Mechanism of Action of Topically Applied Autologous Blood Clot Tissue: A
Quintessential Cellular and Tissue Based Therapy.
Snyder RJ, Schultz G, Wachuku C, Rashid AM, Ead JKK.
BACKGROUND: Chronic wounds, especially in patients with diabetes, oftenrepresent
clinical challenges. Recently the use of a topically applied blood clot has
garnered significant interest. This stromal matrix contains viable cells that are
autologous, biocompatible, biological and consistent with a metabolically active
scaffold. It has been shown to be safe, effective, and cost efficient. However,
the mechanism of action of this modality remains elusive. The objective of this
manuscript is to identify a potential mechanism of action of an autologous blood
clot.
METHODS: Review of clinical and scientific literature hypothesizes on how
autologous blood clots may stimulate healing and facilitate the movement of
critical substrates while lowering bioburden and fostering angiogenesis.
RESULTS: Blood serves as a carrier for many components: red blood cells, white
blood cells, platelets, proteins, clotting factors, minerals, electrolytes, and
dissolved gasses. In response to tissue injury, the hemostatic mechanism employs
a host of vascular and extravascular responses initiating primary, secondary, and
tertiary hemostasis. The scaffold created by the autologous blood clot tissue
provides a medium in which the body can transform the wound from a non-healing
chronic condition into a healing "acute" condition. The autologous blood clot
tissue also creates a protective setting for the body to utilize its own
mechanisms to promote wound healing in an organized manner. This transient
scaffold recruits surrounding fibroblasts and promotes cell ingrowth to foster
granulation tissue remodeling. Cells in this matrix not only sense soluble
factors, but also their physical environments. This well-orchestrated mechanism
includes signals from soluble molecules, from the substrate/matrix to which the
cell is adherent, from the mechanical or physical forces acting on it, and from
contact with other cells. Topically applied autologous blood clot tissue can
lower bacterial bioburden while stimulating angiogenesis and fostering the
movement of keratinocytes and fibroblasts.
CONCLUSIONS: Topically applied autologous blood clot tissue represents a
formidable cellular and tissue based therapy that has been shown to be safe and
effective. Although the central component of this therapy is blood, the
autologous clot tissue creates a scaffold that performs as a biologic delivery
system that functions to control the release of growth factors and cytokines over
several days.
DOI: 10.7547/20-140
PMID: 33052392
