Aseptically Processed Dehydrated Human Amnion/Chorion Allografts Restores Type II Diabetic Cell-Mediated Granulation, Angiogenesis and Epithelialization Activities that Support Wound Healing

Chronic wound environments are complicated by an imbalance of signaling cues that compromise cell function. Moreover, diabetic wounds are characterized by elevated levels of pro-inflammatory cytokines and proteases, impaired extracellular matrix (ECM) proteins and growth factors, which culminate in decreased cell attachment/proliferation, migration and production of new ECM and growth factors, compared to normal wounds. Amniotic membranes serve as a scaffold foundation that contains inherent biochemical factors that can facilitate the wound healing process. We have previously reported that aseptically processed dehydrated human amnion/chorion allografts (dHACA) support granulation and remodeling activities through the promotion of cell proliferation, new matrix production and migration.

The goal of this study was to investigate the cellular behavior and functionality of Type II human diabetic fibroblasts, endothelial cells and keratinocytes compared to normal human cells in the presence of aseptically processed dHACA. Diabetic cells were cultured on dHACA and evaluation of cell attachment/proliferation and secretion of new matrix and growth factors were evaluated over time through assays, confocal microscopy and histology. The results demonstrated that the cellular responsiveness of the diabetic cells was facilitated by dHACA. Observations included diabetic fibroblasts secreting angiogenic growth factors and new matrix proteins that are essential for the healing process, at levels similar to normal fibroblasts. Diabetic endothelial cells exhibited comparable tube-network formation along with secretion of functional proteins. Diabetic keratinocytes displayed greater migration upon exposure to dHACA compared to the control (basal media) and secreted new matrix proteins that constitute the basement membrane, at similar levels to normal keratinocytes.

In summary, the inherent preserved biological factors that are prevalent in aseptically-processed dehydrated amnion/chorion allografts, support wound healing activities by restoring functional diabetic cell behavior. Furthermore; they can shift a chronic diabetic microenvironment to a normal wound setting, allowing for the facilitation of wound closure.