Regenerative Healing of Large Pressure Wounds Using Topical Mesenchymal Stem Cell Conditioned Media Spray: Translational Rationale, Clinical Potential, and Early Case Outcome
Background: Stage IV pressure injuries are among the most difficult chronic wounds to treat,
particularly in patients with type 2 diabetes mellitus (T2D), severe obesity, and prolonged immobility,
where impaired angiogenesis, persistent inflammation, and defective tissue remodeling contribute to
poor healing. Mesenchymal stromal cell-conditioned media (MSC-CM) is a cell-free regenerative
biologic that delivers a bioactive secretome of growth factors, cytokines, and extracellular vesicles
capable of modulating multiple pathways involved in tissue repair. We describe the clinical application
of an investigational topical MSC-CM spray as adjunctive therapy for extensive refractory Stage IV
pressure injuries.
Case Summary: A 66-year-old woman with T2D, severe obesity, and complete immobility presented
with five chronic Stage IV pressure injuries involving the sacrococcygeal region, bilateral buttocks, and
posterior thighs, with a combined baseline wound surface area of 326.0 cm² despite comprehensive
standard wound care. An investigational MSC-CM spray was administered weekly as adjunctive
therapy for 120 days while conventional wound management was maintained. Early treatment was
characterized by progressive granulation tissue formation, reduction in wound depth, and improved
wound bed quality preceding measurable wound contraction. By Day 120, total wound surface area had
decreased to 205.86 cm², representing a 36.9% reduction from baseline, with the greatest contraction
occurring between Days 60 and 90 (42.1% reduction). Patient-reported pain improved from moderate-
severe at baseline to 3/10 at Day 120. No local hypersensitivity reactions, treatment-related infections,
systemic adverse events, or hospitalizations were observed.
Conclusion: Adjunctive topical MSC-CM therapy was associated with progressive wound bed
regeneration, substantial wound contraction, pain reduction, and favorable tolerability in a patient with
extensive refractory Stage IV pressure injuries and multiple adverse healing comorbidities. Although
causality cannot be established from a single uncontrolled case, these findings provide preliminary
clinical support for further prospective evaluation of cell-free MSC-derived biologic therapies as
adjuncts to standard wound care.
