Jornal Vascular Brasileiro
https://app.periodikos.com.br/journal/jvb/article/doi/10.1590/1677-5449.202501391
Jornal Vascular Brasileiro
Artigo de Revisão

Eficácia e segurança da terapia com células derivadas do tecido adiposo no tratamento de úlceras crônicas de extremidades: uma revisão sistemática e metanálise de ensaios clínicos randomizados e controlados

Efficacy and safety of adipose tissue-derived cell therapy in the treatment of chronic extremity ulcers: a systematic review and meta-analysis of randomized controlled trials

Edenilson de Souza Teixeira; Vanessa Ellen Silva Carmo; Hideki Zimermann Kamitani; Johnnatas Mikael Lopes; Sydney Correia Leão; Carlos Alberto de Lima Botelho Filho; Pedro Pereira Tenório

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Resumo

Contexto: As úlceras crônicas de extremidades representam um importante problema de saúde na prática clínica. As células-tronco derivadas do tecido adiposo (ADSCs) surgem como uma alternativa promissora para promover a cicatrização dessas lesões, embora sua eficácia e segurança ainda não estejam definitivamente estabelecidas.

Objetivos: Avaliar a eficácia e a segurança das ADSCs em comparação com o tratamento convencional.

Métodos: Foi realizada revisão sistemática e metanálise de 11 ensaios clínicos randomizados, envolvendo 474 pacientes. Foram avaliados a taxa e o tempo de cicatrização, os desfechos relacionados à dor e a segurança. As medidas de efeito incluíram odds ratio (ORs) e diferença média ponderada.

Resultados: A taxa de cicatrização completa foi maior no grupo tratado com ADSCs (84,2% vs. 49,0%; OR 5,77; p < 0,00001). O tempo de cicatrização foi, em média, 19,39 dias menor no grupo intervenção (p = 0,0004). Não houve diferença estatisticamente significativa em relação à dor ou à incidência de complicações (p = 0,22).

Conclusão: As ADSCs aumentaram a taxa de cicatrização e reduziram o tempo necessário para a cicatrização de úlceras crônicas de extremidades, sem evidência de aumento significativo do risco associados ao tratamento. Contudo, a heterogeneidade dos achados e o tamanho amostral limitado reforçam a necessidade de estudos com maior poder estatístico e protocolos metodológicos padronizados para confirmar esses resultados.

Palavras-chave

células-tronco mesenquimais; cicatrização de feridas; terapia baseada em transplante de células e tecidos; dor crônica

Abstract

Background: Chronic extremity ulcers represent a major clinical challenge. Adipose-derived stem cells (ADSCs) have emerged as a promising therapeutic option for wound healing; however, their efficacy and safety remain incompletely established.

Objectives: To evaluate the efficacy and safety of ADSCs compared with conventional treatment.

Methods: A systematic review and meta-analysis of 11 randomized clinical trials involving 474 patients was conducted. Outcomes included healing rate, mean healing time, pain-related outcomes, and safety. Odds ratios (ORs) and weighted mean differences were used as summary effect measures.

Results: Complete healing rates were significantly higher in the ADSC group than in the conventional treatment group (84.2% vs. 49.0%; OR 5.77; p < 0.00001). Healing time was reduced by 19.39 days on average in ADSC group (p = 0.0004). No statistically significant differences were observed regarding pain outcomes or complication rates (p = 0.22).

Conclusion: ADSC therapy increased healing rates and shortened healing time in patients with chronic extremity ulcers, with no evidence of a significant increase in treatment-related risks. However, the heterogeneity of the findings and the limited sample size highlight the need for studies with greater statistical power and methodological standardization to confirm these results.

Keywords

mesenchymal stem cells; wound healing; cell and tissue transplantation-based therapy; chronic pain

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