Adjunctive Mesenchymal Stem Cell Secretome Therapy for a Chronic Hard to Heal Wound in a Patient with Multiple Comorbids: A Case Report

Abstract

Introduction: Chronic wounds in patients with complex comorbidities such as diabetes mellitus (DM), hypertension (HPT), and chronic kidney disease (CKD) are notoriously difficult to heal due to impaired angiogenesis, persistent inflammation, and fibroblast dysfunction which are frequently refractory to standard wound care. Mesenchymal stem cell (MSC) secretome, acellular biologic rich in growth factors, cytokines, and extracellular vesicles, has emerged as a promising therapeutic strategy demonstrated regenerative, angiogenic, and immunomodulatory properties capable of reactivating stalled wound healing processes Objectives: To evaluate the effectiveness of adjunctive MSC secretome therapy in a patient with a 7-year history of chronic, non-healing wound with multiple comorbidities who failed to respond to conventional and advanced wound care modalities. Case Summary: Case report was conducted on a 67-year-old male with a stable DM, HPT, and CKD with a 7- year history of chronic wounds on the right lateral leg. MSC secretome (5 mL) was administered via subcutaneous injection twice weekly at the wound edges, alongside standard wound care based on the TIME framework. Wound surface area was calculated as length × width (cm 2 ) and photographic progression were documented over 126 days. Results: The total wound surface area initially measured 19.65 cm 2 . A transient increase to 33.32 cm 2 was observed on Day 32 due to coalescence of wound margins, followed by steady and progressive reduction. By Day 126, the area had decreased to 2.4 cm 2 . Despite an initial increase in wound area due to margin coalescence, a steady reduction followed, culminating in an 87.79% total wound surface area reduction (from 19.65 cm² to 2.4 cm²). Clinical improvement in granulation tissue formation and partial to complete epithelialization was observed. Discussion: In this case report, wound healing progressed steadily despite pale granulation, indicating that MSC secretome may exert its effects by activating cellular repair pathways through paracrine signalling before structural tissue changes are clinically apparent. MSC secretome components including growth factors, cytokines, and extracellular vesicles such as exosomes are believed to modulate inflammation, promote angiogenesis, and stimulate fibroblast activity, which may help overcome the impaired healing typical in patients with multiple comorbidities.