Umbilical Cord-Derived Therapies for Wound Healing: A Scoping Review of Clinical and Translational Evidence.

Wound healing is a complex process, and although there are existing wound management therapies, they can be limited by poor response rate, cosmetic concerns and other procedure-related risks. Umbilical cord (UC) and umbilical cord blood (UCB)-based therapies have therefore emerged as an area of research interest that aims to address current limitations in wound management. This scoping review summarises the extent of research into these therapies, including mechanisms of action, clinical translation and artificial modifications. A systematic search of two electronic databases (PubMed and Embase-Ovid) was carried out before supplementation with reference list screening and citation tracking. Of the 133 included articles, there were 20 in vitro studies, 19 review articles, 1 editorial, 16 human studies and 77 animal studies. UC and UCB-based therapies consist of cellular and acellular factors that act through paracrine mechanisms rather than direct differentiation. Immunomodulation, growth stimulation, angiogenesis and anti-apoptosis are the main mechanisms by which these therapies exert their effect, and initial reports provide some evidence that these therapies could be useful clinically. Nevertheless, such preliminary evidence is limited by study heterogeneity, short follow-up durations and small sample sizes. Various modifications to these therapies, such as preconditioning, are also being explored to increase treatment yield. Although infection and multi-organ effects are common safety concerns, current literature has also yet to establish long-term safety. Preclinical data on UC-based therapies appear promising; however, larger multicentric human trials are essential to validate clinical efficacy. Furthermore, comprehensive evaluations of safety and standardisation protocols will be critical for clinical translation.