Cells or No Cells…Understanding Acellular and Cellular Therapies for Wound Healing
By Ned Swanson, MD, President & Chief Medical Officer, PolarityBio
As regenerative treatments become more common in wound care, one distinction is critical: cellular versus acellular therapies. These terms often get used interchangeably, but biologically they represent very different approaches. Understanding that difference is key to knowing whether a therapy can truly support tissue regeneration.
What Acellular Therapies Are Designed to Do
Acellular therapies are widely used in wound care. As the name suggests, they contain no living cells. Instead, they work by:
Providing structural support
Modifying the wound environment
Acting as a scaffold for the patient’s own tissue to grow
These methods can be highly effective for stabilizing wounds and promoting healing. In many cases, they play an important role in care. However, they depend entirely on the patient’s remaining biological capacity to repopulate and remodel tissue, which can be particularly challenging in patients with comorbidities and chronic wounds that have exhausted their local biological potential.
What Cellular Therapies Bring to the Table
Cellular therapies introduce living components directly into the healing process. Rather than just supporting the environment, they actively participate in it. Broadly, cellular approaches can:
Deliver viable cells that signal and interact
Support organized tissue remodeling
More closely mimic natural repair processes
Add cells that can divide, differentiate, and migrate to directly contribute to healing
This concept isn’t unique to wound care - it’s a recurring theme across regenerative medicine.
Lessons from Other Fields
In hematology, for example, true regeneration means restoring native cell populations. Stem cell transplants don’t just “support” blood formation - they rebuild a functional system.
In orthopedics, repairing bone defects with scaffolds is not the same as using viable bone marrow derived mesenchymal stem cells. Tissue formed without proper cellular organization may look fine initially but often lacks durability and function.
Across these disciplines, one theme stands out: living cells are imperative when the goal is functional regeneration.
Why This Matters in Wound Care
Chronic wounds exist in compromised environments by definition. Cellular signaling is disrupted, inflammation persists, and tissue architecture breaks down. In these cases, environmental support alone may not restart organized healing.
If regeneration means restoring tissue that behaves like native skin, the biological requirements are very different from those needed for temporary coverage.
Choosing the Right Approach
The question isn’t which therapy is “better.” It’s what outcome are we trying to achieve?
For stabilization or support, acellular approaches may be enough.
For bridging an exposed avascular structure, a scaffold might be adequate
For functional tissue restoration, therapies that replicate natural healing processes may be necessary.
For covering exposed avascular structures and achieving epithelial closure, therapies with viable cells capable of continual maturation might be ideal.
Clear definitions help set expectations for clinicians, health systems, and patients.
Looking Ahead
As regenerative medicine and particularly regenerative wound care evolves, precision in describing these approaches and their uses helps build clinical treatment protocols to ultimately support patient care. Distinguishing between cellular and acellular strategies isn’t just academic; it shapes how we measure durability, functionality, and long-term success. The next question becomes: is the source of cells from the patient (autologous) or from a donor (allogeneic), and what are the implications of the cell source?