101
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Osada A, Sekine H, Soejima K, Sakurai H, Shimizu T. Harvesting epithelial keratinocyte sheets from temperature-responsive dishes preserves basement membrane proteins and improves cell survival in a skin defect model. J Tissue Eng Regen Med 2016; 11:2516-2524. [PMID: 27061496 DOI: 10.1002/term.2149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 11/10/2022]
Abstract
Cultured epithelial autograft (CEA) therapy has been used in clinical applications since the 1980s. However, there are some issues related to this treatment that still remain unsolved. Enzymatic treatment is typically used in the collection of epithelial keratinocyte sheets, but it tends to break the adhesion and basement membrane proteins. It is thought that the loss of proteins after enzymatic treatment is responsible for the poor survival of transplanted cell sheets. Our laboratory has developed a temperature-responsive culture dish that does not require enzymatic treatment to harvest the cells. In this study, we compare morphological and survival results from rat epithelial keratinocyte cell sheets harvested by temperature-reducing treatment (TT sheets) against cell sheets harvested by enzymatic (dispase) treatment (DT sheets). TT sheets preserve keratin structure in better conditions and express higher levels of collagen IV and laminin 5 than DT sheets. In order to evaluate cell sheet survival after transplantation, we created an in vivo transplant model. Keratinocyte sheets obtained from GFP-positive animals were transplanted into athymic rats. The survival rate 7 days after transplantation of TT sheet was higher than that of DT sheets. Collagen IV and Laminin 5 expression was observed in the TT sheet transplantation group. These results indicate that the remaining basement membrane proteins are important for initial attachment and cell survival. We believe that the cell sheet harvesting method using temperature-responsive culture dishes provides superior cell survival and can solve one of the roadblocks in CEA therapy. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- A Osada
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University (TWIns), Japan.,Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Japan
| | - H Sekine
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University (TWIns), Japan
| | - K Soejima
- Department of Plastic and Reconstructive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - H Sakurai
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Japan
| | - T Shimizu
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University (TWIns), Japan
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102
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Chua AWC, Khoo YC, Tan BK, Tan KC, Foo CL, Chong SJ. Skin tissue engineering advances in severe burns: review and therapeutic applications. BURNS & TRAUMA 2016; 4:3. [PMID: 27574673 PMCID: PMC4963933 DOI: 10.1186/s41038-016-0027-y] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/11/2016] [Indexed: 01/13/2023]
Abstract
Current advances in basic stem cell research and tissue engineering augur well for the development of improved cultured skin tissue substitutes: a class of products that is still fraught with limitations for clinical use. Although the ability to grow autologous keratinocytes in-vitro from a small skin biopsy into sheets of stratified epithelium (within 3 to 4 weeks) helped alleviate the problem of insufficient donor site for extensive burn, many burn units still have to grapple with insufficient skin allografts which are used as intermediate wound coverage after burn excision. Alternatives offered by tissue-engineered skin dermal replacements to meet emergency demand have been used fairly successfully. Despite the availability of these commercial products, they all suffer from the same problems of extremely high cost, sub-normal skin microstructure and inconsistent engraftment, especially in full thickness burns. Clinical practice for severe burn treatment has since evolved to incorporate these tissue-engineered skin substitutes, usually as an adjunct to speed up epithelization for wound closure and/or to improve quality of life by improving the functional and cosmetic results long-term. This review seeks to bring the reader through the beginnings of skin tissue engineering, the utilization of some of the key products developed for the treatment of severe burns and the hope of harnessing stem cells to improve on current practice.
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Affiliation(s)
- Alvin Wen Choong Chua
- Singapore General Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 20 College Road, Academia Level 4, Singapore, 169845 Singapore ; Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore ; Transplant Tissue Centre, c/o Skin Bank Unit, Singapore General Hospital, Block 4 Level 3 Room A7, Outram Road, Singapore, 169608 Singapore
| | - Yik Cheong Khoo
- Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore ; Transplant Tissue Centre, c/o Skin Bank Unit, Singapore General Hospital, Block 4 Level 3 Room A7, Outram Road, Singapore, 169608 Singapore
| | - Bien Keem Tan
- Singapore General Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 20 College Road, Academia Level 4, Singapore, 169845 Singapore ; Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore ; Transplant Tissue Centre, c/o Skin Bank Unit, Singapore General Hospital, Block 4 Level 3 Room A7, Outram Road, Singapore, 169608 Singapore
| | - Kok Chai Tan
- Singapore General Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 20 College Road, Academia Level 4, Singapore, 169845 Singapore ; Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore
| | - Chee Liam Foo
- Singapore General Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 20 College Road, Academia Level 4, Singapore, 169845 Singapore ; Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore
| | - Si Jack Chong
- Singapore General Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 20 College Road, Academia Level 4, Singapore, 169845 Singapore ; Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore ; Transplant Tissue Centre, c/o Skin Bank Unit, Singapore General Hospital, Block 4 Level 3 Room A7, Outram Road, Singapore, 169608 Singapore
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103
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Goh CSL, Tan BK, Hasan M, Chong SJ. Presurgical micrograft-allograft sandwich preparation reduces operative time in massive burns. Burns 2016; 42:478-80. [PMID: 26777457 DOI: 10.1016/j.burns.2015.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 07/31/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Cindy S L Goh
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
| | - Bien-Keem Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Masroor Hasan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Si-Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
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104
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GASPAR A, CONSTANTIN D, SECIU AM, MOLDOVAN L, CRACIUNESCU O, GANEA E. Human adipose-derived stem cells differentiation into epidermal cells and interaction with human keratinocytes in coculture. Turk J Biol 2016. [DOI: 10.3906/biy-1502-36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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105
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Lorente JA, Amaya-Villar R. Update in the management of critically ill burned patients. Med Intensiva 2015; 40:46-8. [PMID: 26746126 DOI: 10.1016/j.medin.2015.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 10/22/2015] [Indexed: 11/17/2022]
Abstract
The management of critically ill burn patients is challenging. These patients have to be managed in specialized centers, where the expertise of physicians and nursing personnel guarantees the best treatment. Mortality of burn patients has improved over the past decades due to a better understanding of burn shock pathophysiology, optimal surgical management, infection control and nutritional support. Indeed, a more aggressive resuscitation, early excision and grafting, the judicious use of topical antibiotics, and the provision of an adequate calorie and protein intake are key to attain best survival results. General advances in critical care have also to be implemented, including protective ventilation, glycemic control, selective decontamination of the digestive tract, and implementation of sedation protocols.
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Affiliation(s)
- J A Lorente
- Cuidados intensivos, Hospital Universitario de Getafe, Madrid, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain; Universidad Europea, Madrid, Spain.
| | - R Amaya-Villar
- Cuidados intensivos, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Spain
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106
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Verbeken G, Huys I, De Vos D, De Coninck A, Roseeuw D, Kets E, Vanderkelen A, Draye JP, Rose T, Jennes S, Ceulemans C, Pirnay JP. Access to bacteriophage therapy: discouraging experiences from the human cell and tissue legal framework. FEMS Microbiol Lett 2015; 363:fnv241. [PMID: 26678555 DOI: 10.1093/femsle/fnv241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 01/12/2023] Open
Abstract
Cultures of human epithelial cells (keratinocytes) are used as an additional surgical tool to treat critically burnt patients. Initially, the production environment of keratinocyte grafts was regulated exclusively by national regulations. In 2004, the European Tissues and Cells Directive 2004/23/EC (transposed into Belgian Law) imposed requirements that resulted in increased production costs and no significant increase in quality and/or safety. In 2007, Europe published Regulation (EC) No. 1394/2007 on Advanced Therapy Medicinal Products. Overnight, cultured keratinocytes became (arguably) 'Advanced' Therapy Medicinal Products to be produced as human medicinal products. The practical impact of these amendments was (and still is) considerable. A similar development appears imminent in bacteriophage therapy. Bacteriophages are bacterial viruses that can be used for tackling the problem of bacterial resistance development to antibiotics. Therapeutic natural bacteriophages have been in clinical use for almost 100 years. Regulators today are framing the (re-)introduction of (natural) bacteriophage therapy into 'modern western' medicine as biological medicinal products, also subject to stringent regulatory medicinal products requirements. In this paper, we look back on a century of bacteriophage therapy to make the case that therapeutic natural bacteriophages should not be classified under the medicinal product regulatory frames as they exist today. It is our call to authorities to not repeat the mistake of the past.
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Affiliation(s)
- G Verbeken
- Laboratory for Molecular and Cellular Technology, Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium Faculty of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium Department of Behavioural Sciences, Royal Military Academy, Renaissancelaan 30, 1000 Brussels, Belgium
| | - I Huys
- Faculty of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium KU Leuven Centre for IT & IP law, Sint Michielsstraat 6, box 3443, 3000 Leuven, Belgium
| | - D De Vos
- Laboratory for Molecular and Cellular Technology, Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium Department of Behavioural Sciences, Royal Military Academy, Renaissancelaan 30, 1000 Brussels, Belgium
| | - A De Coninck
- Department of Dermatology, University Hospital Brussels (UZ Brussel), Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - D Roseeuw
- Department of Dermatology, University Hospital Brussels (UZ Brussel), Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - E Kets
- Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium
| | - A Vanderkelen
- Laboratory for Molecular and Cellular Technology, Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium
| | - J P Draye
- Laboratory for Molecular and Cellular Technology, Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium
| | - T Rose
- Laboratory for Molecular and Cellular Technology, Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium
| | - S Jennes
- Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium
| | - C Ceulemans
- Department of Behavioural Sciences, Royal Military Academy, Renaissancelaan 30, 1000 Brussels, Belgium
| | - J P Pirnay
- Laboratory for Molecular and Cellular Technology, Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium
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107
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Ojeh N, Pastar I, Tomic-Canic M, Stojadinovic O. Stem Cells in Skin Regeneration, Wound Healing, and Their Clinical Applications. Int J Mol Sci 2015; 16:25476-501. [PMID: 26512657 PMCID: PMC4632811 DOI: 10.3390/ijms161025476] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/15/2015] [Accepted: 10/20/2015] [Indexed: 12/18/2022] Open
Abstract
The skin is the largest organ of the body and has an array of functions. Skin compartments, epidermis, and hair follicles house stem cells that are indispensable for skin homeostasis and regeneration. These stem cells also contribute to wound repair, resulting in restoration of tissue integrity and function of damaged tissue. Unsuccessful wound healing processes often lead to non-healing wounds. Chronic wounds are caused by depletion of stem cells and a variety of other cellular and molecular mechanisms, many of which are still poorly understood. Current chronic wound therapies are limited, so the search to develop better therapeutic strategies is ongoing. Adult stem cells are gaining recognition as potential candidates for numerous skin pathologies. In this review, we will discuss epidermal and other stem cells present in the skin, and highlight some of the therapeutic applications of epidermal stem cells and other adult stem cells as tools for cell/scaffold-based therapies for non-healing wounds and other skin disorders. We will also discuss emerging concepts and offer some perspectives on how skin tissue-engineered products can be optimized to provide efficacious therapy in cutaneous repair and regeneration.
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Affiliation(s)
- Nkemcho Ojeh
- Faculty of Medical Sciences, the University of the West Indies, Cave Hill Campus, P.O. Box 64, Bridgetown BB 11000, St. Michael, Barbados; E-Mail:
| | - Irena Pastar
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller Medical School, 1600 NW 10th Avenue, RMSB, Room 2023-A, Miami, FL 33136, USA; E-Mails: (I.P.); (M.T.-C.)
| | - Marjana Tomic-Canic
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller Medical School, 1600 NW 10th Avenue, RMSB, Room 2023-A, Miami, FL 33136, USA; E-Mails: (I.P.); (M.T.-C.)
| | - Olivera Stojadinovic
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller Medical School, 1600 NW 10th Avenue, RMSB, Room 2023-A, Miami, FL 33136, USA; E-Mails: (I.P.); (M.T.-C.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-305-243-7295; Fax: +1-305-243-6191
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108
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van Zuijlen P, Gardien K, Jaspers M, Bos EJ, Baas DC, van Trier A, Middelkoop E. Tissue engineering in burn scar reconstruction. BURNS & TRAUMA 2015; 3:18. [PMID: 27574664 PMCID: PMC4964040 DOI: 10.1186/s41038-015-0017-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/04/2015] [Indexed: 01/05/2023]
Abstract
Nowadays, most patients with severe burns will survive their injury. This evolution is accompanied by the challenge to cover a large percentage of total body surface area burned. Consequently, more and more patients have to deal with the sequelae of burn scars and require (multiple) reconstructions. This review provides a gross overview of developments in the field of tissue engineering for permanent burn wound coverage and reconstructive burn surgery, focusing on usage and clinical effectiveness. Not only skin substitutes will be discussed but also the replacement of subcutaneous fat tissue and cartilage.
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Affiliation(s)
- Ppm van Zuijlen
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands ; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands ; Association of Dutch Burn Centers, Beverwijk, The Netherlands ; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Klm Gardien
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands ; Association of Dutch Burn Centers, Beverwijk, The Netherlands ; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Meh Jaspers
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands ; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands ; Association of Dutch Burn Centers, Beverwijk, The Netherlands ; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - E J Bos
- Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - D C Baas
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
| | - Ajm van Trier
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands ; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - E Middelkoop
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands ; Association of Dutch Burn Centers, Beverwijk, The Netherlands ; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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109
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Chugh RM, Chaturvedi M, Yerneni LK. An evaluation of the choice of feeder cell growth arrest for the production of cultured epidermis. Burns 2015; 41:1788-1795. [PMID: 26392024 DOI: 10.1016/j.burns.2015.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/04/2015] [Accepted: 08/10/2015] [Indexed: 11/27/2022]
Abstract
Growth arrested 3T3 cells have been used as feeder cells in human epidermal keratinocyte cultures to produce cultured epidermal autografts for the treatment of burns. The feeder cells were ideally growth-arrested by gamma-irradiation. Alternatively, growth arrest by mitomycin C treatment is a cost effective option. We compared the functional efficacy of these two approaches in keratinocyte cultures by colony forming efficiency, the net growth area of colonies, BrdU labeling and histological features of cultured epidermal sheets. The growth area estimation involved a semi-automated digital technique using the Adobe Photoshop and comprised of isolation and enumeration of red pixels in Rhodamine B-stained keratinocyte colonies. A further refinement of the technique led to the identification of critical steps to increasing the degree of accuracy and enabling its application as an extension of colony formation assay. The results on feeder cell functionality revealed that the gamma irradiated feeders influenced significantly higher colony forming efficiency and larger growth area than the mitomycin C treated feeders. The BrdU labeling study indicated significant stimulation of the overall keratinocyte proliferation by the gamma irradiated feeders. The cultured epidermal sheets produced by gamma feeders were relatively thicker than those produced by mitomycin C feeders. We discussed the clinical utility of mitomycin C feeders from the viewpoint of cost-effective burn care in developing countries.
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Affiliation(s)
- Rishi Man Chugh
- Cell Biology Laboratory, National Institute of Pathology (ICMR), New Delhi, India
| | - Madhusudan Chaturvedi
- Cell Biology Laboratory, National Institute of Pathology (ICMR), New Delhi, India; Department of Medical Elementology and Toxicology, Jamia Hamdard, New Delhi, India
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110
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Jackson C, Eidet JR, Reppe S, Aass HCD, Tønseth KA, Roald B, Lyberg T, Utheim TP. Effect of Storage Temperature on the Phenotype of Cultured Epidermal Cells Stored in Xenobiotic-Free Medium. Curr Eye Res 2015; 41:757-68. [PMID: 26398483 DOI: 10.3109/02713683.2015.1062113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Cultured epidermal cell sheets (CECS) are used in the treatment of large area burns to the body and have potential to treat limbal stem cell deficiency (LSCD) as shown in animal studies. Despite widespread use, storage options for CECS are limited. Short-term storage allows flexibility in scheduling surgery, quality control and improved transportation to clinics worldwide. Recent evidence points to the phenotype of cultured epithelial cells as a critical predictor of post-operative success following transplantation of CECS in burns and in transplantation of cultured epithelial cells in patients with LSCD. This study, therefore assessed the effect of a range of temperatures, spanning 4-37 °C, on the phenotype of CECS stored over a 2-week period in a xenobiotic-free system. MATERIALS AND METHODS Progenitor cell (p63, ΔNp63α and ABCG2) and differentiation (C/EBPδ and CK10) associated marker expression was assessed using immunocytochemistry. Immunohistochemistry staining of normal skin for the markers p63, ABCG2 and C/EBPδ was also carried out. Assessment of progenitor cell side population (SP) was performed using JC1 dye by flow cytometry. RESULTS P63 expression remained relatively constant throughout the temperature range but was significantly lower compared to control between 20 and 28 °C (p < 0.05). High C/EBPδ together with low p63 suggested more differentiation beginning at 20 °C and above. Lower CK10 and C/EBPδ expression most similar to control was seen at 12 °C. The percentage of ABCG2 positive cells was most similar to control between 8 and 24 °C. Between 4 and 24 °C, the SP fluctuated, but was not significantly different compared to control. Results were supported by staining patterns indicating differentiation status associated with markers in normal skin sections. CONCLUSIONS Lower storage temperatures, and in particular 12 °C, merit further investigation as optimal storage temperature for maintenance of undifferentiated phenotype in CECS.
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Affiliation(s)
- Catherine Jackson
- a Department of Medical Biochemistry , Oslo University Hospital , Oslo , Norway .,b Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Norway
| | - Jon R Eidet
- a Department of Medical Biochemistry , Oslo University Hospital , Oslo , Norway
| | - Sjur Reppe
- a Department of Medical Biochemistry , Oslo University Hospital , Oslo , Norway
| | | | - Kim A Tønseth
- b Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Norway .,c Department of Plastic Surgery , Oslo University Hospital , Oslo , Norway .,d Department of Pathology , Oslo University Hospital , Oslo , Norway and
| | - Borghild Roald
- b Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Norway .,d Department of Pathology , Oslo University Hospital , Oslo , Norway and
| | - Torstein Lyberg
- a Department of Medical Biochemistry , Oslo University Hospital , Oslo , Norway
| | - Tor P Utheim
- a Department of Medical Biochemistry , Oslo University Hospital , Oslo , Norway .,e Department of Oral Biology, Faculty of Dentistry , University of Oslo , Oslo , Norway
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111
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Newsom EC, Connolly KL, Nehal KS. Facilitating Healing of Granulating Wounds: Dressings, Dermal Substitutes, and Other Methods. CURRENT DERMATOLOGY REPORTS 2015. [DOI: 10.1007/s13671-015-0108-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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112
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Miller KJ, Brown DA, Ibrahim MM, Ramchal TD, Levinson H. MicroRNAs in skin tissue engineering. Adv Drug Deliv Rev 2015; 88:16-36. [PMID: 25953499 DOI: 10.1016/j.addr.2015.04.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 04/04/2015] [Accepted: 04/25/2015] [Indexed: 01/08/2023]
Abstract
35.2 million annual cases in the U.S. require clinical intervention for major skin loss. To meet this demand, the field of skin tissue engineering has grown rapidly over the past 40 years. Traditionally, skin tissue engineering relies on the "cell-scaffold-signal" approach, whereby isolated cells are formulated into a three-dimensional substrate matrix, or scaffold, and exposed to the proper molecular, physical, and/or electrical signals to encourage growth and differentiation. However, clinically available bioengineered skin equivalents (BSEs) suffer from a number of drawbacks, including time required to generate autologous BSEs, poor allogeneic BSE survival, and physical limitations such as mass transfer issues. Additionally, different types of skin wounds require different BSE designs. MicroRNA has recently emerged as a new and exciting field of RNA interference that can overcome the barriers of BSE design. MicroRNA can regulate cellular behavior, change the bioactive milieu of the skin, and be delivered to skin tissue in a number of ways. While it is still in its infancy, the use of microRNAs in skin tissue engineering offers the opportunity to both enhance and expand a field for which there is still a vast unmet clinical need. Here we give a review of skin tissue engineering, focusing on the important cellular processes, bioactive mediators, and scaffolds. We further discuss potential microRNA targets for each individual component, and we conclude with possible future applications.
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113
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Full-thickness skin wound healing using autologous keratinocytes and dermal fibroblasts with fibrin: bilayered versus single-layered substitute. Adv Skin Wound Care 2015; 27:171-80. [PMID: 24637651 DOI: 10.1097/01.asw.0000445199.26874.9d] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Split-skin grafting (SSG) is the gold standard treatment for full-thickness skin defects. For certain patients, however, an extensive skin lesion resulted in inadequacies of the donor site. Tissue engineering offers an alternative approach by using a very small portion of an individual's skin to harvest cells for propagation and biomaterials to support the cells for implantation. The objective of this study was to determine the effectiveness of autologous bilayered tissue-engineered skin (BTES) and single-layer tissue-engineered skin composed of only keratinocytes (SLTES-K) or fibroblasts (SLTES-F) as alternatives for full-thickness wound healing in a sheep model. Full-thickness skin biopsies were harvested from adult sheep. Isolated fibroblasts were cultured using medium Ham's F12: Dulbecco modified Eagle medium supplemented with 10% fetal bovine serum, whereas the keratinocytes were cultured using Define Keratinocytes Serum Free Medium. The BTES, SLTES-K, and SLTES-F were constructed using autologous fibrin as a biomaterial. Eight full-thickness wounds were created on the dorsum of the body of the sheep. On 4 wounds, polyvinyl chloride rings were used as chambers to prevent cell migration at the edge. The wounds were observed at days 7, 14, and 21. After 3 weeks of implantation, the sheep were euthanized and the skins were harvested. The excised tissues were fixed in formalin for histological examination via hematoxylin-eosin, Masson trichrome, and elastin van Gieson staining. The results showed that BTES, SLTES-K, and SLTES-F promote wound healing in nonchambered and chambered wounds, and BTES demonstrated the best healing potential. In conclusion, BTES proved to be an effective tissue-engineered construct that can promote the healing of full-thickness skin lesions. With the support of further clinical trials, this procedure could be an alternative to SSG for patients with partial- and full-thickness burns.
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114
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Kym D, Yim H, Yoon J, Yang HT, Cho YS, Hur J, Chun W, Kim JH. The application of cultured epithelial autografts improves survival in burns. Wound Repair Regen 2015; 23:340-4. [PMID: 25758428 DOI: 10.1111/wrr.12279] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 03/02/2015] [Indexed: 11/26/2022]
Abstract
This prospective observational study was performed to analyze the clinical outcomes of patients with massive burns treated using cultured epithelial autografts (CEAs) and to determine the association of this treatment with survival outcomes. During 2006-2013, total 177 massive-burns subjects treated with (96 subjects) or without (81 subjects) CEAs. Data were analyzed using the independent t test or chi-square test. Multivariate logistic regression, Kaplan-Meier survival, and Cox regression analyses were performed to evaluate the factors that influenced mortality. Age, percentage of total body surface area burned, incidence of inhalation injury, allograft-application rate, Abbreviated Burn Severity Index score, length of hospital stay, and mortality significantly differed between the CEA and noncultured epithelial autograft groups. Mortality and other clinical parameters did not differ between the sheet-type and spray-type CEA groups. Allograft application (odds ratio, 4.44; p < 0.01) significantly influenced CEA application. The CEA group showed significantly higher survival rates (p = 0.05). Cultured epithelial autografting had a hazard ratio of 0.55 (p = 0.02) and 0.59 (p = 0.05) according to the uni- and multivariate Cox regression analysis, respectively. In conclusion, early and aggressive allograft application is required to facilitate CEA application. Furthermore, the use of CEAs was associated with a lower mortality, but this result should be interpreted with caution as the groups were not randomized.
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Affiliation(s)
- Dohern Kym
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Haejun Yim
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Jaechul Yoon
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Hyeong-Tae Yang
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Yong Suk Cho
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Jun Hur
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Wook Chun
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Jong-Hyun Kim
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
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Rowan MP, Cancio LC, Elster EA, Burmeister DM, Rose LF, Natesan S, Chan RK, Christy RJ, Chung KK. Burn wound healing and treatment: review and advancements. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:243. [PMID: 26067660 PMCID: PMC4464872 DOI: 10.1186/s13054-015-0961-2] [Citation(s) in RCA: 468] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Burns are a prevalent and burdensome critical care problem. The priorities of specialized facilities focus on stabilizing the patient, preventing infection, and optimizing functional recovery. Research on burns has generated sustained interest over the past few decades, and several important advancements have resulted in more effective patient stabilization and decreased mortality, especially among young patients and those with burns of intermediate extent. However, for the intensivist, challenges often exist that complicate patient support and stabilization. Furthermore, burn wounds are complex and can present unique difficulties that require late intervention or life-long rehabilitation. In addition to improvements in patient stabilization and care, research in burn wound care has yielded advancements that will continue to improve functional recovery. This article reviews recent advancements in the care of burn patients with a focus on the pathophysiology and treatment of burn wounds.
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Affiliation(s)
- Matthew P Rowan
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA.
| | - Leopoldo C Cancio
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Eric A Elster
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - David M Burmeister
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Lloyd F Rose
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Shanmugasundaram Natesan
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Rodney K Chan
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA.,Brooke Army Medical Center, 3551 Roger Brook Dr, Fort Sam Houston, TX, 78234, USA
| | - Robert J Christy
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Kevin K Chung
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA.,Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
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116
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Papuga AY, Lukash LL. Different types of biotechnological wound coverages created with the application of alive human cells. ACTA ACUST UNITED AC 2015. [DOI: 10.7124/bc.0008d1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A. Ye. Papuga
- Institute of Molecular Biology and Genetics, NAS of Ukraine
| | - L. L. Lukash
- Institute of Molecular Biology and Genetics, NAS of Ukraine
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117
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Alexaline MM, Trouillas M, Nivet M, Bourreau E, Leclerc T, Duhamel P, Martin MT, Doucet C, Fortunel NO, Lataillade JJ. Bioengineering a human plasma-based epidermal substitute with efficient grafting capacity and high content in clonogenic cells. Stem Cells Transl Med 2015; 4:643-54. [PMID: 25848122 DOI: 10.5966/sctm.2014-0155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 02/23/2015] [Indexed: 01/09/2023] Open
Abstract
UNLABELLED Cultured epithelial autografts (CEAs) produced from a small, healthy skin biopsy represent a lifesaving surgical technique in cases of full-thickness skin burn covering >50% of total body surface area. CEAs also present numerous drawbacks, among them the use of animal proteins and cells, the high fragility of keratinocyte sheets, and the immaturity of the dermal-epidermal junction, leading to heavy cosmetic and functional sequelae. To overcome these weaknesses, we developed a human plasma-based epidermal substitute (hPBES) for epidermal coverage in cases of massive burn, as an alternative to traditional CEA, and set up critical quality controls for preclinical and clinical studies. In this study, phenotypical analyses in conjunction with functional assays (clonal analysis, long-term culture, or in vivo graft) showed that our new substitute fulfills the biological requirements for epidermal regeneration. hPBES keratinocytes showed high potential for cell proliferation and subsequent differentiation similar to healthy skin compared with a well-known reference material, as ascertained by a combination of quality controls. This work highlights the importance of integrating relevant multiparameter quality controls into the bioengineering of new skin substitutes before they reach clinical development. SIGNIFICANCE This work involves the development of a new bioengineered epidermal substitute with pertinent functional quality controls. The novelty of this work is based on this quality approach.
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Affiliation(s)
- Maia M Alexaline
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Marina Trouillas
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Muriel Nivet
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Emilie Bourreau
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Thomas Leclerc
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Patrick Duhamel
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Michele T Martin
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Christelle Doucet
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Nicolas O Fortunel
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Jean-Jacques Lataillade
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
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118
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Tan TE, Peh GSL, Finkelstein EA, Mehta JS. A practical model for economic evaluation of tissue-engineered therapies. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2015; 7:91-100. [PMID: 25689271 DOI: 10.1002/wsbm.1292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/28/2014] [Accepted: 01/05/2015] [Indexed: 11/06/2022]
Abstract
UNLABELLED Tissue-engineered therapies are being developed across virtually all fields of medicine. Some of these therapies are already in clinical use, while others are still in clinical trials or the experimental phase. Most initial studies in the evaluation of new therapies focus on demonstration of clinical efficacy. However, cost considerations or economic viability are just as important. Many tissue-engineered therapies have failed to be impactful because of shortcomings in economic competitiveness, rather than clinical efficacy. Furthermore, such economic viability studies should be performed early in the process of development, before significant investment has been made. Cost-minimization analysis combined with sensitivity analysis is a useful model for the economic evaluation of new tissue-engineered therapies. The analysis can be performed early in the development process, and can provide valuable information to guide further investment and research. The utility of the model is illustrated with the practical real-world example of tissue-engineered constructs for corneal endothelial transplantation. CONFLICT OF INTEREST The authors have declared no conflicts of interest for this article.
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Affiliation(s)
- Tien-En Tan
- Singapore National Eye Centre, Singapore, Singapore
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119
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Gardien KLM, Middelkoop E, Ulrich MMW. Progress towards cell-based burn wound treatments. Regen Med 2015; 9:201-18. [PMID: 24750061 DOI: 10.2217/rme.13.97] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cell therapy as part of the concept of regenerative medicine represents an upcoming platform technology. Although cultured epidermal cells have been used in burn treatment for decades, new developments have renewed the interest in this type of treatment. Whereas early results were hampered by long culture times in order to produce confluent sheets of keratinocytes, undifferentiated proliferating cells can nowadays be applied on burns with different application techniques. The application of cells on carriers has improved early as well as long-term results in experimental settings. The results of several commercially available epidermal substitutes for burn wound treatment are reviewed in this article. These data clearly demonstrate a lack of randomized comparative trials and application of measurable outcome parameters. Experimental research in culture systems and animal models has demonstrated new developments and proof of concepts of further improvements in epidermal coverage. These include combinations of epidermal cells and mesenchymal stem cells, and the guidance of both material and cell interactions towards regeneration of skin appendages as well as vascular and nerve structures.
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Affiliation(s)
- Kim L M Gardien
- Department of Plastic Reconstructive & Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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120
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Wu Z, Tang Y, Fang H, Su Z, Xu B, Lin Y, Zhang P, Wei X. Decellularized scaffolds containing hyaluronic acid and EGF for promoting the recovery of skin wounds. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:5322. [PMID: 25604697 DOI: 10.1007/s10856-014-5322-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 05/04/2014] [Indexed: 06/04/2023]
Abstract
There is no effective therapy for the treatment of deep and large area skin wounds. Decellularized scaffolds can be prepared from animal tissues and represent a promising biomaterial for investigation in tissue regeneration studies. In this study, MTT assay showed that epidermal growth factor (EGF) increased NIH3T3 cell proliferation in a bell-shaped dose response, and the maximum cell proliferation was achieved at a concentration of 25 ng/ml. Decellularized scaffolds were prepared from pig peritoneum by a series of physical and chemical treatments. Hyaluronic acid (HA) increased EGF adsorption to the scaffolds. Decellularized scaffolds containing HA sustained the release of EGF compared to no HA. Rabbits contain relatively large skin surface and are less expensive and easy to be taken care, so that a rabbit wound healing model was use in this study. Four full-thickness skin wounds were created in each rabbit for evaluation of the effects of the scaffolds on the skin regeneration. Wounds covered with scaffolds containing either 1 or 3 μg/ml EGF were significantly smaller than with vaseline oil gauzes or with scaffolds alone, and the wounds covered with scaffolds containing 1 μg/ml EGF recovered best among all four wounds. Hematoxylin-Eosin staining confirmed these results by demonstrating that significantly thicker dermis layers were also observed in the wounds covered by the decellularized scaffolds containing HA and either 1 or 3 μg/ml EGF than with vaseline oil gauzes or with scaffolds alone. In addition, the scaffolds containing HA and 1 μg/ml EGF gave thicker dermis layers than HA and 3 μg/ml EGF and showed the regeneration of skin appendages on day 28 post-transplantation. These results demonstrated that decellularized scaffolds containing HA and EGF could provide a promising way for the treatment of human skin injuries.
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Affiliation(s)
- Zhengzheng Wu
- Key Lab for Genetic Medicine of Guangdong Province, National Engineering Research Center of Genetic Medicine, Institute of Biomedicine, Jinan University, Guangzhou, 510632, Guangdong, China
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121
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Yim H, Yang HT, Cho YS, Kim D, Kim JH, Chun W, Hur J. A clinical trial designed to evaluate the safety and effectiveness of a thermosensitive hydrogel-type cultured epidermal allograft for deep second-degree burns. Burns 2014; 40:1642-9. [DOI: 10.1016/j.burns.2014.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 01/29/2014] [Accepted: 02/06/2014] [Indexed: 11/27/2022]
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122
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Lenihan C, Rogers C, Metcalfe AD, Martin YH. The effect of isolation and culture methods on epithelial stem cell populations and their progeny—toward an improved cell expansion protocol for clinical application. Cytotherapy 2014; 16:1750-9. [DOI: 10.1016/j.jcyt.2014.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/09/2014] [Accepted: 06/08/2014] [Indexed: 01/01/2023]
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123
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Designer self-assembling hydrogel scaffolds can impact skin cell proliferation and migration. Sci Rep 2014; 4:6903. [PMID: 25384420 PMCID: PMC4227029 DOI: 10.1038/srep06903] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/09/2014] [Indexed: 02/02/2023] Open
Abstract
There is a need to develop economical, efficient and widely available therapeutic approaches to enhance the rate of skin wound healing. The optimal outcome of wound healing is restoration to the pre-wound quality of health. In this study we investigate the cellular response to biological stimuli using functionalized nanofibers from the self-assembling peptide, RADA16. We demonstrate that adding different functional motifs to the RADA16 base peptide can influence the rate of proliferation and migration of keratinocytes and dermal fibroblasts. Relative to unmodified RADA16; the Collagen I motif significantly promotes cell migration, and reduces proliferation.
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124
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Wood FM. Skin regeneration: the complexities of translation into clinical practise. Int J Biochem Cell Biol 2014; 56:133-40. [PMID: 25448410 DOI: 10.1016/j.biocel.2014.10.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/22/2014] [Accepted: 10/22/2014] [Indexed: 12/01/2022]
Abstract
The integration of engineering into biological science has resulted in the capacity to provide tissue engineered solutions for tissue damage. Skin regeneration remains the goal of skin repair to reduce the long term consequences of scarring to the individual. A scar is abnormal in its architecture, chemistry and cell phenotype, tissue engineering of scaffolds and cells opens up the potential of tissue regeneration into the future. Tissue engineering solutions have been applied to skin many decades despite technical success the clinical application has been modest. To realise the potential of the developing technologies needs alignment of not only the science and engineering but also the commercial upscaling of production in a safe and regulated framework for clinical use. In addition the education and training for the introduction of new technology within the health system is essential, bringing together the technology and systems for utilisation to optimise the patient outcome. This article is part of a Directed Issue entitled: Regenerative Medicine: The challenge of translation.
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Affiliation(s)
- Fiona M Wood
- Burns Service of Western Australia, Burn Injury Research Unit, University of Western Australia, Australia.
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125
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Epidermal healing in burns: autologous keratinocyte transplantation as a standard procedure: update and perspective. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e218. [PMID: 25426401 PMCID: PMC4229277 DOI: 10.1097/gox.0000000000000176] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 07/11/2014] [Indexed: 01/03/2023]
Abstract
Background: Treatment of burned patients is a tricky clinical problem not only because of the extent of the physiologic abnormalities but also because of the limited area of normal skin available. Methods: Literature indexed in the National Center (PubMed) has been reviewed using combinations of key words (burns, children, skin graft, tissue engineering, and keratinocyte grafts). Articles investigating the association between burns and graft therapeutic modalities have been considered. Further literature has been obtained by analysis of references listed in reviewed articles. Results: Severe burns are conventionally treated with split-thickness skin autografts. However, there are usually not enough skin donor sites. For years, the question of how covering the wound surface became one of the major challenges in clinical research area and several procedures were proposed. The microskin graft is one of the oldest methods to cover extensive burns. This technique of skin expansion is efficient, but results remain inconsistent. An alternative is to graft cultured human epidermal keratinocytes. However, because of several complications and labor-intensive process of preparing grafts, the initial optimism for cultured epithelial autograft has gradually declined. In an effort to solve these drawbacks, isolated epithelial cells from selecting donor site were introduced in skin transplantation. Conclusions: Cell suspensions transplanted directly to the wound is an attractive process, removing the need for attachment to a membrane before transfer and avoiding one potential source of inefficiency. Choosing an optimal donor site containing cells with high proliferative capacity is essential for graft success in burns.
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126
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Mcheik JN, Barrault C, Pedretti N, Garnier J, Juchaux F, Levard G, Morel F, Bernard FX, Lecron JC. Study of proliferation and 3D epidermal reconstruction from foreskin, auricular and trunk keratinocytes in children. Burns 2014; 41:352-8. [PMID: 25234956 DOI: 10.1016/j.burns.2014.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 05/31/2014] [Accepted: 07/06/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Severe burns in children are conventionally treated with split-thickness skin autografts or epidermal sheets. An alternative approach is to graft isolated keratinocytes. We evaluated foreskin and other anatomic sites as donor sources for autologous keratinocyte graft in children. We studied in vitro capacities of isolated keratinocytes to divide and reconstitute epidermal tissue. METHODS Keratinocytes were isolated from foreskin, auricular skin, chest and abdominal skin by enzymatic digestion. Living cell recovery, in vitro proliferation, epidermal reconstruction capacities and differentiation status were analyzed. RESULTS In vitro studies revealed the higher yield of living keratinocyte recovery from foreskin and higher potential in terms of proliferative capacity, regeneration and differentiation. Cultured keratinocytes from foreskin express lower amounts of differentiation markers than those isolated from trunk and ear. Histological analysis of reconstituted human epidermis derived from foreskin and inguinal keratinocytes showed a structured multilayered epithelium, whereas those obtained from ear pinna-derived keratinocytes were unstructured. CONCLUSION Our studies highlight the potential of foreskin tissue for autograft applications in boys. A suitable alternative donor site for autologous cell transplantation in female paediatric burn patients remains an open question in our department. We tested the hypothesis that in vitro studies and RHE reconstructive capacities of cells from different body sites can be helpful to select an optimal site for keratinocyte isolation before considering graft protocols for girls.
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Affiliation(s)
- Jiad N Mcheik
- Service de Chirurgie Pédiatrique, CHU de Poitiers, Poitiers, France; Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, Poitiers, France.
| | | | | | | | | | - Guillaume Levard
- Service de Chirurgie Pédiatrique, CHU de Poitiers, Poitiers, France
| | - Frank Morel
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, Poitiers, France
| | - François-Xavier Bernard
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, Poitiers, France; BIOalternatives, Gençay, France
| | - Jean-Claude Lecron
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, Poitiers, France; Laboratoire d'Immunologie et Inflammation, CHU de Poitiers, Poitiers, France
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127
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Proliferation of keratinocytes induced by adipose-derived stem cells on a chitosan scaffold and its role in wound healing, a review. Arch Plast Surg 2014; 41:452-7. [PMID: 25276634 PMCID: PMC4179346 DOI: 10.5999/aps.2014.41.5.452] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 04/25/2014] [Accepted: 04/26/2014] [Indexed: 01/09/2023] Open
Abstract
In the field of tissue engineering and reconstruction, the development of efficient biomaterial is in high demand to achieve uncomplicated wound healing. Chronic wounds and excessive scarring are the major complications of tissue repair and, as this inadequate healing continues to increase, novel therapies and treatments for dysfunctional skin repair and reconstruction are important. This paper reviews the various aspects of the complications related to wound healing and focuses on chitosan because of its unique function in accelerating wound healing. The proliferation of keratinocytes is essential for wound closure, and adipose-derived stem cells play a significant role in wound healing. Thus, chitosan in combination with keratinocytes and adipose-derived stem cells may act as a vehicle for delivering cells, which would increase the proliferation of keratinocytes and help complete recovery from injuries.
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128
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Vyas KS, Vasconez HC. Wound Healing: Biologics, Skin Substitutes, Biomembranes and Scaffolds. Healthcare (Basel) 2014; 2:356-400. [PMID: 27429283 PMCID: PMC4934597 DOI: 10.3390/healthcare2030356] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/08/2014] [Accepted: 08/19/2014] [Indexed: 12/25/2022] Open
Abstract
This review will explore the latest advancements spanning several facets of wound healing, including biologics, skin substitutes, biomembranes and scaffolds.
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Affiliation(s)
- Krishna S Vyas
- Division of Plastic Surgery, Department of Surgery, University of Kentucky, Kentucky Clinic K454, 740 South Limestone, Lexington, KY 40536, USA.
| | - Henry C Vasconez
- Division of Plastic Surgery, Department of Surgery, University of Kentucky, Kentucky Clinic K454, 740 South Limestone, Lexington, KY 40536, USA.
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129
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Jackson C, Aabel P, Eidet JR, Messelt EB, Lyberg T, von Unge M, Utheim TP. Effect of storage temperature on cultured epidermal cell sheets stored in xenobiotic-free medium. PLoS One 2014; 9:e105808. [PMID: 25170754 PMCID: PMC4149437 DOI: 10.1371/journal.pone.0105808] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 07/25/2014] [Indexed: 12/20/2022] Open
Abstract
Cultured epidermal cell sheets (CECS) are used in regenerative medicine in patients with burns, and have potential to treat limbal stem cell deficiency (LSCD), as demonstrated in animal models. Despite widespread use, short-term storage options for CECS are limited. Advantages of storage include: flexibility in scheduling surgery, reserve sheets for repeat operations, more opportunity for quality control, and improved transportation to allow wider distribution. Studies on storage of CECS have thus far focused on cryopreservation, whereas refrigeration is a convenient method commonly used for whole skin graft storage in burns clinics. It has been shown that preservation of viable cells using these methods is variable. This study evaluated the effect of different temperatures spanning 4°C to 37°C, on the cell viability, morphology, proliferation and metabolic status of CECS stored over a two week period in a xenobiotic–free system. Compared to non-stored control, best cell viability was obtained at 24°C (95.2±9.9%); reduced cell viability, at approximately 60%, was demonstrated at several of the temperatures (12°C, 28°C, 32°C and 37°C). Metabolic activity was significantly higher between 24°C and 37°C, where glucose, lactate, lactate/glucose ratios, and oxygen tension indicated increased activation of the glycolytic pathway under aerobic conditions. Preservation of morphology as shown by phase contrast and scanning electron micrographs was best at 12°C and 16°C. PCNA immunocytochemistry indicated that only 12°C and 20°C allowed maintenance of proliferative function at a similar level to non-stored control. In conclusion, results indicate that 12°C and 24°C merit further investigation as the prospective optimum temperature for short-term storage of cultured epidermal cell sheets.
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Affiliation(s)
- Catherine Jackson
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
- * E-mail:
| | - Peder Aabel
- Ear, Nose and Throat Department, Division of Surgery, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jon R. Eidet
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Edward B. Messelt
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Torstein Lyberg
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Magnus von Unge
- Ear, Nose and Throat Department, Division of Surgery, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Centre for Clinical Research, LT Vastmanland, Uppsala University, Uppsala, Sweden
| | - Tor P. Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Abstract
PURPOSE OF REVIEW There have been 26 cases of facial transplantation reported, and three deaths, 11.5%. Mortality raises the issue of risk versus benefit for face transplantation, a procedure intended to improve quality of life, rather than saving life. Thus, one of the most innovative surgical procedures has opened the debate on the ethical, legal, and philosophical aspects of face transplantation. RECENT FINDINGS Morbidity in face transplant recipients includes infections and metabolic consequences. No graft loss caused by technical failure, hyperacute, or chronic graft rejection or graft-versus-host disease has been reported. One case of posttransplant lymphoproliferative disorder, 3.45% and one case of lymphoma in an HIV-positive recipient were reported. Psychological issues in candidates can include chronic pain, mood disorders, preexisting psychotic disorders, post-traumatic stress disorder (PTSD), and substance abuse. SUMMARY Early publications on ethical aspects of face transplantation focused mainly on informed consent. Many other ethical issues have been identified, including lack of coercion, donor family consent and confidentiality, respect for the integrity of the donor's body, and financial promotion of the recipient and transplant team, as well as the cost to society for such a highly technical procedure, requiring lifelong immunosuppression.
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131
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Hackl F, Kiwanuka E, Philip J, Gerner P, Aflaki P, Diaz-Siso JR, Sisk G, Caterson E, Junker JP, Eriksson E. Moist dressing coverage supports proliferation and migration of transplanted skin micrografts in full-thickness porcine wounds. Burns 2014; 40:274-80. [DOI: 10.1016/j.burns.2013.06.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 03/18/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
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132
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Böttcher-Haberzeth S, Biedermann T, Klar AS, Pontiggia L, Rac J, Nadal D, Schiestl C, Reichmann E, Meuli M. Tissue engineering of skin: human tonsil-derived mesenchymal cells can function as dermal fibroblasts. Pediatr Surg Int 2014; 30:213-22. [PMID: 24363059 DOI: 10.1007/s00383-013-3454-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE It is unclear whether dermal fibroblasts are indispensable key players for tissue engineering of dermo-epidermal skin analogs. In this experimental study, we wanted to test the hypothesis that tonsil-derived mesenchymal cells can assume the role of dermal fibroblasts when culturing pigmented skin analogs for transplantation. METHODS Mesenchymal cells from excised tonsils and keratinocytes, melanocytes, and fibroblasts from skin biopsies were isolated, cultured, and expanded. Melanocytes and keratinocytes were seeded in a ratio of 1:5 onto collagen gels previously populated either with tonsil-derived mesenchymal cells or with autologous dermal fibroblasts. These laboratory engineered skin analogs were then transplanted onto full-thickness wounds of immuno-incompetent rats and analyzed after 3 weeks with regard to macroscopic and microscopic epidermal characteristics. RESULTS The skin analogs containing tonsil-derived mesenchymal cells showed the same macroscopic appearance as the ones containing dermal fibroblasts. Histologically, features of epidermal stratification, pigmentation, and cornification were identical to those of the controls assembled with autologous dermal fibroblasts. Transmission electron microscopy confirmed these findings. CONCLUSION These data suggest that human tonsil-derived mesenchymal cells can assume dermal fibroblast functions, indicating that possibly various types of mesenchymal cells can successfully be employed for "skingineering" purposes. This aspect may have clinical implications when sources for dermal fibroblasts are scarce.
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133
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Supp DM. Skin substitutes for burn wound healing: current and future approaches. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.10.73] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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134
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Abstract
Bioengineered alternative tissues (BATs) are heterogeneous processed materials used to aid in wound closure of diabetic foot ulcers. There has been significant progress in the development and clinical use of BATs in the last decade. BATs may be derived from an autograft, allograft, or xenograft source. They may be a single-layer material and consist of only an epidermal or dermal component or they may be bilayer, consisting of both epidermal and dermal components. The holy grail of tissue replacement has yet to be discovered. Nevertheless, if researchers and bioengineers can flip the switch to return cells to their prenatal period, this can be a breakthrough in cellular regeneration.
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Affiliation(s)
- Emily A Cook
- Mount Auburn Hospital, Harvard Medical School, Cambridge, MA 02138, USA.
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135
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Cigognini D, Lomas A, Kumar P, Satyam A, English A, Azeem A, Pandit A, Zeugolis D. Engineering in vitro microenvironments for cell based therapies and drug discovery. Drug Discov Today 2013; 18:1099-108. [DOI: 10.1016/j.drudis.2013.06.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 06/06/2013] [Accepted: 06/17/2013] [Indexed: 12/15/2022]
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136
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Ma B, Xie J, Jiang J, Wu J. Sandwich-type fiber scaffolds with square arrayed microwells and nanostructured cues as microskin grafts for skin regeneration. Biomaterials 2013; 35:630-41. [PMID: 24144904 DOI: 10.1016/j.biomaterials.2013.09.111] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 09/30/2013] [Indexed: 11/19/2022]
Abstract
The paper reports the fabrication of sandwich-type scaffolds consisting of radially-aligned nanofibers at the bottom, nanofiber membranes with square arrayed microwells and nanostructured cues at the top, and microskin tissues in between as microskin grafts for use in skin regeneration. This class of nanofiber scaffolds was able to confine the microskin tissues in the square arrayed wells and simultaneously present nanotopographic cues to the cultured NIH 3T3 fibroblasts and primary rat skin cells, guiding and facilitating their migration in vitro. More importantly, we demonstrated that the sandwich-type transplants exhibited an even distribution of microskin grafts, greatly improved the 'take' rate of microskin tissues, and promoted re-epithelialization on wound in vivo. In addition, the void area in the scaffolds was well suitable for exudate drainage in wound. The sandwich-type scaffolds show great potential as microskin grafts for repairing extensive burn injuries and may provide a good solution for the treatment of acute skin defects and chronic wounds including diabetic ulcer, pressure ulcer, and venous stasis ulcer.
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Affiliation(s)
- Bing Ma
- Marshall Institute for Interdisciplinary Research and Center for Diagnostic Nanosystems, Marshall University, WV 25755, USA
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137
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van den Broek LJ, Kroeze KL, Waaijman T, Breetveld M, Sampat-Sardjoepersad SC, Niessen FB, Middelkoop E, Scheper RJ, Gibbs S. Differential response of human adipose tissue-derived mesenchymal stem cells, dermal fibroblasts, and keratinocytes to burn wound exudates: potential role of skin-specific chemokine CCL27. Tissue Eng Part A 2013; 20:197-209. [PMID: 23980822 DOI: 10.1089/ten.tea.2013.0123] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Many cell-based regenerative medicine strategies toward tissue-engineered constructs are currently being explored. Cell-cell interactions and interactions with different biomaterials are extensively investigated, whereas very few studies address how cultured cells will interact with soluble wound-healing mediators that are present within the wound bed after transplantation. The aim of this study was to determine how adipose tissue-derived mesenchymal stem cells (ASC), dermal fibroblasts, and keratinocytes will react when they come in contact with the deep cutaneous burn wound bed. Burn wound exudates isolated from deep burn wounds were found to contain many cytokines, including chemokines and growth factors related to inflammation and wound healing. Seventeen mediators were identified by ELISA (concentration range 0.0006-9 ng/mg total protein), including the skin-specific chemokine CCL27. Burn wound exudates activated both ASC and dermal fibroblasts, but not keratinocytes, to increase secretion of CXCL1, CXCL8, CCL2, and CCL20. Notably, ASC but not fibroblasts or keratinocytes showed significant increased secretion of vascular endothelial growth factor (5-fold) and interleukin-6 (253-fold), although when the cells were incorporated in bi-layered skin substitute (SS) these differences were less pronounced. A similar discrepancy between ASC and dermal fibroblast mono-cultures was observed when recombinant human-CCL27 was used instead of burn wound exudates. Although CCL27 did not stimulate the secretion of any of the wound-healing mediators by keratinocytes, these cells, in contrast to ASC or dermal fibroblasts, showed increased proliferation and migration. Taken together, these results indicate that on transplantation, keratinocytes are primarily activated to promote wound closure. In contrast, dermal fibroblasts and, in particular, ASC respond vigorously to factors present in the wound bed, leading to increased secretion of angiogenesis/granulation tissue formation factors. Our findings have implications for the choice of cell type (ASC or dermal fibroblast) to be used in regenerative medicine strategies and indicate the importance of taking into account interactions with the wound bed when developing advanced therapies for difficult-to-close cutaneous wounds.
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Affiliation(s)
- Lenie J van den Broek
- 1 Department of Dermatology, VU University Medical Center , Amsterdam, The Netherlands
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138
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Wong VW, Gurtner GC, Longaker MT. Wound healing: a paradigm for regeneration. Mayo Clin Proc 2013; 88:1022-31. [PMID: 24001495 DOI: 10.1016/j.mayocp.2013.04.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/12/2013] [Indexed: 02/07/2023]
Abstract
Human skin is a remarkably plastic organ that sustains insult and injury throughout life. Its ability to expeditiously repair wounds is paramount to survival and is thought to be regulated by wound components such as differentiated cells, stem cells, cytokine networks, extracellular matrix, and mechanical forces. These intrinsic regenerative pathways are integrated across different skin compartments and are being elucidated on the cellular and molecular levels. Recent advances in bioengineering and nanotechnology have allowed researchers to manipulate these microenvironments in increasingly precise spatial and temporal scales, recapitulating key homeostatic cues that may drive regeneration. The ultimate goal is to translate these bench achievements into viable bedside therapies that address the growing global burden of acute and chronic wounds. In this review, we highlight current concepts in cutaneous wound repair and propose that many of these evolving paradigms may underlie regenerative processes across diverse organ systems.
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Affiliation(s)
- Victor W Wong
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University, Stanford, CA, USA
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139
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van Kilsdonk JWJ, van den Bogaard EH, Jansen PAM, Bos C, Bergers M, Schalkwijk J. An in vitro wound healing model for evaluation of dermal substitutes. Wound Repair Regen 2013; 21:890-6. [DOI: 10.1111/wrr.12086] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 06/02/2013] [Indexed: 01/07/2023]
Affiliation(s)
- Jeroen W. J. van Kilsdonk
- Department of Dermatology; Nijmegen Center for Molecular Life Sciences; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
| | - Ellen H. van den Bogaard
- Department of Dermatology; Nijmegen Center for Molecular Life Sciences; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
| | - Patrick A. M. Jansen
- Department of Dermatology; Nijmegen Center for Molecular Life Sciences; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
| | - Charlotte Bos
- Department of Dermatology; Nijmegen Center for Molecular Life Sciences; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
| | - Mieke Bergers
- Department of Dermatology; Nijmegen Center for Molecular Life Sciences; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
| | - Joost Schalkwijk
- Department of Dermatology; Nijmegen Center for Molecular Life Sciences; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
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140
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Gilmartin DJ, Alexaline MM, Thrasivoulou C, Phillips ARJ, Jayasinghe SN, Becker DL. Integration of scaffolds into full-thickness skin wounds: the connexin response. Adv Healthc Mater 2013; 2:1151-60. [PMID: 23417927 DOI: 10.1002/adhm.201200357] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/05/2012] [Indexed: 01/04/2023]
Abstract
Scaffolds have been reported to promote healing of hard-to-heal wounds such as burns and chronic ulcers. However, there has been little investigation into the cell biology of wound edge tissues in response to the scaffolds. Here, we assess the impact of collagen scaffolds on mouse full-thickness wound re-epithelialisation during the first 5 days of healing. We find that scaffolds impede wound re-epithelialisation, inducing a bulbous thickening of the wound edge epidermis as opposed to the thin tongue of migratory keratinocytes seen in normal wound healing. Scaffolds also increase the inflammatory response and the numbers of neutrophils in and around the wound. These effects were also produced by scaffolds made of alginate in the form of fibers and microspheres, but not as an alginate hydrogel. In addition, we find the gap junction protein connexin 43, which normally down-regulates at the wound edge during re-epithelialisation, to be up-regulated in the bulbous epidermal wound edge. Incorporation of connexin 43 antisense oligodeoxynucleotides into the scaffold can be performed to reduce inflammation whilst promoting scaffold biocompatibility.
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Affiliation(s)
- Daniel J Gilmartin
- Department of Cell and Developmental Biology, University College London, Gower Street, WC1E 6BT, UK
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141
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Kamel RA, Ong JF, Eriksson E, Junker JPE, Caterson EJ. Tissue engineering of skin. J Am Coll Surg 2013; 217:533-55. [PMID: 23816384 DOI: 10.1016/j.jamcollsurg.2013.03.027] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/15/2013] [Accepted: 03/18/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Rami A Kamel
- Division of Plastic Surgery, Brigham and Women's Surgery, Harvard Medical School, Boston, MA 02115, USA
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142
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Auxenfans C, Shipkov H, Bach C, Catherine Z, Lacroix P, Bertin-Maghit M, Damour O, Braye F. Cultured allogenic keratinocytes for extensive burns: a retrospective study over 15 years. Burns 2013; 40:82-8. [PMID: 23764150 DOI: 10.1016/j.burns.2013.05.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 03/25/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED The aim was to review the use and indications of cultured allogenic keratinocytes (CAlloK) in extensive burns and their efficiency. MATERIALS AND METHODS This retrospective study comprised 15 years (1997-2012). INCLUSION CRITERIA all patients who received CAlloK. EXCLUSION CRITERIA patients who died before complete healing. Evaluation criteria were clinical. Time and success of wound healing after CAlloK use were evaluated. RESULTS The CAlloK were used for 2 indications - STSG donor sites and deep 2nd degree burns in extensively burned patients. A total of 70 patients were included with severity Baux score of 99.2 (from 51 to 144) and mean percentage of TBSA of 63.49% (from 21 to 96%). Fifty nine patients received CAlloK for STSG donor sites with a mean number of applications of 4 and mean surface of 3800 cm(2) per patient. Treated donor sites were re-harvested 2.5 times. The mean time of complete epithelialization was 7 days. In 11 patients, CAlloK were used for deep 2nd degree burns. The mean percentage of burned surface was 73.7%. The mean surface of CAlloK per patient was 2545 cm(2). Complete healing was achieved in 6.4 days. CONCLUSION The CAlloK allow rapid healing of STSG donor-sites and deep 2nd second degree burns in extensively burned patients.
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Affiliation(s)
- Celine Auxenfans
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France
| | - Hristo Shipkov
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France.
| | - Christine Bach
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France
| | - Zulma Catherine
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France
| | - Pierre Lacroix
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France
| | - Marc Bertin-Maghit
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France
| | - Odile Damour
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France
| | - Fabienne Braye
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France
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143
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Alamein MA, Stephens S, Liu Q, Skabo S, Warnke PH. Mass Production of Nanofibrous Extracellular Matrix with Controlled 3D Morphology for Large-Scale Soft Tissue Regeneration. Tissue Eng Part C Methods 2013; 19:458-72. [DOI: 10.1089/ten.tec.2012.0417] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mohammad A. Alamein
- Clem Jones Research Centre for Stem Cells and Tissue Regenerative Therapies, Bond University, Gold Coast, Australia
| | - Sebastien Stephens
- Clem Jones Research Centre for Stem Cells and Tissue Regenerative Therapies, Bond University, Gold Coast, Australia
| | - Qin Liu
- Clem Jones Research Centre for Stem Cells and Tissue Regenerative Therapies, Bond University, Gold Coast, Australia
| | - Stuart Skabo
- Clem Jones Research Centre for Stem Cells and Tissue Regenerative Therapies, Bond University, Gold Coast, Australia
| | - Patrick H. Warnke
- Clem Jones Research Centre for Stem Cells and Tissue Regenerative Therapies, Bond University, Gold Coast, Australia
- Department for Oral and Maxillofacial Surgery, University of Kiel, Kiel, Germany
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144
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Mcheik JN, Barrault C, Pedretti N, Garnier J, Juchaux F, Levard G, Morel F, Lecron JC, Bernard FX. Foreskin-isolated keratinocytes provide successful extemporaneous autologous paediatric skin grafts. J Tissue Eng Regen Med 2013; 10:252-60. [PMID: 23495214 DOI: 10.1002/term.1690] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 10/09/2012] [Accepted: 12/20/2012] [Indexed: 11/06/2022]
Abstract
Severe burns in children are conventionally treated with split-thickness skin autografts or epidermal sheets. However, neither early complete healing nor quality of epithelialization is satisfactory. An alternative approach is to graft isolated keratinocytes. We evaluated paediatric foreskin and auricular skin as donor sources, autologous keratinocyte transplantation, and compared the graft efficiency to the in vitro capacities of isolated keratinocytes to divide and reconstitute epidermal tissue. Keratinocytes were isolated from surgical samples by enzymatic digestion. Living cell recovery, in vitro proliferation and epidermal reconstruction capacities were evaluated. Differentiation status was analysed, using qRT-PCR and immunolabelling. Eleven children were grafted with foreskin-derived (boys) or auricular (girls) keratinocyte suspensions dripped onto deep severe burns. The aesthetic and functional quality of epithelialization was monitored in a standardized way. Foreskin keratinocyte graft in male children provides for the re-epithelialization of partial deep severe burns and accelerates wound healing, thus allowing successful wound closure, and improves the quality of scars. In accordance, in vitro studies have revealed a high yield of living keratinocyte recovery from foreskin and their potential in terms of regeneration and differentiation. We report a successful method for grafting paediatric males presenting large severe burns through direct spreading of autologous foreskin keratinocytes. This alternative method is easy to implement, improves the quality of skin and minimizes associated donor site morbidity. In vitro studies have highlighted the potential of foreskin tissue for graft applications and could help in tissue selection with the prospect of grafting burns for girls.
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Affiliation(s)
- Jiad N Mcheik
- Service de Chirurgie Pédiatrique, CHU de Poitiers, France.,Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, France
| | | | | | | | | | | | - Franck Morel
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, France
| | - Jean-Claude Lecron
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, France.,Laboratoire d'Immunologie et Inflammation, CHU de Poitiers, France
| | - François-Xavier Bernard
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, France.,BIOalternatives, Gençay, France
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145
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Wong VW, Sorkin M, Gurtner GC. Enabling stem cell therapies for tissue repair: current and future challenges. Biotechnol Adv 2012. [PMID: 23178704 DOI: 10.1016/j.biotechadv.2012.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Stem cells embody the tremendous potential of the human body to develop, grow, and repair throughout life. Understanding the biologic mechanisms that underlie stem cell-mediated tissue regeneration is key to harnessing this potential. Recent advances in molecular biology, genetic engineering, and material science have broadened our understanding of stem cells and helped bring them closer to widespread clinical application. Specifically, innovative approaches to optimize how stem cells are identified, isolated, grown, and utilized will help translate these advances into effective clinical therapies. Although there is growing interest in stem cells worldwide, this enthusiasm must be tempered by the fact that these treatments remain for the most part clinically unproven. Future challenges include refining the therapeutic manipulation of stem cells, validating these technologies in randomized clinical trials, and regulating the global expansion of regenerative stem cell therapies.
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Affiliation(s)
- Victor W Wong
- Department of Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305, USA
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146
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147
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Cultured epithelial autografts for the coverage of large wounds: minimizing skin graft donor sites in the sick patient. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-012-0770-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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148
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Development of a vascularized skin construct using adipose-derived stem cells from debrided burned skin. Stem Cells Int 2012; 2012:841203. [PMID: 22848228 PMCID: PMC3399490 DOI: 10.1155/2012/841203] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 05/25/2012] [Indexed: 01/06/2023] Open
Abstract
Large body surface area burns pose significant therapeutic challenges. Clinically, the extent and depth of burn injury may mandate the use of allograft for temporary wound coverage while autografts are serially harvested from the same donor areas. The paucity of donor sites in patients with burns involving large surface areas highlights the need for better skin substitutes that can achieve early and complete coverage and retain normal skin durability with minimal donor requirements. We have isolated autologous stem cells from the adipose layer of surgically debrided burned skin (dsASCs), using a point-of-care stem cell isolation device. These cells, in a collagen—polyethylene glycol fibrin-based bilayer hydrogel, differentiate into an epithelial layer, a vascularized dermal layer, and a hypodermal layer. All-trans-retinoic acid and fenofibrate were used to differentiate dsASCs into epithelial-like cells. Immunocytochemical analysis showed a matrix- and time-dependent change in the expression of stromal, vascular, and epithelial cell markers. These results indicate that stem cells isolated from debrided skin can be used as a single autologous cell source to develop a vascularized skin construct without culture expansion or addition of exogenous growth factors. This technique may provide an alternative approach for cutaneous coverage after extensive burn injuries.
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149
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Sotiropoulou PA, Blanpain C. Development and homeostasis of the skin epidermis. Cold Spring Harb Perspect Biol 2012; 4:a008383. [PMID: 22751151 DOI: 10.1101/cshperspect.a008383] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The skin epidermis is a stratified epithelium that forms a barrier that protects animals from dehydration, mechanical stress, and infections. The epidermis encompasses different appendages, such as the hair follicle (HF), the sebaceous gland (SG), the sweat gland, and the touch dome, that are essential for thermoregulation, sensing the environment, and influencing social behavior. The epidermis undergoes a constant turnover and distinct stem cells (SCs) are responsible for the homeostasis of the different epidermal compartments. Deregulation of the signaling pathways controlling the balance between renewal and differentiation often leads to cancer formation.
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Plichta JK, Radek KA. Sugar-coating wound repair: a review of FGF-10 and dermatan sulfate in wound healing and their potential application in burn wounds. J Burn Care Res 2012; 33:299-310. [PMID: 22561305 PMCID: PMC3348504 DOI: 10.1097/bcr.0b013e318240540a] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Thousands of patients suffer from burn injuries each year, yet few therapies have been developed to accelerate the wound healing process. Most fibroblast growth factors (FGFs) have been extensively evaluated but only a few have been found to participate in the wound healing process. In particular, FGF-10 is robustly increased in the wound microenvironment after injury and has demonstrated some ability to promote wound healing in vitro and in vivo. Glycosaminoglycans are linear carbohydrates that participate in wound repair by influencing cytokine/growth factor localization and interaction with cognate receptors. Dermatan sulfate (DS) is the most abundant glycosaminoglycan in human wound fluid and has been postulated to be directly involved in the healing process. Recently, the combination of FGF-10 and DS demonstrated the potential to accelerate wound healing via increased keratinocyte proliferation and migration. Based on these preliminary studies, DS may serve as a cofactor for FGF-10, and together they are likely to expedite the healing process by stimulating keratinocyte activity. As a specific subtype of wounds, the overall healing process of burn injuries does not significantly differ from other types of wounds, where optimal repair results in matrix regeneration and complete reepithelialization. At present, standard burn treatment primarily involves topical application of antimicrobial agents, while no routine therapies target acceleration of reepithelialization, the key to wound closure. Thus, this novel therapeutic combination could be used in conjunction with some of the current therapies, but it would have the unique ability to initiate wound healing by stimulating keratinocyte epithelialization.
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Affiliation(s)
- Jennifer K Plichta
- Department of Surgery, Burn and Shock Trauma Institute, Loyola University Medical Center, Maywood, Illinois 60153, USA
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