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Fisher MD, Norbury W. Pediatric Burns: From Acute Care Through Reconstruction in 2024. Clin Plast Surg 2024; 51:379-390. [PMID: 38789147 DOI: 10.1016/j.cps.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Children are disproportionately affected by burn injuries. Differences between adult and pediatric burns range from epidemiologic characteristics to pathophysiological considerations, which vary between different age subgroups. All these factors must be considered in each phase of burn care. This article reviews the most important aspects of the management of a pediatric burned patient starting from the acute through reconstructive phases.
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Affiliation(s)
- Mark D Fisher
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, 4940 Eastern Avenue Suite, P3-4-11, JHBMC Pavilion Building, Baltimore, MD 21224, USA; Bayview Adult Burn Center.
| | - William Norbury
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, 4940 Eastern Avenue Suite, P3-4-11, JHBMC Pavilion Building, Baltimore, MD 21224, USA. https://twitter.com/markdfishermd
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2
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Heuer M, Stiti M, Eras V, Scholz J, Ahmed N, Berrocal E, Brune JC. High-Speed Fluorescence Imaging Corroborates Biological Data on the Influence of Different Nozzle Types on Cell Spray Viability and Formation. J Funct Biomater 2024; 15:126. [PMID: 38786637 PMCID: PMC11122036 DOI: 10.3390/jfb15050126] [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: 04/04/2024] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Treating severe dermal disruptions often presents significant challenges. Recent advancements have explored biological cell sprays as a promising treatment, but their success hinges on efficient cell delivery and complete wound coverage. This requires a good spray distribution with a small droplet size, high particle number, and ample surface coverage. The type of nozzle used with the spray device can impact these parameters. To evaluate the influence of different nozzles on spray characteristics, we compared air-assisted and unassisted nozzles. The unassisted nozzle displayed small particle size, high particle number, good overall coverage, high cell viability, preserved cell metabolic activity, and low cytotoxicity. Air-assisted nozzles did not perform well regarding cell viability and metabolic activity. Flow visualization analysis comparing two different unassisted nozzles using high-speed imaging (100 kHz frame rate) revealed a tulip-shaped spray pattern, indicating optimal spray distribution. High-speed imaging showed differences between the unassisted nozzles. One unassisted nozzle displayed a bi-modal distribution of the droplet diameter while the other unassisted nozzle displayed a mono-modal distribution. These findings demonstrate the critical role of nozzle selection in successful cell delivery. A high-quality, certified nozzle manufactured for human application omits the need for an air-assisted nozzle and provides a simple system to use with similar or better performance characteristics than those of an air-assisted system.
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Affiliation(s)
- Miriam Heuer
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Haus 42, Köpenicker Str. 325, 12555 Berlin, Germany
| | - Mehdi Stiti
- Division of Combustion Physics, Department of Physics, Lund University, P.O. Box 118, 22100 Lund, Sweden
- Institut de Mécanique des Fluides de Toulouse (IMFT), CNRS, Université de Toulouse, 31400 Toulouse, France
| | - Volker Eras
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Haus 42, Köpenicker Str. 325, 12555 Berlin, Germany
| | - Julia Scholz
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Haus 42, Köpenicker Str. 325, 12555 Berlin, Germany
| | - Norus Ahmed
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Haus 42, Köpenicker Str. 325, 12555 Berlin, Germany
| | - Edouard Berrocal
- Division of Combustion Physics, Department of Physics, Lund University, P.O. Box 118, 22100 Lund, Sweden
| | - Jan C Brune
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Haus 42, Köpenicker Str. 325, 12555 Berlin, Germany
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3
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Galili U. Accelerated Burn Healing in a Mouse Experimental Model Using α-Gal Nanoparticles. Bioengineering (Basel) 2023; 10:1165. [PMID: 37892895 PMCID: PMC10604883 DOI: 10.3390/bioengineering10101165] [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: 09/03/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Macrophages play a pivotal role in the process of healing burns. One of the major risks in the course of burn healing, in the absence of regenerating epidermis, is infections, which greatly contribute to morbidity and mortality in such patients. Therefore, it is widely agreed that accelerating the recruitment of macrophages into burns may contribute to faster regeneration of the epidermis, thus decreasing the risk of infections. This review describes a unique method for the rapid recruitment of macrophages into burns and the activation of these macrophages to mediate accelerated regrowth of the epidermis and healing of burns. The method is based on the application of bio-degradable "α-gal" nanoparticles to burns. These nanoparticles present multiple α-gal epitopes (Galα1-3Galβ1-4GlcNAc-R), which bind the abundant natural anti-Gal antibody that constitutes ~1% of immunoglobulins in humans. Anti-Gal/α-gal nanoparticle interaction activates the complement system, resulting in localized production of the complement cleavage peptides C5a and C3a, which are highly effective chemotactic factors for monocyte-derived macrophages. The macrophages recruited into the α-gal nanoparticle-treated burns are activated following interaction between the Fc portion of anti-Gal coating the nanoparticles and the multiple Fc receptors on macrophage cell membranes. The activated macrophages secrete a variety of cytokines/growth factors that accelerate the regrowth of the epidermis and regeneration of the injured skin, thereby cutting the healing time by half. Studies on the healing of thermal injuries in the skin of anti-Gal-producing mice demonstrated a much faster recruitment of macrophages into burns treated with α-gal nanoparticles than in control burns treated with saline and healing of the burns within 6 days, whereas healing of control burns took ~12 days. α-Gal nanoparticles are non-toxic and do not cause chronic granulomas. These findings suggest that α-gal nanoparticles treatment may harness anti-Gal for inducing similar accelerated burn healing effects also in humans.
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Affiliation(s)
- Uri Galili
- Department of Medicine, Rush University Medical College, Chicago, IL 60612, USA
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4
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Advances in spray products for skin regeneration. Bioact Mater 2022; 16:187-203. [PMID: 35386328 PMCID: PMC8965724 DOI: 10.1016/j.bioactmat.2022.02.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/22/2022] [Accepted: 02/18/2022] [Indexed: 12/25/2022] Open
Abstract
To date, skin wounds are still an issue for healthcare professionals. Although numerous approaches have been developed over the years for skin regeneration, recent advances in regenerative medicine offer very promising strategies for the fabrication of artificial skin substitutes, including 3D bioprinting, electrospinning or spraying, among others. In particular, skin sprays are an innovative technique still under clinical evaluation that show great potential for the delivery of cells and hydrogels to treat acute and chronic wounds. Skin sprays present significant advantages compared to conventional treatments for wound healing, such as the facility of application, the possibility to treat large wound areas, or the homogeneous distribution of the sprayed material. In this article, we review the latest advances in this technology, giving a detailed description of investigational and currently commercially available acellular and cellular skin spray products, used for a variety of diseases and applying different experimental materials. Moreover, as skin sprays products are subjected to different classifications, we also explain the regulatory pathways for their commercialization and include the main clinical trials for different skin diseases and their treatment conditions. Finally, we argue and suggest possible future trends for the biotechnology of skin sprays for a better use in clinical dermatology. Skin sprays represent a promising technique for wound healing applications. Skin sprays can deliver cells and hydrogels with great facility over large wounds. Many skin spray products have been studied, only a few have been commercialized. Numerous clinical trials study spray products for skin diseases like psoriasis. Improved spraying devices should be developed for different materials and cells.
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5
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Motamedi S, Esfandpour A, Babajani A, Jamshidi E, Bahrami S, Niknejad H. The Current Challenges on Spray-Based Cell Delivery to the Skin Wounds. Tissue Eng Part C Methods 2021; 27:543-558. [PMID: 34541897 DOI: 10.1089/ten.tec.2021.0158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cell delivery through spray instruments is a promising and effective method in tissue engineering and regenerative medicine. It is used for treating different acute and chronic wounds, including burns with different etiologies, chronic diabetic or venous wounds, postcancer surgery, and hypopigmentation disorders. Cell spray can decrease the needed donor site area compared with conventional autologous skin grafting. Keratinocytes, fibroblasts, melanocytes, and mesenchymal stem cells are promising cell sources for cell spray procedures. Different spray instruments are designed and utilized to deliver the cells to the intended skin area. In an efficient spray instrument, cell viability and wound coverage are two determining parameters influenced by various physical and biological factors such as air pressure, spraying distance, viscosity of suspension, stiffness of the wound surface, and velocity of impact. Besides, to improve cell delivery by spray instruments, some matrices and growth factors can be added to cell suspensions. This review focuses on the different types of cells and spray instruments used in cell delivery procedures. It also discusses physical and biological parameters associated with cell viability and wound coverage in spray instruments. Moreover, the recent advances in codelivery of cells with biological glues and growth factors, as well as clinical translation of cell spraying, have been reviewed. Impact statement Skin wounds are a group of prevalent injuries that can lead to life-threatening complexities. As a focus of interest, stem cell therapy and spray-based cell delivery have effectively decreased associated morbidity and mortality. This review summarizes a broad scope of recent evidence related to spray-based cell therapy, instruments, and approaches adopted to make the process more efficient in treating skin wounds. An overview including utilized cell types, clinical cases, and current challenges is also provided.
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Affiliation(s)
- Shiva Motamedi
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arefeh Esfandpour
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhesam Babajani
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Jamshidi
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheyl Bahrami
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in AUVA Research Center, Vienna, Austria
| | - Hassan Niknejad
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Wu CJ, Li JJ, Liao WC, Wang TH, Perng CK, Ma H, Shih YC, Chen MC, Lin CH. Using Various Skin Graft Techniques in Major Burn Reconstruction: A Lesson Learned From a Taiwanese Cornstarch Explosion. Ann Plast Surg 2021; 86:S30-S34. [PMID: 33438952 DOI: 10.1097/sap.0000000000002705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Four hundred and ninety-nine patients had burn injuries in an explosion in Taiwan on June 27, 2015, 24 were admitted to the intensive care units of Taipei Veterans General Hospital. This study details our experience with surgical management of these patients, focusing primarily on various skin graft techniques. MATERIALS AND METHODS This single-center retrospective study included patients who underwent at least one of the previously mentioned skin graft techniques because of extensive skin defects. The demography, burn diagram, treatment modalities, postoperative outcome, and costs were all analyzed, and a comparison with traditional mesh skin grafts was performed. The literature was also reviewed. RESULTS Fourteen patients underwent the Meek skin graft technique. Only 3 received ReCell and 1 cultured epithelial autograft (CEA) at separate time point. Overall, the autologous skin grafts, including Meek/ReCell/CEA were completed within 6 months. The average skin graft success rate was approximately 72.9%, 79.2%, and 38% in Meek, ReCell, and CEA, respectively. The infection rate was approximately 35.7%, 25%, and 100% in Meek, ReCell, and CEA, respectively. The average surgical cost and total medical cost were significantly higher in patients who underwent Meek/ReCell/CEA treatments. CONCLUSIONS In our experience, Meek and ReCell treatments had acceptable success rates, but CEA treatment not. ReCell and CEA treatments are useful in the event of extremely limited donor sites, and they are fragile, easily infected, and technically challenging. These techniques also require longer hospitalization and tend to be more expensive, all factors that should be considered when assessing treatment options.
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Affiliation(s)
- Chang-Ju Wu
- From the Division of Plastic Surgery, Department of Surgery, Taipei Veterans General Hospital
| | - Jung-Jie Li
- From the Division of Plastic Surgery, Department of Surgery, Taipei Veterans General Hospital
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Local Treatment of Burns with Cell-Based Therapies Tested in Clinical Studies. J Clin Med 2021; 10:jcm10030396. [PMID: 33494318 PMCID: PMC7864524 DOI: 10.3390/jcm10030396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 12/30/2022] Open
Abstract
Effective wound management is an important determinant of the survival and prognosis of patients with severe burns. Thus, novel techniques for timely and full closure of full-thickness burn wounds are urgently needed. The purpose of this review is to present the current state of knowledge on the local treatment of burn wounds (distinguishing radiation injury from other types of burns) with the application of cellular therapies conducted in clinical studies. PubMed search engine and ClinicalTrials.gov were used to analyze the available data. The analysis covered 49 articles, assessing the use of keratinocytes (30), keratinocytes and fibroblasts (6), fibroblasts (2), bone marrow-derived cells (8), and adipose tissue cells (3). Studies on the cell-based products that are commercially available (Epicel®, Keraheal™, ReCell®, JACE, Biobrane®) were also included, with the majority of reports found on autologous and allogeneic keratinocytes. Promising data demonstrate the effectiveness of various cell-based therapies; however, there are still scientific and technical issues that need to be solved before cell therapies become standard of care. Further evidence is required to demonstrate the clinical efficacy and safety of cell-based therapies in burns. In particular, comparative studies with long-term follow-up are critical.
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Abstract
Burn injuries are under-appreciated injuries that are associated with substantial morbidity and mortality. Burn injuries, particularly severe burns, are accompanied by an immune and inflammatory response, metabolic changes and distributive shock that can be challenging to manage and can lead to multiple organ failure. Of great importance is that the injury affects not only the physical health, but also the mental health and quality of life of the patient. Accordingly, patients with burn injury cannot be considered recovered when the wounds have healed; instead, burn injury leads to long-term profound alterations that must be addressed to optimize quality of life. Burn care providers are, therefore, faced with a plethora of challenges including acute and critical care management, long-term care and rehabilitation. The aim of this Primer is not only to give an overview and update about burn care, but also to raise awareness of the ongoing challenges and stigmata associated with burn injuries.
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Affiliation(s)
- Marc G Jeschke
- Ross Tilley Burn Center, Department of Surgery, Sunnybrook Health Science Center, Toronto, Ontario, Canada.
- Departments of Surgery and Immunology, University of Toronto, Toronto, Ontario, Canada.
| | - Margriet E van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands
| | - Mashkoor A Choudhry
- Burn and Shock Trauma Research Institute, Alcohol Research Program, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nicole S Gibran
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Sarvesh Logsetty
- Departments of Surgery and Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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9
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Yan Y, Jiang J, Zhang M, Chen Y, Wang X, Huang M, Zhang L. Effect of iPSCs-derived keratinocytes on healing of full-thickness skin wounds in mice. Exp Cell Res 2019; 385:111627. [DOI: 10.1016/j.yexcr.2019.111627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/29/2019] [Accepted: 09/17/2019] [Indexed: 12/21/2022]
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10
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Ren J, Liu J, Yu N, Zhang W, Qian H, Liu Z, Zhu N. The use of noncultured regenerative epithelial suspension for improving skin color and scars: A report of 8 cases and review of the literature. J Cosmet Dermatol 2019; 18:1487-1494. [PMID: 31347758 DOI: 10.1111/jocd.13071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/05/2019] [Accepted: 06/24/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Regenerative Epithelial Suspension can lead to the restoration of wound and repigmentation, which can be gained by ReCell medical device to treat scar and depigmentation diseases. OBJECTIVES To report the effectivity of ReCell combined with microdermabrasion in scar and depigmentation diseases and review the literature of this new technology. METHODS We gave a differential donor⁄recipient ratio of about 1:20-30 with vitiligo, 1:40 with postburn construction, 1:80 with acne scar, and 1:120 with adult congenital melanocytic nevus, 1:80 with pediatrics, respectively. Photographs of patients before treatment and 3 months following the last treatment session were used to evaluate the effectivity. RESULTS A total of 8 patients including vitiligo vulgaris, postburn reconstruction, acne scars, and congenital melanocytic nevi treated by ReCell technology combined with microdermabrasion showed significant improvement in skin texture and color. And 17 studies of the research on ReCell technology were totally included in the systematic review. CONCLUSION Our investigation showed that Regenerative Epithelial Suspension gained by ReCell technology combined with microdermabrasion may improve scar and depigmentation diseases.
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Affiliation(s)
- Jie Ren
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianlan Liu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Nanze Yu
- Department of Plastic Surgery, Peking Union Medical Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenchao Zhang
- Department of Plastic Surgery, Peking Union Medical Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hui Qian
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhifei Liu
- Department of Plastic Surgery, Peking Union Medical Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ningwen Zhu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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11
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Lo CH, Chong E, Akbarzadeh S, Brown WA, Cleland H. A systematic review: Current trends and take rates of cultured epithelial autografts in the treatment of patients with burn injuries. Wound Repair Regen 2019; 27:693-701. [DOI: 10.1111/wrr.12748] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/15/2019] [Accepted: 07/07/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Cheng H. Lo
- Victorian Adult Burns Service Melbourne Victoria Australia
- Department of Surgery, Central Clinical SchoolMonash University Melbourne Victoria Australia
| | - Elaine Chong
- Centre for Eye Research AustraliaRoyal Victorian Eye & Ear Hospital East Melbourne Victoria Australia
| | - Shiva Akbarzadeh
- Skin Bioengineering LaboratoryVictorian Adult Burns Service Melbourne Victoria Australia
| | - Wendy A. Brown
- Department of Surgery, Central Clinical SchoolMonash University Melbourne Victoria Australia
| | - Heather Cleland
- Victorian Adult Burns Service Melbourne Victoria Australia
- Department of Surgery, Central Clinical SchoolMonash University Melbourne Victoria Australia
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12
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Wound healing after cultured epithelial autografting in patients with massive burn injury: A cohort study. J Plast Reconstr Aesthet Surg 2019; 72:427-437. [DOI: 10.1016/j.bjps.2018.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/12/2018] [Accepted: 11/03/2018] [Indexed: 01/26/2023]
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13
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Li Z, Maitz P. Cell therapy for severe burn wound healing. BURNS & TRAUMA 2018; 6:13. [PMID: 29854856 PMCID: PMC5971426 DOI: 10.1186/s41038-018-0117-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/26/2018] [Indexed: 12/14/2022]
Abstract
Cell therapy has emerged as an important component of life-saving procedures in treating burns. Over past decades, advances in stem cells and regenerative medicine have offered exciting opportunities of developing cell-based alternatives and demonstrated the potential and feasibility of various stem cells for burn wound healing. However, there are still scientific and technical issues that should be resolved to facilitate the full potential of the cellular devices. More evidence from large, randomly controlled trials is also needed to understand the clinical impact of cell therapy in burns. This article aims to provide an up-to-date review of the research development and clinical applications of cell therapies in burn wound healing and skin regeneration.
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Affiliation(s)
- Zhe Li
- Burns Unit, Concord Hospital, Concord, New South Wales 2139 Australia
- Skin Laboratory, NSW Statewide Burns Service, Concord, New South Wales Australia
- Discipline of Surgery, University of Sydney Medical School, Camperdown, New South Wales Australia
| | - Peter Maitz
- Burns Unit, Concord Hospital, Concord, New South Wales 2139 Australia
- Skin Laboratory, NSW Statewide Burns Service, Concord, New South Wales Australia
- Discipline of Surgery, University of Sydney Medical School, Camperdown, New South Wales Australia
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14
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Cooke ME, Jones SW, Ter Horst B, Moiemen N, Snow M, Chouhan G, Hill LJ, Esmaeli M, Moakes RJA, Holton J, Nandra R, Williams RL, Smith AM, Grover LM. Structuring of Hydrogels across Multiple Length Scales for Biomedical Applications. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2018; 30:e1705013. [PMID: 29430770 DOI: 10.1002/adma.201705013] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 10/20/2017] [Indexed: 06/08/2023]
Abstract
The development of new materials for clinical use is limited by an onerous regulatory framework, which means that taking a completely new material into the clinic can make translation economically unfeasible. One way to get around this issue is to structure materials that are already approved by the regulator, such that they exhibit very distinct physical properties and can be used in a broader range of clinical applications. Here, the focus is on the structuring of soft materials at multiple length scales by modifying processing conditions. By applying shear to newly forming materials, it is possible to trigger molecular reorganization of polymer chains, such that they aggregate to form particles and ribbon-like structures. These structures then weakly interact at zero shear forming a solid-like material. The resulting self-healing network is of particular use for a range of different biomedical applications. How these materials are used to allow the delivery of therapeutic entities (cells and proteins) and as a support for additive layer manufacturing of larger-scale tissue constructs is discussed. This technology enables the development of a range of novel materials and structures for tissue augmentation and regeneration.
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Affiliation(s)
- Megan E Cooke
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Institute of Inflammation and Ageing, MRC Musculoskeletal Ageing Centre, QE Hospital, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Simon W Jones
- Institute of Inflammation and Ageing, MRC Musculoskeletal Ageing Centre, QE Hospital, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Britt Ter Horst
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Scar Free Foundation Centre for Burns Research, QE Hospital, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Naiem Moiemen
- Scar Free Foundation Centre for Burns Research, QE Hospital, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Martyn Snow
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Gurpreet Chouhan
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Lisa J Hill
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Maryam Esmaeli
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard J A Moakes
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - James Holton
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Rajpal Nandra
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard L Williams
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Alan M Smith
- Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - Liam M Grover
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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15
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Ter Horst B, Chouhan G, Moiemen NS, Grover LM. Advances in keratinocyte delivery in burn wound care. Adv Drug Deliv Rev 2018; 123:18-32. [PMID: 28668483 PMCID: PMC5764224 DOI: 10.1016/j.addr.2017.06.012] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/14/2017] [Accepted: 06/23/2017] [Indexed: 12/19/2022]
Abstract
This review gives an updated overview on keratinocyte transplantation in burn wounds concentrating on application methods and future therapeutic cell delivery options with a special interest in hydrogels and spray devices for cell delivery. To achieve faster re-epithelialisation of burn wounds, the original autologous keratinocyte culture and transplantation technique was introduced over 3 decades ago. Application types of keratinocytes transplantation have improved from cell sheets to single-cell solutions delivered with a spray system. However, further enhancement of cell culture, cell viability and function in vivo, cell carrier and cell delivery systems remain themes of interest. Hydrogels such as chitosan, alginate, fibrin and collagen are frequently used in burn wound care and have advantageous characteristics as cell carriers. Future approaches of keratinocyte transplantation involve spray devices, but optimisation of application technique and carrier type is necessary.
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Affiliation(s)
- Britt Ter Horst
- School of Chemical Engineering, University of Birmingham, Edgbaston B15 2TT, United Kingdom; University Hospital Birmingham Foundation Trust, Burns Centre, Mindelsohn Way, B15 2TH Birmingham, United Kingdom
| | - Gurpreet Chouhan
- School of Chemical Engineering, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Naiem S Moiemen
- University Hospital Birmingham Foundation Trust, Burns Centre, Mindelsohn Way, B15 2TH Birmingham, United Kingdom
| | - Liam M Grover
- School of Chemical Engineering, University of Birmingham, Edgbaston B15 2TT, United Kingdom.
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16
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Martin YH, Jubin K, Smalley S, Wong JPF, Brown RA, Metcalfe AD. A novel system for expansion and delivery of human keratinocytes for the treatment of severe cutaneous injuries using microcarriers and compressed collagen. J Tissue Eng Regen Med 2017; 11:3124-3133. [PMID: 28052577 DOI: 10.1002/term.2220] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 04/06/2016] [Accepted: 04/19/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Y. H. Martin
- Blond McIndoe Research Foundation; Queen Victoria Hospital; East Grinstead West Sussex UK
- Brighton Centre for Regenerative Medicine; University of Brighton; Brighton East Sussex UK
| | - K. Jubin
- Blond McIndoe Research Foundation; Queen Victoria Hospital; East Grinstead West Sussex UK
| | - S. Smalley
- Blond McIndoe Research Foundation; Queen Victoria Hospital; East Grinstead West Sussex UK
| | - J. P. F. Wong
- UCL Tissue Repair and Engineering Centre; University College London; London UK
| | - R. A. Brown
- UCL Tissue Repair and Engineering Centre; University College London; London UK
| | - A. D. Metcalfe
- Blond McIndoe Research Foundation; Queen Victoria Hospital; East Grinstead West Sussex UK
- Brighton Centre for Regenerative Medicine; University of Brighton; Brighton East Sussex UK
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17
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Changes in the Dermal Structure during Cultured Epidermal Autograft Engraftment Process. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e870. [PMID: 27757335 PMCID: PMC5055001 DOI: 10.1097/gox.0000000000000838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/01/2016] [Indexed: 11/25/2022]
Abstract
The use of cultured epithelial autografts for the treatment of extensive burn wounds has become popular in recent years. We examined extensive burn wounds in 14 patients by using a combination of autograft and cultured epithelial autografts developed in Japan (JACE).
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18
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Abstract
The quest for skin expansion is not restricted to cover a large area alone, but to produce acceptable uniform surfaces, robust engraftment to withstand mechanical shear and infection, with a minimal donor morbidity. Ease of the technique, shorter healing period and reproducible results are essential parameters to adopt novel techniques. Significant advances seen in four fronts of autologous grafting are: (1) Dermal-epidermal graft expansion techniques, (2) epidermal graft harvests technique, (3) melanocyte-rich basal cell therapy for vitiligo and (4) robust and faster autologous cell cultures. Meek's original concept that the sum of perimeter of smaller grafts is larger than the harvested graft, and smaller the graft size, the greater is the potential for regeneration is witnessed in newer modification. Further, as graft size becomes smaller or minced, these micrografts can survive on the wound bed exudate irrespective of their dermal orientation. Expansion produced by 4 mm × 4 mm sized Meek micrografts is 10-folds, similarly 0.8 mm × 0.8 mm size micrografts produce 100-fold expansion, which becomes 700-fold with pixel grafts of 0.3 mm × 0.3 mm size. Fractional skin harvest is another new technique with 700 μ size full thickness graft. These provide instant autologous non-cultured graft to cover extensive areas with similar quality of engraftment surface as split skin grafts. Newer tools for epidermal blister graft harvest quickly, with uniform size to produce 7-fold expansions with reproducible results. In addition, donor area heals faster with minimal scar. Melanocyte-rich cell suspension is utilised in vitiligo surgery tapping the potential of hair root melanocytes. Further advances in the cell culture to reduce the cultivation time and provide stronger epidermal sheets with dermal carrier are seen in trials.
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Affiliation(s)
- Dinesh Kadam
- Department of Plastic and Reconstructive Surgery, A.J. Institute of Medical Sciences and A.J. Hospital and Research Centre, Mangalore, Karnataka, India
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19
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Clinical application of cultured epithelial autografts on acellular dermal matrices in the treatment of extended burn injuries. Ann Plast Surg 2015; 73:509-15. [PMID: 24322642 DOI: 10.1097/sap.0b013e3182840883] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Achieving permanent replacement of skin in extensive full-thickness and deep partial-thickness burn injuries and chronic wounds remains one of the fundamental surgical problems. Presently, split-thickness skin grafts are still considered the best material for surgical repair of an excised burn wound. However, in burns that affect greater than 50% of total body surface area, the patient has insufficient areas of unaffected skin from which split-thickness skin grafts can be harvested. The use of cultured epithelial (or epidermal) autografts (CEAs) has achieved satisfactory results. But the take rate of CEAs is poor in full-thickness bed or in chronically infected area. Providing temporary cover with allograft skin, or a more permanent allodermis, may increase clinical take. This review aims to (1) describe the use of CEAs in the regeneration of the epidermis, (2) introduce the application of the acellular dermal matrices (ADMs) in the clinics, and (3) enhance understanding of the CEAs applied with ADM as an appropriate strategy to treat the extended burn injuries. The current evidence regarding the cultured epithelial cell or keratinocyte autograft and dermal grafts applied in the treatment of burn injuries was investigated with an extensive electronic and manual search (MEDLINE and EMBASE). The included literature (N=136 publications) was critically evaluated focusing on the efficacy and safety of this technique in improving the healing of the deep dermal and full-thickness burn injuries. This review concluded that the use of ADM with CEAs is becoming increasingly routine, particularly as a life-saving tool after acute thermal trauma.
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20
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Experience of using cultured epithelial autografts for the extensive burn wounds in eight patients. Ann Plast Surg 2015; 73:25-9. [PMID: 24918735 DOI: 10.1097/sap.0000000000000200] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED In Japan, the cultured epithelial autografts "JACE" was accepted as a health insurance adaptation from January 1, 2009. We examined the extensive burn wounds in 8 patients by using a combination of autograft and JACE. After debridement, we managed the wound bed preparation by using artificial dermis. The wound bed was covered with fine tissue 2 weeks after we implanted artificial dermis and trafermin was used every day. Meshed 6:1 split-thickness autografts were placed onto the recipient wound bed under the JACE. The epidermalization was nearly complete within 3 to 4 weeks. RESULTS A total of 39 patients underwent medical treatment of burns. All patients burned more than 30% total body surface area (TBSA). We divided them into 2 groups. The control group consisted of 31 patient, 23 men and 8 women. They underwent operation not using JACE but only autograft. The average age of the patients was 59.61 (3.85) years. The TBSA burned in this control group was 58.94% (3.89%). Operation times were 2.16 (0.24) hours. The overall survival rate was 35.5%. The study group consisted of 8 patients, 5 men and 3 women. The average age of the patients was 56.38 (7.04) years. The TBSA burned in this study group was 51.63% (4.17%). Operation times were 4.25 (0.59) hours, and the overall survival rate in this study group was 87.5%. The average take rate of JACE was 80.0% (3.09%) 4 weeks postoperatively. CONCLUSIONS JACE is one of the cultured epithelial autografts. Although we managed the wound bed preparation by using artificial dermis instead of cryopreserved cadaver allograft, we were able to recognize a good result from grafting JACE on meshed 6:1 split-thickness autografts. The study group observed a significant difference in operation times compared with the control group. However, this treatment contributed to reducing the area of the donor site.
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21
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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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22
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Abstract
Harnessing the regenerative capacity of keratinocytes and fibroblasts from human skin has created new opportunities to develop cell-based therapies for patients. Cultured cells and bioengineered skin products are being used to treat patients with inherited and acquired skin disorders associated with defective skin, and further clinical trials of new products are in progress. The capacity of extracutaneous sources of cells such as bone marrow is also being investigated for its plasticity in regenerating skin, and new strategies, such as the derivation of inducible pluripotent stem cells, also hold great promise for future cell therapies in dermatology. This article reviews some of the preclinical and clinical studies and future directions relating to cell therapy in dermatology, particularly for inherited skin diseases associated with fragile skin and poor wound healing.
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Affiliation(s)
- Gabriela Petrof
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London SE1 1UL, United Kingdom
| | - Alya Abdul-Wahab
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London SE1 1UL, United Kingdom
| | - John A McGrath
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London SE1 1UL, United Kingdom
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