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Peake M, Dunnill C, Ibraheem K, Smith A, Clarke DJ, Georgopoulos NT. A novel method for the establishment of autologous skin cell suspensions: characterisation of cellular sub-populations, epidermal stem cell content and wound response-enhancing biological properties. Front Bioeng Biotechnol 2024; 12:1386896. [PMID: 38646012 PMCID: PMC11026634 DOI: 10.3389/fbioe.2024.1386896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction: Autologous cell suspension (ACS)-based therapy represents a highly promising approach for burns and chronic wounds. However, existing technologies have not achieved the desired clinical success due to several limitations. To overcome practical and cost-associated obstacles of existing ACS methods, we have established a novel methodology for rapid, enzymatic disaggregation of human skin cells and their isolation using a procedure that requires no specialist laboratory instrumentation and is performed at room temperature. Methods: Cells were isolated using enzymatic disaggregation of split-thickness human skin followed by several filtration steps for isolation of cell populations, and cell viability was determined. Individual population recovery was confirmed in appropriate culture medium types, and the presence of epidermal stem cells (EpSCs) within keratinocyte sub-populations was defined by flow cytometry via detection of CD49 and CD71. Positive mediators of wound healing secreted by ACS-derived cultures established on a collagen-based wound-bed mimic were detected by proteome arrays and quantified by ELISA, and the role of such mediators was determined by cell proliferation assays. The effect of ACS-derived conditioned-medium on myofibroblasts was investigated using an in-vitro model of myofibroblast differentiation via detection of α-SMA using immunoblotting and immunofluorescence microscopy. Results: Our methodology permitted efficient recovery of keratinocytes, fibroblasts and melanocytes, which remained viable upon long-term culture. ACS-derivatives comprised sub-populations with the CD49-high/CD71-low expression profile known to demarcate EpSCs. Via secretion of mitogenic factors and wound healing-enhancing mediators, the ACS secretome accelerated keratinocyte proliferation and markedly curtailed cytodifferentiation of myofibroblasts, the latter being key mediators of fibrosis and scarring. Discussion: The systematic characterisation of the cell types within our ACS isolates provided evidence for their superior cell viability and the presence of EpSCs that are critical drivers of wound healing. We defined the biological properties of ACS-derived keratinocytes, which include ability to secrete positive mediators of wound healing as well as suppression of myofibroblast cytodifferentiation. Thus, our study provides several lines of evidence that the established ACS isolates comprise highly-viable cell populations which can physically support wound healing and possess biological properties that have the potential to enhance not only the speed but also the quality of wound healing.
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Affiliation(s)
- Michael Peake
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Chris Dunnill
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Khalidah Ibraheem
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Adrian Smith
- Department of General Surgery, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom
| | - Douglas J. Clarke
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Nikolaos T. Georgopoulos
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Biomolecular Sciences Research Centre, Industry and Innovation Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
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Ousey K, Rippon MG, Rogers AA, Totty JP. Considerations for an ideal post-surgical wound dressing aligned with antimicrobial stewardship objectives: a scoping review. J Wound Care 2023; 32:334-347. [PMID: 37300859 DOI: 10.12968/jowc.2023.32.6.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Most surgical wounds heal by primary or secondary intention. Surgical wounds can present specific and unique challenges including wound dehiscence and surgical site infection (SSI), either of which can increase risk of morbidity and mortality. The use of antimicrobials to treat infection in these wounds is prevalent, but there is now an imperative to align treatment with reducing antimicrobial resistance and antimicrobial stewardship (AMS). The aim of this review was to explore the published evidence identifying general considerations/criteria for an ideal post-surgical wound dressing in terms of overcoming potential wound healing challenges (including infection) while supporting AMS objectives. METHOD A scoping review examining evidence published from 1954-2021, conducted by two authors acting independently. Results were synthesised narratively and have been reported in line with PRISMA Extension for Scoping Reviews. RESULTS A total of 819 articles were initially identified and subsequently filtered to 178 for inclusion in the assessment. The search highlighted six key outcomes of interest associated with post-surgical wound dressings: wound infection; wound healing; physical attributes related to comfort, conformability and flexibility; fluid handling (e.g., blood and exudate); pain; and skin damage. CONCLUSION There are several challenges that can be overcome when treating a post-surgical wound with a dressing, not least the prevention and treatment of SSIs. However, it is imperative that the use of antimicrobial wound dressings is aligned with AMS programmes and alternatives to active antimicrobials investigated.
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Affiliation(s)
- Karen Ousey
- Professor Skin Integrity, Director for the Institute of Skin Integrity, and Infection Prevention, University of Huddersfield, UK
- Department of Nursing and Midwifery, Adjunct Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Australia
- Visiting Professor, Royal College of Surgeons of Ireland, Ireland
- Chair, International Wound Infection Institute UK
- President Elect, International Skin Tear Advisory Panel, US
| | - Mark G Rippon
- Visiting Clinical Research Associate, Huddersfield University, Huddersfield, UK
- Consultant, Dane River Consultancy Ltd, Cheshire, UK
| | - Alan A Rogers
- Independent Wound Care Consultant, Flintshire, North Wales, UK
| | - Joshua P Totty
- NIHR Clinical Lecturer in Plastic Surgery, Hull York Medical School, UK
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Mykhaliuk VV, Havryliak VV, Salyha YT. The Role of Cytokeratins in Ensuring the Basic Cellular Functions and in Dignosis of Disorders. CYTOL GENET+ 2022. [DOI: 10.3103/s0095452722060093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Epidermal-cell-based therapy as an adjunct to healing second degree burns—A randomized controlled pilot study. Burns 2022:S0305-4179(22)00239-X. [DOI: 10.1016/j.burns.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022]
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Gupta S, Gupta V, Chanda A. Biomechanical modeling of novel high expansion auxetic skin grafts. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3586. [PMID: 35266310 DOI: 10.1002/cnm.3586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/24/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
Over 20 million burn injuries are reported every year, with severe cases requiring skin grafting. Traditionally, split thickness skin grafts are prepared by excising a small portion of healthy skin and its incision patterning using a suitable meshing device, which allows the graft to be expanded beyond its capacity. To date, the maximum expansion achieved through skin grafting has been reported to be less than three times, which is not sufficient for covering large burn sites with limited donor site skin. In this work, we have attempted to study skin graft expansion potential with novel auxetic patterns, which are known to exhibit negative Poisson's effect. Two-layer skin graft models were developed using eight different auxetic incision patterns, and subjected to uniaxial and biaxial tensile strains. The Poisson's ratio, meshing ratio, and induced stresses were characterized for all graft models. The numerical results indicated expansion potentials greater than that of traditional skin grafts across all loads. Extremely high expansions (i.e., >30 times) were estimated for the I-Shaped Re-entrant and Rotating Triangles shaped auxetic models without rupture. Such pioneering findings are anticipated to initiate ground-breaking advances towards skin graft research and improved outcomes in burn surgeries.
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Affiliation(s)
- Shubham Gupta
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India
| | - Vivek Gupta
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India
| | - Arnab Chanda
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Kanapathy M, Hachach-Haram N, Bystrzonowski N, Becker DL, Mosahebi A, Richards T. Epidermal graft encourages wound healing by down-regulation of gap junctional protein and activation of wound bed without graft integration as opposed to split-thickness skin graft. Int Wound J 2021; 18:332-341. [PMID: 33751815 PMCID: PMC8244016 DOI: 10.1111/iwj.13536] [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: 10/06/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 01/07/2023] Open
Abstract
Wound coverage by split-thickness skin graft (SSG) and epidermal graft (EG) shortens healing time, with comparable outcomes. However, the healing mechanism of EG is not as well understood as SSG. The difference in the healing mechanisms of EG and SSG was investigated using gap junctional proteins, proliferative marker, and cytokeratin markers. Paired punch biopsies were taken from the wound edge and wound bed from patients undergoing EG and SSG at weeks 0 and 1 to investigate wound edge keratinocyte migratory activities (connexins 43, 30, and 26), wound bed activation (Ki67), and the presence of graft integration to the wound bed (cytokeratins 14 and 6). Twenty-four paired biopsies were taken at weeks 0 and 1 (EG, n = 12; SSG, n = 12). Wound edge biopsies demonstrated down-regulation of connexins 43 (P = .023) and 30 (P = .027) after EG, indicating accelerated healing from the wound edge. At week 1, increased expression of Ki67 (P < .05) was seen after EG, indicating activation of cells within the wound bed. Keratinocytes expressing cytokeratins 6 and 14 were observed on all wounds treated with SSG but were absent at week 1 after EG, indicating the absence of graft integration following EG. Despite EG and SSG both being autologous skin grafts, they demonstrate different mechanisms of wound healing. EG accelerates wound healing from the wound edges and activates the wound bed despite not integrating into the wound bed at week 1 post-grafting as opposed to SSG, hence demonstrating properties comparable with a bioactive dressing instead of a skin substitute.
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Affiliation(s)
- Muholan Kanapathy
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Nadine Hachach-Haram
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Nicola Bystrzonowski
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - David L Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Institute of Medical Biology, A*Star, Immunos, Biomedical Grove, Singapore
| | - Afshin Mosahebi
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Toby Richards
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
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