Dermatology: Burns and Fetal Skin Cells

[Ralph]

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Skin Cells from Fetus Heal Serious Burns in Children
By Neil Osterweil , MedPage Today Staff Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco

Now what will Frist say about this?

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Source News Article: Forbes, US News & World Report, Washington Post (Registration Req.)

Review

LAUSANNE, Switzerland, Aug. 18-Skin patches made of fetal skin cells closed wounds from second- and third-degree burns in eight children, bypassing the need for traditional skin grafting, researchers here reported.

All the children in the study had wound closure in just over two weeks, compared with 1.5 to three months for traditional skin grafting, reported Lee Ann Laurent-Applegate, M.D., and colleagues at the University Hospital of Lausanne in the Aug. 18 online edition of The Lancet.

There was little thinning or shrinkage of the new skin, they added. The skin constructs, although engineered from a skin sample from a male fetus, were not rejected by the immune system of a girl with burns over a large surface area.

The newly formed skin also took on pigmentation when given to dark-skinned patients. The skin constructs are easily moldable to the anatomy of small areas such as fingers and toes, and can be applied without glue, sutures, or staples.

"In view of the therapeutic effects of this technique along with the simplicity in application, fetal skin cells could have great potential in tissue engineering," wrote Dr. Laurent-Applegate and colleagues.

The skin constructs were all engineered from a single skin biopsy taken from a fetus aborted at 14 weeks. Although the woman whose pregnancy was terminated consented to the donation, which researchers said can be used to make several million 9 cm x 12 cm (3.5 in. x 4.75 in.) skin constructs, religious conservatives are generally opposed to the use of such tissues.

In their study, the authors obtained informed consent from a woman whose fetus was terminated at 14 weeks' gestation. Both the woman and the skin sample derived from the fetus were carefully screened for infectious diseases.

The Swiss researchers noted that although autologous skin grafting is the gold standard for treatment of second- and third-degree burns, both this technique and the use of bioengineered skin products require a two-step process, and can take several months to heal.

In contrast, "differences between fetal and adult skin could be important in inducing scar-free tissue repair," the Swiss group wrote. "In both animals and people, fetal skin outside the amniotic environment is very efficient in healing rapidly and without scars, emphasizing that fetal cells themselves are responsible."

In addition, fetal cells are less immunogenic than adult cells, decreasing the risk that a donor graft would be rejected by the host's immune system.

The researchers first expanded cells taken from the single 4 cm x 4 cm (1.6 in x 1.6 in) donation and grew them in medium. They then seeded the cells onto collagen sheets that would form the basis of the fetal skin constructs.

After obtaining informed consent from families, they applied the constructs to the wounds of eight children who were candidates for either split- or full-thickness autografts after an average of 10 days of traditional treatment.

The wounds were debrided and the fetal skin constructs were then applied to the lesions and covered with gauze that had been coated with petroleum jelly. A second layer of cotton gauze bandage was placed on top of this. The dressings were changed every three to four days for up to three weeks; if the wound has not healed by that time, the patient would go on to receive an autograft.

At each dressing change, a surgeon assessed epithelial formation in the wounds to determine whether additional constructs needed to be applied. The number of constructs required ranged from one to six.

Patients who had burns on their arms and feet received casts to keep their limbs in a neutral position. After skin closure, clinicians applied various creams to the treated areas, and the patients wore tailored pressure garments around the clock, removing them only for bathing and massage.

The mean time to healing was 15.3 days (SD 5.5) after the first skin patch was applied. Four patients with burns on their hands and fingers had total recovery of mobility, and one dark-skinned patient had recovery of pigmentation in the new skin.

To test whether engraftment of the fetal cells would be successful they received permission for a biopsy at six months after therapy in a girl who had a 29.5 cm x 18 cm (11.6 in. x 7 in) area of second- and third-degree burns on her buttocks. The biopsy sample was screened with fluorescence in situ hybridization (FISH), and no evidence of the presence of Y-chromosomes could be found.

"Aesthetic and functional results were excellent in all eight children showing little hypertrophy of new skin with no retraction or secondary breakdown of healed surfaces," the authors wrote. "We have shown that fetal skin is a substitute for biological skin that can provide burned patients with a very high quality of skin in a short time with no additional grafting techniques."

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[jbuck919]

Love the disclaimer. It's a little like the "theory of evolution," isn't it?

[Ralph]

Love the disclaimer. It's a little like the "theory of evolution," isn't it?

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Evolution isn't a theory. And such disclaimers are very necessary for medical and legal information posted online.

[jbuck919]

Love the disclaimer. It's a little like the "theory of evolution," isn't it?

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Evolution isn't a theory. And such disclaimers are very necessary for medical and legal information posted online.

It strikes me that they are necessary mainly to provide amusement in the context of ironic Ralph posts, it being the case that the press should be more or less immune to printing the truth.

[Corlyss_D]

Bill Clinton!

[Teresa B]

Good article, Ralph. I have a hard time with people who find the use of a little sample of fetal skin immoral when it could save so many burn victims.

No matter how one feels about abortion, it is legal, and once the decision has been made to terminate a pregnancy, what sense does it make to discard the potential of using a tiny piece of skin to treat multiple patients?

Having seen a number of severe burn victims, I'm all for a treatment that could heal them more quickly and with less scarring.

All the best, Teresa

[jbuck919]

No matter how one feels about abortion, it is legal, and once the decision has been made to terminate a pregnancy, what sense does it make to discard the potential of using a tiny piece of skin to treat multiple patients?

It is precisely that semi-apologetic attitude, which has been impelled upon the unsuspecting multitude by a relentless and vicious lobby, that has made abortion de facto illegal on many a local basis and may make it nationally so in the near future.