Cellular dressing for burns

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The Jagiellonian University has one of the most modern laboratories in Poland where human cells are cultured for the treatment of extensive burns.

A method for the treatment of large skin wounds resulting from burns or chronic ulcerations is the application of the patient's own skin cells, which have been cultured outside their bodies. In many cases, this is the only way to regenerate the damaged tissue that is not healing spontaneously if the application of autologous skin grafts from healthy areas of the body is impossible. Work on the improvement of the efficiency of culturing such cells is being conducted at the Laboratory of Cell and Tissue Engineering in the Department of Cell Biology of the Faculty of Biochemistry, Biophysics and Biotechnology and the Małopolska Center of Biotechnology, along with studies conducted in cooperation with other clinical institutions, on the application of such cells in the treatment of burns.

The skin I live in

Skin is a kind of cloak that effectively protects us from the influence of harmful external factors. At the same time, this tissue is most exposed to their influence. Moreover, it is responsible for water and electrolyte management (perspiration glands), reception of stimuli (touch, the sense of pain, cold, warmth), and maintaining appropriate body temperature. The fact that skin performs these functions perfectly is due to its structure: a multi-layered epidermis constantly renewing itself, dermis, and subcutaneous tissue located below it.

Because the skin performs such an important function, damage may lead to harmful consequences. Burns, which may result in the loss of significant amounts of skin surface, infection, and dehydration, are particularly dangerous. This is why it is essential to close wounds as quickly as possible. Tissue engineering comes into action when natural regenerative and repair mechanisms fail. In such cases, the cells of the victims are multiplied outside of their bodies and then grafted.

Human epidermal cell cultures (in vitro)

Proliferation of cells in vitro

Scientists from the Jagiellonian University have the greatest experience in this area in Poland. They are able to use a small fragment of a patient's healthy skin, of a surface of approximately 0.5 cm2, to cultivate enough cells to cover a wound of a size of 200 cm2. How is this possible? In laboratory conditions, single cells are isolated from the collected tissue and then placed in special culture dishes containing an appropriate medium that stimulates the cells to multiply. This is relatively easy in the case of epidermis, as it consists mostly of cells called keratinocytes. Apart from them, it also contains stem cells and progenitor cells originating from them, which determine the pace and quality of the regeneration of epidermis, as they are able to transform into a specific type of cells (in this case into the desired keratinocytes) in a suitable environment. The more keratinocytes are obtained, the more effective the graft will be. After more than 10 days in such a culture, keratinocytes are mixed with a socalled tissue adhesive, transported to the hospital and placed onto the wound. "When applied in the form of a suspension in fibrin glue, keratinocytes form islands of epidermis which grow with time, merging into a homogenous layer. This method constitutes one of the elements of complex general and local treatment, directly saving the lives of victims suffering from the most serious burns, i.e., burns of degrees 2b and 3, covering more than 50% of total body surface," said Justyna Drukała, PhD, head of the laboratory. The advantages of this method include fast and permanent protection of the wound, limiting the formation of scars and, most importantly, the lack of risk of rejection.

Hope becomes reality

However, in the case of deeper burns, i.e., in cases when the dermis itself is damaged, a graft of epidermal cells is insufficient. Such wounds often lack suitable blood vessels that are necessary for the graft to be accepted. "One of the possibilities to solve this problem is the use of a dermal equivalent, for example the biocompatible Integra DRT matrix," said Justyna Drukała. It is a three-dimensional collagen layer placed onto the wound, which enables the migration of patient's skin cells, including those creating blood vessels. It is wholly protected by a silicone layer. When adequate blood vessels of the skin are reconstructed, the silicon is removed and the place is covered with a layer of epidermal cells collected in the form of an autograft or previously obtained from the patient, and multiplied in laboratory conditions. "The application of the culture of the epidermis itself has already been optimized at our center," the scientist told us. She adds, "Attempts to treat wounds with the use of the patient's own cells and the dressing called Integra DRT, proposed by Professor Jacek Puchała, have already been conducted."

The next objective set by the scientists is to develop a method of single-stage treatment of wounds. The possibility, to remove necrotic tissue and transplant a full thickness skin equivalent, would significantly improve the comfort of the patient and shorten the period of recovery, and the procedure itself would become much safer.

Research team: Julia Borowczyk, MSc; Eliza Zimoląg, MSc; Justyna Drukała, PhD