tissue engineering

A recent article in the journal Burns and Trauma summarizes that advances in tissue engineering may soon allow the body, and the lab, to grow real skin.

Burn science remains at the forefront of skin substitute research, and this is because of the challenges in treating the consequences of burn injuries.  Our skin, the largest organ in our body, provides a mechanical barrier against the outside environment, while at the same time ensuring the retention of fluids and moisture. The potentially fatal injuries arising from burns are attributable to the loss of this protective layer. Patients suffering from large-area burns often die of rapid evaporative losses in 48 hours, and infectious organisms can also invade with impunity and cause similarly lethal infections.

The extent of injury determines the reparative capacity of the skin. While the skin possesses enormous regenerative capabilities, this ability is only up to a certain point – the more dermis that is destroyed, the less the possibility of natural healing.

Artificial Skin Substitutes

A 2018 article in Burns and Trauma reviews the current concepts in skin replacement through tissue engineering. Burn care units all over the world have been using artificial skin substitutes to prevent the egress of fluid while keeping infectious pathogens out, and this has increased survival rates for massively-burned patients.  This approach buys time for definitive management, whether to buy time for the skin to heal, or using unburned areas for skin grafting procedures. But these are essentially temporary measures, as they cannot completely replace human skin. Their artificial nature also means that they lack the cellular components, the sweat and oil glands, hair, nerve endings, and pigment, which all contribute to the appearance, texture, and feel of normal skin.

Gene Therapies and Stem Cell Research

Recent advances in tissue engineering have emphasized mimicking both the anatomic and physiologic properties of human skin. Investigations include gene therapies and stem cell research, where the body can grow its own skin source. Because the skin will essentially be from the same person, there are no concerns with regards to skin rejection, and there will be an ideal match in appearance.

Search for Materials to Mimic Living Skin

Parallel initiatives are also in play with regards to artificial bio-engineering, where the search continues in finding the best materials that mimic the function of living skin. The advantage of this approach is the possibility of an unlimited source of supply. And while this ideal material hasn’t been identified as of yet, research continues into exploring this possibility.

Once these technologies become reality, the authors believe that they can offer new hope for patients who urgently need skin replacement. Burn patients won’t be the only ones benefiting; they can also be used for patients who may have large or diffuse skin conditions like psoriasis or neurofibromatosis.   Thanks to science, we may be replacing them with skin that is as good as new.

Written by Jay Martin, M.D.

Reference: Boyce and Lalley. “Tissue engineering of skin and regenerative medicine for wound care.” Burns and Trauma (2018): 6, 4.  DOI: 10.1186/s41038-017-0103-y

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