By: Jean Johnson for Wounds1Using a biological bandage of human fetal skin cells, Swiss researchers dramatically increased the speed and success of treating burns in children.
In preliminary results from the treatment of eight children aged 14 months to 9 years published online by the British journal Lancet, the scientific team said the fetal skin panels promoted extraordinary and unexpected regeneration by the underlying tissue.
Lead researcher Patrick Hohlfeld, M.D., professor of gynecology and obstetrics at the University Hospital in Lausanne, Switzerland, said, “We had expected that the fetal skin would act as a graft, and it did not. Instead we found that it acted more like a biological bandage that stimulated healing. We observed spontaneous healing of the wound, which you would never observe in normal conditions with a traditional skin graft.”
Physicians have historically used skin grafting to treat severe second- and third-degree burns. The procedure has a typical healing time of three months, and not only requires removing skin from another area of the body, but also redressing the wounds periodically in procedures so painful that complete anesthesia is often required. Further, as children grow, skin that is grafted is so thick and inelastic that it does not keep pace, necessitating further surgeries and grafting.
Instead of three months, healing times with the bandages made from the fetal skin cells dropped from 14 days to three weeks. The biologic bandages dissolved every few days to the surprise of the team. Repeated replacement, though, somehow promoted healing in the underlying skin, a far superior outcome to having the fetal skin construct serve as an actual graft the way scientists initially anticipated it would. “The nurses couldn’t believe the speed at which these burns healed,” said Hohlfeld. Moreover, the tissue that regenerated beneath the biological bandages appeared like normal skin. “It was supple, there was no scarring or retraction – it was really different than grafted skin.”
The team obtained the fetal cell specimen of 4 square centimeters (no larger than a postage stamp) three years ago from a 14-week-old fetus that had been aborted for medical-social reasons. The cells were then seeded onto a bed of collagen, an important protein for skin elasticity, to form the biological bandages.
The cells grew well in the lab so ethical concerns over women ending pregnancies to sell body parts are unfounded according to Hohlfeld. “It wouldn’t be a question since we can prepare millions of constructs out of one skin biopsy. I understand the concern, but there are pregnancy terminations every day. Nobody would start a pregnancy for that. There’s absolutely no reason.”
In addition to ethical concerns that are expected in the United States and Italy where the use of human embryos in scientific research is restricted, experts say that much work remains before concluding that fetal skin cell bandages have revolutionized burn treatment.
“It’s hard to judge from a few pictures and such a small number of cases,” said Roger Yurt, M.D., director of the Burn Center at the New York-Presbyterian Hospital.
A counterpart of Yurt’s in Essex, England, Peter Dziewulski, M.D. expressed similar caution. “This is an interesting and exciting innovation, but a lot more needs to be done before it can be said to revolutionize care.”
The medical profession’s conservative response aside, Hohlfeld says that the technique has already made a significant difference in the pain the children he worked with experienced. “Not only did they heal, but it had a very good impact on the pain they were experiencing – you need several dressing changes and usually you have to put them to sleep to do that – and with this technique most of them didn’t need that,” Hohlfeld said. “So you avoid a lot of things. You avoid extreme pain and the further taking another piece of skin on the body and creating another scar.”
Debating the possibility of using human fetal cells for wound healing has gone on among scientists for decades, since they’ve understood that growing fetuses are capable of repairing incisions without scarring. The work of the Swiss team, though, was the first to test the theory. Certainly eight youngsters and their families in Switzerland are grateful the physicians did. Other burn patients – adults and children alike – can only hope that continuing experiments bring as much promise as the initial trial did.
