Koller J

Mesenchymal stem cells for chronic wounds therapy

Abstract Wound healing is a complex process that involves interaction of soluble mediators, extracellular matrix and infiltrating blood cells. Chronic and non-healing skin defects contribute significantly to morbidity and mortality of many patients. Recently, despite the current medical progress, the chronic and non-healing wounds still represent a serious medical problem. In many cases, conventional therapeutic approaches, such as dermal substitutes and growth factor therapy failed and do not produce the expected results, patients are exposed to a high risk of infection, sepsis or amputation. For that reason clinicians and researchers are forced to searching for alternative methods to induce healing process which may result into complete wound closure. Mesenchymal stem cells (MSCs) represent a unique tool of tissue engineering and regenerative medicine and a promising therapeutic strategy. Due to their unique biological properties, MSCs seem to be the perspective modality method for these patients. Many preclinical and clinical studies suggest the possibility of using these cells in tissue regeneration, healing acute and chronic wounds and scar remodelling. The objective of the present review is to summarize the current information and preclinical data about MSCs, their biological characteristics and mode of action during regenerative and healing processes, as well as their clinical application in chronic wounds treatment.

Modification of layered atelocollagen: enzymatic degradation and cytotoxicity evaluation

Two kinds of layered atelocollagen materials cross-linked with hexamethylene diisocyanate (HMDIC), starch dialdehyde and glyoxal were enzymatically treated by bacterial collagenase. Evaluating collagenase digestion assay for these material showed progressive differences, particularly in the group of samples cross-linked with HMDIC. This should offer the possibility of programmed enzymatic degradation. These materials may be toxicologically acceptable as proven by the short-term test used for cytotoxicity evaluation.

High-tension electrical-arc-induced thermal burns caused by railway overhead cables

Eleven patients with high-tension electrical-arc-induced thermal burns due to railway overhead cables were treated at the Bratislava Burn Department during a relatively short period of 18 months. All the injuries occurred by the same mechanism, that is persons climbing on top of railway carriages and approaching the 25,000 V a.c. overhead cables. All the burns were the result of an electrical arc passing externally to the body, with subsequent ignition of the victims clothes. The cutaneous burns, ranging from 24 to 79 per cent of the BSA, were mostly deep partial to full skin thickness injuries. One patient died on day 5 postburn, the other survived. In spite of high-tension aetiology, no true electrical injuries appear to have occurred and no amputations were necessary. The pathophysiology and possible preventive measures are discussed. It must be stressed that arcing can be induced by an earthed object approaching, but not touching, a cable carrying a high voltage.

Induced pluripotent stem cells and their implication for regenerative medicine

Abstract In 2006 Yamanaka’s group showed that stem cells with properties similar to embryonic stem cells could be generated from mouse fibroblasts by introducing four genes. These cells were termed induced pluripotent stem cells (iPSCs). Because iPSCs avoid many of ethical concerns associated with the use of embryonic material, they have great potential in cell-based regenerative medicine. They are suitable also for other various purposes, including disease modelling, personalized cell therapy, drug or toxicity screening and basic research. Moreover, in the future, there might become possible to generate organs for human transplantation. Despite these progresses, several studies have raised the concern for genetic and epigenetic abnormalities of iPSCs that could contribute to immunogenicity of some cells differentiated from iPSCs. Recent methodological improvements are increasing the ease and efficacy of reprogramming, and reducing the genomic modification. However, to minimize or eliminate genetic alternations in the derived iPSC line creation, factor-free human iPSCs are necessary. In this review we discuss recent possibilities of using iPSCs for clinical applications and new advances in field of their reprogramming methods. The main goal of present article was to review the current knowledge about iPSCs and to discuss their potential for regenerative medicine.

Cytotoxicity testing of scaffolds potentially suitable for the preparation of three-dimensional skin substitutes

The preparation and study of three-dimensional functional skin substitutes has been the focus of intense research for several decades. Dermal substitutes are now commonly used in medical practice for a variety of applications. Here, we assess the toxicity of seven selected acellular dermal matrix materials to establish their potential for use in future three-dimensional skin substitute studies. The cytotoxicity of acellular dermis (of Allo- and Xenograft origin) prepared in our lab and biomaterials based on collagen and hyaluronic acid (Coladerm H and Coladerm H–L) were compared to that seen in three commercially available products (Xe-Derma, AlloDerm and Xeno-Impl). Murine fibroblasts NIH-3T3 and human dermal fibroblasts were used in cytotoxicity tests, with any resultant cytotoxic effects caused by the seven tested dermal scaffolds visualised using an inverted microscope system and confirmed in parallel using colorimetric MTT cell proliferation assays. While most of the dermal substitutes did not demonstrate a cytotoxic effect on our two cell types, Xeno and Xeno-Impl scaffolds clearly did. The cytotoxic effect of acellular Xeno dermal matrix could essentially be removed through a regime of multiple washes, but we were unable to remove the cytotoxic effect of Xeno-Impl. Thus, Xeno-Impl alone has been excluded from our future work on preparation of 3D skin substitutes.

Biocompatibility Studies of a New Biosynthetic Dermal Substitute Based on Collagen/Hyaluronan Conjugate

The use of glycosaminoglycans (GAGs) as the second macromolecular component with collagen for the membrane preparation is based on the idea to create a biodegradable scaffold for new tissue. A hybrid collagen/hyaluronan membrane with specific bubble macrostructure was designed to serve as a synthetic dermal substitute. The objectives were to explain the two questions: what is the local biological response to the implanted membrane, and what is its reconstruction rate in tissue. The histological study proved low irritability, good compatibility, ingrowth of autologous tissue starting on day 7 post implantation, and resorption within four weeks. The major part of the implant was replaced by autologous tissue at the end of three weeks post implantation. The overall local biological response to implant was very good.

Skin explant cultures as a source of keratinocytes for cultivation.

Cultivated human keratinocytes can be used successfully in the treatment of burn patients, but efforts to heal burns and other wounds can be hampered by the very small skin biopsies available for cultivation of transplantable keratinocyte sheets. A small biopsy (and correspondingly small number of enzymatically isolated keratinocytes for use in classical cultivation techniques) can lead to a low yield of multilayer sheets for clinical application or unacceptably long cultivation times. One way of addressing this is to make use of skin remnants remaining after enzymatic digestion and culture cells migrating out of these skin explants. Sufficient numbers of explant-derived keratinocytes can be obtained to facilitate additional routine cultivation of these cells. Biopsy remnants can be used to initiate explant cultures repeatedly (we were able to re-use pieces of skin 10 times and still obtain useful numbers of keratinocytes) and this “passaging” yields substantially more cells for classical cultivation than would be available from conventional methodology alone, and in a comparable timeframe. Another advantage of this method is that it does not require additional biopsies to be procured from already-compromised patients and overcomes problems associated with contamination of skin samples with resistant hospital-acquired bacterial infections common during prolonged hospitalization.

European Quality System for Tissue Banking

AIM The aims of this project were to analyze the factors that influence quality and safety of tissues for transplantation and to develop the method to ensure standards of quality and safety in relation to tissue banking as demanded by European Directive 2004/23/EC and its technical annexes. It is organized in 4 Working Groups, the objectives of each one being focused in a specific area. STANDARDS The Guide of Recommendations for Tissue Banking is structured into 4 parts: (1) quality systems that apply to tissue banking and general quality system requirements, (2) regulatory framework in Europe, (3) standards available, and (4) recommendations of the fundamental quality and safety keypoints. REGISTRY This Working Group handled design of a multinational musculoskeletal tissue registry prototype. TRAINING This Working Group handled design and validation of a specialized training model structured into online and face-to-face courses. The model was improved with suggestions from students, and 100% certification was obtained. AUDIT The Guide for Auditing Tissue Establishments provides guidance for auditors, a self-assessment questionnaire, and an audit report form. The effectiveness and sustainability of the outputs were assessed. Both guides are useful for experienced tissue establishments and auditors and also for professionals that are starting in the field. The registry prototype proves it is possible to exchange tissues between establishments throughout Europe. The training model has been effective in educating staff and means having professionals with excellent expertise. Member states could adapt/adopt it. The guides should be updated periodically and perhaps a European organization should take responsibility for this and even create a body of auditors.

Fluid resuscitation in thermally injured pediatric patients.

More than two-thirds of critical burns in special burn units are children. The burned child continues to represent a special challenge, since resuscitation therapy must be more precise than that for an adult with a similar burn. Children have a limited physiologic reserve and the pediatric fluid replacement therapy is based on the principle of separate calculation of physiological and pathological losses. We have reviewed the most widely accepted pediatric isotonic fluid protocols. All these protocols calculate for replacement of pathological losses with a need of 2 ml/kg/% BSAB (body surface area burn) or 4 ml/kg/% BSAB. We choosed the formulas of two Shriners Burns Institutes--the Cincinnati and the Galveston Unit as representatives, and calculated the fluid therapy for model burn children weights of 10 kg, 30 kg with 20, 40, 60, 80% BSAB. The results of calculations where compared with physiologic parameters of children. In conclusions we could show, that the 4 ml/kg/% BSAB formulas do replace all theoretically predicted pathophysiologic losses due to burns. However, the 2 ml/kg/% BSAB formulas are more practical as a guideline for resuscitation of pediatric patients because of greater therapeutical range and better clinical response of children threatened by burn shock. It is important to remember that all formulas are only guides to fluid therapy, they should be modified according to individual needs and clinical status of the patient. Only successful restoring and maintaining perfusion pressures leads to optimal oxygenation of injured and noninjured tissues, which promotes spontaneous healing, prevents wound conversion, minimise bacterial colonisation, and prepares the injured areas for early grafting.

Biocompatibility studies of modified collagen/Hyaluronan membranes after implantation

Two varieties of collagen/sodium hyaluronan membranes were used asdermal substitutes in a biocompatibility implantation study on rats. In orderto improve especially the physical and mechanical properties of the material, themembranes were chemically modified using a combination ofhexamethylenediisocyanate (HMDC) as a crosslinker and polyoxy-ethylene (POE) asa spacer. According to both macroscopic and microscopic histologicalobservations, the membranes were well accepted by the surrounding host tissuein all the animals. No major differences in relation to the outgrowth of thematerial by host tissue have been observed between the implant varieties A andB. The most important finding was that no pathological changes or importantalterations of the host tissues were detected.