Cell-Based Therapeutics in Burn Medicine

     New strategies using skin substitutes and autologous or allogeneic cell suspensions have been developed to improve healing of burn injuries. Skin substitutes grown in a laboratory and populations of individual skin cells harvested from biopsies can be applied to debrided burns to return damaged skin to optimal cosmetic appearance and normal function in the shortest period of time.

     The use of skin substitutes to temporarily restore the multiple functions of normal skin has been of substantial benefit in the management of cutaneous burn injuries. Skin substitutes are widely used in the management of human thermal burns and can be (1) temporary or permanent, (2) epidermal, dermal, or composite, and (3) biologic or synthetic. They have also been shown to be effective in speeding up time to closure of chronic leg and foot ulcers, surgical excision sites, and partial-thickness donor sites.

     The application of keratinocytes in suspension has been shown to improve epidermal wound healing in pig and mouse models. ReCell^® Autologous Cell Harvesting Device (Avita Medical Americas LLC, Woburn, MA) is an innovative medical device that was developed to allow rapid harvesting of autologous cells from a thin split-thickness biopsy. Harvesting is followed by spray application of a population of skin cells onto wounds within 30 min of collecting the biopsy, without the need of culturing the cells in a clinical laboratory. Following processing of the skin biopsy, the resulting cell suspension provides autologous keratinocytes, epidermal stem cells, melanocytes, fibroblasts, and Langerhans cells for application onto prepared wound beds.

     In this talk an overview of cell-based therapeutics in treating cutaneous vesicant injuries will be provided, to include a review of available products and use of several of these products in treating sulfur mustard injuries in a weanling swine model.

The views expressed in this presentation are those of the author and do not reflect the official policy of the Department of Army, Department of Defense, or the U.S. Government. The experimental protocol was approved by the Animal Care and Use Committee at the United States Army Medical Research Institute of Chemical Defense and all procedures were conducted in accordance with the principles stated in the Guide for the Care and Use of Laboratory Animals (National Research Council, 1996), and the Animal Welfare Act of 1966 (P.L. 89-544), as amended. This research was supported by the Defense Threat Reduction Agency, Medical S&T Division.