BURN RESEARCH
Stem cells could be the starting point for a whole new approach to healing severe burns
Dr. Marc Jeschke spends his time pondering how to repair the bodies of burn victims, and even though the tools at his disposal are as stateof- the art as they come, he's not satisfied.
"It's time to find a new approach," he says.
A serious burn is a complex and laborious problem to treat, and Dr. Jeschke and his team at Ross Tilley Burn Centre want to make it easier on both doctors and patients. They are conducting ambitious research to find a better way - and their focus is the use of stem cells to grow new skin.
Stem cells are non-specialized cells that can divide and turn into specialized cells such as bone, nerve or skin cells. They are found in several areas of the human body - the skin, fat and bone marrow - and are naturally present to help with tissue repair.
"The goal with stem cells is to use them to create new skin," says Dr. Jeschke, medical director of the centre. Currently, the primary method for treating severe burns (25% or more of the body covered in second- and third-degree burns) involves treating pain, preventing infection, and surgically replacing the worst of the burnt skin with either healthy skin from another part of the patient's body (which creates an additional injury) or skin from another source such as a cadaver, Dr. Jeschke says.
Another technique, cultured epithelial autograft (CEA), deploys skin-like material grown in a lab to repair damaged areas. These cultures are created from skin cells derived from the patient's body, but growing them takes six-to-eight weeks – a long, painful time for patients to wait.
The most likely sources of stem cells for the team's burn research come from umbilical cords, or from amnion (a thin layer of tissue that surrounds a fetus during pregnancy). Both are materials that are discarded after a baby's birth. Research has shown that the use of stem cells can suffering from sepsis (a body-wide inflammatory illness).
"Stem cells dampen the inflammatory response, they improve the organ function," says Dr. Jeschke, who has a global reputation in burn research.
For burns, stem cells have the potential to work both on the skin surface and on other injured tissue. In previous work, Dr. Jeschke discovered that stem cells harvested from umbilical cord and amniotic membranes can successfully be triggered to turn into skin, bone and cartilage cells. He says this has exciting potential for treating people who suffer from electrical burns.
"What happens with electrical burns is you lose a lot of soft tissue and bone. If you have stem cells, what you could do is try to fill in the soft tissue damage," Dr. Jeschke says. "It would be ideal for electrically- injured patients who have a lot of muscle, fat and bone loss."
For the next phase of the project, studies on animals such as mice will be conducted to determine how stem cells can be applied to treat wounds - enabling researchers to understand more about their behaviour and develop techniques to use them clinically. After that will come human clinical trials - something that could begin in two-to-four years, Dr. Jeschke predicts.
The eventual goal is to create a bank of stem cells that are immediately available to patients. "Stem cells have a huge role to play," says Dr. Jeschke. "They could dramatically improve life for these patients."
The Guinea Pigs
Innovation has a name at the Ross Tilley Burn Centre. It is the Guinea Pig Club – named with deep pride by its own members. They were the over 600 allied airmen of World War II whose horribly injured and disfigured bodies were reconstructed by Dr. Ross Tilley, one of Canada's only four plastic surgeons at the start of the war. These men were some of the first patients to be treated with skin grafting techniques Dr. Tilley invented during the war. Through his work, he developed standards of care that brought Canada into plastic surgery's modern era.
Dr. Tilley (pictured below) cared not only for the Guinea Pigs' bodies but also their minds. He taught civilians about the healing process and the importance of making these heroes feel welcome in the community, encouraging them not to stand and stare. The Guinea Pig Club was also allowed to drink alcohol in their field hospital wards, making Dr. Tilley a hero to his patients in so many ways.