UKM medical researchers achieve breakthrough in skin tissue engineering
By Shahfizal Musa
( Watch video - The process of skin cells growing at a much faster rate once isolated and added nutrients )
BANGI, 5 July 2010 – Universiti Kebangsaan Malaysia (UKM) researchers have made a breakthrough in regenerative medicine through tissue engineering that will benefit burn victims, diabetics and those who suffer from severe skin damage.
Using tissue engineering technology, the team headed by Head of Tissue Engineering Centre UKM, Professor Dr Ruszymah Idrus, has successfully grown human skin which can help burn victims and diabetics heal much faster while eliminating the risk of tissue rejection.
This innovation in skin tissue engineering won them the Geneva Gold Medal Award at The International Exhibition of Invention, New Technique and Products in 2004. This method of making biomaterial from the patient’s own blood was patented as KULITKU.
A cGMP (current Good Manufacturing Practice) laboratory is being built in UKM to enable human clinical trial which is expected to be done next year. Once approved it will be ready to benefit those with severe skin damage including many diabetic patients and burn victims.
UKM recently signed a license agreement with Cell Therapies Pty Ltd (CT) from Melbourne, Australia to set up the internationally recognized quality system.
Prof Ruszymah Idrus and her team were responsible for this new method in modern medicine. This “bi-layered fully autologous tissue engineered skin” is believed to be the first in the world.
“There is a lot of skin substitute in the world but as far as what we know this technique of bi-layer and fully autologous, that is taking healthy skin from a patient then through tissue engineering technique growing it in the lab and then transplanting it back to the patient to replace the damaged skin, is an innovation. Nobody has done this before,” said Prof Ruszymah.
What this means is that skin can now be grown for patients suffering from severe burns with most of their skin destroyed.
What is needed is only a portion of the healthy skin from a patient for the skin culture instead of having to slice a big patch of the remaining healthy skin to cover the wounds.
Though there are other skin substitutes in the market that also uses human cells but they are not fully autologous as they use animal origin biomaterial as the scaffold to construct the skin.
These skin substitute usually use collagen derived from rat, cow or pig. KULITKU, however, uses the patient’s own blood as the biomaterial. Market survey showed that our market segment is very secure as there is no other exactly similar product, Prof Ruszymah said.
Unlike other engineered skin which commonly uses synthetic or artificial material, autologous skin engineering use the same organism. The skin to be cultured and grown is taken from a patient and it is then transplanted back to the patient.
This breakthrough is also immensely beneficial from the Islamic perspective as Islam places a high level of importance on the purity of materials that a Muslim can use or consume. With other methods of skin engineering the materials used in synthetic skin involves collagen, gelatine or other materials which are animal based.
This is not considered as Halal in normal circumstances. However when life is at stakes Islamic scholars have ruled that it is permissible due to the lack of option.
“With autologous engineered skin the source of the skin can be clearly identified. There is no question of the skin being contaminated with non halal material since it came from the same patient. For our skin substitute, we make sure that all the enzymes and chemicals used are not from animal origin.
“With this innovation we hope to penetrate the world halal market especially in the Middle East, InsyaAllah” says Prof Ruszymah.
Prof Ruszymah likened what had been done to the growing of roses. The rose plant is first grown in a pot with rich well drained soil, then when it can grow on its own, the rose plant is transplanted in the garden.
“We take a little cell from the patient and we culture it according to the need of the patient. Once the required size is obtained the cultured skin is transplanted back to the patient. This process will take only two to three weeks. For example we only need to take about 3 cm square of skin from a patient and within two to three weeks we can grow it into a 10 cm square of skin for the patient,” said Prof Ruszymah.
“What fully autologous skin engineering really means is that the source of the skin is taken from a patient, grown to bigger size in the lab and then transplanted back to the same patient. There is no risk of rejection of the skin since it originates from the patient’s own body and not someone else’s or from an artificial material.
“A person who has a kidney transplant for example will have to take anti rejection pills all his life. But not in this case as we grow the skin that originates from the same patient’s body, thus his body will not reject it,” said Prof Ruszymah.
Diabetics and Burn Victims
Skin replacement is commonly needed for those who suffered serious skin damage. For example a diabetic person may suffer from diabetic ulcers on his leg. Often the ulcers do not heal and could result in amputation to save other parts of the body from being infected.
Others who would benefit immensely from this type of skin engineering are burn victims. These are people whose skins are lacerated due to intense heat often the result of being trapped in a burning building or car.
In such cases the victims’ body intrinsic self healing system cannot act swiftly enough to generate the replacement cells to grow new skin, said Prof Ruszymah.
Alternative to Split Skin Grafting (SSG)
“The solution to these potentially fatal problem is Split Skin Grafting or SSG. How SSG work is pretty much like filling a hole, you need soil to cover that hole.
“What happens in this case is that the surgeon will slice healthy skin from a part of the patient’s body not damaged and then pasted it on to the damaged area. The drawback of SSG is of course the pain of having the healthy skin being sliced off so it could be used to patch the damaged area.
“Secondly it is not cosmetically pleasing because the harvested area will be scared.
“Thirdly SSG may be impractical in cases where because of severe burns there is just not enough healthy skin to be harvested.”
Prof Ruszymah said that with skin engineering technology, there was no need to harvest massive parts of the skin from the body. “Our animal studies demonstrate that the rate of healing is faster compared to SSG and what is more important is that there is less scarring,” she said.
Growing your own skin
When a patient needed skin replacement, a small piece of skin of only about 3 cm square of healthy skin is harvested from the patient and taken to the lab. The skin tissue is then disintegrated by mixing it with an enzyme call collaganes. Once disintegrated, the skin will return to its cellular level so you end up with skin cells.
These skin cells are taken and cultured with added nutrients where they will multiply into skin again. When there is enough number of cells, a larger piece of skin will be reconstructed.
“The process is called tissue culture and tissue reconstruction. We need to culture the cells and when there is enough number of cells we reconstruct the cells into skin.
“We have the technology where we can take a small piece of skin and give us two weeks we can grow it into a much bigger piece. Similarly after culturing a big enough skin, it will be transferred to the patient to grow and heal the wound.
“So in short, a sample skin is taken from a patient, disintegrated into cells which will then be cultured and reconstructed back into a bigger piece of human skin,” said Prof Ruszymah.
The autologous skin engineered by Prof Ruszymah is clearly significant as it can benefit patients and modern medicine.
The Next Step
For patients to benefit from this tissue engineering technique, the process must be done in a special lab and undergo clinical trial to make sure it does not have an adverse reaction to patients.
A special lab is being built to culture and reconstruct the skin tissue. This would allow trials to be carried out on humans. Prof Ruszymah attributed the breakthrough to her team members and the very supportive leadership of UKM for allowing innovations and the trying of new ideas.
She appealed for more funding for R&D in tissue engineering research, as it is the forefront of medical biotechnology.