A small patch of skin from a 14-week-old fetus just might hold the key to healing badly burned patients. A paper published this week in the online edition of the Lancet, a British journal, describes how a Swiss team used fetal tissue to successfully treat eight children with deep burns, which normally would have required grafts of skin taken from other parts of the children's bodies.
Burn experts don't see the work as a breakthrough but are hopeful that larger, controlled studies will endorse the findings. Even if that happens, however, it is by no means certain that the technique will be adopted in the United States. Federal law does not prohibit such use, and many states allow fetal tissue to be used medically, but manyperhaps mostphysicians and hospital executives would be fearful of public reaction.
Doctors at University Hospital in Lausanne removed a piece of skin about 1½ inches square from an electively aborted fetus after obtaining the mother's consent. Cells from the skin were grown in a nutrient culture and used as "seeds" to grow sheets of skin about 3½ inches by 4 inches. The sheets were simply laid over the burns and reapplied every few days.
Within one to three weeks, the burns had closed, and all of the children soon healed without any of the scarring, thickening, or loss of mobility that typically follows severe burns. What surprised the researchers was that the sheets gradually eroded but prompted the children's own skin to regenerate.
"There is no evidence that the tissue works as a graft," says lead researcher Patrick Hohlfeld, a fetal medicine specialist, who has a patent pending on the use of fetal skin cells for skin disorders. "What you see is the patients' own skin. The kids healed beneath the fetal tissue."
This was demonstrated by analyzing a bit of regrown skin from one patient, an 8-year-old girl. If the sheets of skin had taken hold, the researchers would have seen male, or Y, chromosomes, because the fetus that supplied the skin cells was male. But no Y chromosomes were found.
Hohlfeld believes equal success can be obtained with adult patients. Surgeon Gary Purdue, director of the burn center at Parkland Health & Hospital System in Dallas and president of the American Burn Association, agrees there is no reason to believe that if the technique works on children it couldn't work on adults. Purdue calls the findings "one more step" to the Holy Grail sought by burn doctors"something on the shelf," he says, "that can cover a big burn completely and permanently from Day 1, when they come into the hospital."
Purdue is not entirely convinced by the Lancet paper, however. The "before" photos of the children's burns, he says, don't suggest the kinds of deep-tissue injury that would make him resort to autografts, as skin patches taken from a patient's own body are called. Some, he says, look as if they were capable of healing without much help other than dressings.
Purdue also instantly dismissed the possibility that he or other burn doctors would employ fetal tissue for burns.
"Nobody's going to use aborted fetuses, because of the moral and political climate," he says.
Rob Sheridan, director of the burn unit at Massachusetts General Hospital, also has reservations. In a "full thickness" burn, which at least some of the children are said to have suffered, there are no remaining skin cells, he says, that could be stimulated to multiply and spread. "There has to be a native source."
Still, Sheridan calls the study "potentially very exciting." And he adds: "We're going to follow this very closely."