Clinical Care Human Skin Equivalent

As noted in the Angiogenesis section of this website, growth factors are critical to the wound healing process. When growth factor expression is blocked or disrupted, wound healing is impaired. Use of human skin equivalent (HSE) has resulted in effective treatment of diabetic foot ulcers,⁸⁹ venous stasis ulcers,⁹⁰ and pressure ulcers.⁹¹ HSE is made up of two essential skin cell types, keratinocytes and fibroblasts. It is hypothesized that HSE is effective in this treatment because the combination of fibroblasts and keratinocytes stimulates synthesis and release of the various growth factors essential to wound healing. In addition to vascular endothelial growth factor (VEGF) and insulin-like growth factor (ILGF), these include transforming growth factor (TGF),⁹² keratinocyte growth factor,⁹³ and interleukin (IL)-6.⁹⁴

The Wound Healing Center is investigating the use of human skin equivalent both experimentally and clinically in the treatment of diabetic foot ulcers. In application to athymic mice, 15 different growth factors were found to be expressed over a study period of 17 days. Among the patient cohort who was treated, all wounds healed in an average of 32 days with a single application of HSE.⁹⁵

HSE should be viewed as an important adjunct in the treatment of chronic wounds, but not as the only therapy to be utilized. It is vital that debridement be performed prior to the application of any cellular therapy such as HSE. Additionally, offloading and controlling for infection/sepsis are necessary components of the treatment regimen.

Apligraf® is a living cell based therapy indicated for the treatment of venous leg ulcers and diabetic foot ulcers. It is the first bio-engineered skin to receive FDA approval. To learn more about Apligraf® or other Organogenesis Inc. products, please visit www.organogenesis.com.