Following the lectures on stem cells and tissue engineering, I was intrigued to learn how stem cells could be used in wound healing and specifically burn treatment. The use of stem cells for burn treatment would be amazing due to their ability to modulate the release of the chemokines, cytokines, and growth factors necessary for wound healing. Although I think this could be a really useful and interesting use of stem cells there are not yet published clinical trials on the efficacy of stem cells in burn wound care.

Pre-clinical trials have showed stem cells induce a significant promotion in healing rate of burn animals, compared with animals in control groups. Hair follicle stem cells (HFSCs) seem to be most effective at promoting the healing of burns. I was surprised to see that at this stage it appears autologous stem cells did not provide a significantly better therapeutic effect than either allogeneic or xenogenic stem cells, even though they could lead to an adverse immune reaction caused by graft-versus-host disease.

During my research I was reminded of a storyline in one of my favourite TV shows Greys Anatomy where as part of an innovation competition one doctor was looking at the use of tilapia fish skin to help with the healing of burn wounds. I was interested in finding out whether this is a reality or just fiction. I quickly found an article on a phase III randomized controlled trial looking at the benefits of Nile tilapia fish skin-based wound dressing.

Severe burns are often life altering and are a leading cause of disability-adjusted life-years especially in developing countries, such as Brazil, which may not have public health systems that can provide modern dressings developed for treating burns. Use of talapia fish skin could improve access to an effective treatment of superficial partial-thickness burns by reducing the treatment-related costs. Currently most Brazilian burn units use silver sulfadiazine cream. This is used as silver ions are antimicrobial and importantly few bacteria have been shown to develop resistance to silver. However, it has been suggested that there might not be enough evidence to suggest that burns heal better when using silver sulphadiazine.

The phase 3 randomized control study (linked above) they compared the time taken for reepithelialization, cost-effectiveness and the pain occurring during treatment with silver sulfadiazine and talapia fish skin. The mean cost per patient and number of days to complete reepithelialization was lower when Nile tilapia fish skin was used. The use of tilapia fish skin showed a reduction of approximately 50.0 percent in the mean costs for each 1 percent total body surface area ($4 vs $8). Even better news was the fact there was also a statistically significant reduction in mean pain score with the talapia fish skin treatment. Therefore, I think this treatment is a fantastic innovation.

My thoughts

Although stem cells are a fascinating area of current research, their use in treatments will not necessarily be accessible in developing countries. Simple but successful innovative treatments like the use of talapia fish skin for healing will remain important in medical research.