Transplantation of a New Biological Product in Rare Diseases, Such as Epidermolysis Bullosa: Response and Clinical Outcome

• Published in: Transplantation proceedings 2020-09, Vol.52 (7), p.2239-2243
• Main Authors: Pliszczyński, J., Nita, M., Kowalewski, C., Woźniak, K., Eljaszewicz, A., Moniuszko, M., Kamiński, A., Śladowski, D., Zimek, Z., Majewski, S., Kosieradzki, M., Fiedor, P.
• Format: Article
• Language: English
• Subjects: Acellular Dermis; Epidermolysis Bullosa - complications; Epidermolysis Bullosa - therapy; Female; Humans; Leg Ulcer - etiology; Leg Ulcer - therapy; Middle Aged; Rare Diseases; Skin Transplantation - methods; Wound Healing
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2020.02.119

Epidermolysis bullosa (EB) is a phenotypically diverse group of hereditary blistering disorders involving mutations in 20 different genes. Those debilitating disorders are currently incurable; however, there are a number of promising preclinical trials, where some treatments already approach the stage of early clinical trial. In this paper we introduce a novel surgical approach to the treatment of EB-induced ulcerations. The purpose of our study was to evaluate the safety and efficacy of a new biological dressing in the form of an allogenic human skin equivalent graft before using multipotent stem cells, classified as an advanced therapy medicinal product. Implanted human acellular dermal matrices were prepared from the superficial layers of donated human skin. Scaffold sterilization was conducted via irradiation with the use of a linear electron accelerator. Following water-knife debridement, wounds were surgically covered with accordingly prepared grafts and dressed in burn-injury fashion. Subsequently, the wounds were monitored for infection and viability. Our data indicate that grafting as a potential new medicinal product was safe and effective in patients with rare diseases, such as EB, and may be used for stem cells to create new Advanced Therapy Medicinal Products. During a 200-day follow-up, we proved the safety of using human scaffolds (allogeneic graft) by observing no apparent infection or necrosis. Instead, we noted fewer required dressing changes, promoted wound healing, pain reduction, and an overall improvement in the quality of life in patients with EB. The protocol for grafting allogenic acellular epidermal sheets is the most promising treatment for severely affected skin areas in EB patients to date.