Living beings have the incredible ability to grow and heal their own matter. During illnesses or injuries, our own bodies will start a healing process that usually works but sometimes needs some outside help. Medicine is all about helping the body to heal itself and pick up the slack when the problem is outside the scope of the body.
The introduction of stem cells to the medical world left everything on its head. The ability to create and heal almost any part of the body was outstanding but confusing. The way wounds heal naturally is already a complicated process, so adding stem cells to the mix makes everything work better so long as we know exactly what we’re doing. In the case of stem cells, knowledge is power, but the same could be said for the entire process of healing.
What Is Skin?
To understand how wounds are healed, we must first understand completely what a wound is, including where they are. The skin, the largest organ of the human body, may seem like an odd place to start this explanation, but a short explanation of what skin is exactly and why it’s there can help us with the rest of this venture.
The skin is outermost tissue of the body that consists of multiple layers each doing different things. The layers are basically the dermis and epidermis but includes the basement membrane, subcutaneous tissue, and other layers. With everything together, the skin’s primary purpose is to protect the rest of the body from the harsh environment outside. As such, the skin is the first organ to take a wound and is actually designed to heal on its own afterwards unlike most other portions of the body.
A wound is described as any disruption of normal structure with loss of function. Despite medical advancements, wounds are still a challenging clinical problem due to the wide variety of types and different conditions of the patient. Normal healing is a complex venture even for the most basic of wounds.
Normal Wound Healing Process
There are three steps to wound healing: inflammation, proliferation, and maturation and remodeling.
Before inflammation begins, the wound begins to clot. The blood clotting, while imperfect, attempts to prevent blood loss and begins work on healing damaged blood vessels. Then the inflammation begins, which heats the area around the wound site. This is to rid the wound of bacteria, foreign objects, and smaller damaged tissue.
Mainly, inflammation is used to prevent infections.
Hours after the initial injury, fibroblasts come in to the wound site to proliferate and produce cells that will begin working on closing the wound. The fibroblasts create a new extracellular matrix or ECM. This ECM provides support for new tissue and blood vessels to grow. In simpler terms, this is the part of the process where the wound scabs over for protection and healing.
Maturation and Remodeling
Type III collagen, which was prevalent during proliferation, becomes degraded and is replaced by type I collagen. This begins to change the granulation tissue that formed thanks to the ECM into scar tissue. Eventually, growth and blood flow in the area declines, marking the end of the healing process and a mature scar.
How Stem Cells Get Involved
The natural wound healing process has a set of basic phases to go through, but each phase is complex and depends on a lot of different variables to get through to the end. The patient’s general state of being along with the condition and location of the wound affects how well healing is done.
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The addition of stem cells, in theory, is better than allowing the wound to heal on its own or adding in any other agent to help healing along. Rather than helping in the healing process, stem cells serve as a direct source of new cells which can simply take the place of the destroyed ones. However, because the stem cells are substituting actual skin, we would have to use a specific type of stem cell. There are so many types that we already know of, so picking which one for the specific need is important.
Embryonic & Induced Pluripotent Stem Cells
Embryonic stem cells are the kind found in embryos and placentas, so there are ethical boundaries when using these types of stem cells. They are considered pluripotent, which means they can become any other type of cell and continue life as a new cell. Ergo, they’re the best stem cells to use for almost any case but their origin is uncomfortable for many, to say the least.
Thankfully, we’re able to create similar properties in other stem cells. Induced pluripotent stem cells or iPSCs are engineered from other stem cells to create the same properties as their pluripotent cousins. iPSCs eliminate the ethical problems because they’re adult stem cells taken from adult donors. Again, these stem cells are highly preferred for almost any issue, except when it comes to the patient’s body rejecting the new cells.
Mesenchymal Stem Cells
Mesenchymal stem cells or MSCs are adult stem cells that can self-renew and differentiate. They are often found in bone marrow, nerve tissue, or even the dermis, so there are no ethical issues on their origins. Even better, they have a very rare chance of the patient rejecting the new stem cells. In the end, MSCs are more highly recommended for wound repair than embryonic stem cells or iPSCs despite not being able to turn into any type of cell.
MSCs have already been tested on acute and chronic skin injuries with success. Usually, the inflammation part of the healing process brings up MSCs from bone marrow naturally, but artificially applying them helps the wound on all counts. Patients have noted improvement to the wound site within days of being treated with MSCs, lending to the belief that they are a great resource for regenerative therapy.
New Ways to Heal
We’ve mentioned several times that the wound healing process is extremely complex. Because of the complexity, it can be easy to mess up if any sudden change or disruption occurs at the wound site. Current therapies aren’t always effective, but we already know how those methods work.
Introducing stem cells to the mix will have great rewards for us in the future but is currently risky business. That said, a lot of progress has already been made and none of it is really guess work. The theories are out there, and we’re discovering what does and doesn’t work every day. Soon, we’ll have brand new healing methods that’ll make our current ones obsolete, assuming all goes well. For now, we’ll keep doing what we know and pushing boundaries for something better.
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