Tissue Engineering von Haut – von der Spalthaut zum gezüchteten Hauttransplantat?

Zusammenfassung

Heutzutage sind Spalt- oder Vollhauttransplantate der Goldstandard in der Behandlung von Substanzdefekten der Haut, deren Erfolge in der Therapie von zum Beispiel Schwerstverbrannten erkennbar sind. Allerdings haben Schwerstverbrannte mit mehr als 50% verbrannter Körperoberfläche nur begrenzte Spenderareale. Des Weiteren haben Hauttransplantate auf chronischen Wunden schlechtere Einheilungsraten als bei Verbrennungspatienten, was z. B. durch Begleiterkrankungen oder vermehrte lokale Infektionen bedingt sein kann. Aufgrund oben genannter Limitationen ist der Bedarf an kostendeckenden, benutzerfreundlichen synthetischen oder gezüchteten Hautersatzmaterialien, die sowohl für akute und chronische Wunden geeignet sind, als auch bei Problempatienten mit Begleiterkrankungen zur Anwendung kommen können, vorhanden. In den letzten 30 Jahren sind eine Vielzahl an unterschiedlichen biologischen und synthetischen Hautersatzmatrizes sowie Produkte mit humanen patienteneigenen Zellen auf den Markt gekommen, an deren Weiterentwicklung ständig gearbeitet wird. Eine Möglichkeit ist die Züchtung eines Hautersatzes in vitro, der sich nach Transplantation in das Wundbett integrieren soll. Eine andere Alternative stellt die Herstellung einer biokompatiblen und bioresorbierbaren Matrix dar, die die ortständigen Zellen rekrutieren kann und zur narbenlosen Heilung anregt. Allerdings können die heute verfügbaren Hautersatzprodukte die Spalt- oder Vollhauttransplantation noch nicht vollständig ersetzen, da noch immer Einschränkungen wie unzureichende Einheilung und/oder mechanische Stabilität des Hautersatzes oder ein Fehlen von differenzierten Strukturen auftreten. An dem Ziel einen Hautersatz herzustellen, der alle funktionellen und strukturellen Fähigkeiten der gesunden menschlichen Haut mit sich bringt und diese vollständig ersetzen kann, wird weiter gearbeitet. Dieser Artikel gibt einen Überblick über die heute verfügbaren Lösungsansätze und Produkte im Feld des Tissue Engineerings von Haut.

Abstract

Today split or full skin grafts are still the gold standard in the treatment of substance defects of the skin. Such results can be seen, for example, in the therapy for burn patients. However, in patients with more than 50% burned skin area, donor sites are limited. Likewise in chronic wound patients inferior take rates of skin grafts as compared to burn wounds are observed. This may be attributed, for example, to accompanying or underlying chronic diseases or a higher rate of local infections. These phenomena also lead to a lack of availability of transplantable skin grafts. Hence the need for cost effective and user friendly synthetic or engineered skin grafts, which can serve for acute and chronic wounds and which can be also used in critically ill patients, is at hand. During the last 30 years a huge number of biological and synthetic skin graft materials and products based on the patient's own cells were launched on the market. Researchers and clinicians are constantly working on further improvements. One possibility is the engineering of skin grafts in vitro, which have to be integrated into the wound bed after transplantation. Another approach is the fabrication of biocompatible and bioresorbable matrices, which can attract host cells and stimulate a wound-healing process without scars. However, the skin graft materials available today cannot yet replace split or full skin grafts completely because of their inherent limitations such as insufficient take rates and/or the lack of mechanical stability and differentiated structures of the grafted artificial skin. Thus researchers in the field of skin tissue engineering are still working on the final goal of developing a skin graft which has all the features of healthy human skin and is capable of replacing human skin completely. This article gives on overview of the currently available solutions and products in the field of skin tissue engineering.

Schlüsselwörter

Haut Tissue Engineering - Hautersatz - Keratinozyten - kultivierte autologe Epidermis

Key words

skin tissue engineering - skin replacement - keratinocytes - cultured epidermal autografts

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