Case report: Long-term follow-up of a large full-thickness skin defect treated with a photosynthetic scaffold for dermal regeneration

Abstract

It is broadly described that almost every step of the regeneration process requires proper levels of oxygen supply; however, due to the vascular disruption in wounds, oxygen availability is reduced, being detrimental to the regeneration process. Therefore, the development of novel biomaterials combined with improved clinical procedures to promote wound oxygenation is an active field of research in regenerative medicine. This case report derives from a cohort of patients enrolled in a previously published ongoing phase I clinical trial (NCT03960164), to assess safety of photosynthetic scaffolds for the treatment of full skin defects. Here, we present a 56 year old patient, with a scar contracture in the cubital fossa, which impaired the elbow extension significantly affecting her quality of life. As part of the treatment, the scar contracture was removed, and the full-thickness wound generated was surgically covered with a photosynthetic scaffold for dermal regeneration, which was illuminated to promote local oxygen production. Then, in a second procedure, an autograft was implanted on top of the scaffold and the patient’s progress was followed for up to 17 months. Successful outcome of the whole procedure was measured as improvement in functionality, clinical appearance, and self-perception of the treated area. This case report underscores the long-term safety and applicability of photosynthetic scaffolds for dermal regeneration and their stable compatibility with other surgical procedures such as autograft application. Moreover, this report also shows the ability to further improve the clinical outcome of this procedure by means of dermal vacuum massage therapy and, more importantly, shows an overall long-term improvement in patient´s quality of life, supporting the translation of photosynthetic therapies into human patients.

Development of a Hibernation‐Inspired Preservation Strategy to Enhance the Clinical Translation of Photosynthetic Biomaterials

“…A previously described photosynthetic biomaterial was chosen for this study due to its in vitro and in vivo validations, [10,12] as well as its ongoing evaluation in a human phase I clinical trial. [21,22] This biomaterial is composed of a collagenglycosaminoglycan matrix, fibrin glue, and C. reinhardtii as a photosynthetic oxygen generator. This microalga has been used as model for studying cold stress adaptation in plants, [32] and abundant literature describes changes in cell proliferation, [35] oxidative status, [36] and photosynthetic rate [33,37] induced by low temperatures, which can be potentially recovered after restoring optimal culture conditions.…”

“…Furthermore, an ongoing Phase I clinical trial (NCT03960164) has shown the safety of implanting photosynthetic scaffolds containing the microalgae Chlamydomonas reinhardtii in human full‐thickness skin wounds. [ 21,22 ]…”

“…Furthermore, an ongoing Phase I clinical trial (NCT03960164) has shown the safety of implanting photosynthetic scaffolds containing the microalgae Chlamydomonas reinhardtii in human full-thickness skin wounds. [21,22] Although the use of photosynthetic biomaterials is promising and could have a tremendous impact in several fields of medicine, their potential use is currently highly limited by the intrinsic low half-life of the photosynthetic microorganisms in the materials, which require specific and strictly controlled culture and transport conditions to maintain their viability until clinical use. This limitation also applies to other living engineered constructs, such as fresh cellularized skin substitutes, which have shelf-lives of under 1 week, [23] limiting their applicability and commercialization.…”

Recent Advances in Living Algae Seeding Wound Dressing: Focusing on Diabetic Chronic Wound Healing

“…Reproduced under the terms of CC BY-NC license. [109,126] Copyright 2021, the Authors, published by Frontiers. Reproduced under the terms of CC BY-NC license.…”

“…In short, the presence of microalgae allowed key regenerative processes, such as cell migration, ECM deposition, and neovascularization, [ 109 ] while one follow‐up patient had a highly positive perception on the survey, i.e., a 6.6‐fold improvement in appearance, a 3.1‐fold reduction in symptoms, and a psychosocial perception score from 0 (worst) to 100 (best). [ 126 ] This will greatly facilitate the translation of photosynthetic biomaterials and therapies into the clinical setting, developing novel concept wound care strategies that may have tremendous translational applications with implications well beyond tissue engineering and regeneration ( Figure ).…”