Table 1.
Different cell types used for tissue-engineered skin substitutes (TESSs) considering clinical studies.
| Human cell type used for TESSs | Ease of isolation | Possibility to differentiate into different cell types | Time required to treat patients | Possibility of immune rejection | Proven Safety | Ethical issues | Proven effectiveness | |
|---|---|---|---|---|---|---|---|---|
| Human adult skin cells | Keratinocytes |
-One or two skin biopsies (3–9 cm2) -Specific conditions for culture (feeder layers or commercial media) |
No | Autologous use: 7–95 days | No | Yes | No | Yes, although with limitations |
| Allogeneic use: 0–24 days | Yes | No | Yes | More clinical studies are required | ||||
| Fibroblasts | -One or two skin biopsies (3–9 cm2) | No | Autologous use: 7–95 days | No | Yes | No | Yes, although with limitations | |
| Allogeneic use: 0–24 days | Yes | Yes | Yes | Before the development of composite skin substitutes were extensively used | ||||
| Melanocytes |
-One or two skin biopsies (3–9 cm2) -Specific conditions for culture (commercial media) -Difficult to isolate |
No | Autologous use: 30–95 days | No | No (risk of cancer) | No | More clinical studies are required | |
| Langerhans cells and Merkel cells |
-Skin biopsies -Difficult to isolate |
No | – | – | – | No | Non-clinical studies using these cells for wound healing | |
| Human stem cells | Skin stem cells |
-Skin biopsies -Difficult to isolate |
Yes (in vitro and in vivo) | – | – | – |
Yes Proliferative capacity of stem cells |
Non-clinical studies using these cells for wound healing |
| Induced pluripotent stem cells | -Any human adult cell | Yes (in vitro and in vivo) | – | – | – |
Yes Proliferative capacity of stem cells Genetic manipulation |
Non-clinical studies using these cells for wound healing | |
| Mesenchymal stem cells |
-Bone marrow: iliac crest injection -Wharton’s Jelly: umbilical cord sample -Adipose tissue: adipose tissue biopsy or liposuction |
Yes (in vitro and in vivo) | 0–28 days |
No for autologous source Yes, for allogeneic source. Although due to their immunomodulatory properties risk is reduce |
Yes |
Yes Proliferative capacity of stem cells Although they have been used (autologous or allogeneic source) for other diseases |
More clinical studies are required |