Abstract
Oral mucosa has been highlighted as a suitable source of epidermal cells due to its intrinsic characteristics such as its higher proliferation rate and its obtainability. Diabetic ulcers have a worldwide prevalence that is variable (1%-11%), meanwhile treatment of this has been proven ineffective. Tissue-engineered skin plays an important role in wound care focusing on strategies such autologous dermal-epidermal substitutes. Objective The aim of this study was to obtain autologous dermal-epidermal skin substitutes from oral mucosa from diabetic subjects as a first step towards a possible clinical application for cases of diabetic foot.Material and Methods Oral mucosa was obtained from diabetic and healthy subjects (n=20 per group). Epidermal cells were isolated and cultured using autologous fibrin to develop dermal-epidermal in vitro substitutes by the air-liquid technique with autologous human serum as a supplement media. Substitutes were immunocharacterized with collagen IV and cytokeratin 5-14 as specific markers. A Student´s t- test was performed to assess the differences between both groups.Results It was possible to isolate epidermal cells from the oral mucosa of diabetic and healthy subjects and develop autologous dermal-epidermal skin substitutes using autologous serum as a supplement. Differences in the expression of specific markers were observed and the cytokeratin 5-14 expression was lower in the diabetic substitutes, and the collagen IV expression was higher in the diabetic substitutes when compared with the healthy group, showing a significant difference.Conclusion Cells from oral mucosa could be an alternative and less invasive source for skin substitutes and wound healing. A difference in collagen production of diabetic cells suggests diabetic substitutes could improve diabetic wound healing. More research is needed to determine the crosstalk between components of these skin substitutes and damaged tissues.
Highlights
Oral mucosa has been highlighted as a suitable source of epidermal cells due to its intrinsic characteristics such as its higher proliferation rate and its obtainability
Oral mucosa has been highlighted as a viable alternative source of epidermal cells, due to its easy preparation and suitable features, such as higher cell proliferation rates, lower terminal cell differentiation degrees and an increased biological activity compared with epidermal keratinocytes22
The aim of the present study was to obtain an autologous dermal-epidermal skin substitute using oral mucosa tissue from diabetic subjects with a PHDVXUDEOHLPPXQRÀXRUHVFHQFHFKDUDFWHUL]DWLRQDVD ¿UVWVWHSWRSHUIHFWLQJWKHGHYHORSPHQWWHFKQLTXHZLWK the main focus of future possible clinical applications on the treatment of diabetic foot ulcers
Summary
Oral mucosa has been highlighted as a suitable source of epidermal cells due to its intrinsic characteristics such as its higher proliferation rate and its obtainability. Oral mucosa has been highlighted as a viable alternative source of epidermal cells, due to its easy preparation and suitable features, such as higher cell proliferation rates, lower terminal cell differentiation degrees and an increased biological activity compared with epidermal keratinocytes22 This tissue has the advantage that its harvesting produces less disability, and provides better aesthetic outcomes. The aim of the present study was to obtain an autologous dermal-epidermal skin substitute using oral mucosa tissue from diabetic subjects with a PHDVXUDEOHLPPXQRÀXRUHVFHQFHFKDUDFWHUL]DWLRQDVD ¿UVWVWHSWRSHUIHFWLQJWKHGHYHORSPHQWWHFKQLTXHZLWK the main focus of future possible clinical applications on the treatment of diabetic foot ulcers. It SURSRVHVIRUWKH¿UVWWLPHPDLQWDLQLQJWKLVVXEVWLWXWH using autologous serum, avoiding the use of animal products and promoting the development of the construct
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