The Effect of an Autologous Protein-Based Topical Serum on Cutaneous Burns

December 2022 | Volume 21 | Issue 12 | 1330 | Copyright © December 2022


Published online December 5, 2022

doi:10.36849/JDD.6763

Eduardo Anitua MD DDS PhDa,b, Zuriñe Martinez MDc, Itziar Arrue MDc, Ricardo Gonzalez MDc, Roberto Tierno PhDa,b, Adrian García MSc,d, Felipe Goñi PhDd, Ander Pino PhDa,b

aUniversity Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain
bBiotechnology Institute (BTI), Vitoria, Spain
cUniversity Hospital of Araba (HUA), Vitoria, Spain
dGAIKER Technology Centre. Basque Research and Technology Alliance (BRTA), Zamudio, Spain

Abstract
Background: Burns are skin lesions that can be life-threatening. Platelet-rich plasma (PRP) is growing as an effective alternative for the management of burns. The objective of this study was to assess the use of a storable topical serum based on plasma rich in growth factors (PRGF) in promoting burn wound healing, called Endoret-Serum (ES).
Materials and Methods: 3D skin models were used to assess thermal burn injury. Extracellular matrix remodeling, tissue damage, and metabolic activity of explants were analyzed, and a histomorphometric examination was carried out. Silver sulfadiazine cream (SC) was used as control ointment for burn management. Three patients suffering from skin burns were also treated with ES and clinically assessed.
Results: Endoret-Serum was based on an enriched platelet fraction with neutral pH and containing a high load of growth factors. Both ES and SC reduced tissue damage after burn, with ES being more effective. ES treatment maintained the metabolic activity of explants at a healthy level, and increased collagen and elastin deposition. Both treatments preserved the cutaneous connective tissue and induced newly synthesized matrix, with ES being more effective. Both treatments induced an intense collagenization, but ES showed better results as it restored the basal layer network with reduced signs of fibrosis. ES decreased the apoptotic cell number. Patients suffering from skin burns showed complete healing after ES treatment.
Conclusion: Endoret-Serum might promote cutaneous healing and may be useful for accelerating the regeneration of skin burns.

J Drugs Dermatol. 2022;21(12):1330-1339. doi:10.36849/JDD.6763

INTRODUCTION

Burns can be either minor medical problems or potentially life-threatening emergencies, and their treatment depends on the location and severity of the injury.1 Although minor burns can be treated on an outpatient basis, some burn injuries require hospital admission, specialized medical treatment, and months of comprehensive care and follow up.2 Sometimes an effective treatment is a significant challenge for healthcare specialists and some approaches involve clinically invasive procedures or incur a significant economic burden to public health systems.3

Platelet-based autologous products such as platelet rich plasma (PRP) are gaining the attention of clinicians and researchers.4 Several studies demonstrate that intradermal PRP injections and PRP-derived fibrin clot application aid in cutaneous repair and re-epithelization after burns.5-10 Burns of different etiology have been treated with PRP alone or in combination with other procedures, and results indicate a significant recovery of the structural and functional integrity of skin.11 However, there are certain limitations of the PRP technique, such as the autologous blood volume that must be obtained to prepare sufficient therapeutic product needed for extensive burn coverage. In addition, PRP treatment follows repeated sessions overtime on a weekly basis; hence the patient is subjected to numerous blood extractions and interventions in the hospital setting.12 This reduces the quality of life of the patient and presents cumulative costs for health systems. Another limitation is the localized use of PRP since it is intradermally injected or placed as a small fibrin clot over the burn bed, which reduces the bioavailability of growth factors. In fact, as burns are usually painful lesions, invasive injections and repeated surface manipulation may provoke a great disturbance in the patient.

Plasma rich in growth factors technology (PRGF) is a specific type of PRP.13 The efficacy and safety of PRGF has been demonstrated in a multitude of clinical trials in various