Avtor/Urednik		Planinšek, Franci; Arnež, M Zoran
Naslov		Zdravljenje obsežnih opeklin in nekaterih drugih kožnih bolezni s keratinociti vzgojenimi "in vitro"
Prevedeni naslov		Treatment of severe burns and some other skin diseases with keratinocytes cultured "in vitro"
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 65, št. 4-5
Leto izdaje		1996
Obseg		str. 269-72
Jezik		slo
Abstrakt		Background. Early excision of full-thickness burns and grafting with avutologous skin has decreased the mortality rate of patients suffering from large burn wounds. However, burns covering more than 60% of total body surface area have a very high mortality rate which is directly related to the limited availability of donor sites for autologous split-thickness grafts. Methods. The key to survival for today's burn patients depends on expedient closure of the wound after excision of the burned tissue. The immediate attainability of unlimited of vital skin transplants with complete graft "take" and durable skin which woud allow us to cover the wound in one single operation, wounld be the ideal. Despite the crucial role of epithelium in maintaining the stability of the interior milieu, stratified epithelia represents one of the simplest organs of the human body. In the case of the epidermis, which is probably the most complex statified epithelium, it is mainly composed of a single cell type - the keratinocyte. Other cells the melanocytes, Langerhans cells and Merkel cells, which all have very important functions, inhabit the epidemis and do not directly participate in the organisation of this tissue. Moreover, the epidermis is not directly vascularized but receives nutrients from the blood vessels of the dermis. These properties allowed the possibility of the reconstruction "in vitro" of a human organ. Keratinocytes in culture form colonies which are the progeny of a single cell. The epidermis is composed of cells with a different growth potential. The ratio of holoclonic- and paroclonic cells is decreased in senium. Also metabolic and morphologic changes are expected. All this is more or less the result of the programmed changes of endogenous regulatory mechanisms. Dermis and subepithelial connective tissue have a permissive and not an inductive role in epithelial gene expression. (Truncated.)
Izvleček		Izhodišča. Zmanjšanje umrljivosti bolnikov z obsežnimi opeklinami omogoča hitra zagotovitev trajnega kožnega pokrova. V idealnem primeru naj bi takoj po opeklini izrezali vso mrtvino in nastalo rano sočasno prekrili z lastnimi kožnimi presadki, ki bi se v celoti prijeli in zagotovili trajen kožni pokrov. Metode. Kljub pomembni vlogi epidermisa pri vzdrževanju stabilnosti notranjega okolja predstavlja ploščatocelični epitelij enega najpreprostejših organov človeškega telesa. Epidemis, ki je med ploščatoceličnimi epiteliji najbolj zapleten, je zgrajen pretežno iz ene same vrste celic - keratinocitov. Poleg keratinocitov najdemo v epidermisu še: melanocite, Langerhansove celice in Merkelove celice, ki imajo pomembno funkcijo, niso pa pomembne za organizacijo in izgradnjo epidermisa. Epidermis se prehranjuje "in vivo" z difuzijo hraniv iz dermalnega žilnega pleteža. Vse te lastnosti omogočajo gojitev epidermisa tudi "in vitro". Keratinociti tvorijo v gojišču kolonije, ki nastanejo s proliferacijo ene same celice. Epidermis sestavljajo celice z različnim rastnim potencialom. Staranje povzroči zmanjšanje števila holoklonskih keratinocitov, narašča pa število paro- in meroklonskih. S starostjo se spremeni tudi vzorec zastopanosti posameznih klonskih tipov keratinocitov v epidermisu. Pride tudi do metaboličnih in morfoloških sprememb, ki nastanejo zaradi načrtovanih sprememb endogenih regulacijskih mehanizmov. Vloga dermisa pri ekspresiji epiteljskih genov je permisivna in ne induktivna. Zaključki. Bolniki z zelo obsežnimi opeklinami nimajo dovolj neopečene kože za odvzem potrebne količine lastnih kožnih presadkov. Laboratorijska gojitev kože je tehnično zapletena in draga. "Prijetje" tako vzgojene kože še vedno ne dosega uspešnosti prijetja lastnih presadkov delne debeline kože (avtotransplantatov). Kljub temu je uvedba novega načina zdravljenja omogočila preživetje tudi kritično opečenim bolnikom.
Deskriptorji		BURNS SKIN TRANSPLANTATION KERATINOCYTES CELLS, CULTURED