Auböck J, Irschick E, Romani N, Kompatscher P, Höpfl R, Herold M, Schuler G, Bauer M, Huber C, Fritsch P
Department of Dermatology, University of Innsbruck, Austria.
Transplantation. 1988 Apr;45(4):730-7. doi: 10.1097/00007890-198804000-00013.
Autologous cultured epidermis (CE) grown from small skin biopsies in vitro has been successfully applied for wound grafting in humans. Since it has been reported recently that allogeneic CE might be tolerated as permanent wound cover, we investigated the properties of CE and its use as autologous and allogeneic grafts. Except for some differences, such as the absence of Langerhans cells and the lack of a stratum corneum, CE resembled its natural analogue. Autologous CE applied for grafting of leg ulcers and various surgical skin defects adhered firmly and permanently to the wound bed within 2 weeks, became regularly stratified, and formed a stratum corneum. Langerhans cells gradually entered the grafts; the dermis contained no inflammatory infiltrate. Allogeneic CE unmatched for MHC and blood group antigens used to partially cover tangentially excised third-degree burns, donor sites of split-thickness skin, and a defect after tumor excision initially survived well like the autografts. However, they were completely rejected after 10-22 (mean, 14.5) days, which is 4-5 days later than reported for split-thickness skin allografts. Clinically, rejection presented as "melting" of the graft. (Immuno)histologically, we found a dense mononuclear dermal infiltrate consisting predominantly of activated T cells, vacuolization, and single-cell necrosis of keratinocytes, as well as HLA-DR expression on keratinocytes, and finally separation and lysis of the epidermis. Limiting dilution analysis in 2 out of 4 allograft recipients revealed a considerable increase of circulating donor-specific cytotoxic T cell precursors during graft rejection. We conclude that grafting of allogeneic CE does not lead to permanent but to slightly prolonged graft survival.
从小块皮肤活检组织体外培养的自体培养表皮（CE）已成功应用于人类伤口移植。由于最近有报道称同种异体CE可能作为永久性伤口覆盖物被耐受，我们研究了CE的特性及其作为自体和同种异体移植物的用途。除了一些差异，如缺乏朗格汉斯细胞和角质层缺失外，CE与其天然类似物相似。用于腿部溃疡和各种手术皮肤缺损移植的自体CE在2周内牢固且永久地附着于伤口床，形成规则分层，并形成角质层。朗格汉斯细胞逐渐进入移植物；真皮无炎性浸润。用于部分覆盖切痂的三度烧伤、中厚皮片供皮区和肿瘤切除后缺损的MHC和血型抗原不匹配的同种异体CE，最初像自体移植物一样存活良好。然而，它们在10 - 22（平均14.5）天后被完全排斥，比报道的中厚皮片同种异体移植排斥时间晚4 - 5天。临床上，排斥表现为移植物“融化”。（免疫）组织学上，我们发现真皮密集单核浸润，主要由活化T细胞组成，角质形成细胞空泡化和单细胞坏死，以及角质形成细胞上的HLA - DR表达，最终表皮分离和溶解。4名同种异体移植受者中的2名进行的有限稀释分析显示，在移植物排斥期间循环供体特异性细胞毒性T细胞前体显著增加。我们得出结论，同种异体CE移植不会导致永久性移植存活，但会使移植存活时间略有延长。
