Fighting for a world without scars

Every scar tells a story. Sometimes it can be dramatic, dealing with complicated injuries, surgeries and chronic diseases. Dr. Yuval Rinkevich would rather like to tell stories of regeneration, the healing of wounds on skin or organs without much traces left. To get there, Yuval and his team at Helmholtz Zentrum München look at every single aspect of wound healing in mammals whether embryos or adults. In an interview Yuval talks about his vision of a world without scars.

Scars form as part of the body’s healing process following an injury. Why wouldn’t we want that to happen?
Yuval: It’s true that scars can save lives and we need scars to quickly close open wounds – whether that is after we cut our finger with a knife or after a severe injury because a fire accident. However, scar tissue is only partially functional – the more extensive the scar, the lower the function. For example, fire victims can no longer move their arms or fingers properly because scar tissue prevents them from doing so. When you think about internal scarring on organs, this can lead to the failure of the entire organ and make organ transplantation necessary. A solution to this problem would be a tremendous relief. In surgery, the absence of scarring would lead to fewer complications and a faster procedure – maybe even to new types of surgery which have not been possible so far due to the impact of scarring.

Is it only about scar prevention or would it also be possible to reverse scars in people with existent scarring?
Yuval: Hopefully one day it will be! It would be very exciting if, for example, the sensitivity of scar tissue could be brought back into harmony with the surrounding skin. Like this, we could help people with severe skin scarring re-gain their tactile sense. What we focus on at the moment is to find the right balance between rapid wound closure and tissue regeneration. Abdominal adhesions are one of our key research areas. Most of the times, these adhesions, which consist of bands of fibrous scar tissue, form after surgery and can cause organs in the abdomen to stick together. This restricts the movement of organs and, for example, are the main cause of female infertility and postsurgical complications. Abdominal surgeries therefore would benefit tremendously from scar prevention and make them much faster! Our clinical partners regularly report hours of delay in abdominal surgery due to the physical removal of abdominal adhesions. A solution would dramatically simplify not only the lives of patients but also those of surgeons.

How could we possibly prevent scars to form in the first place?
Yuval: Once we fully understand how scars form naturally, we might be able to manipulate this process and tune it down. I can give you an example: We know that scars form when fibroblasts, a type of cell of connective tissue, reach wounded skin. When we are young, these fibroblasts have a regenerative function. Thus, wounds heal much better. When we get older, however, fibroblasts form more scars. Already two years ago, we have succeeded in transplanting fibroblasts of very young mice into the wounds of older mice. The result: significantly less scarring. If we could apply this to the human, this would be a breakthrough for regenerative medicine – not only for scarring but also for chronic conditions such as lung fibrosis. The more we learn about scarring, the better. The fact that we have recently discovered the anatomic origin of fibroblasts, the fascia, opens up new possibilities and will help us tremendously in achieving our goal.

Learn more:
Fischer et al., 2020: Post-surgical adhesions are triggered by calcium-dependent membrane bridges between mesothelial surfaces. Nature Communications, DOI: 10.1038/s41467-020-16893-3
Correa-Gallegos et al., 2019: Fascia is a repository of mobile scar tissue. Nature, DOI: 10.1038/s41586-019-1794-y


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