Scars are no longer for life

by Vivienne ParryA genetically engineered drug developed in Manchester could prevent scarring inside and out

Ten years ago, I faced a man with one arm held above his head. He handed me a Stanley knife and asked me to make a cut in the skin under his arm which, very gingerly, and looking away, I did. I hated doing it. This was not some weird psychological experiment but one of the first demonstrations that anti-scarring treatments were possible. The man was Professor Mark Ferguson, of the School of Biological Sciences at Manchester University, and today his pristine underarm bears witness to the success of his treatments for scar-free wound healing, now completing their final clinical trials.
There aren’t many of us who don’t have a scar somewhere that makes us more self-conscious — at least when we don a bikini or swimming trunks. But aesthetics are the least of it. Scarring is a major medical problem following accidents and surgery. Scar tissue can restrict the movement of joints, prevent growth and cause great pain and psychological distress. Straps of internal scar tissue called adhesions, which typically form after surgery to the abdomen, pelvis and chest, stick organs together causing pain and even infertility, if the tugging of adhesions distorts Fallopian tubes. This week, a new study linked infertility with previous Caesarian sections — and scar tissue resulting from the surgery is one the suspected causes.
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The number of hospital readmissions for adhesion-related complications rival the number of operations for heart bypass, hip replacement and appendix. And scarring after eye surgery can cause hazy vision and even blindness.
But there is one very curious thing about scarring that is now forming the basis for new products that could spell the end of unsightly and potentially dangerous scars within the next five years. Experiments have shown that in the early months of pregnancy, all baby mammals (including humans) heal perfectly. But, by adolescence, there is significant scarring, particularly when the wound is to the chest and shoulders.
Why? The answer lies in the body’s healing mechanisms. When the body is wounded, it releases a cocktail of chemicals called transforming growth factors (TGF) to promote skin growth and close the gap. Researchers have found that in embryonic wounds that heal without a scar, one of these chemicals, TGF-Beta 3, is found in high amounts, but two others, TGF-Beta 1 and 2, are found only in very small levels. In adult wounds, however, the reverse is true.
Now both these groups of substances contribute to healing. TGF-Beta 1 and 2 encourage an emergency repair for the hole, with protein fibres being arranged in parallel lines, creating the structure typical of scar tissue. TGF-Beta 3, on the other hand, speeds up the migration of the connective cells that normally make up skin tissue to the wound. At the wound site, they randomly insert themselves amongst collagen fibres, creating a strong basket-weave structure like normal skin.
What Professor Ferguson has found, however, is that even when a wound is major and needs “emergency” healing, there’s no need for the rather crude and unsightly skin structure of scar tissue. The regeneration brought by TGF-Beta 3 works just as well.
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Read abstract
Experimental Manipulation of Transforming Growth Factor-{beta} Isoforms Significantly Affects Adhesion Formation in a Murine Surgical Model.
Gorvy DA, Herrick SE, Shah M, Ferguson MW.