Marcella Townsend remembers looking at the kitchen in shock. In the silence after the explosion, before the pain set in, she found herself almost in awe of the crushed stove and collapsed cabinets.
Published at 0:00
Kate Morgan
The New York Times
“It looked like Bigfoot had walked through the counters,” she said.
Following a propane explosion at her mother’s home in Savannah, Georgia, in 2021, Marcella Townsend spent more than six weeks in an induced coma in a burn trauma unit. She had second- and third-degree burns over most of her body, and her face was left unrecognizable.
Looking for a way to help, surgeons turned to a rarely used tool: the human placenta. They carefully applied a thin layer of the donated organ to his face, which M saidme Townsend, was “the best thing they could ever do.” She still has scars from transplants on other parts of her body, but the 47-year-old’s face, she says, “looks exactly like it did before.”
During pregnancy, the placenta forms in the uterus, where it provides the fetus with nutrients and antibodies and protects it from viruses and toxins. Then it follows the baby out of the body, still filled with a host of stem cells, collagen and cytokines that doctors and researchers have realized make it especially useful after birth.
Research has shown that placenta-derived grafts can reduce pain and inflammation, heal burns, prevent scar tissue and adhesions from forming around surgical sites, and even restore vision.
Underutilized
Yet of the approximately 3.5 million placentas delivered each year in the United States, most end up in biowaste disposal bags or hospital incinerators. This situation disconcerts Mme Townsend, who returned to her job as a surgical assistant with a new perspective.
PHOTO KENDRICK BRINSON, THE NEW YORK TIMES
Marcella Townsend
I’m constantly in these hospitals that don’t donate or use placental tissue. I hear the obstetrician say, “I don’t need to send this tissue to pathology or anything; I just throw it away.” I tense up every time.
Marcella Townsend, surgical assistant
Decades ago, the medical community turned away from the use of placentas, in part because of fears over the AIDS epidemic. Today, some doctors and researchers say this change was unwise and that the placenta is an underutilized medical tool, hidden but in plain sight.
As the placenta protects the fetus from the maternal immune system, its tissue is considered immunologically privileged. Although it is technically foreign tissue, placental transplants have been found to not cause an immune response in transplant recipients. Placental tissue also contains proteins and sugars that prompt patients’ cells to multiply rapidly, and grafts have been shown to promote rapid regrowth of skin and tissue.
“We call it a healing factor, but it would be more accurate to say it is a regenerative factor,” explains Dr.r Scheffer Chuei-Goong Tseng, a Miami ophthalmologist who has studied the use of placental transplants to treat eye injuries and diseases for decades. “The scarring is extensive; we can heal while still having scars. But here we are talking about almost scarless healing. »
Great bandages
To make placenta grafts, manufacturers collect placentas free of charge from pre-screened donors. The amniotic membrane, the innermost layer of the placenta that faces the fetus, is peeled off and sterilized. After being cut to a uniform size and shape, the tissue is frozen, dehydrated or freeze-dried. To use it on a patient, doctors unwrap a wrapped slice of membrane and place it over a wound or incision – the graft can be held in place with sutures or, in some cases, a simple bandage.
The Food and Drug Administration allows amniotic membrane grafts to be sold as long as they are “minimally handled” – that is, cleaned, preserved and not altered after being harvested from the placenta – and they are intended to perform the same function in the recipient as in the donor, said an agency spokesperson.
This means that because the amniotic membrane serves as a barrier between the fetus and the mother, doctors can use the grafts as internal or external bandages.
Another use approved by the Food and Drug Administration (FDA) is for the treatment of chronic wounds. Treating these sores can be a matter of life and death for the millions of people who suffer from them.
In such situations, placental transplants appear to be a promising tool, reducing the likelihood of amputation and improving not only the patient’s overall life expectancy, but also the quality of the years remaining to live, explains Dr.r Dennis Orgill, professor of surgery at Harvard Medical School and director of the Wound Care Center at Brigham and Women’s Hospital in Boston.
In a small study of 25 patients with foot wounds, for example, those who were treated with an amnion transplant had their wounds healed by an average of more than 98 percent in six weeks, while the wounds of those that received standard cleaning and dressing grew by almost 2% on average.
“Change the nature of the wound”
Phyllis Thomas, an 83-year-old woman from Carrollton, Missouri, was sure she would lose her left leg to an infected wound that wouldn’t heal after surgery in 2017.
Doctors at the hospital attempted drastic measures to save the limb, including sealing 1,000 immature fly larvae inside and letting them get to work eating what Mme Thomas called it “the poison.” Maggots, combined with antibiotics, brought the infection under control, but to close the wound, they used amniotic membrane grafts. Phyllis Thomas’ leg has completely healed.
PHOTO DAVID ROBERT ELLIOTT, THE NEW YORK TIMES
Doctors used placenta-derived grafts to close the leg wound of Phyllis Thomas, seen here in her home in Carrollton, Missouri.
When placed on difficult-to-heal wounds like M’sme Thomas, the grafts seem to “change the nature of the wound”, explains the Dr David Armstrong, podiatric surgeon and wound care specialist at Keck Medicine at the University of Southern California.
Transplants can trigger what the Dr Armstrong calls it a “histological reboot,” allowing the most damaged tissue to heal.
The Dre Jennifer Tsai, an optometrist in New York, says amniotic membrane grafts are a valuable tool in her practice. In the case of a patient whose eyes were burned by a bottle of bleach that fell from a shelf, the grafts quickly regenerated the cornea.
Beyond treating eyes and wounds, some doctors are using grafts in creative ways. Neurosurgeons have used amniotic membrane grafts to repair the layer of connective tissue surrounding the brain, called the dura, and to prevent the formation of scar tissue that can lead to paralysis after spinal surgery.
A potential recognized by the FDA
The FDA closely follows the broader field of regenerative medicine, which aims to restore tissues and organs damaged by disease or age. Some companies make products from other birth tissues, including umbilical cord blood and amniotic fluid. The FDA has issued consumer alerts about certain products and sent warning letters to manufacturers using ingredients that “have not been adequately studied in clinical trials.”
But when it comes to placenta transplants in particular, the agency spokesperson said the FDA recognizes the potential.
Currently, transplant companies only accept placentas retrieved by elective cesarean section. Bypassing the birth canal reduces exposure to bacteria. C-sections, which account for nearly a third of births in the United States, provide enough placentas to meet current demand.
But experts say this demand could be set to increase. Use of amniotic membrane transplants is growing, albeit slowly, says Dr.r Armstrong, because “medicine is, by nature, conservative.”
This article was originally published in the New York Times.
Read the original article from New York Times (in English, subscription required)
