One of the many victims of a fire in a Taiwan waterpark last year was an 18 year old Singaporean who suffered severe burns on 80 per cent of her body. She had a one-in-five chance of survival.
Over weeks, she went through nine skin grafts in SGH to treat her extensive wounds while skin cells from her scalp were taken to be grown in the lab into grafts to provide permanent coverage. It was a tumultuous journey, but she is now free of wounds, apart from some scars and tender spots.
Growing skin cells in the lab to graft onto burn victims like her would not have been possible if not for a game-changing discovery in the 1970s by Harvard physician Professor Howard Green, the founding father of cultured stem cell research and a pioneer in skin regeneration.
Stem cell researcher and regenerative medicine scientist Professor Yann Barrandon, was a postdoctoral research fellow of Prof Green and he played an instrumental role in the setup of the SGH Skin Bank and Skin Culture Laboratory in 1991.
Passionate and committed to breaking new grounds in stem cell dynamics, Prof Barrandon has been travelling to Singapore over the last few decades to provide advice on developing and improving the skin culture expertise at the SGH Burns Centre.
Each year, more than 11 million people worldwide suffer from severe burns and need skin grafts.
In October last year, Prof Barrandon was conferred the Lee Seng Teik and Lee Hoo Leng Professorship in Plastic Surgery and Regenerative Medicine to further the impact of his distinguished work in the SingHealth Duke-NUS Academic Medical Centre.
Prof Barrandon, a world-renowned pioneer of regenerative medicine himself, is focused on researching into bench-to-bedside treatments of burns and skin diseases such as epidermolysis bullosa – a rare disorder that causes the skin to be extremely fragile.
A long-term collaborator with the SGH Department of Plastic, Reconstructive and Aesthetic Surgery, he has also trained Singaporean scientists in his Paris and Lausanne laboratories. His goal is to keep the flame of curiosity burning in advancing the use of cultured cells for skin grafts and other life-saving treatments, both in Europe and Asia.
Dr Alvin Chua, a Clinical Scientist at SGH, is one of the scientists who has passed through Prof Barrandon’s laboratories. As Deputy Head of the Skin Bank Unit, Dr Chua works with Prof Barrandon to drive cutting-edge developments for better skin graft culture and transplantation. It has been a fulfilling journey, with a recent success of isolating a stem cell marker that helped produce thicker and healthier skin grafts in the lab.
“I have a very good relationship with the surgeons here and it is based on trust and respect, which are very important values in clinical research,” Prof Barrandon said, describing the close connection between the collaborative laboratories in Switzerland and Singapore. “Alvin is part of a large family and we have very strong bonds because we share the same vision.”
Currently, Prof Barrandon and Dr Chua are researching into the use of different sources of stem cells for wound healing applications and improving current skin culture technique for therapeutic purposes. One of the published research projects demonstrated the potential for human hair follicle stem cells to enhance wound healing in diabetic mice.
The team in Singapore has also produced a new artificial network of molecules that could support proliferation of outer skin cells. This has great potential for use in engineering future skin grafts and brings even more hope for the recovery of burns patients.
"Seeing life in the eyes of the patient is the ultimate goal of our pursuit of science.”
- Prof Yann Barrandon
Dr Chua credits these advancements to Prof Barrandon’s mentorship. “Many laboratories can culture cells, but it is not easy to have a robust culture system which can maintain the regenerative properties of these cells  which can repair severe defects on the body. The system we have came from Prof Howard Green’s technology, and was advanced by Yann’s laboratory,” Dr Chua explained. “I had to go to Yann’s lab to re-learn the system, and optimise it back [at SGH].”
Dr Chua highlighted that the value of advancing skin graft research will go beyond just treating severe burns. “Skin culture technology is already being utilised in healing complex or chronic wounds on patients with co-morbidities such as Thalassemia Major, Hepatitis C and diabetes,” he explained.
Each year, more than 11 million people worldwide suffer from severe burns and need skin grafts. Translational research over the years has resulted in the tissue engineering of the epidermis and dermis layers, the two major layers of the skin. The future holds the potential to create the skin’s full structure, including hair follicles, sebaceous glands and sweat glands, for therapeutic use.
In summing the relevance of his research focus, Prof Barrandon highlighted a sobering reminder that burns can happen to anyone. “It doesn’t matter whether you are a child or a grandfather, we all run the risk of getting burnt. Often, burns can happen right at home,” he said.
“We will only have a chance at improving things if we continue to do the work. Seeing patients recover is very important to me, because seeing life in the eyes of the patient is the ultimate goal of our pursuit of science.”