Initial trials of a drug that reduces scar formation have produced encouraging results. Although the substance still has numerous regulatory hurdles to clear, it is the first of its type to be tested on people. If the drug proves successful, it could routinely be used to prevent scarring after surgery or following serious accidents.
"Scarring is a problem that is much more important to patients than it is to doctors," says Mark Ferguson, an expert on skin healing at the University of Manchester, UK, and chief executive of Renovo, the company set up to develop the drug.
Even a skilful performance in the operating theatre can leave a patient with a disfiguring scar that restricts movement. Facial scarring, in particular, can have a profound effect on self-confidence.
The anti-scarring drug consists of a signalling molecule produced during wound healing called transforming growth factor beta 3 (TGFß3). Ferguson found that wounds in mammalian fetuses, which heal without scarring, contain high levels of TGFß3. After birth, mammals produce less TGFß3 when wounded.
This difference may have been an evolutionary trade-off: before we had antiseptics and antibiotics, preventing infection of wounds was far more important than avoiding scarring. The massive inflammatory response that destroys invading bacteria and swiftly closes wounds also slows healing and creates the tangled masses of tissue that form scars.
TGFß3 acts by speeding up cell migration. Ferguson thinks it encourages fibroblasts and keratinocytes, two of the cell types that generate new skin, move more rapidly into the wound site. This allows the skin to regenerate its usual orderly structure before a scar can form.
At a meeting at the Royal Society in London, UK, last week, Ferguson reported results of the first clinical trials of TGFß3. The experiments involved making two separate wounds in volunteers' arms. One wound was injected with the drug while the other was injected with a placebo. Ferguson says the final product might be given as a cream or injected into the bloodstream.
To date, the drug has been tried on just over 300 volunteers. It does not always prevent scarring, Ferguson says, but it does reduce it. And it also dramatically speeds up healing. Some wounds took around seven days to heal without the drug but only two days with it. Adjusting the size and timing of the dose should produce even better results, he thinks, although it will probably work better in some people than others.
Surprisingly, the results were most impressive in people over 60 years old. Some of the wounds healed so well the researchers could not find them.
Eye surgeons already use a range of drugs to reduce scarring of the eye. Most of these are not suitable for use on the skin, but doctors hope at least one under development will work anywhere in the body (New Scientist print edition, 21 June 2003).
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