Proposal

SCARS - Research that improves the lives of people with severe damage or disfigurement…

About Blond McIndoe (BMRF)

BMRF is a not-for-profit centre for regenerative medicine. Our research supports

people who have experienced life-changing damage or disfigurement as a result of

serious burns, major soft tissue trauma or disease. Our programmes are focused on

advancing techniques and technologies that aim to repair, restore and regenerate

tissue and reduce debilitating scarring in order to improve function, form and comfort.

Our co-location and strategic alliance with Clinicians at The Queen Victoria Hospital

(QVH) and Horder Healthcare here on the East Grinstead campus underpins our

collective aspiration to deliver patient oriented innovations.

Our history

We were founded in the name of surgical

pioneer Sir Archibald McIndoe who treated

many injured airmen during WW2, known as

The Guinea Pigs, and foresaw the need to

advance the science of healing in order to

benefit future generations. This pioneering

spirit continued over the years leading to

many significant developments in areas such

as graft rejection research, the use of amnion

in wound healing and improved

understanding in nerve repair. Some of our

more recent innovations have included the

development of sprayed skin cells for

children’s burns and new biomaterials

designed to reconstruct tissue damaged by

high energy trauma, such as blast injuries.

Timeline of Innovation

What is scarring?

Scarring occurs after trauma, injury or surgery to any tissue or organ in the body. Scars form as a consequence of a repair mechanism that replaces the missing normal tissue with an extracellular matrix filler. In man and animals, scarring causes major medical problems as shown in the table below.

Visible scarring can have a profound and adverse emotional and psychological impact.

Additionally, thickening of the skin and loss of pliability caused by contracting scar

tissue can severely limit movement and lead to significant disability. Scars can cause

pain and itching which can lead to further distress. Multiple operations are often

required to release scars to allow movement and surgery may also be required to

reconstruct the skin to improve their physical appearance. Scarring is a significant

clinical problem that affects millions of people each year but has no reliable effective

treatment or cure.

Location of Scar Potential Consequence Skin Scars restrict movement, often requiring repeated surgeries over a number of

years. They can cause pain and itch. Scars can be noticeably different from surrounding skin, becoming discoloured and raised in appearance. They often have a psychological impact upon many patients, affecting daily life.

Eye Scarring in the eye causes pain, sensitivity to light, blurred or hazy vision and can lead to blindness.

Nervous system Scarring in nerves causes pain and numbness. It can prevent neuronal reconnections and inhibit nerve function.

Gastrointestinal and reproductive organs

Strictures and adhesions caused by scarring can lead to internal pain, restricted movement, infertility or failure of bowel function.

Ligaments and tendons Scarring causes restricted movement, decreased strength in ligaments, tendons and limbs by shortening muscles. This can affect joints, the surrounding nerves, causing pain and ultimately preventing normal function.

Internal organs Scarring can affect internal organs such as the liver, kidney, lungs and heart. The functioning of these vital organs can be severely restricted by scarring, preventing vital functions and can become life threatening.

How many people are affected in the UK?

In 2015 just under 3 million people presented with wound injuries. We know that a

high proportion of these injuries will result in significant scarring that will require life-

long interventions. For patients, the scarring and loss of function associated with

injuries can cause significant loss of quality of life. For healthcare providers, the effects

of scarring result in long-term patient care resulting in an estimated £5.3billion spend

for the NHS. To provide some context of the burden these

injuries have on the NHS, the current annual spend on

managing obesity is estimated to be £5.0 billion.

According to The Mattson Jack Group, an independent

research group, the US commercial market for reduction

of scarring in the skin is valued at approximately US$4

billion a year. There are 41.8 million surgical procedures to

the skin each year in Europe and 70 million procedures

annually in the United States involving wounds, which

could benefit from an intervention that improves the

appearance of the scar.

Our work to improve scarring

Scars occur inside and outside of the body. The skin represents the most frequently

damaged tissue and is therefore the most accessible model for studying how scars are

formed. Understanding the molecular composition of a scar, how it evolves and

responds to different interventions will enable us to develop innovative approaches to

stop the formation of fibrotic tissue and ultimately achieve scar-free healing. As a

model system, this will also improve our understanding of internal fibroses known to

cause damage to the liver, lungs and kidneys.

Project Funding – Scar Biobank

The Scar BioBank programme is a

collaboration between BMRF, The Queen

Victoria Hospital and Horder Healthcare. All

three organisations are based on the East

Grinstead Campus.

We plan to create a collection of skin scar

tissue that will assist research in

understanding processes and therapies that

lead to scar free healing. As a resource, the scar tissue collection will assist

research in understanding processes and therapies that lead to scar free healing. It is

anticipated that, in time, this resource will be expanded to build a scar biobank that, in

addition, will support other groups in the scientific research community.

“More and more research is needed- accidents will continue to happen” Amanda Redman Actress, Patron, and Burn Survivor

“The availability of patient-consented surplus tissues accessible from the campus hospitals, QVH & Horder, makes the preservation and archiving of tissues samples for future research easily accessible and achievable. The close working relationships between clinicians and scientists help to jointly realise our ambition to achieve scar free healing.” Tony Metcalfe, Professor of Wound Healing & Director of Research, Blond McIndoe

Ethical approval from The Regional Ethics Committee for this study has been received.

Study participants will be patients with existing scars of the skin undergoing surgical

revision or reconstructive surgery. The criteria for inclusion in the study will be that the

participant is willing and able to give informed consent to take part in the study, has a

scar which can be revised with surgery and is male or female, aged 18 years or above.

As scarring has no reliable

effective treatment or cure, the

potential to reduce the impact of

scarring on the patient exists

through the development of novel

materials, cell therapies and

medicines. However to

understand how these materials

should be developed, a better

understanding of the molecules

and proteins (biomarkers)

involved in scarring is necessary.

Knowing the role of key molecules,

proteins and processes involved

during scarring will enable

innovative approaches to be

harnessed, perhaps enhancing the

body’s own regenerative

processes which have become redundant because of the drive for the organism to heal

a wound, resulting in a scar.

Wider Collaborations

Further operational input, oversight and guidance will be provided by a steering

committee comprising senior members of staff from BMRF, QVH and Horder with

“Scarring, which encompasses the life threatening internal fibrosis associated with many diseases, remains an enormous challenge but with leadership, collaboration and support it can be addressed.” Professor Maggie Dallman Chair, Scar Free Advisory Group, Associate Provost (Academic Partnerships) and Professor of Immunology, Imperial College

The Scar Free Foundation, Imperial College

London, University of Birmingham and The

Queen Elizabeth Hospital, Birmingham have

expressed an interest in collaborating on this

project. It also has the support of the Research

Specialist Interest Group of the British Burns

Association.

relevant expertise, derived from the partner organisations. The committee will meet

regularly to organise delivery and set-up of the collection, identify and overcome

problems as they arise, and actively identify opportunities for collaboration and

funding. They will also be responsible for monitoring and evaluating the impact of the

collection.

How can you help?

The development of this Scar Biobank has

the potential to provide a repository of

tissue, knowledge and learning that will

advance scarring research both locally,

nationally and internationally. We have

obtained the required ethical approval,

launched the study at the campus hospital

sites and begun sample collection. Our

strategy is aligned with the key regenerative medicine university groups,

clinical partners and the Scar Free Foundation who are leading on the quest to ‘put an

end to scarring within a generation’.

We would be grateful for your consideration in

supporting us at this early stage in order to help us

initiate and underpin the collection development. We

would be pleased to present this project or provide

further information. A budget for the initial phase of

development of the Scar Biobank is attached for your

consideration.

Thank you for your consideration.

For further information please contact:

Maxine Smeaton

Chief Executive

maxine.smeaton@blondmcindoe.org

Professor Tony Metcalfe

Director of Research

tony.metcalfe@blondmcindoe.org

“I think it’s the three way partnership between the patient, surgeons and people behind the scenes doing the research which helps us to heal better, quicker and ease the pain.” Mike, Burns Survivor

“ Working with patients, and the scientists creates an environment which makes you think that bit further, and makes you want to stretch things” Mr Baljit Dheansa, Lead Consultant Burns & Plastic Surgeon, QVH