The Current - Using placentas to heal complex wounds

Episode Date: October 9, 2024

A Toronto hospital is using human placentas to treat complex burns and wounds. We look at how it works — and why doctors are urging women to donate rather than dump the organ.

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On Drugs is available now wherever you get your podcasts. This is a CBC Podcast. Hello, I'm Matt Galloway and this is The Current Podcast. The standard life cycle of a human placenta goes something like this. Forms in the uterus during pregnancy where it helps nourish and protect the fetus, follows the baby from the body, and then along with other birth tissue, it usually ends up being discarded as medical waste. Doctors and researchers are realizing that placenta tissue can actually be useful after birth and have a second life in aiding the healing of complex burns and wounds. Mount Sinai Hospital in Toronto is the first hospital in Ontario to begin using the treatment.

Bauram Sukhu is director of Mount Sinai Allograft Technologies at Sinai Health. Bauram, good morning. Good morning, Matt. What is it that makes human placenta good at promoting healing in a wound? at promoting healing in a wound? This tissue that would normally be discarded has a set of amazing properties. Not only does it serve as a physical barrier, it contains a whole host of growth factors.

It allows for new cells to come in the wound area. It is considered immunoprivileged, meaning there is no rejection per se when it's applied to a patient. It has anti-inflammatory properties, as well as antimicrobial properties, and it's known to, is shown to have reduced scar formation. So all of these properties makes it a very, very powerful healing membrane. Let's talk about what is actually being used here, because it's not the whole placenta that's used in this procedure, right? It's an allograft. So what is that? That's correct. So the placental remain is a large,

you can say a large piece of tissue. What we actually use is the amniotic sac, that membrane that surrounds the baby and contains the fluid, just that part of it. So it's fairly thin membrane. The membrane actually has two parts. One is called the amniotic membrane and one is called the chorionic membrane. So the amniotic membrane is actually less than one millimeter thick. So it's fairly, fairly thin. So we just simply separate that part of it out and use that. We process it, we make sure it's clean, free of microbial growth, and we process that, cut it in required sizes, and that's what we provide for a healing membrane. I'd said in the introduction that it can be used in everything from aiding the healing of complex burns to wounds. There's a long list of things that this can be used for.

What sort of wounds are you referring to when we say that this can be applied to a wound or a burn? Actually, it's most widely used in the area of ophthalmology for corneal abrasions, chemical burns, and those type of things. So that's the number one place it's being used. Other burns would include burns due to, say, fire on the skin, those type of thing. Diabetic foot ulcer is another area that is very, those are very challenging wounds and that's where it's applied also. And many types of surgical wounds that are hard to heal. Most of them will heal, but maybe 10 or 15% of them will not heal

and can cause issues down the road. For example, in the area of ear, nose, throat oncology, some of those wounds don't heal, and those patients would need to move on to other therapy like radiation. And if those wounds don't heal, then there is a delay in the second treatment. If there is a delay, prognosis will drop. So these membranes allow for a faster healing of those wounds and allow those patients to move on for further treatment.

People may have read a story that was in the New York Times yesterday. It was an incredible story about a woman whose face was badly burned. In the process of healing, placenta was applied. And she said, and if you take a look at the photos, it's hard to dispute what she's saying. She says that her face looks exactly as it did before this happened. Can you, I mean, I don't know,

I'm sure you looked at this as somebody who's involved in this work. Can you, I mean, I don't know, I'm sure you looked at this as somebody who's involved in this work. Can you understand how something like that is possible? Yes, indeed. Again, what I said earlier, these amazing properties of this membrane, they contain these molecules. So instead of the healing process

where you have scar formation, this is more of a rejuvenation type of healing. It actually involves all the steps towards what we would consider a normal healing. So you don't have that scarring type of healing. And hence, it looks like the type of tissue that would originally be there, like the skin would look like skin instead of a scar formation. It was remarkable to see. How common is that sort of work?

I mean, I mentioned that Sinai Hospital is the first program in the province of Ontario that's using the amniotic membrane in that wound healing. How successful has that been in this country? I should say it's starting. We are a little bit behind our American counterpart. But the fact that when we started this about three years ago, and thanks to the late Dr. Laura Teague, who was the first person,

she was the head of the wound care team at Mount Sinai Hospital, and she was the first one that applied to a patient there. And again, these were very difficult wounds. These wounds were not closing for, I would say, a month, a month and a half. And the first time she applied it, within the first week, we would start to see movement, closure of those wounds. So we have treated since, I would say, nearly 80 patients. And again, these are patients with difficult-to-heal wounds. And we have seen amazing, I would say, nearly 80 patients. And again, these are patients with difficult to heal wounds.

And we have seen amazing, amazing results. In one case, a patient was offered amputation because the wound was so large and was challenging. And we were able to close that wound. So, I mean, more and more physicians are realizing this, not just at Sinai, elsewhere. And they're coming on board. And I think it's great for patient care. Not only that, think about the healthcare economics that's involved here. A patient can be discharged earlier because their wounds are healed sooner.

And it will help us save dollars in the long term. This is a procedure and an understanding that goes back in time. People used this decades ago, and then it fell out of fashion, right? It has regained a new currency. Do you understand how that happened? Why something that was perhaps used 70, 80, 90 years ago, or at least understood then, is now back in fashion? Yes, indeed.

You always have, in time, you always have challenges that are faced by a physician. And at that time, 100 years ago, a physician would find wounds and situations where they need something else to apply to their patients. And I think it was John Hopkins was the first physician that tried the placental membrane to heal. And it worked beautifully and it took hold a bit. But through the years, you have onset of certain infectious disease, for example, AIDS when it came on in the late 70s, 80s.

And the screening of donors was not well established. So this whole idea of donating, whether it's blood or tissue, was sort of put on hold because we find that recipients were receiving or getting some kind of transmission of diseases. So because of that, it was kind of put on the sidelines until the whole tissue donation program was revamped and became very, very safe. So Health Canada, we follow the regulation to the teeth. We are also accredited with the American Association of Tissue Banks. That is of very high standard. So when you look now in the past few decades about transmission of diseases, you find it's such a low risk. Same like blood

donation, such a low risk. So this whole tissue donation program has actually spiraled upwards. We're out of time, but let me just end with that donation issue. There is a placenta donation program at Sinai Hospital called Mothers Healing Others. This is a tissue that's often discarded after birth. Do mothers know that it is an option to donate? Yes, so we have established that program a little over three years now. And we provide information, provide some literature to expectant mothers to allow them to donate their program.

And we ensure we answer all their questions. We receive informed consent. We conduct a short interview similar to that when donating blood. And they can choose to donate their tissue for a very, very worthy cause. This is fascinating to hear about and holds great promise, it sounds like. Bahram, thank you very much.

Thank you very much, Matt. Bahram Suku is Director of Mount Sinai Allograft Technologies at Sinai Health in Toronto. For more CBC Podcasts, go to cbc.ca slash podcasts.