The Unreal World: ‘The Skin I Live In’
The premise
The year is 2012, the place Toledo, Spain. Famed plastic surgeon Robert Ledgard (Antonio Banderas), one of the few in the world to have successfully performed face transplants, presents his discovery called “Gal” to a group scientists. It is a burn-proof, super-strong artificial skin, created with genes from pigs, and it has tested well in mice. An older scientist at the talk protests that the skin is unethical because of the introduction of animal genes into humans and that the research should be stopped, not knowing that Ledgard has already secretly used it on a human subject.
Ledgard, it turns out, lost his wife, Gal, to suicide 12 years earlier after a terrible car accident burned her skin and she could no longer tolerate her appearance. Afterward, he dedicated himself to creating burn-proof skin. He succeeds, and, in a private clinic attached to his house, he imprisons and operates on a mysterious woman, called Vera Cruz (Elena Anaya), to give her the skin and make her look like his dead wife, Gal, but never able to be burned.
The medical questions
Is it possible to use animal genes to create improved human organs, including skin? Could such skin be stronger and more resistant to burns? What about host rejection? Would this process be deemed any more unethical than the current process of using heart valves from pigs and cows in human patients?
The reality
The first synthetically produced human skin was developed in 1980 by the late Dr. John F. Burke at Harvard along with Dr. Ioannis V. Yannas, a professor of mechanical engineering at MIT. Created to treat burn victims, the artificial skin (known as Integra) has two parts: A top layer of synthetic silicone protects the patient from infection and fluid loss, and an inner layer composed of cow tendons and shark cartilage is a kind of scaffold that is implanted with healthy skin cells taken from other parts of the patient’s body. As the human cells take hold and the burned skin begins to heal, the silicone layer is peeled off.
Recently, tissue engineer Hanna Wendt and colleagues at Hannover Medical School in Germany created a stronger scaffold for skin regeneration using silk fibers from spiders woven onto steel frames that are seeded with human fibroblasts (connective tissue).
The primary goal of such efforts is to supply stronger skin for recovery from burns and other forms of skin damage. In the future, the goal will be to create tissues with new properties through a combination of tissue engineering and genetic engineering, says Dr. Andrew Ordon, plastic surgeon and Director of the Roxbury Clinic and Surgery Center in Beverly Hills and co-host of “The Doctors” TV show.
“It is theoretically possible to transfer animal genes to humans to provide humans with certain desirable traits,” says Dr. Reza Jarrahy, assistant professor of plastic and craniofacial surgery at UCLA. Though there are no such therapies currently available, it is an active area of promising research, he says. Jarrahy believes the process could theoretically impart new properties to human skin cells so that they would take on beneficial characteristics such as resistance to burns.
Yannas of MIT says he doesn’t believe that use of pig tissue or pig genes could yield a fire-resistant skin the way the film depicts. That’s because animal genes are very similar to human genes, and they synthesize skin that is very similar — and just as burnable — as human skin, he says.
And what about rejection? “Using tissue from another species always creates a risk of host rejection, as it is perceived as foreign,” Ordon says, though genetic engineering and immunosuppression could help to mitigate it (by, for example, altering the genes that trigger rejection). Alternatively, tissue rejection could be avoided altogether by using human stem cells from the patient rather than animal tissues, because these would be a good match and the problem of immune rejection wouldn’t be there.
Ordon believes that uses of “designer” skin or other tissues could improve the quality of life for trauma victims and this would overshadow the ethical issues. But Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, says that skin-grafting is ethically different than transplanting pig or bovine valves because valves are dead tissue and are pretreated to prevent viral contamination. Live skin carries not only the risk of rejection but a much greater risk of viral contamination and the possibility of spread beyond the recipient. The ethical decision, he says, is therefore more difficult.
Siegel is an associate professor of medicine at New York University Langone Medical Center. His latest book is “The Inner Pulse: Unlocking the Secret Code of Sickness and Health.”
‘The Skin I Live In’ (‘La Piel Que Habito’)
El Deseo Production Co., Sony Pictures Classic
U.S. premiere, Oct. 14
Based on Thierry Jonquet’s novel “Tarantula”
