How are Kerecis (Omega-3 rich fish skin grafts) broken down by the body?

Mechanism of Kerecis Fish Skin Graft Breakdown in the Body

Kerecis fish skin grafts are broken down through a natural process involving inflammation resolution, specialized pro-resolving mediators (SPMs) derived from omega-3 fatty acids, and integration with the body's wound healing mechanisms. 1

Composition and Initial Integration

• Kerecis grafts are composed of acellular fish skin rich in omega-3 fatty acids, collagen, and selenium, which serve as a scaffold for the body's natural healing process 1, 2
• The fish skin matrix provides structural support while the body begins breaking down and integrating the graft material 3
• Unlike some other biological dressings, the omega-3 rich composition of fish skin contributes to its unique breakdown process 4

Breakdown Mechanism Through Inflammation Resolution

• The breakdown process begins with a controlled inflammatory response at the wound site, which is modulated by the omega-3 fatty acids in the fish skin 1
• Omega-3 polyunsaturated fatty acids (PUFAs) in the fish skin serve as precursors for specialized pro-resolving mediators (SPMs) including resolvins, protectins, and maresins 5
• These SPMs actively disrupt inflammatory pathways and shift the immune response toward resolution and homeostasis, facilitating proper tissue integration 5
• Unlike traditional anti-inflammatory agents, the SPMs from omega-3 PUFAs promote immune modulation and tissue repair without compromising host defenses 5

Cellular Interaction and Tissue Integration

• The collagen structure in fish skin interacts with collagen receptors in human cells, upregulating the Ras/Raf/MEK/ERK and PI3K/Akt pathways that are essential for wound healing 1
• These pathways promote angiogenesis (formation of new blood vessels) and epithelialization (replacement of injured skin) 1
• As the body's cells migrate into the fish skin matrix, they gradually replace the fish collagen with human collagen through enzymatic degradation 6
• The selenium content in fish skin modulates selenoproteins that further enhance the wound healing process 1

Advantages of the Breakdown Process

• The anti-inflammatory properties of omega-3 fatty acids in fish skin help prevent excessive inflammation that could delay healing 1, 3
• The breakdown process promotes excellent granulation tissue formation, even over exposed bone and tendons 4
• Patients often experience pain relief during the breakdown and integration process, possibly due to the anti-inflammatory effects of omega-3 fatty acids 4
• The gradual breakdown allows for sustained release of beneficial components that support wound healing over time 6

Clinical Implications

• The unique breakdown mechanism of fish skin grafts contributes to faster wound healing rates compared to some alternative dressings 2
• The process requires fewer dressing changes than traditional wound care approaches 2
• The breakdown and integration process works effectively even in complex wounds with challenging conditions such as stool contamination or necrotizing infections 3
• While promising, more high-quality randomized controlled trials are needed to fully understand the comparative advantages of fish skin graft breakdown versus other dermal substitutes 7