What is the mechanism of action of Kerecis (fish skin graft)?

Mechanism of Action of Kerecis Fish Skin Grafts

Kerecis fish skin grafts function primarily through providing a decellularized extracellular matrix scaffold rich in omega-3 fatty acids that supports tissue regeneration by facilitating revascularization and cellular ingrowth during the proliferation and remodeling phases of wound healing. 1

Key Components and Properties

• Kerecis is an acellular dermal matrix derived from Atlantic cod (Gadus morhua) skin that undergoes proprietary processing to preserve its natural structure and lipid composition 1
• The product is structurally more similar to human skin than many other processed skin substitutes, providing an effective three-dimensional scaffold for wound healing 1
• Unlike mammalian-derived products, fish skin grafts have no known risk of prion, bacterial, or viral disease transmission to humans 1
• The fish skin matrix contains polyunsaturated fatty acids (PUFAs), particularly omega-3 fatty acids, which contribute to its anti-inflammatory and angiogenic properties 2, 3

Mechanism of Action

Scaffold Function

• The decellularized fish skin provides a three-dimensional extracellular matrix that maintains its natural structure through minimal processing 4
• This preserved structure serves as a template for cellular migration and tissue regeneration 1
• The fish skin matrix supports host cell infiltration and integration, promoting the formation of granulation tissue 5

Anti-inflammatory Effects

• The omega-3 fatty acids retained in the fish skin matrix have documented anti-inflammatory properties 3
• These fatty acids help modulate the inflammatory response in the wound bed, potentially reducing excessive inflammation that can impair healing 2

Angiogenic Support

• The fish skin graft supports revascularization of the wound bed, which is essential for delivering oxygen and nutrients to regenerating tissues 1
• Studies have demonstrated accelerated formation of granulation tissue following application of fish skin grafts 5

Cellular Integration

• The matrix facilitates cellular ingrowth during the proliferation and remodeling phases of wound healing 1
• The preserved extracellular matrix components provide binding sites for host cells, supporting their migration and proliferation 4

Clinical Applications

• Kerecis fish skin grafts have FDA clearance for use in partial and full-thickness wounds 1
• They have been successfully used in various wound types, including:
  • Diabetic foot ulcers 3
  • Complex surgical wounds 2
  • Burn wounds 4
  • Abdominal wall dehiscence 1
  • Open abdomen management 5

Evidence Limitations

• The International Working Group on the Diabetic Foot (IWGDF) notes insufficient evidence to establish which particular skin substitute products may be more effective 6
• Most studies on skin substitutes, including fish skin grafts, have methodological limitations such as non-blinding, high dropout rates, and per-protocol analyses rather than intention-to-treat analyses 7
• Current guidelines suggest not using acellular skin substitute products as routine adjunct therapy for wound healing in diabetic foot ulcers due to limited high-quality evidence 7

Practical Considerations

• Fish skin grafts may be particularly valuable for complex wounds where conventional approaches have failed 6
• The product is completely reabsorbed over time as it is replaced by the patient's own tissue 1
• Further high-quality research with larger sample sizes and longer follow-up periods is needed to establish definitive recommendations for routine use 6