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Suriyaamporn P, Dechsri K, Charoenying T, Ngawhirunpat T, Rojanarata T, Patrojanasophon P, Opanasopit P, Pamornpathomkul B. Multiple strategies approach: A novel crosslinked hydrogel forming chitosan-based microneedles chemowrap patch loaded with 5-fluorouracil liposomes for chronic wound cancer treatment. Int J Biol Macromol 2024:134973. [PMID: 39182897 DOI: 10.1016/j.ijbiomac.2024.134973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/27/2024] [Accepted: 08/20/2024] [Indexed: 08/27/2024]
Abstract
Untreated or poorly managed chronic wounds can progress to skin cancer. Topically applied 5-fluorouracil (5-FU), a nonspecific cytostatic agent, can cause various side effects. Its high polarity also results in low cell membrane affinity and bioavailability. Hydrogel, used for its occlusive effect, is one platform for treating chronic wounds combined with PEGylated liposomes (LPs), developed to increase drug-skin affinity. This research aimed to develop a novel hydrogel forming chitosan-based microneedles (HFM) chemowrap patch containing 5-FU PEGylated LPs, improving 5-FU efficiency for pre-carcinogenic and carcinogenic skin lesions. The results indicated that the 5-FU-PEGylated LPs-loaded HFM chemowrap patch exhibited desirable physical and mechanical characteristics with complete penetration ability. Furthermore, in vivo skin permeation studies demonstrated the highest percentage of 5-FU permeated the skin (42.06 ± 11.82 %) and skin deposition (75.90 ± 1.13 %) compared to the other treatments, with demonstrated superior percentages of complete wound healing in in vivo (47.00 ± 5.77 % wound healing at day 7) and in NHF cells (92.79 ± 7.15 % at 48 h). Furthermore, 5-FU-PEGylated LPs-loaded HFM chemowrap patches exhibit efficient anticancer activity while maintaining safety for normal cells. The results also show that the developed formulation of a 5-FU-PEGylated LPs-loaded HFM chemowrap patch could enhance apoptosis higher than that of the 5-FU solution. Consequently, 5-FU PEGylated LPs-loaded HFM chemowrap patch represented a promising drug delivery approach for treating pre-carcinogenic and carcinogenic skin lesions.
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Affiliation(s)
- Phuvamin Suriyaamporn
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand
| | - Koranat Dechsri
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand
| | - Thapakorn Charoenying
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand
| | - Tanasait Ngawhirunpat
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand
| | - Theerasak Rojanarata
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand
| | - Prasopchai Patrojanasophon
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand
| | - Praneet Opanasopit
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand
| | - Boonnada Pamornpathomkul
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand.
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Picciotti SL, El-Ahmad H, Bucci MP, Grayton QE, Wallet SM, Schoenfisch MH. Delivery of Nitric Oxide by Chondroitin Sulfate C Increases the Rate of Wound Healing through Immune Modulation. ACS APPLIED BIO MATERIALS 2024. [PMID: 39159191 DOI: 10.1021/acsabm.4c00731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
Chronic wounds impact 2.5% of the United States population and will continue to be a major clinical challenge due to increases in population age, chronic disease diagnoses, and antibiotic-resistant infection. Nitric oxide (NO) is an endogenous signaling molecule that represents an attractive, simple therapeutic for chronic wound treatment due to its innate antibacterial and immunomodulatory function. Unfortunately, modulating inflammation for extended periods by low levels of NO is not possible with NO gas. Herein, we report the utility of a NO-releasing glycosaminoglycan biopolymer (GAG) for promoting wound healing. GAGs are naturally occurring biopolymers that are immunomodulatory and known to be involved in the native wound healing process. Thus, the combination of NO and GAG biopolymers represents an attractive wound therapeutic due to these known independent roles. The influence and contribution of chondroitin sulfate C (CSC) modified to facilitate controlled and targeted delivery of NO (CSC-HEDA/NO) was evaluated using in vitro cell proliferation and migration assays and an in vivo wound model.
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Affiliation(s)
- Samantha L Picciotti
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Heba El-Ahmad
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, Florida 32610, United States
| | - Madelyn P Bucci
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, Florida 32610, United States
| | - Quincy E Grayton
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Shannon M Wallet
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, Florida 32610, United States
| | - Mark H Schoenfisch
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
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3
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Ghanbari M, Salkovskiy Y, Carlson MA. The rat as an animal model in chronic wound research: An update. Life Sci 2024; 351:122783. [PMID: 38848945 DOI: 10.1016/j.lfs.2024.122783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/29/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024]
Abstract
The increasing global prevalence of chronic wounds underscores the growing importance of developing effective animal models for their study. This review offers a critical evaluation of the strengths and limitations of rat models frequently employed in chronic wound research and proposes potential improvements. It explores these models in the context of key comorbidities, including diabetes, venous and arterial insufficiency, pressure-induced blood flow obstruction, and infections. Additionally, the review examines important wound factors including age, sex, smoking, and the impact of anesthetic and analgesic drugs, acknowledging their substantial effects on research outcomes. A thorough understanding of these variables is crucial for refining animal models and can provide valuable insights for future research endeavors.
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Affiliation(s)
- Mahboubeh Ghanbari
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA.
| | - Yury Salkovskiy
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA.
| | - Mark A Carlson
- Department of Surgery, Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, USA.
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4
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Kang M, Yum HY, Kim HT, Park BJ, Cho DS, Choi Y, Kim HJ, Cho Y, Kim YJ, Lee DM, Lee DG, Song HC, Nam SH, Lee JH, Choi BO, Kim SW. Self-Powered Electrical Bandage Based on Body-Coupled Energy Harvesting. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2402491. [PMID: 38837481 DOI: 10.1002/adma.202402491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 05/06/2024] [Indexed: 06/07/2024]
Abstract
Self-powered electrical bandages (SEBs), integrated with wearable energy harvesters, can provide an effective and autonomous electrical stimulation (ES) solution for rapid and scarless wound healing. A continuously operating, wireless, and applicable-to-comprehensive-wound ES device is essential for the quick restoration of wounds and convenience. This work illustrates a SEB powered by body-coupled energy harvesting. The SEB continuously treats the wound with 60-Hz sinusoidal electrical potential gained from the coupling of the human body and ambient electrical waves. It is demonstrated that enough level of electrical potential can be applied to the wound, further enhanced by strong capacitive coupling arising from the use of high-permittivity poly(vinylidene fluoride-trifluoroethylene):CaCu3Ti4O12 (P(VDF-TrFE):CCTO) nanocomposite. The potential clinical efficacy of the SEB is illustrated by preclinical analysis of human fibroblasts and mouse wound model, thus confirming the successful expedition of wound recovery. This work suggests a new class of wearable devices to provide ES events and its potential for extension to other conventional wound care materials and device technology.
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Affiliation(s)
- Minki Kang
- School of Advanced Materials Science and Engineering, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Han-Yup Yum
- School of Advanced Materials Science and Engineering, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Hyoung Taek Kim
- Department of Research and Development, SEMS Co. Ltd, Suwon, 16229, Republic of Korea
| | - Byung-Joon Park
- Department of Materials Science and Engineering, Center for Human-oriented Triboelectric Energy Harvesting, Yonsei University, Seoul, 03722, Republic of Korea
| | - Daniel Sanghyun Cho
- School of Advanced Materials Science and Engineering, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - YoungHwan Choi
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06355, Republic of Korea
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, 06355, Republic of Korea
| | - Hye Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06355, Republic of Korea
| | - Youngmin Cho
- School of Advanced Materials Science and Engineering, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Young-Jun Kim
- Advanced Functional Polymers Center, Korea Research Institute of Chemical Technology, Daejeon, 34114, Republic of Korea
| | - Dong-Min Lee
- Department of Materials Science and Engineering, Center for Human-oriented Triboelectric Energy Harvesting, Yonsei University, Seoul, 03722, Republic of Korea
| | - Dong-Gyu Lee
- Electronic Materials Research Center, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
- Materials Science and Engineering, Korea University, Seoul, 02841, Republic of Korea
| | - Hyun-Cheol Song
- Electronic Materials Research Center, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
- KIST-SKKU Carbon-Neutral Research Center, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Soo Hyun Nam
- Cell and Gene Therapy Institute, Samsung Medical Center, Seoul, 06351, Republic of Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06355, Republic of Korea
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, 06355, Republic of Korea
| | - Byung-Ok Choi
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, 06355, Republic of Korea
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06355, Republic of Korea
- Cell and Gene Therapy Institute, Samsung Medical Center, Seoul, 06351, Republic of Korea
| | - Sang-Woo Kim
- Department of Materials Science and Engineering, Center for Human-oriented Triboelectric Energy Harvesting, Yonsei University, Seoul, 03722, Republic of Korea
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5
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Gonçalves RR, Peixoto D, Costa RR, Franco AR, Castro VIB, Pires RA, Reis RL, Pashkuleva I, Maniglio D, Tirella A, Motta A, Alves NM. Antibacterial properties of photo-crosslinked chitosan/methacrylated hyaluronic acid nanoparticles loaded with bacitracin. Int J Biol Macromol 2024:134250. [PMID: 39089541 DOI: 10.1016/j.ijbiomac.2024.134250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 07/25/2024] [Accepted: 07/27/2024] [Indexed: 08/04/2024]
Abstract
The current treatments for wounds often fail to produce adequate healing, leaving wounds vulnerable to persistent infections and development of drug-resistant microbial biofilms. New natural-derived nanoparticles were studied to impair bacteria colonization and hinder the formation of biofilms in wounds. The nanoparticles were fabricated through polyelectrolyte complexation of chitosan (CS, polycation) and hyaluronic acid (HA, polyanion). UV-induced photo-crosslinking was used to enhance the stability of the nanoparticles. To achieve this, HA was methacrylated (HAMA, degree of modification of 20 %). Photo-crosslinked nanoparticles obtained from HAMA and CS had a diameter of 478 nm and a more homogeneous size distribution than nanoparticles assembled solely through complexation (742 nm). The nanoparticles were loaded with the antimicrobial agent bacitracin (BC), resulting in nanoparticles with a diameter of 332 nm. The encapsulation of BC was highly efficient (97 %). The BC-loaded nanoparticles showed significant antibacterial activity against gram-positive bacteria Staphylococcus aureus, Methicillin-resistant S. aureus and S. epidermidis. The nanoparticles loaded with BC based on photo-crosslinked HAMA/CS demonstrated inhibition of biofilm formation and a positive effect on the proliferation of mammalian cells (L929). These crosslinked nanoparticles have potential for the long-term treatment of wounds and controlled antibiotic delivery at the location of a lesion.
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Affiliation(s)
- Raquel R Gonçalves
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; BIOtech Research Center, Department of Industrial Engineering, University of Trento, Via Delle Regole 101, 38123 Trento, Italy
| | - Daniela Peixoto
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui R Costa
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Albina R Franco
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Vânia I B Castro
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ricardo A Pires
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Iva Pashkuleva
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Devid Maniglio
- BIOtech Research Center, Department of Industrial Engineering, University of Trento, Via Delle Regole 101, 38123 Trento, Italy
| | - Annalisa Tirella
- BIOtech Research Center, Department of Industrial Engineering, University of Trento, Via Delle Regole 101, 38123 Trento, Italy
| | - Antonella Motta
- BIOtech Research Center, Department of Industrial Engineering, University of Trento, Via Delle Regole 101, 38123 Trento, Italy
| | - Natália M Alves
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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6
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Boraldi F, Lofaro FD, Bonacorsi S, Mazzilli A, Garcia-Fernandez M, Quaglino D. The Role of Fibroblasts in Skin Homeostasis and Repair. Biomedicines 2024; 12:1586. [PMID: 39062158 PMCID: PMC11274439 DOI: 10.3390/biomedicines12071586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/08/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Fibroblasts are typical mesenchymal cells widely distributed throughout the human body where they (1) synthesise and maintain the extracellular matrix, ensuring the structural role of soft connective tissues; (2) secrete cytokines and growth factors; (3) communicate with each other and with other cell types, acting as signalling source for stem cell niches; and (4) are involved in tissue remodelling, wound healing, fibrosis, and cancer. This review focuses on the developmental heterogeneity of dermal fibroblasts, on their ability to sense changes in biomechanical properties of the surrounding extracellular matrix, and on their role in aging, in skin repair, in pathologic conditions and in tumour development. Moreover, we describe the use of fibroblasts in different models (e.g., in vivo animal models and in vitro systems from 2D to 6D cultures) for tissue bioengineering and the informative potential of high-throughput assays for the study of fibroblasts under different disease contexts for personalized healthcare and regenerative medicine applications.
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Affiliation(s)
- Federica Boraldi
- Department of Life Science, University of Modena and Reggio Emilia, 41125 Modena, Italy; (F.D.L.); (S.B.); (A.M.)
| | - Francesco Demetrio Lofaro
- Department of Life Science, University of Modena and Reggio Emilia, 41125 Modena, Italy; (F.D.L.); (S.B.); (A.M.)
| | - Susanna Bonacorsi
- Department of Life Science, University of Modena and Reggio Emilia, 41125 Modena, Italy; (F.D.L.); (S.B.); (A.M.)
| | - Alessia Mazzilli
- Department of Life Science, University of Modena and Reggio Emilia, 41125 Modena, Italy; (F.D.L.); (S.B.); (A.M.)
| | - Maria Garcia-Fernandez
- Department of Human Physiology, Institute of Biomedical Investigation (IBIMA), University of Málaga, 29010 Málaga, Spain;
| | - Daniela Quaglino
- Department of Life Science, University of Modena and Reggio Emilia, 41125 Modena, Italy; (F.D.L.); (S.B.); (A.M.)
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Beyna AT, Mengesha AK, Yefter ET, Kahaliw W. Evaluation of wound healing and anti-inflammatory activity of hydro-alcoholic extract and solvent fractions of the leaves of Clerodendrum myricoides (Lamiaceae) in mice. PLoS One 2024; 19:e0306766. [PMID: 38985716 PMCID: PMC11236120 DOI: 10.1371/journal.pone.0306766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/20/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Wounds significantly affect people's quality of life and the clinical and financial burden of healthcare systems around the world. Many of the current drugs used to treat wounds have problems such as; allergies and drug resistance. Hence, the exploration of new therapeutic agents from natural origin may avert this problem. Clerodendrum myricoides have long been used to treat wounds in Ethiopia. Despite this, nothing has so far been reported about the wound healing and anti-inflammatory activity of C. myricoides. This study aimed to evaluate the wound healing and anti-inflammatory activity of 80% methanol extract and solvent fractions of C. myricoides leaves in mice. METHODS Leaves of C. myricoides were extracted using the maceration technique. The extract was formulated as 5% and 10% w/w ointments. The wound healing activity of the extract was evaluated using excision, incision, and burn wound models whereas the healing activities of solvent fractions were evaluated using the excision wound model. A carrageenan-induced paw edema model was used for the anti-inflammatory test. RESULTS In the dermal toxicity test, 2000 mg/kg of 10% extract was found to be safe. In excision and burn wound models, treatment with 10% and 5% extract showed a significant (p<0.001) wound contraction. Solvent fractions of the extract significantly reduced wound contraction. A significant reduction in periods of epithelialization and favorable histopathology changes were shown by extract ointments. In incision wounds, 10% (p<0.001) and 5% (p<0.01) extracts significantly increase skin-breaking strength. After one hour of treatment, 400 mg/kg (p<0.001) and 200 mg/kg (p<0.05) showed significant reduction in paw edema. CONCLUSION Results of this study indicate that 80% methanol extract and the solvent fraction of the leaves of C. myricoides possess wound-healing and anti-inflammatory activity and support traditional claims.
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Affiliation(s)
- Alemante Tafese Beyna
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Assefa Kebad Mengesha
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ermias Teklehaimanot Yefter
- Department of Pathology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubayehu Kahaliw
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sedighi O, Bednarke B, Sherriff H, Doiron AL. Nanoparticle-Based Strategies for Managing Biofilm Infections in Wounds: A Comprehensive Review. ACS OMEGA 2024; 9:27853-27871. [PMID: 38973924 PMCID: PMC11223148 DOI: 10.1021/acsomega.4c02343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 07/09/2024]
Abstract
Chronic wounds containing opportunistic bacterial pathogens are a growing problem, as they are the primary cause of morbidity and mortality in developing and developed nations. Bacteria can adhere to almost every surface, forming architecturally complex communities called biofilms that are tolerant to an individual's immune response and traditional treatments. Wound dressings are a primary source and potential treatment avenue for biofilm infections, and research has recently focused on using nanoparticles with antimicrobial activity for infection control. This Review categorizes nanoparticle-based approaches into four main types, each leveraging unique mechanisms against biofilms. Metallic nanoparticles, such as silver and copper, show promising data due to their ability to disrupt bacterial cell membranes and induce oxidative stress, although their effectiveness can vary based on particle size and composition. Phototherapy-based nanoparticles, utilizing either photodynamic or photothermal therapy, offer targeted microbial destruction by generating reactive oxygen species or localized heat, respectively. However, their efficacy depends on the presence of light and oxygen, potentially limiting their use in deeper or more shielded biofilms. Nanoparticles designed to disrupt extracellular polymeric substances directly target the biofilm structure, enhancing the penetration and efficacy of antimicrobial agents. Lastly, nanoparticles that induce biofilm dispersion represent a novel strategy, aiming to weaken the biofilm's defense and restore susceptibility to antimicrobials. While each method has its advantages, the selection of an appropriate nanoparticle-based treatment depends on the specific requirements of the wound environment and the type of biofilm involved. The integration of these nanoparticles into wound dressings not only promises enhanced treatment outcomes but also offers a reduction in the overall use of antibiotics, aligning with the urgent need for innovative solutions in the fight against antibiotic-tolerant infections. The overarching objective of employing these diverse nanoparticle strategies is to replace antibiotics or substantially reduce their required dosages, providing promising avenues for biofilm infection management.
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Affiliation(s)
- Omid Sedighi
- Department
of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont 05405, United States
| | - Brooke Bednarke
- Department
of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont 05405, United States
| | - Hannah Sherriff
- Department
of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont 05405, United States
| | - Amber L. Doiron
- Department
of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont 05405, United States
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9
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Cazzell SM, Caporusso J, Vayser D, Davis RD, Alvarez OM, Sabolinski ML. Dehydrated Amnion Chorion Membrane versus standard of care for diabetic foot ulcers: a randomised controlled trial. J Wound Care 2024; 33:S4-S14. [PMID: 38973638 DOI: 10.12968/jowc.2024.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
OBJECTIVE Diabetic foot ulcers (DFUs) continue to challenge wound care practitioners. This prospective, multicentre, randomised controlled trial (RCT) evaluated the effectiveness of a dehydrated Amnion Chorion Membrane (dACM) (Organogenesis Inc., US) versus standard of care (SoC) alone in complex DFUs in a challenging patient population. METHOD Subjects with a DFU extending into dermis, subcutaneous tissue, tendon, capsule, bone or joint were enrolled in a 12-week trial. They were allocated equally to two treatment groups: dACM (plus SoC); or SoC alone. The primary endpoint was frequency of wound closure determined by a Cox analysis that adjusted for duration and wound area. Kaplan-Meier analysis was used to determine median time to complete wound closure (CWC). RESULTS The cohort comprised 218 patients, and these were split equally between the two treatment groups with 109 patients in each. A Cox analysis showed that the estimated frequency of wound closure for the dACM plus SoC group was statistically superior to the SoC alone group at week 4 (12% versus 8%), week 6 (22% versus 11%), week 8 (31% versus 21%), week 10 (42% versus 27%) and week 12 (50% versus 35%), respectively (p=0.04). The computed hazard ratio (1.48 (confidence interval: 0.95, 2.29) showed a 48% greater probability of wound closure in favour of the dACM group. Median time to wound closure for dACM-treated ulcers was 84 days compared to 'not achieved' in the SoC-treated group (i.e., ≥50% of SoC-treated DFUs failed to heal by week 12; p=0.04). CONCLUSION In an adequately powered DFU RCT, dACM increased the frequency, decreased the median time, and improved the probability of CWC when compared with SoC alone. dACM demonstrated beneficial effects in DFUs in a complex patient population. DECLARATION OF INTEREST This study was funded by Organogenesis Inc., US. JC serves as a consultant and speaker for Organogenesis. RDD serves as a speaker for Organogenesis. OMA and MLS serve as consultants for Organogenesis. The authors have no other conflicts of interest to declare.
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Affiliation(s)
| | | | | | | | - Oscar M Alvarez
- Department of Surgery, Division of Plastic Surgery, Rutgers NJMS, Newark, NJ, US
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Guo S, Wang P, Sun Y, Cao C, Gao J, Hong S, Li N, Xu R. Transformation of Natural Resin Resina Draconis to 3D Functionalized Fibrous Scaffolds for Efficient Chronic Wound Healing. Adv Healthc Mater 2024:e2401105. [PMID: 38889446 DOI: 10.1002/adhm.202401105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/14/2024] [Indexed: 06/20/2024]
Abstract
Chronic wound healing is a major challenge in clinical practice. Secondary dressing damage and antibiotic resistance are the main obstacles for traditional wound dressings. Resina draconis (RD), a natural resin traditionally used in powder form for wound care, is now considered unsuitable due to the lack of gas permeability and moist environment required for wound healing. Here, RD is incorporated in situ by constructing a 3D coiled fibrous scaffold with polycaprolactone/polyethylene oxide. Due to the high porosity of 3D scaffold, the RD-3D dressings have a favorable swelling capacity, providing permeability and moisture for wound repair. Meanwhile, the transformation of RD powder into 3D dressings fully demonstrates capabilities of RD in rapid hemostasis, bactericidal, and inflammation-regulating activities. In vivo evaluations using pressure ulcer and infected wound models confirm the high efficacy of RD-3D dressing in early wound healing, particularly beneficial in the infected wound model compared to recombinant bovine FGF-basic. Further biological analysis shows that resveratrol, loureirin A, and loureirin B, as potentially bioactive components of RD, individually contribute to different aspects of wound healing. Collectively, RD-3D integrated dressings represent a simple, cost-effective, and safe approach to wound healing, providing an alternative therapy for translating medical dressings from bench to bedside.
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Affiliation(s)
- Shijie Guo
- Department of Biomedical Engineering and Technology, Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Pengyu Wang
- Department of Biomedical Engineering and Technology, Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Yu Sun
- Department of Biomedical Engineering and Technology, Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Can Cao
- Department of Biomedical Engineering and Technology, Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Junwei Gao
- Department of Biomedical Engineering and Technology, Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Shihao Hong
- Department of Biomedical Engineering and Technology, Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Ning Li
- Department of Biomedical Engineering and Technology, Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Ruodan Xu
- Department of Biomedical Engineering and Technology, Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
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Barzegar Amin A, Dorpmans D, Mufty H, Fourneau I. Treatment of vascular leg ulcers with leukocyte- and platelet-rich fibrin (L-PRF): A systematic review. Phlebology 2024:2683555241256543. [PMID: 38782448 DOI: 10.1177/02683555241256543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Objectives: This systematic review aimed to assess the efficacy of Leukocyte- and Platelet-Rich Fibrin (L-PRF) for the treatment of vascular leg ulcers. Method: Following PRISMA guidelines, a literature search was done for studies where L-PRF was used to treat vascular leg ulcers. Results: Among six included articles, a total of 76 venous leg ulcers were treated with L-PRF. None of the studies included ulcers of arterial or lymphatic origin. Fifty-seven (75.0%) of the venous ulcers completely healed at end of follow-up. Mean time to complete healing was 6.7 weeks (SD = 5.0). All non-healed ulcers showed an important reduction in wound area. No adverse effects related to L-PRF therapy were reported. Conclusions: The results suggest that L-PRF could be a safe, simple to use and effective therapeutic option for the treatment of venous leg ulcers, however, caution is advised as the results are based on small sample sizes.
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Affiliation(s)
| | - Dries Dorpmans
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Research Unit of Vascular Surgery, KU Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Research Unit of Vascular Surgery, KU Leuven, Leuven, Belgium
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Subramaniam MD, Bae JS, Son J, Anggradita LD, Kim MK, Lee MY, Jang S, Choi K, Lee JC, Nam SM, Hwang Y. Floating electrode-dielectric barrier discharge-based plasma promotes skin regeneration in a full-thickness skin defect mouse model. Biomed Eng Lett 2024; 14:605-616. [PMID: 38645591 PMCID: PMC11026333 DOI: 10.1007/s13534-024-00356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/09/2024] [Accepted: 01/24/2024] [Indexed: 04/23/2024] Open
Abstract
Wound healing involves a complex and dynamic interplay among various cell types, cytokines, and growth factors. Macrophages and transforming growth factor-β1 (TGF-β1) play an essential role in different phases of wound healing. Cold atmospheric plasma has a wide range of applications in the treatment of chronic wounds. Hence, we aimed to investigate the safety and efficacy of a custom-made plasma device in a full-thickness skin defect mouse model. Here, we investigated the wound tissue on days 6 and 12 using histology, qPCR, and western blotting. During the inflammation phase of wound repair, macrophages play an important role in the onset and resolution of inflammation, showing decreased F4/80 on day 6 of plasma treatment and increased TGF-β1 levels. The plasma-treated group showed better epidermal epithelialization, dermal fibrosis, collagen maturation, and reduced inflammation than the control group. Our findings revealed that floating electrode-dielectric barrier discharge (FE-DBD)-based atmospheric-pressure plasma promoted significantly faster wound healing in the plasma-treated group than that in the control group with untreated wounds. Hence, plasma treatment accelerated wound healing processes without noticeable side effects and suppressed pro-inflammatory genes, suggesting that FE-DBD-based plasma could be a potential therapeutic option for treating various wounds.
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Affiliation(s)
- Mohana Devi Subramaniam
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soonchunhyang University, Cheonan-si, Chungnam-do 31151 Republic of Korea
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon-si, Gyeonggi-do 14584 Republic of Korea
| | - Joon Suk Bae
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon-si, Gyeonggi-do 14584 Republic of Korea
| | - Jiwon Son
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soonchunhyang University, Cheonan-si, Chungnam-do 31151 Republic of Korea
| | - Laurensia Danis Anggradita
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soonchunhyang University, Cheonan-si, Chungnam-do 31151 Republic of Korea
- Department of Integrated Biomedical Science, Soonchunhyang University, Asan-si, Chungnam-do 31538 Republic of Korea
| | - Min-Kyu Kim
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soonchunhyang University, Cheonan-si, Chungnam-do 31151 Republic of Korea
| | - Min Yong Lee
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soonchunhyang University, Cheonan-si, Chungnam-do 31151 Republic of Korea
- Department of Integrated Biomedical Science, Soonchunhyang University, Asan-si, Chungnam-do 31538 Republic of Korea
| | - Seokyoon Jang
- HK-MnS Co. Ltd., Osan-si, Gyeonggi-do 18111 Republic of Korea
| | - Kwangok Choi
- HK-MnS Co. Ltd., Osan-si, Gyeonggi-do 18111 Republic of Korea
| | - Justine C. Lee
- The Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095 USA
| | - Seung Min Nam
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon-si, Gyeonggi-do 14584 Republic of Korea
| | - Yongsung Hwang
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soonchunhyang University, Cheonan-si, Chungnam-do 31151 Republic of Korea
- Department of Integrated Biomedical Science, Soonchunhyang University, Asan-si, Chungnam-do 31538 Republic of Korea
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Kruczkowska W, Gałęziewska J, Grabowska K, Liese G, Buczek P, Kłosiński KK, Kciuk M, Pasieka Z, Kałuzińska-Kołat Ż, Kołat D. Biomedical Trends in Stimuli-Responsive Hydrogels with Emphasis on Chitosan-Based Formulations. Gels 2024; 10:295. [PMID: 38786212 PMCID: PMC11121652 DOI: 10.3390/gels10050295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/13/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Biomedicine is constantly evolving to ensure a significant and positive impact on healthcare, which has resulted in innovative and distinct requisites such as hydrogels. Chitosan-based formulations stand out for their versatile utilization in drug encapsulation, transport, and controlled release, which is complemented by their biocompatibility, biodegradability, and non-immunogenic nature. Stimuli-responsive hydrogels, also known as smart hydrogels, have strictly regulated release patterns since they respond and adapt based on various external stimuli. Moreover, they can imitate the intrinsic tissues' mechanical, biological, and physicochemical properties. These characteristics allow stimuli-responsive hydrogels to provide cutting-edge, effective, and safe treatment. Constant progress in the field necessitates an up-to-date summary of current trends and breakthroughs in the biomedical application of stimuli-responsive chitosan-based hydrogels, which was the aim of this review. General data about hydrogels sensitive to ions, pH, redox potential, light, electric field, temperature, and magnetic field are recapitulated. Additionally, formulations responsive to multiple stimuli are mentioned. Focusing on chitosan-based smart hydrogels, their multifaceted utilization was thoroughly described. The vast application spectrum encompasses neurological disorders, tumors, wound healing, and dermal infections. Available data on smart chitosan hydrogels strongly support the idea that current approaches and developing novel solutions are worth improving. The present paper constitutes a valuable resource for researchers and practitioners in the currently evolving field.
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Affiliation(s)
- Weronika Kruczkowska
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
| | - Julia Gałęziewska
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
| | - Katarzyna Grabowska
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
| | - Gabriela Liese
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
| | - Paulina Buczek
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
| | - Karol Kamil Kłosiński
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
| | - Mateusz Kciuk
- Department of Molecular Biotechnology and Genetics, University of Lodz, Banacha 12/16, 90-237 Lodz, Poland;
| | - Zbigniew Pasieka
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
| | - Żaneta Kałuzińska-Kołat
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
- Department of Functional Genomics, Faculty of Medicine, Medical University of Lodz, Zeligowskiego 7/9, 90-752 Lodz, Poland
| | - Damian Kołat
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
- Department of Functional Genomics, Faculty of Medicine, Medical University of Lodz, Zeligowskiego 7/9, 90-752 Lodz, Poland
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Sharma A, Shankar R, Yadav AK, Pratap A, Ansari MA, Srivastava V. Burden of Chronic Nonhealing Wounds: An Overview of the Worldwide Humanistic and Economic Burden to the Healthcare System. INT J LOW EXTR WOUND 2024:15347346241246339. [PMID: 38659348 DOI: 10.1177/15347346241246339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Chronic wounds have long been a significant public health concern, but the true impact of these wounds is unknown since research designs and measuring techniques vary, leading to inconsistent estimates. The definition of a wound is a loss of epithelial continuity caused by damage to the tissue. The following conditions can cause chronic wounds: panniculitis, pyoderma gangrenosum, traumatic, neurological, metabolic, hematologic, neoplastic, or infection-related. The growing global incidence of diabetes and the aging population necessitate greater attention to chronic wounds. Regrettably, it is sad that significant healthcare institutions have overlooked wound research. The study of health-related illnesses and occurrences in particular populations, including their distribution, frequency, and determinants, and the application of this research to control health problems.
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Affiliation(s)
- Aditya Sharma
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ravi Shankar
- Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ashish Kumar Yadav
- Centre of Biostatistics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Arvind Pratap
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mumtaz Ahmad Ansari
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vivek Srivastava
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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15
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Cornwell D, Goldstein Z, Chrea B, McLafferty R. Timolol in the treatment of hard-to-heal wounds: a comprehensive review. J Wound Care 2024; 33:243-252. [PMID: 38573903 DOI: 10.12968/jowc.2024.33.4.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE The aims of this study were to ascertain the effectiveness and safety of the off-label use of topical timolol as an adjunct treatment for hard-to-heal (chronic) wounds. Furthermore, to review and analyse the existing literature regarding the use of topical timolol on wounds of varying aetiologies. METHOD A systematic review of literature in the English language published between May 1961-May 2021 on the application of topical timolol for hard-to-heal wounds in adults was performed. Each research study was evaluated by two reviewers independently. Studies eligible for inclusion in the review were randomised controlled trials (RCTs), clinical trials, observational studies of at least 4 weeks' duration, case series and case studies. Search strategies were performed according to PRISMA guidelines and included MeSH terms and keyword searches. RESULTS An initial 878 articles were identified from a search of PubMed, Ovid Medline, Embase, Cochrane, and SCOPUS. Of these, 699 were reviewed for eligibility, 19 were read in full-text, and 12 were selected for inclusion in the review. In total, two RCTs and 10 observational studies, including five case studies, were analysed. All studies demonstrated efficacy and safety of topical timolol; however, statistical analysis remained limited by lack of blinding and small sample sizes. CONCLUSION This review concludes with all currently available evidence that topical timolol may be considered as an effective and safe adjunct treatment for refractory wounds, primarily venous leg ulcers and diabetic foot ulcers. Given the overall safety, low cost and ease of application of topical timolol, this review provides evidence in favour of off-label use and should prompt further, more rigorous studies.
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Affiliation(s)
- David Cornwell
- Division of Vascular Surgery, Oregon Health and Science University, Portland, OR, US
| | - Zachary Goldstein
- Division of Vascular Surgery, Oregon Health and Science University, Portland, OR, US
| | - Bopha Chrea
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, US
| | - Robert McLafferty
- Division of Vascular Surgery, Oregon Health and Science University, Portland, OR, US
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Jain M, Bhogar K, Baral P, Gaind R. Evaluation of risk factors associated with hard-to-heal wound infection in a tertiary care hospital. J Wound Care 2024; 33:180-188. [PMID: 38451790 DOI: 10.12968/jowc.2024.33.3.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE The incidence of hard-to-heal wound infection, especially as a result of multidrug-resistant Gram-negative organisms, has increased in recent years. The reason for the increase is multifactorial and the ability of these pathogenic isolates to form biofilms is one of the important risk factors in wound infection. This study aimed to evaluate the risk factors associated with such cases. METHOD This prospective analytical study, conducted over a period of two months, included pus or tissue samples from hospital inpatients with Gram-negative hard-to-heal wound infection. The samples were processed with conventional microbiological techniques. Patient demographic details and the presence of various risk factors were recorded. Biofilm production was detected by tissue culture plate method in the laboratory. The data were analysed using SPSS version 21 (IBM Ltd., US). RESULTS The experimental cohort comprised 200 patients. Klebsiella spp. was the most common identified organism, followed by Escherichia coli and Pseudomonas spp. Carbapenem resistance was observed in 106 (53%) strains. Almost 66% of the strains showed biofilm formation. On evaluation of associated risk factors, age (p=0.043), presence of biofilms (p=0.0001), diabetes (p=0.002), hypertension (p=0.02) and medical device use (p=0.008) had significant association, whereas sex, previous surgery and prior antibiotic use had no significant impact on the chronicity of the wound. CONCLUSION In this study, chronicity of wounds was observed to be associated with multiple risk factors, especially the biofilm-forming ability of the strain. Biofilms are difficult to eradicate and additional measures, such as physical debridement, are important for resolving chronicity. Knowledge about specific risk factors would also allow clinicians a better understanding of the healing process and drive appropriate wound care interventions. DECLARATION OF INTEREST A grant was received from the Indian Council of Medical Research (ICMR) for this work (grant ID: 2017-02686). The authors have no conflicts of interest to declare.
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Affiliation(s)
- Manisha Jain
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Kavin Bhogar
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Purabi Baral
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Rajni Gaind
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
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Marangi GF, Mirra C, Gratteri M, Cogliandro A, Salzillo R, Segreto F, Federico G, Romano FD, Rossi C, Persichetti P. Switching from Galenic to Advanced Dressings or Vacuum Assisted Closure Therapy Can Improve Quality of Life of Patients with Chronic Non-Responsive Pressure Skin Ulcers: Preliminary Data with Italian Translation of WOUND-Q. Adv Wound Care (New Rochelle) 2024; 13:131-139. [PMID: 37551983 DOI: 10.1089/wound.2022.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Objective: A few studies have focused on the quality of life (QoL) of patients with chronic non-responsive pressure skin ulcers. The aim of this study was to assess how correct treatment (advanced wound care [AWC] dressings alone or vacuum assisted closure [VAC] therapy alone) changes the QoL of these patients. Approach: One hundred six patients with chronic non-responsive pressure skin ulcers, who had previously used galenic dressings, applied without proper therapeutic indication, were included in this study. We administered the WOUND-Q, at time 0 and after 1 month of appropriate therapy, to assess patient-reported outcome measures. Group 1 consisted of 30 patients treated with advanced dressings, Group 2: 22 patients treated with VAC therapy, and Group 3: 30 patients continuing conventional galenic dressings (Control group). Statistical analysis allowed us to analyze QoL changes over time and to compare WOUND-Q Group 1 and 2 deltas with those of Group 3. The study followed the STROBE statement. Results and Innovation: In all the scales evaluated (Assessment, Drainage, Smell, Life impact, Psychological, Social, Sleep and Dressing), there were significant improvements in mean values for Groups 1 and 2. Kruskal-Wallis tests with Dunn's multiple-comparisons tests and Brown-Forsythe and Welch Analysis of Variance tests demonstrated significant differences between deltas of Group 1 and Group 2 compared with those of Group 3 for most scales analyzed. Conclusions: Administration of the WOUND-Q demonstrated that the application of advanced dressings alone or VAC therapy alone positively affects the QoL of patients with chronic nonresponsive pressure wounds, in comparison with galenic dressings alone. The WOUND-Q has been shown to be a valid tool in studying changes in QoL of these patients.
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Affiliation(s)
- Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Carlo Mirra
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Marco Gratteri
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Annalisa Cogliandro
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Rosa Salzillo
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Gaetano Federico
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Fara Desiree Romano
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Caterina Rossi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
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18
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Horvath V, Svobodova A, Cabral JV, Stadler P, Lindner J, Mrstinova MB, Balogh L, Jirsova K. Cryopreserved amniotic membrane in chronic nonhealing wounds: a series of case reports. Cell Tissue Bank 2024; 25:325-337. [PMID: 37945942 PMCID: PMC10901998 DOI: 10.1007/s10561-023-10100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/19/2023] [Indexed: 11/12/2023]
Abstract
A case series of the use of amniotic membrane (AM) for treating chronic nonhealing wounds. It presents five cases of polymorbid patients with a total of nine chronic nonhealing wounds. The patient group consisted of four men and one woman with various comorbidities, aged 45-72 years. The mean initial wound size was 15.8 cm2, and the mean time from the onset of the wound to the first application of AM was 122 weeks. The wounds were caused by chronic venous insufficiency and/or peripheral arterial disease. Wounds were treated in a standardized protocol. AM was applied weekly in the first month and then every two weeks. Photo documentation of the wound and microbiological colonization was carried out at each visit. In three out of five patients, the AM treatment effectively promoted healing up to complete wound closure. In two cases, the wounds stayed unhealed despite numerous AM applications. Pain relief was noted in all patients. The success of the treatment was closely tied to patient factors, such as adherence to the prescribed treatment regimen and individual patient characteristics. In some cases, treatment failure was observed, possibly due to underlying comorbidities, wound parameters, or poor patient compliance. AM treatment has the potential to become a viable treatment option for these nonhealing wounds. However, the effectiveness of the treatment may be influenced by various patient factors and the underlying cause of the wound. Therefore, it is crucial to have an individualized treatment plan that considers these particular factors.
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Affiliation(s)
- Vojtech Horvath
- Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Alzbeta Svobodova
- 2nd Department of Surgery-Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Joao Victor Cabral
- Department of Obstetrics and Gynaecology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Petr Stadler
- Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaroslav Lindner
- 2nd Department of Surgery-Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Miluse Berka Mrstinova
- Department of Obstetrics and Gynaecology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Lukas Balogh
- Laboratory of Biology and Pathology of the Eye, Institute of Biology and Medical Genetics, 1st Faculty of Medicine and General Teaching Hospital, Charles University, Albertov 4, 128 01, Prague, Czech Republic
| | - Katerina Jirsova
- Laboratory of Biology and Pathology of the Eye, Institute of Biology and Medical Genetics, 1st Faculty of Medicine and General Teaching Hospital, Charles University, Albertov 4, 128 01, Prague, Czech Republic.
- Department of Transplantation and Tissue Bank, Motol University Hospital, Prague, Czech Republic.
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Babaluei M, Mojarab Y, Mottaghitalab F, Saeb MR, Farokhi M. Conductive hydrogels based on tragacanth and silk fibroin containing dopamine functionalized carboxyl-capped aniline pentamer: Merging hemostasis, antibacterial, and anti-oxidant properties into a multifunctional hydrogel for burn wound healing. Int J Biol Macromol 2024; 261:129932. [PMID: 38309399 DOI: 10.1016/j.ijbiomac.2024.129932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 02/05/2024]
Abstract
Hydrogels possessing both conductive characteristics and notable antibacterial and antioxidant properties hold considerable significance within the realm of wound healing and recovery. The object of current study is the development of conductive hydrogels with antibacterial and antioxidant properties, emphasizing their potential for effective wound healing, especially in treating third-degree burns. For this purpose, various conductive hydrogels are developed based on tragacanth and silk fibroin, with variable dopamine functionalized carboxyl-capped aniline pentamer (CAP@DA). The FTIR analysis confirms that the CAP powder was successfully synthesized and modified with DA. The results show that the incorporation of CAP@DA into hydrogels can increase the porosity and swellability of the hydrogels. Additionally, the mechanical and viscoelastic properties of the hydrogels are also improved. The release of vancomycin from the hydrogels is sustained over time, and the hydrogels are effective in inhibiting the growth of Methicillin-resistant Staphylococcus aureus (MRSA). In vitro cell studies of the hydrogels show that all hydrogels are biocompatible and support cell attachment. The hydrogels' tissue adhesiveness yielded a satisfactory hemostatic outcome in a rat-liver injury model. The third-degree burn was created on the dorsal back paravertebral region of the rats and then grafted with hydrogels. The burn was monitored for 3, 7, and 14 days to evaluate the efficacy of the hydrogel in promoting wound healing. The hydrogels revealed treatment effect, resulting in enhancements in wound closure, dermal collagen matrix production, new blood formation, and anti-inflammatory properties. Better results were obtained for hydrogel with increasing CAP@DA. In summary, the multifunctional conducive hydrogel, featuring potent antibacterial properties, markedly facilitated the wound regeneration process.
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Affiliation(s)
| | - Yasamin Mojarab
- National Cell Bank of Iran, Pasteur Institute of Iran, Tehran, Iran
| | - Fatemeh Mottaghitalab
- Nanotechnology Research Centre, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Saeb
- Department of Pharmaceutical Technology, Medical University of Gdańsk, J. Hallera 107, 80-416 Gdańsk, Poland
| | - Mehdi Farokhi
- National Cell Bank of Iran, Pasteur Institute of Iran, Tehran, Iran.
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La Monica F, Campora S, Ghersi G. Collagen-Based Scaffolds for Chronic Skin Wound Treatment. Gels 2024; 10:137. [PMID: 38391467 PMCID: PMC10888252 DOI: 10.3390/gels10020137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
Chronic wounds, commonly known as ulcers, represent a significant challenge to public health, impacting millions of individuals every year and imposing a significant financial burden on the global health system. Chronic wounds result from the interruption of the natural wound-healing process due to internal and/or external factors, resulting in slow or nonexistent recovery. Conventional medical approaches are often inadequate to deal with chronic wounds, necessitating the exploration of new methods to facilitate rapid and effective healing. In recent years, regenerative medicine and tissue engineering have emerged as promising avenues to encourage tissue regeneration. These approaches aim to achieve anatomical and functional restoration of the affected area through polymeric components, such as scaffolds or hydrogels. This review explores collagen-based biomaterials as potential therapeutic interventions for skin chronic wounds, specifically focusing on infective and diabetic ulcers. Hence, the different approaches described are classified on an action-mechanism basis. Understanding the issues preventing chronic wound healing and identifying effective therapeutic alternatives could indicate the best way to optimize therapeutic units and to promote more direct and efficient healing.
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Affiliation(s)
- Francesco La Monica
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Ed. 16, 90128 Palermo, Italy
| | - Simona Campora
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Ed. 16, 90128 Palermo, Italy
| | - Giulio Ghersi
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Ed. 16, 90128 Palermo, Italy
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21
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Bazaliński D, Sieńczak K, Pytlak K, Przybek-Mita J, Pelczar K, Leppert W, Więch P. Pain Assessment in Patients Undergoing Maggot Debridement Therapy in the Process of Local Treatment of Chronic Wounds. J Clin Med 2024; 13:884. [PMID: 38337579 PMCID: PMC10856309 DOI: 10.3390/jcm13030884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Developing and implementing strategies for local wound care focused on improving the quality of life related to health status and reducing treatment costs for this patient group poses a challenge to contemporary healthcare systems. The utilization of Maggot Debridement Therapy (MDT) is one potential form of local therapy for preparing wounds for the healing process. The debridement of the wound bed with medical maggots is highly precise, and the defensins produced by the larvae eliminate bacteria and stimulate tissue regeneration. However, the presence of larvae in the wound may lead to the occurrence of pain symptoms. The aim of the study was to assess the intensity of pain during larval therapy in patients with chronic wounds treated in outpatient settings. (2) Patients and Methods: The study employed a diagnostic survey and estimation; the tool consisted of a research protocol comprising three parts (questionnaires). Inclusion criteria for the study were voluntary consent to participate (completion of the MDT acceptance questionnaire), chronic wounds of vascular etiology or pressure injuries, full-thickness skin or deep tissue damage, and pain intensity not exceeding four on the NRS (Numerical Rating Scale: 0-no pain, 10-the most severe pain) at the time of the study. Patient observation during the 3-day treatment was conducted by a wound care clinic nurse, assessing pain intensity once every 24 h during the larval dressing changes. (3) Results: Out of 348 individuals who qualified for MDT during the study period, 215 individuals participated in the study: 94 women (43.7%) and 121 men (56.3%). The age of the participants ranged from 28 to 97 years (mean 69.87 ± 12.95). Each participant experienced mild pain (2.26 ± 1.60 on the NRS) on the day of qualification for the study. An increase in pain intensity, according to subjective assessments, was reported by 29.3% of participants (n = 63). On the third day of MDT therapy, an increase in pain intensity was observed, reaching a mean value of 4.79 ± 2.12 (p < 0.0001). Participants with pressure injuries showed the lowest pain intensity, which increased in consecutive days for all types of wounds. Additionally, the increase in pain intensity in patients with vascular etiology wounds was greater compared to patients with pressure injuries (p < 0.001). (4) Conclusions: Local wound therapy with Lucilia sericata larvae increases pain intensity in the consecutive days of treatment. The wound area and the time since its occurrence may determine pain symptoms.
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Affiliation(s)
- Dariusz Bazaliński
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland; (D.B.); (K.P.); (J.P.-M.)
- Podkarpackie Specialist Oncology Centre, Father B. Markiewicz Specialist Hospital in Brzozów, 36-200 Brzozów, Poland;
| | - Karol Sieńczak
- Podkarpackie Specialist Oncology Centre, Father B. Markiewicz Specialist Hospital in Brzozów, 36-200 Brzozów, Poland;
- Institute of Medicine, Sanok State University, 38-500 Sanok, Poland
| | - Kamila Pytlak
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland; (D.B.); (K.P.); (J.P.-M.)
- Podkarpackie Specialist Oncology Centre, Father B. Markiewicz Specialist Hospital in Brzozów, 36-200 Brzozów, Poland;
| | - Joanna Przybek-Mita
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland; (D.B.); (K.P.); (J.P.-M.)
- Postgraduate Nursing and Midwifery Education Centre, 35-083 Rzeszów, Poland
| | - Klaudia Pelczar
- Independent Public Healthcare Institution, Ministry of Internal Affairs and Administration, 35-959 Rzeszów, Poland;
| | - Wojciech Leppert
- Institute of Medical Sciences, Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland;
- University Clinical Hospital in Poznań, 60-245 Poznań, Poland
| | - Paweł Więch
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland; (D.B.); (K.P.); (J.P.-M.)
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22
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Singh R, Roopmani P, Hasan U, Dogra P, Giri J. Airbrushed nanofibers with bioactive core and antibacterial shell for wound healing application. Eur J Pharm Biopharm 2024; 195:114169. [PMID: 38159872 DOI: 10.1016/j.ejpb.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
Acute and chronic wounds are vulnerable to infection and delayed healing and require critical care and advanced wound protection. To overcome the challenges, dual therapy of antibacterial and growth factors will be a novel wound care strategy. The present study explores airbrushed core-shell nanofiber for dual delivery of epidermal growth factor (EGF) and amoxicillin (AMOX) in a sustained manner. A blend of polycaprolactone (PCL)-polyethylene oxide (PEO) was used to prepare the shell compartment for amoxicillin loading and poly-DL-lactide (PDLLA) core for EGF loading by using a customized airbrush setup. Characterization result shows a uniform distribution of nanofibers ranging between 200 and 500 nm in diameter. Amoxicillin loading in the shell compartment offers an initial burst release followed by a sustained release for up to 14 days. Whereas EGF in the core part shows a continuous sustained release throughout the release study.In-vitrostudy indicates the biocompatibility of EGF-AMOX loaded core-shell nanofibers with human dermal fibroblast cell (HDF) cells and a higher cellular proliferation compared to control samples. Gene expression data show an increase in fold change of collagen I and tropoelastin expression, indicating the regenerative properties of EGF-AMOX encapsulated nanofiber. The combination of bioactive core (EGF) and antibiotic shell (amoxicillin) in an airbrushed nanofibrous scaffold is a novel approach, which is the first time explored to deliver sustainable therapy to treat skin wounds. Our results demonstrate that PCL-PEO-Amoxicillin/PDLLA-EGF-loaded core-shell nanofibers are promising dual therapy scaffolds to deliver effective skin wound care, with the possibility of direct deposition on the wound.
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Affiliation(s)
- Ruby Singh
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Telangana 502285, India
| | - Purandhi Roopmani
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Telangana 502285, India
| | - Uzma Hasan
- Department of Biotechnology, Indian Institute of Technology Hyderabad, Kandi, Telangana 502285, India
| | - Poonam Dogra
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Telangana 502285, India
| | - Jyotsnendu Giri
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Telangana 502285, India.
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Tsangaris E, van Haren EL, Poulsen L, Squitieri L, Hoogbergen MM, Cross K, Sørensen JA, van Alphen TC, Pusic A, Klassen AF. Identifying health-related quality of life concepts to inform the development of the WOUND-Q. J Wound Care 2024; 33:28-38. [PMID: 38197277 DOI: 10.12968/jowc.2024.33.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE The impact of hard-to-heal wounds extends beyond traditional clinical metrics, negatively affecting a patient's health-related quality of life (HRQoL). Yet treatment outcomes are seldom measured from the patient's perspective. The purpose of the present study was to perform in-depth qualitative interviews with patients diagnosed with varying types of hard-to-heal wounds to identify outcomes important to them. METHOD Participants were recruited from wound care clinics in Canada, Denmark, the Netherlands and the US, and were included if they had a hard-to-heal wound (i.e., lasting ≥3 months), were aged ≥18 years, and fluent in English, Dutch or Danish. Qualitative interviews took place between January 2016 and March 2017. An interpretive description qualitative approach guided the data analysis. Interviews were audio-recorded, transcribed and coded line-by-line. Codes were categorised into top-level domains and themes that formed the final conceptual framework. RESULTS We performed 60 in-depth interviews with patients with a range of wound types in different anatomic locations that had lasted from three months to 25 years. Participants described outcomes that related to three top-level domains and 13 major themes: wound (characteristics, healing); HRQoL (physical, psychological, social); and treatment (cleaning, compression stocking, debridement, dressing, hyperbaric oxygen, medication, suction device, surgery). CONCLUSION The conceptual framework developed as part of this study represents the outcome domains that mattered the most to the patients with hard-to-heal wounds. Interview quotes were used to generate items that formed the WOUND-Q scales, a patient-reported outcome measure for patients with hard-to-heal wounds.
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Affiliation(s)
- Elena Tsangaris
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, US
| | - Emiel Lwg van Haren
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, Denmark
- Odense Explorative Patient Network, Odense, Denmark
| | - Lee Squitieri
- RAND Corporation, Santa Monica, CA, US
- Plastic and Reconstructive Surgery, Adventist Health White Memorial, Los Angeles, CA, US
| | - Maarten M Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Karen Cross
- St. Michael's Hospital, Keenan Research Centre, Toronto, Ontario, Canada
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, Denmark
- Odense Explorative Patient Network, Odense, Denmark
| | - Tert C van Alphen
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Andrea Pusic
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, US
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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24
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Deldar R, Huffman SS, Bovill JD, Gupta N, Truong BN, Haffner ZK, Sayyed AA, Fan KL, Evans KK. Clinical utility of the modified frailty index in predicting adverse outcomes in patients undergoing lower extremity free flap reconstruction. Microsurgery 2024; 44:e31135. [PMID: 38124444 DOI: 10.1002/micr.31135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/30/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Identifying at-risk patients for complications remains challenging in patients with chronic lower extremity (LE) wounds receiving free tissue transfer (FTT) for limb salvage. The modified-5 frailty index (mFI-5) has been utilized to predict postoperative complications, yet it has not been studied in this population. The aim of this study was to determine the utility of the mFI-5 in predicting adverse postoperative outcomes. METHODS Patients ≥60 years, who underwent LE FTT reconstruction at a single institution from 2011 to 2022, were retrospectively reviewed. Patient characteristics, mFI-5, and postoperative outcomes were collected. Cohorts were divided by an mFI-5 score of <2 or ≥2. RESULTS A total of 115 patients were identified, of which 71.3% (n = 82) were male, 64.3% (n = 74) had a mFI-5 score of ≥2, and 35.7% (n = 41) had a score <2. The average age and body mass index were 67.8 years and 28.7 kg/m2 , respectively. The higher mFI-5 cohort had lower baseline albumin levels (3.0 vs. 4.0 g/dL, p = .015) and higher hemoglobin A1c levels (7.4 vs. 5.8%, p < .001). The postoperative length of stay was longer in the higher mFI-5 cohort (18 vs. 13.4 days, p = .003). The overall flap success was 96.5% (n = 111), with no difference between cohorts (p = .129). Postoperative complications were comparable between cohorts (p = .294). At a mean follow-up of 19.8 months, eight patients (7.0%) underwent amputation, and 91.3% (n = 105) were ambulatory. CONCLUSION High microsurgical success rates can be achieved in comorbid patients with high frailty indexes who undergo FTT for limb salvage. A multidisciplinary team approach may effectively mitigate negative outcomes in elderly, frail patients.
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Affiliation(s)
- Romina Deldar
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - John D Bovill
- Georgetown University School of Medicine, Washington, DC, USA
| | - Nisha Gupta
- Georgetown University School of Medicine, Washington, DC, USA
| | - Brian N Truong
- Georgetown University School of Medicine, Washington, DC, USA
| | - Zoë K Haffner
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Adaah A Sayyed
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
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25
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Swerdlow M, Lo J, Armstrong DG. Reliability of an AI-Powered Application Across Different Mobile Devices for Assessment of Chronic Wounds. Adv Wound Care (New Rochelle) 2024; 13:14-21. [PMID: 36721378 PMCID: PMC11071090 DOI: 10.1089/wound.2022.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/31/2023] [Indexed: 02/02/2023] Open
Abstract
Objective: Evaluate the inter- and intrarater reliability of a wound assessment tool in iPhone 12 and 13 mini modalities against a validated iPad mini/Structure Sensor configuration. Approach: We assessed a wound measurement application (eKare inSight®) for result consistency in patients presenting with wounds. Assessments were analyzed using a two-way analysis of variance. Intraclass correlation coefficient (ICC) was computed for intrarater (ICC1,1) and inter-rater (ICC2,1) analysis using a two-way random effects model. Paired t-test assessed the statistical difference between measurement methods. Results: Forty-two lesions were analyzed with surface areas ranging from 0.2 to 23 cm2 (average 4.33 ± 5.44 cm2). A high level of reliability was observed for repeat wound area measurements by the same examiner (ICC1,1 = 0.997) and between examiners with iPhone 13 mini (ICC2,1 = 0.998). There was no significant difference between iPhone 12 and iPad mini/Structure Sensor (p = 0.78) or between iPhone 13 mini and iPhone 12 (p = 0.22). Minimal difference existed between iPhone 13 mini and iPad mini/Structure Sensor (p = 0.049, Cohen's d = 0.01). Innovation: Increased pervasiveness of smartphones in clinical care, coupled with advances in smartphone imaging and machine learning, allows for a potential solution to the problem of fast and accurate wound measurements. The application investigated produces wound measurement results quickly and with demonstrated accuracy. It does not require a calibration sticker or reference marker and allows for automatic wound boundary delineation. Conclusion: The results of this study suggest that a digital planimetry mobile application may offer high levels of reliability across devices and users.
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Affiliation(s)
- Mark Swerdlow
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Jessica Lo
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, California, USA
| | - David G. Armstrong
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, California, USA
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26
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Bhardwaj P, Zolper EG, Abadeer AI, Kim KG, Attinger CE, Atves JN, Fan KL, Evans KK. New and Recurrent Ulcerations after Free Tissue Transfer with Partial Bony Resection in Chronic Foot Wounds within a Comorbid Population. Plast Reconstr Surg 2024; 153:233-241. [PMID: 37075302 DOI: 10.1097/prs.0000000000010564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Chronic foot wounds often require bony resection; however, altering the tripod of the foot carries a risk of new ulcer development nearing 70%. Resulting defects often require free tissue transfer (FTT) reconstruction; outcomes data for various bony resection and FTT options may guide clinical decision-making regarding bone and soft-tissue management. The authors hypothesized that alteration of the bony tripod will increase risk of new lesion development after FTT reconstruction. METHODS A single-center retrospective cohort analysis of patients undergoing FTT from 2011 through 2019 with bony resection and soft-tissue defects of the foot was performed. Data collected included demographics, comorbidities, wound locations, and FTT characteristics. Primary outcomes were recurrent lesion (RL) and new lesion (NL) development. Multivariate logistic regression and Cox hazards regression were used to produce adjusted odds ratios and hazard ratios. RESULTS Sixty-four patients (mean age, 55.9 years) who underwent bony resection and FTT were included. Mean Charlson Comorbidity Index was 4.1 (SD 2.0), and median follow-up was 14.6 months (range, 7.5 to 34.6 months). Wounds developed after FTT in 42 (67.1%) (RL, 39.1%; NL, 40.6%). Median time to NL development was 3.7 months (range, 0.47 to 9.1 months). First-metatarsal defect (OR, 4.8; 95% CI, 1.5 to 15.7) and flap with cutaneous component (OR, 0.24; 95% CI, 0.07 to 0.8) increased and decreased odds of NL development, respectively. CONCLUSIONS First-metatarsal defects significantly increase NL risk after FTT. The majority of ulcerations heal with minor procedures but require long-term follow-up. Soft-tissue reconstruction with FTT achieves success in the short term, but NL and RL occur at high rates in the months to years after initial healing. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
| | - Elizabeth G Zolper
- From the Georgetown University School of Medicine
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | - Andrew I Abadeer
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | - Kevin G Kim
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | - Christopher E Attinger
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | - Jayson N Atves
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
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Keshavarz R, Olsen S, Almeida B. Using biomaterials to improve mesenchymal stem cell therapies for chronic, nonhealing wounds. Bioeng Transl Med 2024; 9:e10598. [PMID: 38193114 PMCID: PMC10771568 DOI: 10.1002/btm2.10598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 01/10/2024] Open
Abstract
Historically, treatment of chronic, nonhealing wounds has focused on managing symptoms using biomaterial-based wound dressings, which do not adequately address the underlying clinical issue. Mesenchymal stem cells (MSCs) are a promising cell-based therapy for the treatment of chronic, nonhealing wounds, yet inherent cellular heterogeneity and susceptibility to death during injection limit their clinical use. Recently, researchers have begun to explore the synergistic effects of combined MSC-biomaterial therapies, where the biomaterial serves as a scaffold to protect the MSCs and provides physiologically relevant physicochemical cues that can direct MSC immunomodulatory behavior. In this review, we highlight recent progress in this field with a focus on the most commonly used biomaterials, classified based on their source, including natural biomaterials, synthetic biomaterials, and the combination of natural and synthetic biomaterials. We also discuss current challenges regarding the clinical translation of these therapies, as well as a perspective on the future outlook of the field.
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Affiliation(s)
- Romina Keshavarz
- Department of Chemical and Biomolecular EngineeringClarkson UniversityPotsdamNew YorkUSA
| | - Sara Olsen
- Department of Chemical and Biomolecular EngineeringClarkson UniversityPotsdamNew YorkUSA
| | - Bethany Almeida
- Department of Chemical and Biomolecular EngineeringClarkson UniversityPotsdamNew YorkUSA
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28
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Derwin R, Patton D, Strapp H, Moore Z. Integrating Point-of-Care Bacterial Fluorescence Imaging-Guided Care with Continued Wound Measurement for Enhanced Wound Area Reduction Monitoring. Diagnostics (Basel) 2023; 14:2. [PMID: 38201311 PMCID: PMC10802895 DOI: 10.3390/diagnostics14010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
AIM This prospective observational study investigated wound area reduction (WAR) outcomes in a complex wound population composed of non-healing acute and chronic wounds. The relationship between bacterial autofluorescence signals and WAR was investigated. Area measurements were collected both manually and digitally, and both methods were compared for accuracy. METHODS Twenty-six participants with 27 wounds of varying etiologies were observed twice weekly for two weeks. Digital wound measurement, wound bacterial status assessment, and targeted debridement were performed through a point-of-care fluorescence imaging device (MolecuLight® i: X, MolecuLight Inc, Toronto, Canada). The wound area reduction (WAR) rate was calculated using baseline and last visit measurements. Statistical analyses, including t-tests, Fisher exact tests, the Wilcoxon signed rank test for method comparison, and ANOVA for bacterial subgroups, were applied as pertinent. RESULTS The overall average WAR was -3.80 cm2, or a decrease of 46.88% (manual measurement), and -2.62 cm2, or a 46.05% decrease (digital measurement via MolecuLight® device). There were no statistically significant differences between the WAR of acute and chronic wounds (p = 0.7877). A stepwise correlation between the WAR and bacterial status classification per fluorescence findings was observed, where persistent bacteria resulted in worse WAR outcomes. An overestimation of wound area by manual measurement was 23% on average. CONCLUSION Fluorescence imaging signals were linked to WAR outcome and could be considered predictive. Wounds exhibiting bacterial loads that persisted at the end of the study period had worse WAR outcomes, while those for which management was able to effectively remove them demonstrated greater WAR. Manual measurement of the wound area consistently overestimated wound size when compared to digital measurement. However, if performed by the same operator, the overestimation was uniform enough that the WAR was calculated to be close to accurate. Notwithstanding, single wound measurements are likely to result in overestimation.
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Affiliation(s)
- Rosemarie Derwin
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
- Fakeeh College of Health Sciences, Jeddah 23323, Saudi Arabia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong NSW 2522, Australia
| | - Helen Strapp
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD 4222, Australia
- School of Health Sciences, Faculty of Life and Health Sciences, Ulster University, Belfast BT15 1AP, UK
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah 23323, Saudi Arabia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, 9000 Gent, Belgium
- Lida Institute, Shanghai 201609, China
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Verdú-Soriano J, Casado-Díaz A, de Cristino-Espinar M, Luna-Morales S, Dios-Guerra C, Moreno-Moreno P, Dorado G, Quesada-Gómez JM, Rodríguez-Mañas L, Lázaro-Martínez JL. Hard-to-Heal Wound Healing: Superiority of Hydrogel EHO-85 (Containing Olea europaea Leaf Extract) vs. a Standard Hydrogel. A Randomized Controlled Trial. Gels 2023; 9:962. [PMID: 38131948 PMCID: PMC10742797 DOI: 10.3390/gels9120962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Chronic wounds, especially those that are hard-to-heal, constitute a serious public-health problem. Although progress has been made in the development of wound dressings for healing, there is little high-quality evidence of their efficacy, with no evidence of superiority in the use of one hydrogel over another. To evaluate the superiority of a hydrogel (EHO-85), containing Olea europaea leaf extract (OELE), over a standard hydrogel (SH), the promotion and/or improvement of healing of difficult-to-heal wounds was compared in a prospective, parallel-group multicenter, randomized, observer-blinded, controlled trial ("MACAON"). Non-hospitalized patients with pressure, venous or diabetic foot-ulcers difficult-to-heal were recruited and treated with standard care, and EHO-85 (n = 35) or VariHesive (n = 34) as SH. Wound-area reduction (WAR; percentage) and healing rate (HR; mm2/day) were measured. EHO-85 showed a statistically significant superior effect over VariHesive. At the end of the follow-up period, the relative WAR decreased by 51.6% vs. 18.9% (p < 0.001), with a HR mean of 10.5 ± 5.7 vs. 1.0 ± 7.5 mm2/day (p = 0.036). EHO-85 superiority is probably based on its optimal ability to balance the ulcer bed, by modulating pH and oxidative stress. That complements the wetting and barrier functions, characteristics of conventional hydrogels. These results support the use of EHO-85 dressing, for treatment of hard-to-heal ulcers. Trial Registration AEMPS:PS/CR623/17/CE.
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Affiliation(s)
- José Verdú-Soriano
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain
| | - Antonio Casado-Díaz
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, 14004 Córdoba, Spain; (M.d.C.-E.); (S.L.-M.); (C.D.-G.); (P.M.-M.); (J.M.Q.-G.)
- Endocrinology and Nutrition Unit, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Consortium for Biomedical Research in Frailty & Healthy Ageing (CIBERFES), Institute of Health Carlos III, 28029 Madrid, Spain; (G.D.); (L.R.-M.)
| | - Marisol de Cristino-Espinar
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, 14004 Córdoba, Spain; (M.d.C.-E.); (S.L.-M.); (C.D.-G.); (P.M.-M.); (J.M.Q.-G.)
- Pharmacy Department, Reina Sofia University Hospital, 14004 Córdoba, Spain
| | - Silvia Luna-Morales
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, 14004 Córdoba, Spain; (M.d.C.-E.); (S.L.-M.); (C.D.-G.); (P.M.-M.); (J.M.Q.-G.)
- Occidente Health Center, Córdoba and Guadalquivir Health Management Area, 14005 Córdoba, Spain
| | - Caridad Dios-Guerra
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, 14004 Córdoba, Spain; (M.d.C.-E.); (S.L.-M.); (C.D.-G.); (P.M.-M.); (J.M.Q.-G.)
- Occidente Health Center, Córdoba and Guadalquivir Health Management Area, 14005 Córdoba, Spain
- Department of Nursing, Faculty of Medicine and Nursing, University of Cordoba, 14004 Córdoba, Spain
| | - Paloma Moreno-Moreno
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, 14004 Córdoba, Spain; (M.d.C.-E.); (S.L.-M.); (C.D.-G.); (P.M.-M.); (J.M.Q.-G.)
- Endocrinology and Nutrition Unit, Reina Sofia University Hospital, 14004 Córdoba, Spain
| | - Gabriel Dorado
- Consortium for Biomedical Research in Frailty & Healthy Ageing (CIBERFES), Institute of Health Carlos III, 28029 Madrid, Spain; (G.D.); (L.R.-M.)
- Department Bioquímica y Biología Molecular, Campus Rabanales C6-1-E17, Campus de Excelencia Internacional Agroalimentario (ceiA3), Universidad de Córdoba, 14071 Córdoba, Spain
| | - José Manuel Quesada-Gómez
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, 14004 Córdoba, Spain; (M.d.C.-E.); (S.L.-M.); (C.D.-G.); (P.M.-M.); (J.M.Q.-G.)
- Consortium for Biomedical Research in Frailty & Healthy Ageing (CIBERFES), Institute of Health Carlos III, 28029 Madrid, Spain; (G.D.); (L.R.-M.)
| | - Leocadio Rodríguez-Mañas
- Consortium for Biomedical Research in Frailty & Healthy Ageing (CIBERFES), Institute of Health Carlos III, 28029 Madrid, Spain; (G.D.); (L.R.-M.)
- Department of Geriatrics, University Hospital of Getafe, 28905 Getafe, Spain
| | - José Luis Lázaro-Martínez
- Diabetic Foot Unit, University Podiatry Clinic, Complutense University of Madrid, 28040 Madrid, Spain;
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Chen YJ, Hsu CY, Lin CH. Chronic Leg Ulcer Associated with Cutaneous IgG4-Related Disease. INT J LOW EXTR WOUND 2023; 22:792-797. [PMID: 35068233 DOI: 10.1177/15347346221075873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Chronic leg ulcer occurs in up to 13% of the general population and leads to economic and health care burdens. Approximately 20% of chronic nonhealing wounds are related to autoimmune diseases or vasculitis. Of these, chronic wounds associated with IgG4-related disease, a group of fibroinflammatory disorders that can have cutaneous and systemic involvement, are rarely reported. This case report describes a chronic leg ulcer associated with cutaneous IgG4-related disease. In addition to disease control with anti-inflammatory agents, following the principles of wound management and providing adjuvant wound treatment (eg, debridement, dressing, photobiomodulation therapy, or hyperbaric oxygen therapy) can promote the wound healing process.
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Affiliation(s)
- Yi-Jye Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Yi Hsu
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chih-Hsun Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Nasra S, Patel M, Shukla H, Bhatt M, Kumar A. Functional hydrogel-based wound dressings: A review on biocompatibility and therapeutic efficacy. Life Sci 2023; 334:122232. [PMID: 37918626 DOI: 10.1016/j.lfs.2023.122232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/04/2023]
Abstract
Chronic wounds, burns, and surgical incisions represent critical healthcare challenges that significantly impact patient quality of life and strain healthcare resources. In response to these pressing needs, the field of wound healing has witnessed a radical advancement with the emergence of functional hydrogel-based dressings. This review article underscores the severity and importance of this transformative study in the domain of wound healing. The hydrogel matrix offers a moist and supportive environment that facilitates cellular migration, proliferation, and tissue regeneration, vital for efficient wound closure. Their conformable nature ensures patient comfort, reducing pain and uneasiness during dressing changes, particularly in chronic wounds where frequent interventions are required. Beyond their structural merits, functional hydrogel dressings possess the capability of incorporating bioactive molecules such as growth factors and antimicrobial agents. This facilitates targeted and sustained delivery of therapeutics directly to the wound site, addressing the multifactorial nature of chronic wounds and enhancing the healing trajectory. The integration of advanced nanotechnology has propelled the design of hydrogel dressings with enhanced mechanical strength and controlled drug release profiles, amplifying their therapeutic potential. In conclusion, the significance of this study lies in its ability to revolutionize wound healing practices and positively impact the lives of countless individuals suffering from chronic wounds and burns. As this transformative technology gains momentum, it holds the promise of addressing a major healthcare burden worldwide, thus heralding a new era in wound care management.
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Affiliation(s)
- Simran Nasra
- Biological and Life Sciences, School of Arts & Sciences, Ahmedabad University, Central Campus, Navrangpura, Ahmedabad 380009, Gujarat, India
| | - Milonee Patel
- Biological and Life Sciences, School of Arts & Sciences, Ahmedabad University, Central Campus, Navrangpura, Ahmedabad 380009, Gujarat, India
| | - Haly Shukla
- Biological and Life Sciences, School of Arts & Sciences, Ahmedabad University, Central Campus, Navrangpura, Ahmedabad 380009, Gujarat, India
| | - Mahek Bhatt
- Biological and Life Sciences, School of Arts & Sciences, Ahmedabad University, Central Campus, Navrangpura, Ahmedabad 380009, Gujarat, India
| | - Ashutosh Kumar
- Biological and Life Sciences, School of Arts & Sciences, Ahmedabad University, Central Campus, Navrangpura, Ahmedabad 380009, Gujarat, India.
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Chalikkandy SN, Bhandi S, Shawkani HAAA, Wadei MHDA, Mohammed Abdul Kader M, Jaafari AHH, Vinothkumar TS, Varadarajan S, Testarelli L, Patil S. A systematic review assessing the dental pulp stone prevalence in the Saudi Arabian population. Saudi Dent J 2023; 35:803-811. [PMID: 38077230 PMCID: PMC10699125 DOI: 10.1016/j.sdentj.2023.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 06/21/2024] Open
Abstract
This Systematic Review (SR) was to report on the prevalence of pulp stones in the Saudi Arabian (KSA) population. The electronic databases were searched for scientific research articles during May 2021. The data search was performed in electronic search engines like PubMed, Scopus, Web of science, and Saudi Digital Library, and 6 original research articles which fulfilled the eligibility criteria were assessed for qualitative data. The prevalence of pulp stones among the KSA population ranged from 4.6% to 50.93% among the study participants and it ranged between 10.2%-13.34% in the teeth assessed. The pulp stones were more frequently reported in decayed teeth, periodontal diseases, attrition, teeth with dental restorations, and higher in the molar teeth in comparison with the premolar teeth. The data on the prevalence of pulp stones among the Saudi population will be helpful for clinicians in planning endodontic procedures.
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Affiliation(s)
| | - Shilpa Bhandi
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Hamed Ahmed Ali Al Shawkani
- Department of Restorative Dental Science, Division of Endodontics, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | | | - M. Mohammed Abdul Kader
- Department of Restorative Dental Science, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | | | - Thilla Sekar Vinothkumar
- Department of Restorative Dental Science, Division of Operative Dentistry, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Saranya Varadarajan
- Distinguished Adjunct Faculty, Department of Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600 077, India
| | - Luca Testarelli
- Department of Oral and Maxillo-Facial Sciences, University di Roma La Sapienza, Roma 00185, Italy
| | - Shankargouda Patil
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
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Li Z, Zhang S, Zuber F, Altenried S, Jaklenec A, Langer R, Ren Q. Topical application of Lactobacilli successfully eradicates Pseudomonas aeruginosa biofilms and promotes wound healing in chronic wounds. Microbes Infect 2023; 25:105176. [PMID: 37406851 DOI: 10.1016/j.micinf.2023.105176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/18/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023]
Abstract
Chronic wounds are difficult to treat due to the presence of biofilm which prevents wound healing. Pseudomonas aeruginosa is one of the most common pathogens found in chronic wounds and conventional treatment strategies have been ineffective in the eradication of its biofilm, without harming the surrounding healthy tissue at the same time. Here, we introduced an innovative approach applying the probiotic product Bio-K+ (containing three lactobacilli) topically as an antimicrobial and antibiofilm agent. We identified lactic acid as the main active component. While antibiotics and antiseptics such as silver-ions only demonstrated limited efficacy, Bio-K+ was able to completely eradicate mature P. aeruginosa biofilms established in an in-vitro and ex-vivo human skin model. Furthermore, it demonstrated biocompatibility in the co-culture with human dermal fibroblasts and accelerated the migration of fibroblasts in a cell migration assay promoting wound healing. To enhance clinical practicability, we introduced Bio-K+ into the hydrocolloid dressing Aquacel, achieving sustained release of lactic acid and biofilm eradication. This new treatment approach applying probiotics could represent a major improvement in the management of chronic wounds and can be extended in treating other biofilm-associated infections.
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Affiliation(s)
- Zhihao Li
- Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland.
| | - Sixuan Zhang
- Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland
| | - Flavia Zuber
- Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland
| | - Stefanie Altenried
- Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland
| | - Ana Jaklenec
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA 02139, USA
| | - Robert Langer
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA 02139, USA
| | - Qun Ren
- Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland.
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Pacheco YJ, Marin ELN, Ocampo DB, Gutiérrez CBB, Salom GAM, Ruiz JB, Garzon GFM, Casado JJP, Agudelo IMH, Mendez JAV, Lopez EHD, Bohorquez UM, Chamorro DR, Carrascal AO, Suarez EB, Cole W, Serena T, Marquez CA, Woodmansey E. Consenso de expertos sobre la eficacia clínica y directrices sobre la terapia de oxígeno transdérmico continuo para la cicatrización de las heridas complejas o difíciles de cicatrizar. J Wound Care 2023; 32:1-37. [PMID: 37934612 DOI: 10.12968/jowc.2023.32.latam_sup_10.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Oxygen is pivotal for wound healing. Its lack or hypoxia can delay this process, especially in individuals with comorbidities, potentially resulting in complex or hard-to-heal wounds. The Colombian Association of Diabetes (ACD) and the Colombian Association of Internal Medicine (ACMI) collaborated with a diverse group of experts to provide recommendations on the efficacy and best practices of continuous transdermal oxygen therapy (TOTc) in the care of such wounds. METHOD A modified Delphi technique was employed to obtain controlled feedback and responses. Experts from various disciplines engaged in reviewing and discussing numerous relevant scientific studies, focusing on the role of TOTc in treating chronic ulcers. RESULTS Continuous transdermal oxygen therapy has proven to be an effective and safe treatment for chronic and/or hard-to-heal ulcers. This therapy directly addresses the wound's oxygen deficiency, providing an environment conducive to healing. Significant benefits were observed, including the acceleration of the healing process, wound size reduction, and an enhancement in patient quality of life. Its efficacy was found across various ulcer etiologies, underscoring its therapeutic versatility. CONCLUSIONS Continuous transdermal oxygen therapy is effective and safe for treating chronic and hard-to-heal ulcers. It's crucial to address each case individually and through a multidisciplinary approach to maximize this therapy's benefits. Both evidence and clinical experience back its utility across a variety of ulcer etiologies.
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Affiliation(s)
- Yamile Jubiz Pacheco
- Coordinadora zona norte de Suramérica ante el D-Foot International. Médico diabetóloga-experta en el cuidado del pie diabético y heridas complejas. Jefe unidad interdisciplinaria de pie diabético y heridas complejas
| | | | - Dora Bernal Ocampo
- Médica especialista en medicina familiar. Vicepresidenta confederación Iberoamericana de medicina familiar. Presidenta Asociación Colombiana de Sociedades Científicas
| | | | - Gustavo Adolfo Marquez Salom
- Médico especialista en medicina interna y clínica de hipertensión. Diabetólogo experto en pie diabético y heridas complejas. Director centro de atención integral de personas con diabetes y comorbilidades
| | - Jaime Brugés Ruiz
- Médico diabetólogo experto en pie diabético y heridas complejas. Director fundación Medicus - Cartagena
| | - Gary Fernando Monclou Garzon
- Médico especialista en ortopedia y traumatología. Especialista en cirugía de cadera reconstructiva. Magister en educación médica. Jefe del servicio de ortopedia Clínica Palermo - Bogotá
| | - John Jairo Perez Casado
- Médico especialista en ortopedia y traumatología. Reconstrucción, salvamento de extremidades y técnicas microquirúrgicas
| | - Iván Mauricio Hernández Agudelo
- Méico especialista en ortopedia y traumatología. Fellowship trauma y cirugía reconstructiva Medizinische Hochschule Hannover. Cirujano trauma y reconstructivo Clínica Palermo - Clínica Universidad La Sabana
| | | | - Enfermera Hilsen Duran Lopez
- Enfermera profesional especialista en cuidado de persona con heridas, ostomías, y lesiones de piel. Coordinadora de la unidad de heridas del Hospital Militar Central Colombia
| | - Ulises Múnera Bohorquez
- Médico experto en el cuidado de heridas complejas. Presidente Fundepiel Colombia 2022-2024. Autor del libro Introducción al mundo de las heridas, Editorial Bonaventuriano
| | - Damaris Romero Chamorro
- Médico especialista en cirugía plástica, Estética y reconstructiva. Miembro de la Federación IberoLatinoamericana de Cirugía Plástica FILACP. Secretaría ejecutiva, Sociedad Colombiana de Cirugía Plástica, Estética y Reconstructiva. Miembro Sociedad Americana de Cirugía Plástica
| | - Alexandra Otero Carrascal
- Médico especialista en cirugía plástica, Reconstructiva y estética. Subespecialista en mano. Miembro del Grupo Colombiano Interdisciplinario de Pie Diabético y Heridas Complejas
| | - Emerson Barajas Suarez
- Médico especialista en cirugía vascular y endovascular. Especialista en docencia universitaria
| | - Windy Cole
- Licenciatura en biología, Universidad de Cincinnati. Doctor en medicina podológica, Kent State University College. Médico especialista certificado en cuidado de heridas, American Board of Wound Management. Director de investigación de cuidado de heridas, Facultad de Medicina Podiátrica de la Universidad de Kent. Editor de la sección del consejo asesor editorial, cirugía podológica
| | - Thomas Serena
- Doctor en Medicina (MD), Universidad Estatal de Pensilvania. Vicepresidente Anterior, Colegio Americano de medicina hiperbárica. Presidente anterior, Asociación para el Avance del Cuidado de Heridas. Licenciatura en biología, pre-médica - The College of William and Mary
| | - Camilo Acosta Marquez
- MSc Magister Ingeniería Biomédica - Universidad de los Andes. Ingeniero Eléctrico - Universidad de los Andes. Doctor (PhD) en Robótica Abertay University, Dundee, Escocia. Postdoctorado en Robótica Aplicada a la Rehabilitación - Abertay University, Dundee, Escocia
| | - Emma Woodmansey
- Doctor of Philosophy (PhD), gut microbiology, University of Dundee. BSc (Hons) degree, medical microbiology, University of Dundee
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Choma P, Bazin I, Cerutti M, Vena A, Sorli B. Capacitive immunosensor based on grafted Anodic Aluminum Oxide for the detection of matrix metalloproteinase 9 found in chronic wounds. Anal Biochem 2023; 678:115282. [PMID: 37572841 DOI: 10.1016/j.ab.2023.115282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/14/2023]
Abstract
Chronic wounds impose a significant burden on healthcare resources, society and more specifically on patients. Preliminary research showed that as of today, there is not a system that can do a precise monitoring of these wounds so that healthcare systems can manage them with efficiency. The overall aim of our project is to produce a capacitive sensor able to detect a specific molecule in chronic wounds, thus giving information concerning its inflammation state. In this article, we present a system that uses nanoporous Anodic Aluminum Oxide (AAO) grafted with a commercially available anti-MMP9 antibody able to interact with Matrix Metalloproteinase 9, an enzyme that works as an indicator of inflammation. In order to produce a proof-of-concept we chose to compare two methods of functionalization followed by a thorough analysis with biological, electrical and optical testing. This study produced reproducible results for each functionalization method, chemisorption being the best choice for the immobilization of conventional antibodies on AAO-based sensors for a detection of MMP9 in pure and complex conditions. This proof-of-concept and its analysis allowed a better understanding of the needs of the overall project and will be helpful to produce a prototype of smart dressing in the near future.
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Affiliation(s)
- Pauline Choma
- Institut d'Electronique et des Systèmes, CNRS UMR5214, Université Montpellier, 860 rue Saint Priest, 34090, Montpellier, France
| | - Ingrid Bazin
- LGEI, IMT Mines Ales, Université de Montpellier, 6 avenue de Clavières, 30319, Ales Cedex, France
| | - Martine Cerutti
- Unité Baculovirus et Thérapie, Station Recherche, CNRS UPS3044, 410 chemin des Boissières, 30380, Saint Christol Lès Alès, France
| | - Arnaud Vena
- Institut d'Electronique et des Systèmes, CNRS UMR5214, Université Montpellier, 860 rue Saint Priest, 34090, Montpellier, France
| | - Brice Sorli
- Institut d'Electronique et des Systèmes, CNRS UMR5214, Université Montpellier, 860 rue Saint Priest, 34090, Montpellier, France.
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Thai VL, Ramos-Rodriguez DH, Mesfin M, Leach JK. Hydrogel degradation promotes angiogenic and regenerative potential of cell spheroids for wound healing. Mater Today Bio 2023; 22:100769. [PMID: 37636986 PMCID: PMC10450977 DOI: 10.1016/j.mtbio.2023.100769] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/27/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023] Open
Abstract
Chronic nonhealing wounds are debilitating and diminish one's quality of life, necessitating the development of improved strategies for effective treatment. Biomaterial- and cell-based therapies offer an alternative treatment compared to conventional wound care for regenerating damaged tissues. Cell-based approaches frequently utilize endothelial cells (ECs) to promote vascularization and mesenchymal stromal cells (MSCs) for their potent secretome that promotes host cell recruitment. Spheroids have improved therapeutic potential over monodisperse cells, while degradable scaffolds can influence cellular processes conducive to long-term tissue regeneration. However, the role of biomaterial degradation on the therapeutic potential of heterotypic EC-MSC spheroids for wound healing is largely unknown. We formed poly(ethylene) glycol (PEG) hydrogels with varying ratios of matrix metalloproteinase (MMP)-degradable and non-degradable crosslinkers to develop three distinct constructs - fully degradable, partially degradable, and non-degradable - and interrogate the influence of degradation rate on engineered cell carriers for wound healing. We found that the vulnerability to degradation was critical for cellular proliferation, while inhibition of degradation impaired spheroid metabolic activity. Higher concentrations of degradable crosslinker promoted robust cell spreading, outgrowth, and secretion of proangiogenic cytokines (i.e., VEGF, HGF) that are critical in wound healing. The degree of degradation dictated the unique secretory profile of spheroids. When applied to a clinically relevant full-thickness ex vivo skin model, degradable spheroid-loaded hydrogels restored stratification of the epidermal layer, confirming the efficacy of scaffolds to promote wound healing. These results highlight the importance of matrix remodeling and its essential role in the therapeutic potential of heterotypic spheroids.
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Affiliation(s)
- Victoria L. Thai
- Department of Orthopaedic Surgery, UC Davis Health, Sacramento, CA, 95817, USA
- Department of Biomedical Engineering, UC Davis, Davis, CA, 95616, USA
| | | | - Meron Mesfin
- Department of Biomedical Engineering, UC Davis, Davis, CA, 95616, USA
| | - J. Kent Leach
- Department of Orthopaedic Surgery, UC Davis Health, Sacramento, CA, 95817, USA
- Department of Biomedical Engineering, UC Davis, Davis, CA, 95616, USA
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Kłosiński KK, Wach RA, Kruczkowska W, Duda Ł, Kołat D, Kałuzińska-Kołat Ż, Arkuszewski PT, Pasieka ZW. Carboxymethyl Chitosan Hydrogels for Effective Wound Healing-An Animal Study. J Funct Biomater 2023; 14:473. [PMID: 37754888 PMCID: PMC10531907 DOI: 10.3390/jfb14090473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/23/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Hydrogels have various applications in medicine, for example, in systems for controlled drug release or as wound dressings, where they provide an appropriate environment for healing and constitute a barrier to microorganisms. The aim of this study was to evaluate the action of carboxymethyl chitosan (CMCS) hydrogels in wound healing therapy in vivo using a laboratory rat model. The hydrogels were formed from aqueous solutions of a CMCS biopolymer via electron beam irradiation, with the presence of a crosslinking agent of poly(ethylene glycol) diacrylate. A histopathological examination of injured tissue, using a model of a hard-to-heal wound, indicated that the CMCS hydrogel supported healing. The new gel dressing, being noncytotoxic, presents great potential in wound treatment, with positive effects on the amount of inflammatory infiltration, young collagen formation, and the degree of epidermalization. A key advantage of the current approach (i.e., using competitive radiation technology for synthesis) is that it includes only one step, with the product being sterilized as it is synthesized. The hydrogel effectively supports wound healing and can serve as a bio-based and biodegradable platform for other medical applications.
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Affiliation(s)
- Karol Kamil Kłosiński
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (Ł.D.); (D.K.); (Ż.K.-K.); (P.T.A.); (Z.W.P.)
| | - Radosław Aleksander Wach
- Institute of Applied Radiation Chemistry, Faculty of Chemistry, Lodz University of Technology, Wróblewskiego 15, 93-590 Lodz, Poland
| | - Weronika Kruczkowska
- Faculty of Biomedical Sciences, Medical University of Lodz, Żeligowskiego 7/9, 90-752 Lodz, Poland;
| | - Łukasz Duda
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (Ł.D.); (D.K.); (Ż.K.-K.); (P.T.A.); (Z.W.P.)
| | - Damian Kołat
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (Ł.D.); (D.K.); (Ż.K.-K.); (P.T.A.); (Z.W.P.)
| | - Żaneta Kałuzińska-Kołat
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (Ł.D.); (D.K.); (Ż.K.-K.); (P.T.A.); (Z.W.P.)
- Department of Functional Genomics, Faculty of Medicine, Medical University of Lodz, Żeligowskiego 7/9, 90-752 Lodz, Poland
| | - Piotr Tomasz Arkuszewski
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (Ł.D.); (D.K.); (Ż.K.-K.); (P.T.A.); (Z.W.P.)
| | - Zbigniew Włodzimierz Pasieka
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (Ł.D.); (D.K.); (Ż.K.-K.); (P.T.A.); (Z.W.P.)
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Popescu V, Cauni V, Petrutescu MS, Rustin MM, Bocai R, Turculet CR, Doran H, Patrascu T, Lazar AM, Cretoiu D, Varlas VN, Mastalier B. Chronic Wound Management: From Gauze to Homologous Cellular Matrix. Biomedicines 2023; 11:2457. [PMID: 37760898 PMCID: PMC10525626 DOI: 10.3390/biomedicines11092457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Chronic wounds are a significant health problem with devastating consequences for patients' physical, social, and mental health, increasing healthcare systems' costs. Their prolonged healing times, economic burden, diminished quality of life, increased infection risk, and impact on patients' mobility and functionality make them a major concern for healthcare professionals. PURPOSE This review offers a multi-perspective analysis of the medical literature focusing on chronic wound management. METHODS USED We evaluated 48 articles from the last 21 years registered in the MEDLINE and Global Health databases. The articles included in our study had a minimum of 20 citations, patients > 18 years old, and focused on chronic, complex, and hard-to-heal wounds. Extracted data were summarized into a narrative synthesis using the same health-related quality of life instrument. RESULTS We evaluated the efficacy of existing wound care therapies from classical methods to modern concepts, and wound care products to regenerative medicine that uses a patient's pluripotent stem cells and growth factors. Regenerative medicine and stem cell therapies, biologic dressings and scaffolds, negative pressure wound therapy (NPWT), electrical stimulation, topical growth factors and cytokines, hyperbaric oxygen therapy (HBOT), advanced wound dressings, artificial intelligence (AI), and digital wound management are all part of the new arsenal of wound healing. CONCLUSION Periodic medical evaluation and proper use of modern wound care therapies, including the use of plasma-derived products [such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF)] combined with proper systemic support (adequate protein levels, blood sugar, vitamins involved in tissue regeneration, etc.) are the key to a faster wound healing, and, with the help of AI, can reach the fastest healing rate possible.
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Affiliation(s)
- Valentin Popescu
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (V.P.); (M.S.P.); (A.M.L.); (B.M.)
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
| | - Victor Cauni
- Urology Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania;
| | - Marius Septimiu Petrutescu
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (V.P.); (M.S.P.); (A.M.L.); (B.M.)
| | - Maria Madalina Rustin
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
| | - Raluca Bocai
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
| | - Cristina Rachila Turculet
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
| | - Horia Doran
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
- Prof. I. Juvara General Surgery Clinic, Dr. I. Cantacuzino Clinical Hospital, 011437 Bucharest, Romania
| | - Traian Patrascu
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
- Prof. I. Juvara General Surgery Clinic, Dr. I. Cantacuzino Clinical Hospital, 011437 Bucharest, Romania
| | - Angela Madalina Lazar
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (V.P.); (M.S.P.); (A.M.L.); (B.M.)
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
| | - Dragos Cretoiu
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania
- Department of Genetics, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
| | - Valentin Nicolae Varlas
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
- Department of Obstetrics and Gynaecology, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania
| | - Bogdan Mastalier
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (V.P.); (M.S.P.); (A.M.L.); (B.M.)
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
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Tatarusanu SM, Lupascu FG, Profire BS, Szilagyi A, Gardikiotis I, Iacob AT, Caluian I, Herciu L, Giscă TC, Baican MC, Crivoi F, Profire L. Modern Approaches in Wounds Management. Polymers (Basel) 2023; 15:3648. [PMID: 37688274 PMCID: PMC10489962 DOI: 10.3390/polym15173648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Wound management represents a well-known continuous challenge and concern of the global healthcare systems worldwide. The challenge is on the one hand related to the accurate diagnosis, and on the other hand to establishing an effective treatment plan and choosing appropriate wound care products in order to maximize the healing outcome and minimize the financial cost. The market of wound dressings is a dynamic field which grows and evolves continuously as a result of extensive research on developing versatile formulations with innovative properties. Hydrogels are one of the most attractive wound care products which, in many aspects, are considered ideal for wound treatment and are widely exploited for extension of their advantages in healing process. Smart hydrogels (SHs) offer the opportunities of the modulation physico-chemical properties of hydrogels in response to external stimuli (light, pressure, pH variations, magnetic/electric field, etc.) in order to achieve innovative behavior of their three-dimensional matrix (gel-sol transitions, self-healing and self-adapting abilities, controlled release of drugs). The SHs response to different triggers depends on their composition, cross-linking method, and manufacturing process approach. Both native or functionalized natural and synthetic polymers may be used to develop stimuli-responsive matrices, while the mandatory characteristics of hydrogels (biocompatibility, water permeability, bioadhesion) are preserved. In this review, we briefly present the physiopathology and healing mechanisms of chronic wounds, as well as current therapeutic approaches. The rational of using traditional hydrogels and SHs in wound healing, as well as the current research directions for developing SHs with innovative features, are addressed and discussed along with their limitations and perspectives in industrial-scale manufacturing.
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Affiliation(s)
- Simona-Maria Tatarusanu
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (S.-M.T.); (F.-G.L.); (A.-T.I.); (I.C.); (L.H.)
- Research & Development Department, Antibiotice Company, 1 Valea Lupului Street, 707410 Iasi, Romania
| | - Florentina-Geanina Lupascu
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (S.-M.T.); (F.-G.L.); (A.-T.I.); (I.C.); (L.H.)
| | - Bianca-Stefania Profire
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 University Street, 700115 Iasi, Romania;
| | - Andrei Szilagyi
- Advanced Research and Development Center for Experimental Medicine (CEMEX), University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 University Street, 700115 Iasi, Romania; (A.S.); (I.G.)
| | - Ioannis Gardikiotis
- Advanced Research and Development Center for Experimental Medicine (CEMEX), University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 University Street, 700115 Iasi, Romania; (A.S.); (I.G.)
| | - Andreea-Teodora Iacob
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (S.-M.T.); (F.-G.L.); (A.-T.I.); (I.C.); (L.H.)
| | - Iulian Caluian
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (S.-M.T.); (F.-G.L.); (A.-T.I.); (I.C.); (L.H.)
| | - Lorena Herciu
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (S.-M.T.); (F.-G.L.); (A.-T.I.); (I.C.); (L.H.)
| | - Tudor-Catalin Giscă
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 University Street 700115 Iasi, Romania;
| | - Mihaela-Cristina Baican
- Department of Pharmaceutical Physics, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 University Street, 700115 Iasi, Romania;
| | - Florina Crivoi
- Department of Pharmaceutical Physics, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 University Street, 700115 Iasi, Romania;
| | - Lenuta Profire
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (S.-M.T.); (F.-G.L.); (A.-T.I.); (I.C.); (L.H.)
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Lyu X, Hu Y, Shi S, Wang S, Li H, Wang Y, Zhou K. Hydrogel Bioelectronics for Health Monitoring. BIOSENSORS 2023; 13:815. [PMID: 37622901 PMCID: PMC10452556 DOI: 10.3390/bios13080815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
Hydrogels are considered an ideal platform for personalized healthcare due to their unique characteristics, such as their outstanding softness, appealing biocompatibility, excellent mechanical properties, etc. Owing to the high similarity between hydrogels and biological tissues, hydrogels have emerged as a promising material candidate for next generation bioelectronic interfaces. In this review, we discuss (i) the introduction of hydrogel and its traditional applications, (ii) the work principles of hydrogel in bioelectronics, (iii) the recent advances in hydrogel bioelectronics for health monitoring, and (iv) the outlook for future hydrogel bioelectronics' development.
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Affiliation(s)
- Xinyan Lyu
- School of Science and Engineering, The Chinese University of Hong Kong, Shenzhen 518172, China; (X.L.); (S.W.); (H.L.)
| | - Yan Hu
- The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710061, China; (Y.H.); (S.S.)
| | - Shuai Shi
- The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710061, China; (Y.H.); (S.S.)
| | - Siyuan Wang
- School of Science and Engineering, The Chinese University of Hong Kong, Shenzhen 518172, China; (X.L.); (S.W.); (H.L.)
| | - Haowen Li
- School of Science and Engineering, The Chinese University of Hong Kong, Shenzhen 518172, China; (X.L.); (S.W.); (H.L.)
| | - Yuheng Wang
- Faculty of Electrical Engineering and Computer Science, Ningbo University, Ningbo 315211, China;
| | - Kun Zhou
- School of Science and Engineering, The Chinese University of Hong Kong, Shenzhen 518172, China; (X.L.); (S.W.); (H.L.)
- The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710061, China; (Y.H.); (S.S.)
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Grzelak EM, Elshan NGRD, Shao S, Bulos ML, Joseph SB, Chatterjee AK, Chen JJ, Nguyên-Trân V, Schultz PG, Bollong MJ. Pharmacological YAP activation promotes regenerative repair of cutaneous wounds. Proc Natl Acad Sci U S A 2023; 120:e2305085120. [PMID: 37399395 PMCID: PMC10334740 DOI: 10.1073/pnas.2305085120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/26/2023] [Indexed: 07/05/2023] Open
Abstract
Chronic cutaneous wounds remain a persistent unmet medical need that decreases life expectancy and quality of life. Here, we report that topical application of PY-60, a small-molecule activator of the transcriptional coactivator Yes-associated protein (YAP), promotes regenerative repair of cutaneous wounds in pig and human models. Pharmacological YAP activation enacts a reversible pro-proliferative transcriptional program in keratinocytes and dermal cells that results in accelerated re-epithelization and regranulation of the wound bed. These results demonstrate that transient topical administration of a YAP activating agent may represent a generalizable therapeutic approach to treating cutaneous wounds.
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Affiliation(s)
- Edyta M. Grzelak
- Department of Chemistry, The Scripps Research Institute, San Diego, CA92037
| | | | - Sida Shao
- Department of Chemistry, The Scripps Research Institute, San Diego, CA92037
| | - Maya L. Bulos
- Department of Chemistry, The Scripps Research Institute, San Diego, CA92037
| | - Sean B. Joseph
- Calibr, A Division of Scripps Research, San Diego, CA92037
| | | | | | | | - Peter G. Schultz
- Department of Chemistry, The Scripps Research Institute, San Diego, CA92037
- Calibr, A Division of Scripps Research, San Diego, CA92037
| | - Michael J. Bollong
- Department of Chemistry, The Scripps Research Institute, San Diego, CA92037
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Johnson J, Law SQK, Shojaee M, Hall AS, Bhuiyan S, Lim MBL, Silva A, Kong KJW, Schoppet M, Blyth C, Ranasinghe HN, Sejic N, Chuei MJ, Tatford OC, Cifuentes‐Rius A, James PF, Tester A, Dixon I, Lichtfuss G. First-in-human clinical trial of allogeneic, platelet-derived extracellular vesicles as a potential therapeutic for delayed wound healing. J Extracell Vesicles 2023; 12:e12332. [PMID: 37353884 PMCID: PMC10290200 DOI: 10.1002/jev2.12332] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/04/2023] [Accepted: 05/23/2023] [Indexed: 06/25/2023] Open
Abstract
The release of growth factors, cytokines and extracellular matrix modifiers by activated platelets is an important step in the process of healthy wound healing. Extracellular vesicles (EVs) released by activated platelets carry this bioactive cargo in an enriched form, and may therefore represent a potential therapeutic for the treatment of delayed wound healing, such as chronic wounds. While EVs show great promise in regenerative medicine, their production at clinical scale remains a critical challenge and their tolerability in humans is still to be fully established. In this work, we demonstrate that Ligand-based Exosome Affinity Purification (LEAP) chromatography can successfully isolate platelet EVs (pEVs) of clinical grade from activated platelets, which retain the regenerative properties of the parent cell. LEAP-isolated pEVs display the expected biophysical features of EV populations and transport essential proteins in wound healing processes, including insulin growth factor (IGF) and transforming growth factor beta (TGF-ß). In vitro studies show that pEVs induce proliferation and migration of dermal fibroblasts and increase dermal endothelial cells' angiogenic potential, demonstrating their wound healing potential. pEV treatment activates the ERK and Akt signalling pathways within recipient cells. In a first-in-human, double-blind, placebo-controlled, phase I clinical trial of healthy volunteer adults, designed primarily to assess safety in the context of wound healing, we demonstrate that injections of LEAP-purified pEVs in formulation buffer are safe and well tolerated (Plexoval II study, ACTRN12620000944932). As a secondary objective, biological activity in the context of wound healing rate was assessed. In this cohort of healthy participants, in which the wound bed would not be expected to be deficient in the bioactive cargo that pEVs carry, all wounds healed rapidly and completely and no difference in time to wound closure of the treated and untreated wounds was observed at the single dose tested. The outcomes of this study evidence that pEVs manufactured through the LEAP process can be injected safely in humans as a potential wound healing treatment, and warrant further study in clinical trials designed expressly to assess therapeutic efficacy in patients with delayed or disrupted wound healing.
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Affiliation(s)
- Jancy Johnson
- Exopharm LtdMelbourneVICAustralia
- Department of Biochemistry and PharmacologyUniversity of MelbourneParkvilleVICAustralia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gregor Lichtfuss
- Exopharm LtdMelbourneVICAustralia
- Department of Biochemistry and PharmacologyUniversity of MelbourneParkvilleVICAustralia
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Horgos MS, Pop OL, Sandor M, Borza IL, Negrean R, Marc F, Major K, Sachelarie L, Grierosu C, Huniadi A. Laser in the Treatment of Atonic Wounds. Biomedicines 2023; 11:1815. [PMID: 37509454 PMCID: PMC10376327 DOI: 10.3390/biomedicines11071815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
Atonic wounds represent a major health problem, being frequently encountered in medical practice with consequences that have a negative impact on the patient's daily life as well as their general condition. In this study, a brand laser with a 12-watt probe was used to stimulate patients' wounds. We involved in this study a group of 65 patients, which was compared with a group of 30 patients, the latter not receiving this laser therapy. The data were accumulated from the questionnaire of subjective assessment of the laser impact on patients' condition as well as from the local evolution. We noticed the improvement of the local symptomatology which was found to be more effective in the patients from the study group compared to the reference group. The beneficial and positive effects, mainly on the symptoms but also on the local evolution of atonic wounds, can be observed in our study. We consider that this therapy is of major importance considering the lower costs both from the shortening of hospitalization and the long-term use of various substances. The early reintegration of patients into daily life is an important benefit for them.
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Affiliation(s)
- Maur Sebastian Horgos
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Ovidiu Laurean Pop
- Department of Pathology, County Clinical Emergency Hospital, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq. No. 10, 410087 Oradea, Romania
| | - Mircea Sandor
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Ioan Lucian Borza
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Rodica Negrean
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Felicia Marc
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Klaudia Major
- Szabolcs-Szatmár-Bereg County Hospital and University Centre, Josa Andras, Szent István u. 68, 4400 Nyiregyhaza, Hungary
| | - Liliana Sachelarie
- Department of Preclinical Disciplines, Faculty of Dental Medicine, Apollonia University, 700511 Iasi, Romania
| | - Carmen Grierosu
- Department of Preclinical Disciplines, Faculty of Dental Medicine, Apollonia University, 700511 Iasi, Romania
| | - Anca Huniadi
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
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Tan ST, Aisyah PB, Firmansyah Y, Nathasia N, Budi E, Hendrawan S. Effectiveness of Secretome from Human Umbilical Cord Mesenchymal Stem Cells in Gel (10% SM-hUCMSC Gel) for Chronic Wounds (Diabetic and Trophic Ulcer) - Phase 2 Clinical Trial. J Multidiscip Healthc 2023; 16:1763-1777. [PMID: 37383529 PMCID: PMC10295509 DOI: 10.2147/jmdh.s408162] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/30/2023] [Indexed: 06/30/2023] Open
Abstract
Background Chronic wounds carry financial burdens and increase morbidity and mortality, especially in diabetic ulcers and Hansen's Morbus. More than 50% of chronic ulcers are difficult to heal with regular treatment and require new types of therapy such as the use of secretome of human umbilical cord mesenchymal stem cells (SM-hUCMSC). Methods This experimental study was carried out to see the effectiveness of using SM-hUCMSC in diabetic ulcers and Hansen's Morbus in four medical facilities (multicentre). The level of active secretion has been measured by default in 10% SM-hUCMSC gel, used as a treatment intervention. The primary outcome is wound healing in terms of the length, width, and extent of the wound. The secondary is the side effects of treatment 2 weeks after administration. Follow-up visits will be scheduled at 1 and 2 weeks post-treatment. Results Forty-one chronic ulcers successfully followed the study until the end. In patients with chronic ulcers, the mean ulcer length, width, and area were 1.60 (0,50-13,0), 1.3 (0,5-6,0), and 2.21 (0,25-78) cm square, respectively, before interventions and 1 (0-12), 0,8 (0-6,0), and 1 (0-72) square cm after interventions at the second follow-up. The change between the beginning and end of the intervention was significant (p-value <0.05). Conclusion The use of 10% SM-hUCMSC gel topically has been proven effective in accelerating the process of wound healing, especially chronic ulcers with side effects that are not present in this study.
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Affiliation(s)
- Sukmawati Tansil Tan
- Department of Dermatology and Venereology, Faculty of Medicine, Tarumanagara University, Jakarta, Indonesia
| | | | | | | | - Erwin Budi
- Faculty of Medicine, Tarumanagara University, Jakarta, Indonesia
| | - Siufui Hendrawan
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Tarumanagara University, Jakarta, Indonesia
- Tarumanagara Human Cell Technology Laboratory, Tarumanagara University, Jakarta, Indonesia
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Suchithra KV, Hameed A, Rekha PD, Arun AB. Description and host-range determination of phage PseuPha1, a new species of Pakpunavirus infecting multidrug-resistant clinical strains of Pseudomonas aeruginosa. Virology 2023; 585:222-231. [PMID: 37392714 DOI: 10.1016/j.virol.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/03/2023] [Accepted: 06/08/2023] [Indexed: 07/03/2023]
Abstract
A new phage PseuPha1, infecting multiple multi-drug resistant strains of Pseudomonas aeruginosa with strong anti-biofilm activities, was isolated from wastewater in India. PseuPha1 showed optimal multiplicity of infection at 10-3, maintained the infectivity at wide ranges of pH (6-9) and temperature (4-37 ⁰C), and exhibited 50 minutes latent period and a burst size of 200 when tested against P. aeruginosa PAO1. PseuPha1 shared 86.1-89.5% pairwise intergenomic similarity with Pakpunavirus species (n = 11) listed by the International Committee on Taxonomy of Viruses and established distinct phyletic lineages during phylogenetic analyses of phage proteins. While genomic data validated the taxonomic novelty and lytic attributes of PseuPha1, BOX-PCR profiling asserted the genetic heterogeneity of susceptible clinical P. aeruginosa. Our data supported the affiliation of PseuPha1 as a new Pakpunavirus species and provided the first line of evidence for its virulence and infectivity that can be harnessed in wound therapeutics.
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Affiliation(s)
- Kokkarambath Vannadil Suchithra
- Division of Microbiology and Biotechnology, Yenepoya Research Centre, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore, 575018, India
| | - Asif Hameed
- Division of Microbiology and Biotechnology, Yenepoya Research Centre, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore, 575018, India.
| | - Punchappady Devasya Rekha
- Division of Microbiology and Biotechnology, Yenepoya Research Centre, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore, 575018, India
| | - Ananthapadmanabha Bhagwath Arun
- Division of Microbiology and Biotechnology, Yenepoya Research Centre, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore, 575018, India; Yenepoya Institute of Arts, Science, Commerce and Management, Balmatta, Mangalore, 575002, India.
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Miranda CS, Silva AFG, Seabra CL, Reis S, Silva MMP, Pereira-Lima SMMA, Costa SPG, Homem NC, Felgueiras HP. Sodium alginate/polycaprolactone co-axial wet-spun microfibers modified with N-carboxymethyl chitosan and the peptide AAPV for Staphylococcus aureus and human neutrophil elastase inhibition in potential chronic wound scenarios. BIOMATERIALS ADVANCES 2023; 151:213488. [PMID: 37285725 DOI: 10.1016/j.bioadv.2023.213488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/02/2023] [Accepted: 05/28/2023] [Indexed: 06/09/2023]
Abstract
In chronic wound (CW) scenarios, Staphylococcus aureus-induced infections are very prevalent. This leads to abnormal inflammatory processes, in which proteolytic enzymes, such as human neutrophil elastase (HNE), become highly expressed. Alanine-Alanine-Proline-Valine (AAPV) is an antimicrobial tetrapeptide capable of suppressing the HNE activity, restoring its expression to standard rates. Here, we proposed the incorporation of the peptide AAPV within an innovative co-axial drug delivery system, in which the peptide liberation was controlled by N-carboxymethyl chitosan (NCMC) solubilization, a pH-sensitive antimicrobial polymer effective against Staphylococcus aureus. The microfibers' core was composed of polycaprolactone (PCL), a mechanically resilient polymer, and AAPV, while the shell was made of the highly hydrated and absorbent sodium alginate (SA) and NCMC, responsive to neutral-basic pH (characteristic of CW). NCMC was loaded at twice its minimum bactericidal concentration (6.144 mg/mL) against S. aureus, while AAPV was loaded at its maximum inhibitory concentration against HNE (50 μg/mL), and the production of fibers with a core-shell structure, in which all components could be detected (directly or indirectly), was confirmed. Core-shell fibers were characterized as flexible and mechanically resilient, and structurally stable after 28-days of immersion in physiological-like environments. Time-kill kinetics evaluations revealed the effective action of NCMC against S. aureus, while elastase inhibitory activity examinations proved the ability of AAPV to reduce HNE levels. Cell biology testing confirmed the safety of the engineered fiber system for human tissue contact, with fibroblast-like cells and human keratinocytes maintaining their morphology while in contact with the produced fibers. Data confirmed the engineered drug delivery platform as potentially effective for applications in CW care.
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Affiliation(s)
- Catarina S Miranda
- Centre for Textile Science and Technology (2C2T), University of Minho, Campus of Azurém, 4800-058 Guimarães, Portugal.
| | - A Francisca G Silva
- Centre of Chemistry (CQ), University of Minho, Campus of Gualtar, 4710-057 Braga, Portugal.
| | - Catarina L Seabra
- Associate Laboratory for Green Chemistry (LAQV), Network of Chemistry and Technology (REQUIMTE), Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal.
| | - Salette Reis
- Associate Laboratory for Green Chemistry (LAQV), Network of Chemistry and Technology (REQUIMTE), Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal.
| | - M Manuela P Silva
- Centre of Chemistry (CQ), University of Minho, Campus of Gualtar, 4710-057 Braga, Portugal.
| | | | - Susana P G Costa
- Centre of Chemistry (CQ), University of Minho, Campus of Gualtar, 4710-057 Braga, Portugal.
| | - Natália C Homem
- Digital Transformation CoLab (DTx), Building 1, University of Minho, Campus of Azurém, 4800-058 Guimarães, Portugal.
| | - Helena P Felgueiras
- Centre for Textile Science and Technology (2C2T), University of Minho, Campus of Azurém, 4800-058 Guimarães, Portugal.
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Coleman L, Adams JRG, Buchanan W, Chen T, La Ragione RM, Liu LX. Non-Antibiotic Compounds Synergistically Kill Chronic Wound-Associated Bacteria and Disrupt Their Biofilms. Pharmaceutics 2023; 15:1633. [PMID: 37376081 DOI: 10.3390/pharmaceutics15061633] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/21/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic wounds and their treatment present a significant burden to patients and healthcare systems alike, with their management further complicated by bacterial infection. Historically, antibiotics have been deployed to prevent and treat infections, but the emergence of bacterial antimicrobial resistance and the frequent development of biofilms within the wound area necessitates the identification of novel treatment strategies for use within infected chronic wounds. Here, several non-antibiotic compounds, polyhexamethylene biguanide (PHMB), curcumin, retinol, polysorbate 40, ethanol, and D-α-tocopheryl polyethylene glycol succinate 1000 (TPGS) were screened for their antibacterial and antibiofilm capabilities. The minimum inhibitory concentration (MIC) and crystal violet (CV) biofilm clearance against two bacteria frequently associated with infected chronic wounds, Staphylococcus aureus and Pseudomonas aeruginosa, were determined. PHMB was observed to have highly effective antibacterial activity against both bacteria, but its ability to disperse biofilms at MIC levels was variable. Meanwhile, TPGS had limited inhibitory activity but demonstrated potent antibiofilm properties. The subsequent combination of these two compounds in a formulation resulted in a synergistic enhancement of their capability to kill both S. aureus and P. aeruginosa and disperse their biofilms. Collectively, this work highlights the utility of combinatory approaches to the treatment of infected chronic wounds where bacterial colonization and biofilm formation remains significant issues.
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Affiliation(s)
- Lucy Coleman
- School of Chemistry & Chemical Engineering, Faculty of Engineering and Physical Science, University of Surrey, Guildford GU2 7XH, UK
| | - James R G Adams
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, UK
- Avian Immunology, The Pirbright Institute, Woking GU24 0NE, UK
| | - Will Buchanan
- Phytoceutical Ltd., Midhurst, West Sussex GU29 9DJ, UK
| | - Tao Chen
- School of Chemistry & Chemical Engineering, Faculty of Engineering and Physical Science, University of Surrey, Guildford GU2 7XH, UK
| | - Roberto M La Ragione
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, UK
- School of Biosciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Lian X Liu
- School of Chemistry & Chemical Engineering, Faculty of Engineering and Physical Science, University of Surrey, Guildford GU2 7XH, UK
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48
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Namgoong S, Baik S, Han SK, Son JW, Kim JY. Developing and Establishing a Wound Dressing Team: Experience and Recommendations. J Korean Med Sci 2023; 38:e168. [PMID: 37270921 DOI: 10.3346/jkms.2023.38.e168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/16/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND The existing literature has comprehensively examined the benefits of specialized wound-care services and multidisciplinary team care. However, information on the development and integration of wound-dressing teams for patients who do not require specialized wound care is scarce. Therefore, the present study aimed to elucidate the benefits of a wound-dressing team by reporting our experiences with the establishment of a wound-dressing team. METHODS The wound-dressing team was established at Korea University Guro Hospital. Between July 2018 and June 2022, 180,872 cases were managed for wounds at the wound-dressing team. The data were analyzed to assess the types of wounds and their outcomes. In addition, questionnaires assessing the satisfaction with the service were administered to patients, ward nurses, residents/internists, and team members. RESULTS Regarding the wound type, 80,297 (45.3%) were catheter-related, while 48,036 (27.1%), 26,056 (14.7%), and 20,739 (11.7%) were pressure ulcers, dirty wounds, and simple wounds, respectively. In the satisfaction survey, the scores of the patient, ward nurse, dressing team nurse, and physician groups were 8.9, 8.1, 8.2, and 9.1, respectively. Additionally, 136 dressing-related complications (0.08%) were reported. CONCLUSION The wound dressing team can enhance satisfaction among patients and healthcare providers with low complications. Our findings may provide a potential framework for establishing similar service models.
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Affiliation(s)
- Sik Namgoong
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
- Diabetic Wound Center, Korea University Guro Hospital, Seoul, Korea
| | - Seunghee Baik
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seung-Kyu Han
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
- Diabetic Wound Center, Korea University Guro Hospital, Seoul, Korea.
| | - Ji-Won Son
- Diabetic Wound Center, Korea University Guro Hospital, Seoul, Korea
- Department of Nursing Service, Korea University Guro Hospital, Seoul, Korea
| | - Jae-Yeon Kim
- Department of Nursing Service, Korea University Guro Hospital, Seoul, Korea
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Ma H, Siu WS, Leung PC. The Potential of MSC-Based Cell-Free Therapy in Wound Healing-A Thorough Literature Review. Int J Mol Sci 2023; 24:ijms24119356. [PMID: 37298306 DOI: 10.3390/ijms24119356] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/25/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
A wound is an interruption of the normal anatomic structure and function of the skin, which is critical in protecting against foreign pathogens, regulating body temperature and water balance. Wound healing is a complex process involving various phases, including coagulation, inflammation, angiogenesis, re-epithelialization, and re-modeling. Factors such as infection, ischemia, and chronic diseases such as diabetes can compromise wound healing, leading to chronic and refractory ulcers. Mesenchymal stem cells (MSCs) have been used to treat various wound models due to their paracrine activity (secretome) and extracellular vehicles (exosomes) that contain several molecules, including long non-coding RNAs (lncRNAs), micro-RNAs (miRNAs), proteins, and lipids. Studies have shown that MSCs-based cell-free therapy using secretome and exosomes has great potential in regenerative medicine compared to MSCs, as there are fewer safety concerns. This review provides an overview of the pathophysiology of cutaneous wounds and the potential of MSCs-based cell-free therapy in each phase of wound healing. It also discusses clinical studies of MSCs-based cell-free therapies.
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Affiliation(s)
- Hui Ma
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Wing-Sum Siu
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Ping-Chung Leung
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
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50
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Li H, Cheng B, Zhang C. Editorial: Wound repair: establishment and development of a new discipline in China. Front Surg 2023; 10:1207709. [PMID: 37260596 PMCID: PMC10227557 DOI: 10.3389/fsurg.2023.1207709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Haihong Li
- Department of Wound Repair, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Biao Cheng
- Department of Plastic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou, China
| | - Cuiping Zhang
- Research Center for Tissue Repair and Regeneration Affiliated to the Medical Innovation Research Department, Fourth Medical Center of PLA General Hospital, Beijing, China
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