51
|
Rennekampff HO, Kremer T. [Surgical management of burn injury patients : Comments on the guidelines on treatment of thermal injuries in adults]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:135-145. [PMID: 38252166 DOI: 10.1007/s00113-024-01417-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The treatment of burn injury patients is a unique challenge for clinicians. The extent of thermal injuries ranges from very small burns to life-threatening burn injuries. Insufficient treatment can result in a substantial impairment in the quality of life. In order to avoid such sequelae a targeted treatment must be carried out. A precise diagnosis determines the necessary treatment. Superficial second-degree burns (2a) not involving the face, hand or joints with a total body surface area smaller than 10% can usually be treated with modern wound dressings in an outpatient setting. Deep second-degree burns (2b) are an indication for debridement. In addition to the classical surgical procedures with tangential excision, enzymatic debridement can also be employed. Similarly, indeterminate burns (2a/2b) are also considered to be an indication for enzymatic debridement. Third-degree burns are treated with early debridement and skin grafting. These patients can also benefit from special dermal replacement procedures for an improvement of the functional and esthetic results. Due to the long-term visible sequelae of burns, aftercare of these patients is indicated.
Collapse
Affiliation(s)
- Hans-Oliver Rennekampff
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Rhein Maas Klinikum, Mauerfelchen 25, 52146, Würselen, Deutschland.
| | - Thomas Kremer
- Klinik für Plastische und Handchirurgie mit Schwerbrandverletztenzentrum, Klinikum St. Georg, Leipzig, Deutschland
| |
Collapse
|
52
|
Qu Z, Chen Y, Du K, Qiao J, Chen L, Chen J, Wei L. ALA-PDT promotes the death and contractile capacity of hypertrophic scar fibroblasts through inhibiting the TGF-β1/Smad2/3/4 signaling pathway. Photodiagnosis Photodyn Ther 2024; 45:103915. [PMID: 38128289 DOI: 10.1016/j.pdpdt.2023.103915] [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: 07/30/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Hypertrophic scars, an abnormal wound-healing response to burn injuries, are characterized by massive fibroblast proliferation and excessive deposition of extracellular matrix and collagen. 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) is a promising therapy for hypertrophic scar, details of the mechanisms remain to be elucidated. In this study, we aimed to investigate the molecular mechanisms involved in ALA-PDT against hypertrophic scar fibroblasts. METHODS The morphologies of hypertrophic scar fibroblasts (HSFs) treated with ALA-PDT were observed under a light microscopy. The viability of HSFs was detected using the CCK-8 assay. HSFs-populated collagen gel contraction assays were conducted to examine the fibroblast contractility and the cytotoxicity of HSFs in 3D collagen tissues were observed using confocal microscopy. The effect of ALA-PDT on TGF-β1/Smad2/3/4 signaling pathway activation and effector gene expression were verified by immunoprecipitation, western blot and real-time quantitative PCR analysis. RESULTS We observed significant changes in cell morphology after ALA-PDT treatment of HSFs. As ALA concentration and light dose increased, the viability of HSFs significantly decreased. ALA-PDT can significantly alleviate the contractile capacity and promote the death of HSFs induced by TGF-β1 treatment in a three-dimensional collagen culture model. TGF-β1 treatment of HSFs can significantly induce phosphorylation of Smad2/3 (p-Smad2/3) in whole cells, as well as p-Smad2/3 and Smad4 proteins into the nucleus and increase the mRNA levels of collagen 1/3 and α-SMA. ALA-PDT hampers the TGF-β1-Smad2/3/4 signaling pathway activation by inducing K48-linked ubiquitination and degradation of Smad4. CONCLUSIONS Our results provide evidence that ALA-PDT can inhibit fibroblast contraction and promote cell death by inhibiting the activation of the TGF-β1 signaling pathway that mediates hypertrophic scar formation, which may be the basis for the efficacy of ALA-PDT in the treatment of hypertrophic scars.
Collapse
Affiliation(s)
- Zilu Qu
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan 430022, China; Hubei Province & Key Laboratory of Skin Infection And Immunity, Wuhan No. 1 Hospital, Wuhan 430022, China
| | - Yao Chen
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan 430022, China; Hubei Province & Key Laboratory of Skin Infection And Immunity, Wuhan No. 1 Hospital, Wuhan 430022, China
| | - Kun Du
- Medical Engineering Section, Wuhan No. 1 Hospital, Wuhan 430022, China
| | - JiaXi Qiao
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan 430022, China
| | - Liuqing Chen
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan 430022, China; Hubei Province & Key Laboratory of Skin Infection And Immunity, Wuhan No. 1 Hospital, Wuhan 430022, China
| | - Jinbo Chen
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan 430022, China; Hubei Province & Key Laboratory of Skin Infection And Immunity, Wuhan No. 1 Hospital, Wuhan 430022, China.
| | - Li Wei
- Deans Office,Wuhan No. 1 Hospital, Tongji Medical College, Wuhan 430022, China.
| |
Collapse
|
53
|
Yu S, Dwight J, Siska RC, Burkart H, Quan P, Yi F, Du S, Daoud Y, Plant K, Criscitiello A, Molnar J, Thatcher JE. Feasibility of intra-operative image guidance in burn excision surgery with multispectral imaging and deep learning. Burns 2024; 50:115-122. [PMID: 37821282 DOI: 10.1016/j.burns.2023.07.005] [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: 11/16/2022] [Revised: 06/28/2023] [Accepted: 07/19/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Exposing a healthy wound bed for skin grafting is an important step during burn surgery to ensure graft take and maintain good functional outcomes. Currently, the removal of non-viable tissue in the burn wound bed during excision is determined by expert clinician judgment. Using a porcine model of tangential burn excision, we investigated the effectiveness of an intraoperative multispectral imaging device combined with artificial intelligence to aid clinician judgment for the excision of non-viable tissue. METHODS Multispectral imaging data was obtained from serial tangential excisions of thermal burn injuries and used to train a deep learning algorithm to identify the presence and location of non-viable tissue in the wound bed. Following algorithm development, we studied the ability of two surgeons to estimate wound bed viability, both unaided and aided by the imaging device. RESULTS The deep learning algorithm was 87% accurate in identifying the viability of a burn wound bed. When paired with the surgeons, this device significantly improved their abilities to determine the viability of the wound bed by 25% (p = 0.03). Each time a surgeon changed their decision after seeing the AI model output, it was always a change from an incorrect decision to excise more tissue to a correct decision to stop excision. CONCLUSION This study provides insight into the feasibility of image-guided burn excision, its effect on surgeon decision making, and suggests further investigation of a real-time imaging system for burn surgery could reduce over-excision of burn wounds.
Collapse
Affiliation(s)
- Shuai Yu
- Spectral MD, Inc., Dallas, TX, USA
| | | | - Robert C Siska
- Wake Forest University School of Medicine, Plastic and Reconstructive Surgery, Winston-Salem, NC, USA
| | - Heather Burkart
- Wake Forest University School of Medicine, Pathology - Comparative Medicine, Winston-Salem, NC, USA
| | | | - Faliu Yi
- Spectral MD, Inc., Dallas, TX, USA
| | | | | | | | | | - Joseph Molnar
- Wake Forest University School of Medicine, Plastic and Reconstructive Surgery, Winston-Salem, NC, USA
| | | |
Collapse
|
54
|
Harris IM, Lee KC, Deeks JJ, Moore DJ, Moiemen NS, Dretzke J. Pressure-garment therapy for preventing hypertrophic scarring after burn injury. Cochrane Database Syst Rev 2024; 1:CD013530. [PMID: 38189494 PMCID: PMC10772976 DOI: 10.1002/14651858.cd013530.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND Burn damage to skin often results in scarring; however in some individuals the failure of normal wound-healing processes results in excessive scar tissue formation, termed 'hypertrophic scarring'. The most commonly used method for the prevention and treatment of hypertrophic scarring is pressure-garment therapy (PGT). PGT is considered standard care globally; however, there is continued uncertainty around its effectiveness. OBJECTIVES To evaluate the benefits and harms of pressure-garment therapy for the prevention of hypertrophic scarring after burn injury. SEARCH METHODS We used standard, extensive Cochrane search methods. We searched CENTRAL, MEDLINE, Embase, two other databases, and two trials registers on 8 June 2023 with reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing PGT (alone or in combination with other scar-management therapies) with scar management therapies not including PGT, or comparing different PGT pressures or different types of PGT. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials for inclusion using predetermined inclusion criteria, extracted data, and assessed risk of bias using the Cochrane RoB 1 tool. We assessed the certainty of evidence using GRADE. MAIN RESULTS We included 15 studies in this review (1179 participants), 14 of which (1057 participants) presented useable data. The sample size of included studies ranged from 17 to 159 participants. Most studies included both adults and children. Eight studies compared a pressure garment (with or without another scar management therapy) with scar management therapy alone, five studies compared the same pressure garment at a higher pressure versus a lower pressure, and two studies compared two different types of pressure garments. Studies used a variety of pressure garments (e.g. in-house manufactured or a commercial brand). Types of scar management therapies included were lanolin massage, topical silicone gel, silicone sheet/dressing, and heparin sodium ointment. Meta-analysis was not possible as there was significant clinical and methodological heterogeneity between studies. Main outcome measures were scar improvement assessed using the Vancouver Scar Scale (VSS) or the Patient and Observer Scar Assessment Scale (POSAS) (or both), pain, pruritus, quality of life, adverse events, and adherence to therapy. Studies additionally reported a further 14 outcomes, mostly individual scar parameters, some of which contributed to global scores on the VSS or POSAS. The amount of evidence for each individual outcome was limited. Most studies had a short follow-up, which may have affected results as the full effect of any therapy on scar healing may not be seen until around 18 months. PGT versus no treatment/lanolin We included five studies (378 participants). The evidence is very uncertain on whether PGT improves scars as assessed by the VSS compared with no treatment/lanolin. The evidence is also very uncertain for pain, pruritus, adverse events, and adherence. No study used the POSAS or assessed quality of life. One additional study (122 participants) did not report useable data. PGT versus silicone We included three studies (359 participants). The evidence is very uncertain on the effect of PGT compared with silicone, as assessed by the VSS and POSAS. The evidence is also very uncertain for pain, pruritus, quality of life, adverse events, adherence, and other scar parameters. It is possible that silicone may result in fewer adverse events or better adherence compared with PGT but this was also based on very low-certainty evidence. PGT plus silicone versus no treatment/lanolin We included two studies (200 participants). The evidence is very uncertain on whether PGT plus silicone improves scars as assessed by the VSS compared with no treatment/lanolin. The evidence is also very uncertain for pain, pruritus, and adverse events. No study used the POSAS or assessed quality of life or adherence. PGT plus silicone versus silicone We included three studies (359 participants). The evidence is very uncertain on the effect of PGT plus silicone compared with silicone, as assessed by the VSS and POSAS. The evidence is also very uncertain for pain, pruritus, quality of life, adverse events, and adherence. PGT plus scar management therapy including silicone versus scar management therapy including silicone We included one study (88 participants). The evidence is very uncertain on the effect of PGT plus scar management therapy including silicone versus scar management therapy including silicone, as assessed by the VSS and POSAS. The evidence is also very uncertain for pain, pruritus, quality of life, adverse events, and adherence. High-pressure versus low-pressure garments We included five studies (262 participants). The evidence is very uncertain on the effect of high pressure versus low pressure PGT on adverse events and adherence. No study used the VSS or the POSAS or assessed pain, pruritus, or quality of life. Different types of PGT (Caroskin Tricot + an adhesive silicone gel sheet versus Gecko Nanoplast (silicone gel bandage)) We included one study (60 participants). The evidence is very uncertain on the effect of Caroskin Tricot versus Gecko Nanoplast on the POSAS, pain, pruritus, and adverse events. The study did not use the VSS or assess quality of life or adherence. Different types of pressure garments (Jobst versus Tubigrip) We included one study (110 participants). The evidence is very uncertain on the adherence to either Jobst or Tubigrip. This study did not report any other outcomes. AUTHORS' CONCLUSIONS There is insufficient evidence to recommend using either PGT or an alternative for preventing hypertrophic scarring after burn injury. PGT is already commonly used in practice and it is possible that continuing to do so may provide some benefit to some people. However, until more evidence becomes available, it may be appropriate to allow patient preference to guide therapy.
Collapse
Affiliation(s)
- Isobel M Harris
- Biostatistics, Evidence Synthesis, Test Evaluation and prediction Models (BESTEAM), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kwang Chear Lee
- Department of Burns and Plastic Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan J Deeks
- Biostatistics, Evidence Synthesis, Test Evaluation and prediction Models (BESTEAM), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David J Moore
- Biostatistics, Evidence Synthesis, Test Evaluation and prediction Models (BESTEAM), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Naiem S Moiemen
- Department of Burns and Plastic Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Janine Dretzke
- Biostatistics, Evidence Synthesis, Test Evaluation and prediction Models (BESTEAM), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
55
|
Kohlhauser M, Tuca A, Kamolz LP. The efficacy of adipose-derived stem cells in burn injuries: a systematic review. Cell Mol Biol Lett 2024; 29:10. [PMID: 38182971 PMCID: PMC10771009 DOI: 10.1186/s11658-023-00526-w] [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: 10/13/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Burn injuries can be associated with prolonged healing, infection, a substantial inflammatory response, extensive scarring, and eventually death. In recent decades, both the mortality rates and long-term survival of severe burn victims have improved significantly, and burn care research has increasingly focused on a better quality of life post-trauma. However, delayed healing, infection, pain and extensive scar formation remain a major challenge in the treatment of burns. ADSCs, a distinct type of mesenchymal stem cells, have been shown to improve the healing process. The aim of this review is to evaluate the efficacy of ADSCs in the treatment of burn injuries. METHODS A systematic review of the literature was conducted using the electronic databases PubMed, Web of Science and Embase. The basic research question was formulated with the PICO framework, whereby the usage of ADSCs in the treatment of burns in vivo was determined as the fundamental inclusion criterion. Additionally, pertinent journals focusing on burns and their treatment were screened manually for eligible studies. The review was registered in PROSPERO and reported according to the PRISMA statement. RESULTS Of the 599 publications screened, 21 were considered relevant to the key question and were included in the present review. The included studies were almost all conducted on rodents, with one exception, where pigs were investigated. 13 of the studies examined the treatment of full-thickness and eight of deep partial-thickness burn injuries. 57,1 percent of the relevant studies have demonstrated that ADSCs exhibit immunomodulatory effects during the inflammatory response. 16 studies have shown improved neovascularisation with the use of ADSCs. 14 studies report positive influences of ADSCs on granulation tissue formation, while 11 studies highlight their efficacy in promoting re-epithelialisation. 11 trials demonstrated an improvement in outcomes during the remodelling phase. CONCLUSION In conclusion, it appears that adipose-derived stem cells demonstrate remarkable efficacy in the field of regenerative medicine. However, the usage of ADSCs in the treatment of burns is still at an early experimental stage, and further investigations are required in order to examine the potential usage of ADSCs in future clinical burn care.
Collapse
Affiliation(s)
- Michael Kohlhauser
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - Alexandru Tuca
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Department of Surgery, State Hospital Güssing, Güssing, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| |
Collapse
|
56
|
van de Warenburg MS, Munk EFL, Davies A, McBride CA, Edgar DW, Vehmeijer-Heeman MLAW, Young AE. Working Towards Holistic Scar Assessment and Improved Shared Decision Making in Global Burn Care. J Burn Care Res 2024; 45:112-119. [PMID: 37310702 PMCID: PMC10768758 DOI: 10.1093/jbcr/irad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Indexed: 06/14/2023]
Abstract
Cutaneous burn scars impact various aspects of life. Scar treatment is mainly evaluated on scar characteristics. Consensus is needed on which other outcomes to capture, ensuring they are relevant to patients, clinicians, and researchers. The aim of this study was to identify, discuss and analyze outcomes related to cutaneous burn scarring, incorporating the voice of patients and views of healthcare professionals. For this, a Delphi process consisting of two survey rounds and a consensus meeting was initiated. Burn scar-related outcomes were identified from an existing comprehensive list of 100 outcomes by an international panel of patients, healthcare professionals and researchers. Fifty-nine outcomes were identified from the Delphi process as related to scarring (≥60% votes). Outcomes less impactful in relation to scar outcomes included psychosocial issues, sense of normality, understanding of treatment, costs and systemic issues. To represent a holistic assessment of outcomes related to cutaneous burn scarring, this Delphi process established a battery of outcomes currently included in scar quality assessment tools, and an expanded set of less frequently considered outcomes. Future work in this area must include the patient voice from developing countries. This is essential to identify globally applicable outcomes related to scarring.
Collapse
Affiliation(s)
- Milly S van de Warenburg
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Elleke F L Munk
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Anna Davies
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Craig A McBride
- Centre for Children’s Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Australia
- Burn Injury Research Node, The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia
| | - Mariëlle L A W Vehmeijer-Heeman
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Amber E Young
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol University, Bristol, UK
| |
Collapse
|
57
|
Zhao S, Liu H, Wang H, He X, Tang J, Qi S, Yang R, Xie J. Inhibition of phosphatidylinositol 3-kinase catalytic subunit alpha by miR-203a-3p reduces hypertrophic scar formation via phosphatidylinositol 3-kinase/AKT/mTOR signaling pathway. BURNS & TRAUMA 2024; 12:tkad048. [PMID: 38179473 PMCID: PMC10762504 DOI: 10.1093/burnst/tkad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/24/2023] [Accepted: 09/12/2023] [Indexed: 01/06/2024]
Abstract
Background Hypertrophic scar (HS) is a common fibroproliferative skin disease that currently has no truly effective therapy. Given the importance of phosphatidylinositol 3-kinase catalytic subunit alpha (PIK3CA) in hypertrophic scar formation, the development of therapeutic strategies for endogenous inhibitors against PIK3CA is of great interest. Here, we explored the molecular mechanisms underlying the protective effects of miR-203a-3p (PIK3CA inhibitor) against excessive scar. Methods Bioinformatic analysis, immunohistochemistry, immunofluorescence, miRNA screening and fluorescence in situ hybridization assays were used to identify the possible pathways and target molecules mediating HS formation. A series of in vitro and in vivo experiments were used to clarify the role of PIK3CA and miR-203a-3p in HS. Mechanistically, transcriptomic sequencing, immunoblotting, dual-luciferase assay and rescue experiments were executed. Results Herein, we found that PIK3CA and the phosphatidylinositol 3-kinase (PI3K)/AKT/mTOR pathway were upregulated in scar tissues and positively correlated with fibrosis. We then identified miR-203a-3p as the most suitable endogenous inhibitor of PIK3CA. miR-203a-3p suppressed the proliferation, migration, collagen synthesis and contractility as well as the transdifferentiation of fibroblasts into myofibroblasts in vitro, and improved the morphology and histology of scars in vivo. Mechanistically, miR-203a-3p attenuated fibrosis by inactivating the PI3K/AKT/mTOR pathway by directly targeting PIK3CA. Conclusions PIK3CA and the PI3K/AKT/mTOR pathway are actively involved in scar fibrosis and miR-203a-3p might serve as a potential strategy for hypertrophic scar therapy through targeting PIK3CA and inactivating the PI3K/AKT/mTOR pathway.
Collapse
Affiliation(s)
- Shixin Zhao
- Department of Burns, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510062, China
- Guangdong Provincial Engineering Technology Research Center of Burn and Wound Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, No. 58 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510062, China
| | - Hengdeng Liu
- Department of Burns, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510062, China
- Guangdong Provincial Engineering Technology Research Center of Burn and Wound Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, No. 58 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510062, China
| | - Hanwen Wang
- Department of Burns, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510062, China
- Guangdong Provincial Engineering Technology Research Center of Burn and Wound Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, No. 58 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510062, China
| | - Xuefeng He
- Department of Burns, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510062, China
- Guangdong Provincial Engineering Technology Research Center of Burn and Wound Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, No. 58 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510062, China
| | - Jinming Tang
- Department of Burns, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510062, China
- Guangdong Provincial Engineering Technology Research Center of Burn and Wound Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, No. 58 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510062, China
| | - Shaohai Qi
- Department of Burns, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510062, China
- Guangdong Provincial Engineering Technology Research Center of Burn and Wound Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, No. 58 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510062, China
| | - Ronghua Yang
- Department of Burn and Plastic Surgery, Guangzhou First People's Hospital, South China University of technology, No. 1 Panfu Road, Yuexiu District, Guangzhou, Guangdong, 510062, China
| | - Julin Xie
- Department of Burns, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510062, China
- Guangdong Provincial Engineering Technology Research Center of Burn and Wound Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, No. 58 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510062, China
| |
Collapse
|
58
|
Santuzzi CH, Gonçalves Liberato FM, Fachini de Oliveira NF, Sgrancio do Nascimento A, Nascimento LR. Massage, laser and shockwave therapy improve pain and scar pruritus after burns: a systematic review. J Physiother 2024; 70:8-15. [PMID: 38072714 DOI: 10.1016/j.jphys.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/28/2023] [Accepted: 10/30/2023] [Indexed: 01/07/2024] Open
Abstract
QUESTIONS In adults with a burn injury, do non-invasive therapies improve pain and burn scar pruritus, elasticity and vascularisation? Are any effects maintained beyond the intervention period? DESIGN Systematic review of randomised trials with meta-analyses. PARTICIPANTS Adults with burn scars. INTERVENTION The experimental intervention was a non-invasive (ie, non-surgical or non-pharmacological) therapy applied to the burn scar. OUTCOME MEASURES Pain intensity, pruritus intensity, elasticity and vascularisation. RESULTS Fifteen trials involving 780 participants were included. The results indicated a beneficial effect on pain intensity on a 0-to-10 scale after massage (MD -1.5, 95% CI -1.8 to -1.1), shockwave therapy (MD -0.8, 95% CI -1.2 to -0.4) and laser (MD -4.0, 95% CI -6.0 to -2.0). The results indicated a beneficial effect on pruritus intensity on a 0-to-10 scale after massage (MD -0.4, 95% CI -0.7 to -0.2), shockwave therapy (MD -1.3, 95% CI -2.3 to -0.3) and laser (MD -4.8, 95% CI -6.1 to -3.5). Massage, shockwave therapy and silicone produced negligible or unclear benefits on scar elasticity and vascularisation. The quality of evidence varied from low to moderate. CONCLUSION Among all commonly used non-invasive therapies for the treatment of burn scars, low-to-moderate quality evidence indicated that massage, laser and shockwave therapy reduce pain and the intensity of scar pruritus. Low-to-moderate quality evidence suggested that massage, shockwave therapy and silicone have negligible or unclear effects for improving scar elasticity and vascularisation. REVIEW REGISTRATION PROSPERO (CRD42021258336).
Collapse
Affiliation(s)
- Cintia Helena Santuzzi
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil.
| | | | | | | | - Lucas Rodrigues Nascimento
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil
| |
Collapse
|
59
|
Dong Y, Cao X, Huang J, Hu Z, Chen C, Chen M, Long Q, Xu Z, Lv D, Rong Y, Luo S, Wang H, Deng W, Tang B. Melatonin inhibits fibroblast cell functions and hypertrophic scar formation by enhancing autophagy through the MT2 receptor-inhibited PI3K/Akt /mTOR signaling. Biochim Biophys Acta Mol Basis Dis 2024; 1870:166887. [PMID: 37739092 DOI: 10.1016/j.bbadis.2023.166887] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
Hypertrophic scar (HS) is a fibrotic skin condition and characterized by abnormal proliferation of myofibroblasts and accumulation of extracellular matrix. Melatonin, an endogenous hormone, can alleviate fibrosis in multiple models of diseases. This study examined the effect of melatonin on fibrosis in primary fibroblasts from human HS (HSFs) and a rabbit ear model and potential mechanisms. Melatonin treatment significantly decreased the migration and contraction capacity, collagen and α-smooth muscle actin (α-SMA) production in HSFs. RNA-sequencing and bioinformatic analyses indicated that melatonin modulated the expression of genes involved in autophagy and oxidative stress. Mechanistically, melatonin treatment attenuated the AKT/mTOR activation through affecting the binding of MT2 receptor with PI3K to enhance autophagy, decreasing fibrogenic factor production in HSFs. Moreover, melatonin treatment inhibited HS formation in rabbit ears by enhancing autophagy. The anti-fibrotic effects of melatonin were abrogated by treatment with an autophagy inhibitor (3-methyladenine, 3-MA), an Akt activator (SC79), or an MT2 selective antagonist (4-phenyl-2propionamidotetralin, 4-P-PDOT). Therefore, melatonin may be a potential drug for prevention and treatment of HS.
Collapse
Affiliation(s)
- Yunxian Dong
- Department of Burns, Wound Repair and Reconstruction, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xiaoling Cao
- Department of Burns, Wound Repair and Reconstruction, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinsheng Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Canter of Cancer Medicine, Guangzhou, China
| | - Zhicheng Hu
- Department of Burns, Wound Repair and Reconstruction, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chufen Chen
- Department of Burns, Wound Repair and Reconstruction, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Miao Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Canter of Cancer Medicine, Guangzhou, China
| | - Qian Long
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Canter of Cancer Medicine, Guangzhou, China
| | - Zhongye Xu
- Department of Burns, Wound Repair and Reconstruction, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dongming Lv
- Department of Burns, Wound Repair and Reconstruction, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanchao Rong
- Department of Burns, Wound Repair and Reconstruction, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shengkang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Haibin Wang
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wuguo Deng
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Canter of Cancer Medicine, Guangzhou, China.
| | - Bing Tang
- Department of Burns, Wound Repair and Reconstruction, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
60
|
Zhang XR, Ryu U, Najmiddinov B, Trinh TTT, Choi KM, Nam SY, Heo CY. Effect of Silicone Patch Containing Metal-organic Framework on Hypertrophic Scar Suppression. In Vivo 2024; 38:235-245. [PMID: 38148076 PMCID: PMC10756491 DOI: 10.21873/invivo.13430] [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: 08/11/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND/AIM Hypertrophic scars (HS) are an abnormal cutaneous condition of wound healing characterized by excessive fibrosis and disrupted collagen deposition. This study assessed the potential of a silicone patch embedded with chemically stable zirconium-based metal-organic frameworks (MOF)-808 structures to mitigate HS formation using a rabbit ear model. MATERIALS AND METHODS A silicone patch was strategically engineered by incorporating Zr-MOF-808, a composite structure comprising metal ions and organic ligands. Structural integrity of the Zr-MOF-808 silicone patch was validated using scanning electron microscopy and X-ray diffraction analysis. The animals were divided into three groups: a control, no treatment group (Group 1), a silicone patch treatment group (Group 2), and a group treated with a 0.2% loaded Zr-MOF-808 silicone patch (Group 3). HS suppression effects were quantified using scar elevation index (SEI), dorsal skin thickness measurements, and myofibroblast protein expression. RESULTS Histopathological examination of post-treatment HS samples revealed substantial reductions in SEI (34.6%) and epidermal thickness (49.5%) in Group 3. Scar hyperplasia was significantly diminished by 53.5% (p<0.05), while collagen density declined by 15.7% in Group 3 compared to Group 1. Western blot analysis of protein markers, including TGF-β1, collagen-1, and α-SMA, exhibited diminished levels by 8.8%, 12%, and 21.3%, respectively, in Group 3, and substantially higher levels by 21.9%, 27%, and 39.9%, respectively, in Group 2. On the 35th day post-wound generation, Zr-MOF-808-treated models exhibited smoother, less conspicuous, and flatter scars. CONCLUSION Zr-MOF-808-loaded silicone patch reduced HS formation in rabbit ear models by inducing the proliferation and remodeling of the wound healing process.
Collapse
Affiliation(s)
- Xin Rui Zhang
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Unjin Ryu
- Department of Chemical and Biological Engineering, Sookmyung Women's University, Seoul, Republic of Korea
| | - Bakhtiyor Najmiddinov
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Thuy-Tien Thi Trinh
- Korean Institute of Nonclinical Study, H&Bio. Co. Ltd., Seongnam, Republic of Korea
| | - Kyung Min Choi
- Department of Chemical and Biological Engineering, Sookmyung Women's University, Seoul, Republic of Korea;
- R&D Center, LabInCube Co. Ltd., Cheongju, Republic of Korea
| | - Sun-Young Nam
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea;
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea;
- Korean Institute of Nonclinical Study, H&Bio. Co. Ltd., Seongnam, Republic of Korea
- Department of Medical Device Development, College of Medicine, Seoul National University, Seoul, Republic of Korea
| |
Collapse
|
61
|
Zhou S, Wang Q, Yang W, Wang L, Wang J, You R, Luo Z, Zhang Q, Yan S. Development of a bioactive silk fibroin bilayer scaffold for wound healing and scar inhibition. Int J Biol Macromol 2024; 255:128350. [PMID: 37995792 DOI: 10.1016/j.ijbiomac.2023.128350] [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: 07/29/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
In cases of deep skin defects, spontaneous tissue regeneration and excessive collagen deposition lead to hyperplastic scars. Conventional remedial action after scar formation is limited with a high recurrence rate. In this study, we designed a new artificial skin bilayer using silk fibroin nanofibers films (SNF) as the epidermis, and silk fibroin (SF) / hyaluronic acid (HA) scaffold as the dermal layer. The regenerated SF film was used as a binder to form a functional SNF-SF-HA bilayer scaffold. The bilayer scaffold showed high porosity, hydrophilicity, and strength, and retained its shape over 30 days in PBS. In vitro, human umbilical vein endothelial cells were seeded into the bilayer scaffold and showed superior cell viability. In vivo analyses using the rabbit ear hypertrophic scar (HS) model indicated that the bilayer scaffold not only supported the reconstruction of new tissue, but also inhibited scar formation. The scaffold possibly achieved scar inhabitation by reducing wound contraction, weakening inflammatory reactions, and regulating collagen deposition and type conversion, which was partly observed through the downregulation of type I collagen, transforming growth factor-β, and α-smooth muscle actin. This study describes a new strategy to expand the application of silk-based biomaterials for the treatment of hyperplastic skin scars.
Collapse
Affiliation(s)
- Shuiqing Zhou
- State Key Laboratory of New Textile Materials and Advanced Processing Technologies, School of Textile Science and Engineering, Wuhan Textile University, Wuhan 430200, China
| | - Qiusheng Wang
- State Key Laboratory of New Textile Materials and Advanced Processing Technologies, School of Textile Science and Engineering, Wuhan Textile University, Wuhan 430200, China
| | - Wenjing Yang
- State Key Laboratory of New Textile Materials and Advanced Processing Technologies, School of Textile Science and Engineering, Wuhan Textile University, Wuhan 430200, China
| | - Lu Wang
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, School and Hospital of Stomatology, Shanxi Medical University, Taiyuan 030001, China
| | - Jiangnan Wang
- Key Laboratory of Textile Industry for Silk Products in Medical and Health Use, Soochow University, Suzhou 215123, China
| | - Renchuan You
- State Key Laboratory of New Textile Materials and Advanced Processing Technologies, School of Textile Science and Engineering, Wuhan Textile University, Wuhan 430200, China
| | - Zuwei Luo
- State Key Laboratory of New Textile Materials and Advanced Processing Technologies, School of Textile Science and Engineering, Wuhan Textile University, Wuhan 430200, China.
| | - Qiang Zhang
- State Key Laboratory of New Textile Materials and Advanced Processing Technologies, School of Textile Science and Engineering, Wuhan Textile University, Wuhan 430200, China.
| | - Shuqin Yan
- State Key Laboratory of New Textile Materials and Advanced Processing Technologies, School of Textile Science and Engineering, Wuhan Textile University, Wuhan 430200, China; Key Laboratory of Textile Industry for Silk Products in Medical and Health Use, Soochow University, Suzhou 215123, China.
| |
Collapse
|
62
|
Manole CG, Soare C, Ceafalan LC, Voiculescu VM. Platelet-Rich Plasma in Dermatology: New Insights on the Cellular Mechanism of Skin Repair and Regeneration. Life (Basel) 2023; 14:40. [PMID: 38255655 PMCID: PMC10817627 DOI: 10.3390/life14010040] [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: 10/23/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
The skin's recognised functions may undergo physiological alterations due to ageing, manifesting as varying degrees of facial wrinkles, diminished tautness, density, and volume. Additionally, these functions can be disrupted (patho)physiologically through various physical and chemical injuries, including surgical trauma, accidents, or chronic conditions like ulcers associated with diabetes mellitus, venous insufficiency, or obesity. Advancements in therapeutic interventions that boost the skin's innate regenerative abilities could significantly enhance patient care protocols. The application of Platelet-Rich Plasma (PRP) is widely recognized for its aesthetic and functional benefits to the skin. Yet, the endorsement of PRP's advantages often borders on the dogmatic, with its efficacy commonly ascribed solely to the activation of fibroblasts by the factors contained within platelet granules. PRP therapy is a cornerstone of regenerative medicine which involves the autologous delivery of conditioned plasma enriched by platelets. This is achieved by centrifugation, removing erythrocytes while retaining platelets and their granules. Despite its widespread use, the precise sequences of cellular activation, the specific cellular players, and the molecular machinery that drive PRP-facilitated healing are still enigmatic. There is still a paucity of definitive and robust studies elucidating these mechanisms. In recent years, telocytes (TCs)-a unique dermal cell population-have shown promising potential for tissue regeneration in various organs, including the dermis. TCs' participation in neo-angiogenesis, akin to that attributed to PRP, and their role in tissue remodelling and repair processes within the interstitia of several organs (including the dermis), offer intriguing insights. Their potential to contribute to, or possibly orchestrate, the skin regeneration process following PRP treatment has elicited considerable interest. Therefore, pursuing a comprehensive understanding of the cellular and molecular mechanisms at work, particularly those involving TCs, their temporal involvement in structural recovery following injury, and the interconnected biological events in skin wound healing and regeneration represents a compelling field of study.
Collapse
Affiliation(s)
- Catalin G. Manole
- Department of Cellular and Molecular Biology and Histology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Ultrastructural Pathology Laboratory, “Victor Babeș” National Institute of Pathology, 050096 Bucharest, Romania
| | - Cristina Soare
- Department of Oncological Dermatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Laura Cristina Ceafalan
- Department of Cellular and Molecular Biology and Histology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Cell Biology, Neurosciences and Experimental Myology Laboratory, “Victor Babeș” National Institute of Pathology, 050096 Bucharest, Romania
| | - Vlad M. Voiculescu
- Department of Oncological Dermatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| |
Collapse
|
63
|
Zhou J, Hao F, Huang L, Fu Q, Yuan L, Luo G, Tan J. Treatment of hypertrophic scars with ablative fractional carbon dioxide laser assisted with different topical triamcinolone delivery ways. Heliyon 2023; 9:e22818. [PMID: 38125450 PMCID: PMC10730585 DOI: 10.1016/j.heliyon.2023.e22818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives Ablative fractional carbon dioxide laser has been used with triamcinolone to treat hypertrophic scars, resulting in promising success rates. However, there are different topical triamcinolone delivery methods used in scar treatment. To assess the efficacy among the different triamcinolone delivery methods, this study was designed to compare the efficacy and safety of ablative fractional carbon dioxide laser followed by penetration and injection of topical triamcinolone into thicker hypertrophic scars (height score of VSS ≥2). Study design/materials and methods We performed a retrospective study of 155 thicker hypertrophic scar patients (height score of VSS ≥2), including 88 patients in the triamcinolone external application group and 67 patients in the triamcinolone intralesional injection group. One month after the patients had 3 treatment sessions at 4-week intervals, the scars were assessed by photography, the Vancouver Scar Scale (VSS), durometry and spectrocolorimetry. Any adverse effects were also evaluated. Results The VSS scores and the hardness of the scars in both groups improved significantly compared to baseline. Moreover, the patients in the triamcinolone intralesional injection group had higher treatment efficacy (19.77 ± 21.25 %) based on their VSS scores than the patients in the triamcinolone external application group (5.94 ± 24.07 %), especially in the improvement of scar pliability, height and hardness. Meanwhile, in the triamcinolone injection group, more patients had mild and moderate improvement than in the triamcinolone application group. However, there were no differences in the distribution of the adverse effects in either group. Conclusions This study demonstrated that using the ablative fractional carbon dioxide laser followed by different topical triamcinolone delivery methods is effective and safe for thicker hypertrophic scar improvement. The method of using the ablative fractional carbon dioxide laser assisted with triamcinolone injection had a better therapeutic outcome in thicker hypertrophic scars, as compared with triamcinolone penetration.
Collapse
Affiliation(s)
| | | | - Ling Huang
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Qingqing Fu
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Lili Yuan
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Gaoxing Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Jianglin Tan
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| |
Collapse
|
64
|
Faour S, Farahat M, Aijaz A, Jeschke MG. Fibrosis in burns: an overview of mechanisms and therapies. Am J Physiol Cell Physiol 2023; 325:C1545-C1557. [PMID: 37811732 PMCID: PMC10881229 DOI: 10.1152/ajpcell.00254.2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/10/2023]
Abstract
Scar development remains a common occurrence and a major healthcare challenge affecting the lives of millions of patients annually. Severe injuries to the skin, such as burns can lead to pathological wound healing patterns, often characterized by dermal fibrosis or excessive scarring, and chronic inflammation. The two most common forms of fibrotic diseases following burn trauma are hypertrophic scars (HSCs) and keloids, which severely impact the patient's quality of life. Although the cellular and molecular mechanisms are similar, HSC and keloids have several distinct differences. In this review, we discuss the different forms of fibrosis that occur postburn injury, emphasizing how the extent of burn influences scar development. Moreover, we highlight how a systemic response induced by a burn injury drives wound fibrosis, including both the role of the inflammatory response, as well as the fate of fibroblast during skin healing. Finally, we list potential therapeutics aimed at alleviating pathological scar formation. An understanding of the mechanisms of postburn fibrosis will allow us to effectively move studies from bench to bedside.
Collapse
Affiliation(s)
- Sara Faour
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- TaARI, Hamilton, Ontario, Canada
| | - Mahmoud Farahat
- TaARI, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ayesha Aijaz
- TaARI, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marc G Jeschke
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- TaARI, Hamilton, Ontario, Canada
- Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
65
|
Xu Z, Cheng C, Zhang Y, Yang D, Jing W, Liu X, Li X. Lipopolysaccharide induces skin scarring through the TLR4/Myd88 inflammatory signaling pathway in dermal fibroblasts. Burns 2023; 49:1997-2006. [PMID: 37821278 DOI: 10.1016/j.burns.2023.06.005] [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: 12/07/2022] [Revised: 04/19/2023] [Accepted: 06/12/2023] [Indexed: 10/13/2023]
Abstract
Skin scarring is a frequent complication of the wound healing process. Bacterial contamination and prolonged inflammation in wounds are thought to play significant roles during scar formation, but little is known about their specific mechanisms of action. In this study, hypertrophic scar derived fibroblasts (HSFs) and paired normal skin derived fibroblasts (NSFs) were used to evaluate the effects of lipopolysaccharide (LPS) on inflammation-induced skin scarring and explore the inflammation-mediated mechanism of activity of LPS on dermal fibroblasts. LPS was found to significantly upregulate the expression of the proinflammatory molecules TLR4, Myd88, TRAF6, and p65, and the fibrosis-related proteins Col I, Col III, and α-SMA, in NSFs. Blocking Myd88 expression with T6167923 downregulated the expression of Col I, Col III, and α-SMA, whereas activating Myd88 expression with CL075 significantly upregulated their expression in LPS-treated NSFs. LPS was found to delay wound healing and increase skin scarring in cell and mouse models. These results showed that LPS could induce scar formation through the TLR4/Myd88 signaling pathway in dermal fibroblasts, suggesting that the downregulation of excessive inflammation in wound tissues inhibits skin scarring and improves scar appearance.
Collapse
Affiliation(s)
- Zhigang Xu
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi Wu Road, No 157, Xi'an 710004, China; Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, West Chang-le Road, No 127, Xi'an 710032, China
| | - Chuantao Cheng
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi Wu Road, No 157, Xi'an 710004, China
| | - Yangang Zhang
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi Wu Road, No 157, Xi'an 710004, China
| | - Danyang Yang
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi Wu Road, No 157, Xi'an 710004, China
| | - Wenwen Jing
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi Wu Road, No 157, Xi'an 710004, China
| | - Xin Liu
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi Wu Road, No 157, Xi'an 710004, China
| | - Xiaoli Li
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi Wu Road, No 157, Xi'an 710004, China.
| |
Collapse
|
66
|
Zhang H, Zang C, Zhao W, Zhang L, Liu R, Feng Z, Wu J, Cui R. Exosome Derived from Mesenchymal Stem Cells Alleviates Hypertrophic Scar by Inhibiting the Fibroblasts via TNFSF-13/HSPG2 Signaling Pathway. Int J Nanomedicine 2023; 18:7047-7063. [PMID: 38046235 PMCID: PMC10693282 DOI: 10.2147/ijn.s433510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/19/2023] [Indexed: 12/05/2023] Open
Abstract
Background Mesenchymal stem cell-derived exosomes (MSC-exo) have been shown to have significant potential in wound healing and scar relief processes. According to reports, TNFSF13 and HSPG2 are associated with various fibrotic diseases. The aim of this study is to investigate how TNFSF13 and HSPG2 affect the formation of hypertrophic scar (HS) and the mechanism by which exosomes regulate HS. Methods Immunohistochemistry, qRT-PCR, Western blot, and immunofluorescence were performed to measure TNFSF13 expression in HS skin tissues and hypertrophic scar fibroblast (HSF). HSF were treated with recombinant TNFSF13 protein and TNFSF13 siRNAs to probe the effect of TNFSF13 on the activity of HSF. The CCK-8, EdU, Transwell, and Western blot were used to investigate the role of TNFSF13 in viability, proliferation and inflammation. The influence of MSC-exo on the proliferation and function of HSF was determined by scratch and Western blot. Results TNFSF13 was dramatically up-regulated in HS skin tissues and HSF. Recombinant TNFSF13 protein increased cell viability, proliferation, migration, fibrosis, inflammation, and the binding between TNFSF13 and HSPG2 of HSF. The opposite results were obtained in TNFSF13 siRNAs transferred HSF. Furthermore, TNFSF13 activated the nuclear factor-κB (NF-κB) signaling pathway. Silencing of HSPG2 and inhibition of NF-κB remarkably eliminated the promoting effects of TNFSF13 on cell viability, proliferation, migration, fibrosis and inflammation of HSF. MSC-exo reduced α-SMA and COL1A1 inhibited the proliferation and migration of HSF by inhibiting TNFSF13 and HSPG2. Conclusion TNFSF13 activates NF-κB signaling pathway by interacting with HSPG2, which regulates the proliferation, migration, fibrosis and inflammatory response of HSF. Through the above mechanisms, knocking out TNFSF13 can inhibit the proliferation, migration, fibrosis and inflammatory response of HSF, whereas MSC-exo could reverse this process. These results suggest that MSC-exo alleviates HS by inhibiting the fibroblasts via TNFSF-13/HSPG2 signaling pathway.
Collapse
Affiliation(s)
- Huimin Zhang
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Chengyu Zang
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China
| | - Wen Zhao
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Linfeng Zhang
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Rui Liu
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Zhang Feng
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Jie Wu
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Rongtao Cui
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, People’s Republic of China
| |
Collapse
|
67
|
Irilouzadian R, Khalaji A, Baghsheikhi H, Sarmadian R, Hoveidamanesh S, Ghadimi T, Farokh Forghani S. The clinical outcomes of xenografts in the treatment of burn patients: a systematic review and meta-analysis. Eur J Med Res 2023; 28:524. [PMID: 37974238 PMCID: PMC10652578 DOI: 10.1186/s40001-023-01505-9] [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: 05/13/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Although autografts are not feasible in patients with extensive burn wounds, allografts and xenografts can be used for temporary coverage. In this systematic review and meta-analysis, we compared the outcomes of xenografts and the standard treatment of burn wounds. METHODS International online databases were searched for English articles comparing xenografts with routine treatment in the burn patients. The random-effects model was used to estimate standardized mean differences (SMD) or odds ratios (OR) with a 95% confidence interval (CI). RESULTS From a total of 7144 records, 14 studies were included in our review after screening by title and abstracts followed by full-texts. No significant difference in hospital stays was found between the mammalian xenografts and control groups (SMD [95% CI] = - 0.18 [- 0.54-0.18]). The mean number of dressing changes was significantly lower in both mammalian xenografts compared to the controls (SMD [95% CI] = - 1.01 [- 1.61-- 0.41]) and fish xenografts compared to controls (SMD [95% CI] = - 6.16 [- 7.65-- 4.66]). In the fish xenografts, re-epithelialization time was significantly lower compared to controls (SMD [95% CI] = - 1.18 [- 2.23-- 0.14]). CONCLUSIONS Xenografts showed a significantly lower number of dressing changes and fish xenografts showed significant benefit in re-epithelialization compared to routine treatment. The beneficial results of xenografts suggest further research in the use of different types of xenografts in patients with extensive burn.
Collapse
Affiliation(s)
- Rana Irilouzadian
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Hediyeh Baghsheikhi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roham Sarmadian
- Infectious Diseases Research Center, Arak University of Medical Sciences, Arak, Iran
| | | | - Tayyeb Ghadimi
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
68
|
Abstract
Wound healing occurs as a response to disruption of the epidermis and dermis. It is an intricate and well-orchestrated response with the goal to restore skin integrity and function. However, in hundreds of millions of patients, skin wound healing results in abnormal scarring, including keloid lesions or hypertrophic scarring. Although the underlying mechanisms of hypertrophic scars and keloid lesions are not well defined, evidence suggests that the changes in the extracellular matrix are perpetuated by ongoing inflammation in susceptible individuals, resulting in a fibrotic phenotype. The lesions then become established, with ongoing deposition of excess disordered collagen. Not only can abnormal scarring be debilitating and painful, it can also cause functional impairment and profound changes in appearance, thereby substantially affecting patients' lives. Despite the vast demand on patient health and the medical society, very little progress has been made in the care of patients with abnormal scarring. To improve the outcome of pathological scarring, standardized and innovative approaches are required.
Collapse
Affiliation(s)
- Marc G Jeschke
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Fiona M Wood
- Burns Service of Western Australia, Fiona Stanley Hospital, Perth Children's Hospital, Perth, Western Australia, Australia
- Burn Injury Research Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Esther Middelkoop
- Burn Center, Red Cross Hospital, Beverwijk, Netherlands
- Association of Dutch Burn Centers (ADBC), Beverwijk, Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, Netherlands
| | - Ardeshir Bayat
- Medical Research Council Wound Healing Unit, Hair and Skin Research Lab, Division of Dermatology, Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
| | - Luc Teot
- Department of Plastic Surgery, Burns, Wound Healing, Montpellier University Hospital, Montpellier, France
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Gerd G Gauglitz
- Department of Dermatology and Allergy, Ludwig-Maximilian University Munich, Munich, Germany
- Haut- und Laserzentrum Glockenbach, Munich, Germany
| |
Collapse
|
69
|
Radzikowska-Büchner E, Łopuszyńska I, Flieger W, Tobiasz M, Maciejewski R, Flieger J. An Overview of Recent Developments in the Management of Burn Injuries. Int J Mol Sci 2023; 24:16357. [PMID: 38003548 PMCID: PMC10671630 DOI: 10.3390/ijms242216357] [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: 09/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
According to the World Health Organization (WHO), around 11 million people suffer from burns every year, and 180,000 die from them. A burn is a condition in which heat, chemical substances, an electrical current or other factors cause tissue damage. Burns mainly affect the skin, but can also affect deeper tissues such as bones or muscles. When burned, the skin loses its main functions, such as protection from the external environment, pathogens, evaporation and heat loss. Depending on the stage of the burn, the patient's condition and the cause of the burn, we need to choose the most appropriate treatment. Personalization and multidisciplinary collaboration are key to the successful management of burn patients. In this comprehensive review, we have collected and discussed the available treatment options, focusing on recent advances in topical treatments, wound cleansing, dressings, skin grafting, nutrition, pain and scar tissue management.
Collapse
Affiliation(s)
- Elżbieta Radzikowska-Büchner
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Inga Łopuszyńska
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Wojciech Flieger
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4 Street, 20-090 Lublin, Poland;
| | - Michał Tobiasz
- Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, Krasnystawska 52 Street, 21-010 Łęczna, Poland;
| | - Ryszard Maciejewski
- Faculty of Medicine, University of Warsaw, Żwirki i Wigury 101 Street, 02-089 Warszawa, Poland;
| | - Jolanta Flieger
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4A Street, 20-093 Lublin, Poland
| |
Collapse
|
70
|
Joglar A, Song J, Golovko G, Jay J, Wolf S, El Ayadi A. Comparing the Effectiveness of Glucocorticoids in Preventing Hypertrophic Scar Diagnosis in Burn Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1970. [PMID: 38004018 PMCID: PMC10673324 DOI: 10.3390/medicina59111970] [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: 09/04/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: The prevalence of hypertrophic scarring after a burn is approximately 70%. Despite advances in burn management, there is currently no gold standard treatment to reduce or prevent its occurrence. Glucocorticoids are frequently given to patients early after burns for other therapeutic purposes and have been shown to induce scar regression. Therefore, the purpose of the present work is to determine the incidence of hypertrophic scar diagnosis in burn patients who were administered glucocorticoid treatment using TriNetX, a large patient database. Materials and Methods: Patients diagnosed with hypertrophic scarring, hypertrophic disorders of the skin, or scar conditions and fibrosis of the skin after burn injury were identified in the TriNetX database. The glucocorticoids investigated include hydrocortisone, methylprednisolone, dexamethasone, triamcinolone, and prednisone. Patients were stratified into three groups based on total body surface area (TBSA) burned: 0-19%, 20-39%, and 40-100%. The risk ratio was evaluated for burn patients who received varying glucocorticoids after injury based on TBSA burned. Additionally, treatment pathways, time of treatment, and treatment purity pathways were evaluated. Results: In patients with a 0-19% TBSA burn, methylprednisolone showed a decreased risk of developing hypertrophic scar diagnosis. In those with a 20-39% TBSA burn or 40-100% TBSA burn, dexamethasone showed an increased risk of developing hypertrophic scar diagnosis. Additionally, dexamethasone was the most commonly administered glucocorticoid for burn patients and was most likely to be administered earlier after burn injury, comparatively. Conclusions: Methylprednisolone was associated with reduced hypertrophic scar diagnosis in burn patients independent of TBSA burn. While glucocorticoids are one of the mainstay treatments for hypertrophic scarring, further studies are needed to determine early therapeutic interventions that will reduce the potential for hypertrophic scar development in burn patients.
Collapse
Affiliation(s)
| | | | | | | | | | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.J.); (J.S.); (G.G.); (J.J.); (S.W.)
| |
Collapse
|
71
|
Jacobson MJ, Masry ME, Arrubla DC, Tricas MR, Gnyawali SC, Zhang X, Gordillo G, Xue Y, Sen CK, Wachs J. Autonomous Multi-modality Burn Wound Characterization using Artificial Intelligence. Mil Med 2023; 188:674-681. [PMID: 37948279 DOI: 10.1093/milmed/usad301] [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: 12/13/2022] [Revised: 04/05/2023] [Accepted: 08/10/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Between 5% and 20% of all combat-related casualties are attributed to burn wounds. A decrease in the mortality rate of burns by about 36% can be achieved with early treatment, but this is contingent upon accurate characterization of the burn. Precise burn injury classification is recognized as a crucial aspect of the medical artificial intelligence (AI) field. An autonomous AI system designed to analyze multiple characteristics of burns using modalities including ultrasound and RGB images is described. MATERIALS AND METHODS A two-part dataset is created for the training and validation of the AI: in vivo B-mode ultrasound scans collected from porcine subjects (10,085 frames), and RGB images manually collected from web sources (338 images). The framework in use leverages an explanation system to corroborate and integrate burn expert's knowledge, suggesting new features and ensuring the validity of the model. Through the utilization of this framework, it is discovered that B-mode ultrasound classifiers can be enhanced by supplying textural features. More specifically, it is confirmed that statistical texture features extracted from ultrasound frames can increase the accuracy of the burn depth classifier. RESULTS The system, with all included features selected using explainable AI, is capable of classifying burn depth with accuracy and F1 average above 80%. Additionally, the segmentation module has been found capable of segmenting with a mean global accuracy greater than 84%, and a mean intersection-over-union score over 0.74. CONCLUSIONS This work demonstrates the feasibility of accurate and automated burn characterization for AI and indicates that these systems can be improved with additional features when a human expert is combined with explainable AI. This is demonstrated on real data (human for segmentation and porcine for depth classification) and establishes the groundwork for further deep-learning thrusts in the area of burn analysis.
Collapse
Affiliation(s)
- Maxwell J Jacobson
- Department of Computer Science, Purdue University, West Lafayette, IN 47907, USA
| | - Mohamed El Masry
- School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | | | - Maria Romeo Tricas
- Department of Computer Science, Purdue University, West Lafayette, IN 47907, USA
| | - Surya C Gnyawali
- School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Xinwei Zhang
- Department of Computer Science, Purdue University, West Lafayette, IN 47907, USA
| | - Gayle Gordillo
- School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Yexiang Xue
- Department of Computer Science, Purdue University, West Lafayette, IN 47907, USA
| | - Chandan K Sen
- School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Juan Wachs
- School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA
| |
Collapse
|
72
|
Jung Y, Cui HS, Lee EK, Joo SY, Seo CH, Cho YS. Effects of Factors Influencing Scar Formation on the Scar Microbiome in Patients with Burns. Int J Mol Sci 2023; 24:15991. [PMID: 37958976 PMCID: PMC10648024 DOI: 10.3390/ijms242115991] [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: 09/21/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Skin microbiome dysbiosis has deleterious effects, and the factors influencing burn scar formation, which affects the scar microbiome composition, are unknown. Therefore, we investigated the effects of various factors influencing scar formation on the scar microbiome composition in patients with burns. We collected samples from the burn scar center and margin of 40 patients with burns, subgrouped by factors influencing scar formation. Scar microbiome composition-influencing factors were analyzed using univariate and multivariate analyses. Skin graft, hospitalization period, intensive care unit (ICU) admission, burn degree, sex, age, total body surface area burned (TBSA), time post-injury, transepidermal water loss, the erythrocyte sedimentation rate, and C-reactive protein levels were identified as factors influencing burn scar microbiome composition. Only TBSA and ICU admission were associated with significant differences in alpha diversity. Alpha diversity significantly decreased with an increase in TBSA and was significantly lower in patients admitted to the ICU than in those not admitted to the ICU. Furthermore, we identified microorganisms associated with various explanatory variables. Our cross-sectional systems biology study confirmed that various variables influence the scar microbiome composition in patients with burns, each of which is associated with various microorganisms. Therefore, these factors should be considered during the application of skin microbiota for burn scar management.
Collapse
Affiliation(s)
- Yeongyun Jung
- Burn Institute, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (Y.J.); (H.S.C.); (E.K.L.)
| | - Hui Song Cui
- Burn Institute, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (Y.J.); (H.S.C.); (E.K.L.)
| | - Eun Kyung Lee
- Burn Institute, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (Y.J.); (H.S.C.); (E.K.L.)
| | - So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (S.Y.J.); (C.H.S.)
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (S.Y.J.); (C.H.S.)
| | - Yoon Soo Cho
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (S.Y.J.); (C.H.S.)
| |
Collapse
|
73
|
Qian M, Li S, Xi K, Tang J, Shen X, Liu Y, Guo R, Zhang N, Gu Y, Xu Y, Cui W, Chen L. ECM-engineered electrospun fibers with an immune cascade effect for inhibiting tissue fibrosis. Acta Biomater 2023; 171:308-326. [PMID: 37673231 DOI: 10.1016/j.actbio.2023.08.058] [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: 04/25/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
Tissue regeneration/fibrosis after injury is intricately regulated by the immune cascade reaction and extracellular matrix (ECM). Dysregulated cascade signal could jeopardize tissue homeostasis leading to fibrosis. Bioactive scaffolds mimicking natural ECM microstructure and chemistry could regulate the cascade reaction to achieve tissue regeneration. The current study constructed an ECM-engineered micro/nanofibrous scaffold using self-assembled nanofibrous collagen and decorin (DCN)-loaded microfibers to regulate the immune cascade reaction. The ECM-engineered scaffold promoted anti-inflammatory and pro-regenerative effects, M2 polarization of macrophages, by nanofibrous collagen. The ECM-engineered scaffold could release DCN to inhibit inflammation-associated fibrous angiogenesis. Yet, to prevent excessive M2 activity leading to tissue fibrosis, controlled release of DCN was expected to elicit M1 activity and achieve M1/M2 balance in the repair process. Regulated cascade reaction guided favorable crosstalk between macrophages, endothelial cells and fibroblasts by proximity. Additionally, decorin could also antagonize TGF-β1 via TGF-β/Smad3 pathway to suppress fibrotic activity of fibroblasts. Hence, ECM-engineered scaffolds could exert effective regulation of the immune cascade reaction by microstructure and DCN release and achieve the balance between tissue fibrosis and regeneration. STATEMENT OF SIGNIFICANCE: With the incidence of up to 74.6%, failed back surgery syndrome (FBSS) has been a lingering issue in spine surgery, which poses a heavy socio-economic burden to society. Epidural fibrosis is believed to be responsible for the onset of FBSS. Current biomaterial-based strategies treating epidural fibrosis mainly rely on physical barriers and unidirectional suppression of inflammation. Regulation of the immune cascade reaction for inhibiting fibrosis has not been widely studied. Based on the simultaneous regulation of M1/M2 polarization and intercellular crosstalk, the ECM-engineered micro/nanofibrous scaffolds constructed in the current study could exert an immune cascade effect to coordinate tissue regeneration and inhibit fibrosis. This finding makes a significant contribution in the development of a treatment for epidural fibrosis and FBSS.
Collapse
Affiliation(s)
- Ming Qian
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006 PR China
| | - Shun Li
- Center for Rehabilitation Medicine, Department of Pain Management, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310014, PR China
| | - Kun Xi
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006 PR China
| | - Jincheng Tang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006 PR China
| | - Xiaofeng Shen
- Department of Orthopaedic Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, 889 Wuzhong West Road, Suzhou, Jiangsu 215006, PR China
| | - Yong Liu
- Department of Orthopaedic Surgery, Affiliated Jiangyin Hospital of Nantong University, Jiangyin, Jiangsu 215600, PR China
| | - Ran Guo
- Center for Rehabilitation Medicine, Department of Pain Management, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310014, PR China
| | - Nannan Zhang
- Center for Rehabilitation Medicine, Department of Pain Management, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310014, PR China
| | - Yong Gu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006 PR China.
| | - Yun Xu
- Center for Rehabilitation Medicine, Department of Pain Management, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310014, PR China.
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China.
| | - Liang Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006 PR China.
| |
Collapse
|
74
|
Stewart BT, Sheckter CC, Nakarmi KK. Holistic Approach to Burn Reconstruction and Scar Rehabilitation. Phys Med Rehabil Clin N Am 2023; 34:883-904. [PMID: 37806704 DOI: 10.1016/j.pmr.2023.06.018] [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: 10/10/2023]
Abstract
More than 11 million burn injuries occur each year across the world. Many people with burn injuries, regardless of injury size, develop hypertrophic scar, contracture, unstable scar, heterotopic ossification, and disability resulting from these sequelae. Advances in trauma systems, critical care, safe surgery, and multidisciplinary burn care have markedly improved the survival of people who have experienced extensive burn injuries. Burn scar reconstruction aims to improve or restore physical function, confidence, and body image. Like acute burn care, burn scar reconstruction requires thoughtful, coordinated approaches along the continuum of burn injury, recovery, and rehabilitation.
Collapse
Affiliation(s)
- Barclay T Stewart
- UW Medicine Regional Burn Center at Harborview Medical Center, University of Washington, 325 9(th) Avenue, Box 359796, Seattle, WA 98104, USA.
| | - Clifford C Sheckter
- The Burn Center at Santa Clara Valley Medical Center, Standford University, 751 South Bascom Avenue, San Jose, CA 95128, USA
| | - Kiran K Nakarmi
- Nepal Cleft and Burn Center at Kirtipur Hospital, National Academy of Medical Sciences, Kirtipur Ring Road, Kathmandu 44618, Nepal
| |
Collapse
|
75
|
Jia L, Guo R, Ying J, Xiong J, Jiang H. A bibliometric and visualized research on global trends of scar, 2011-2021. Burns 2023; 49:1557-1565. [PMID: 37217380 DOI: 10.1016/j.burns.2023.04.010] [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: 11/03/2022] [Revised: 03/29/2023] [Accepted: 04/28/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Pathological scars are the results of abnormal wound healing, which not only affect the appearance, but may also be accompanied by significant psychosocial burdens. In this study, we aimed to conduct a bibliometric and visualized analysis on pathological scars and provide directions for future research. METHODS The articles on scar research from 2011 to 2021 in the Web of Science Core Collection database were collected. The bibliometrics records were retrieved and analyzed with Excel, CiteSpace V and VOSviewer. RESULTS A total of 944 scar research records published between 2011 and 2021 were collected. Publication output has shown an upward trend as a whole. China ranked first in terms of country contributions (418 publications, 5176 citations), while Germany, with only 22 studies published, had the highest average citation rate (57.18). Shanghai Jiaotong University was the institution with the largest number of related articles published, followed by the fourth military medical university, the University of Alberta and the Second military medical university. Wound repair and regeneration, Burns, Journal of Burn Care & Research, Journal of Cosmetic Dermatology published the most research in this field. Dahai Hu was the most prolific author, while Rei Ogawa was the most cited. The cluster analysis of the reference contributions and keywords indicated that current research hotspots mainly include pathogenesis, treatment strategies, and the safety evaluation of new scar treatment options. CONCLUSION This study provides a comprehensive summary and analysis of the current status and research trends of pathological scars. International research interest in pathological scars is on the rise, and high-quality studies related to the field have also increased in the last decade. The pathogenesis of pathological scars, treatment strategies, such as fractional ablative CO2 laser and molecular targeted therapy, and the safety evaluation of new treatment options will be the focus of future research.
Collapse
Affiliation(s)
- Lingling Jia
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China
| | - Rong Guo
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China
| | - Jianghui Ying
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China
| | - Jiachao Xiong
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China.
| | - Hua Jiang
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China.
| |
Collapse
|
76
|
Zhu Z, Kong W, Lu Y, Shi Y, Gan L, Tang H, Wang H, Sun Y. Epidemiological and clinical features of paediatric inpatients for scars: A retrospective study. Burns 2023; 49:1719-1728. [PMID: 36918334 DOI: 10.1016/j.burns.2023.02.008] [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: 06/21/2022] [Revised: 01/30/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To describe the epidemiological and clinical features of paediatric scar inpatients and then to facilitate therapeutic schedule for children with scars. METHODS In this cross-sectional study, data of patients admitted for scar treatment in 1064 tertiary hospitals from 2013 to 2018 were extracted through the Hospital Quality Monitoring System (HQMS) database. Demographic and clinical features of children with scars were analysed statistically and highlighted compared with those of adults and the elderly scar cases. RESULTS In this study, 53,741 paediatric scar cases, accounting for 30.29% of all hospitalized for scar, were analysed. Compared to adults and the elderly, children with scars were mainly males (62.27% vs 50.98% vs 49.85%, P < 0.001) and were vulnerable to scalds (37.10%) and operative intervention (34.11%). Although the scalp/face/neck was the most common affected location, the proportion of scars involving upper limbs (27.88% vs 21.69% vs 7.28%, P < 0.001), lower limbs (15.14% vs 10.28% vs 6.56%, P < 0.001) and perineum (4.59% vs 3.13% vs 2.65%, P < 0.001) was higher in children than that in other two groups. Scar contracture was the most common complications in children (45.27%). Nearly 66% of paediatric scar cases received surgical treatment during hospitalization, among whom release of lesion was the most frequent operation (56.35%). The proportion of keloids was relatively lower in child cases than in other two groups (6.20% vs 14.48% vs 18.15%, P < 0.001). Additionally, the median LOS in child cases was 9 (5-15) days, slightly exceeding that in adult/elderly cases. CONCLUSIONS Scars were common inducing factors of hospitalization and contributed greatly to the disease burden of children. More attention should be paid to those who are males, burn survivors, or skin-injured at extremities and perineum to improve therapeutic strategies and prognoses for paediatric scar patients.
Collapse
Affiliation(s)
- Zhe Zhu
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai, China; Clinic of the 91681 troop of PLA, Zhejiang, China
| | - Weishi Kong
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yahuan Lu
- Department of Respiratory Medicine, Shanghai 411 Hospital, Shanghai, China
| | - Ying Shi
- China Standard Medical Information Research Centre, Shenzhen, China
| | - Lanxia Gan
- China Standard Medical Information Research Centre, Shenzhen, China
| | - Hongtai Tang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Haibo Wang
- Clinical Trial Unit, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Centre for Data Science in Health and Medicine, Peking University, Beijing, China.
| | - Yu Sun
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai, China.
| |
Collapse
|
77
|
Murtaugh B, Warthman R, Boulter T. Rehabilitation Management of the Burned Hand. Phys Med Rehabil Clin N Am 2023; 34:767-782. [PMID: 37806696 DOI: 10.1016/j.pmr.2023.05.001] [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: 10/10/2023]
Abstract
Burns to the hands constitute a small total surface area burn, but can result in significant functional challenges and disability. The complexity of multiple anatomical structures and intricate interplay of bones, muscles, and connective tissues requires specialized knowledge of how burns of the hand can affect function and independence. This article will provide an evidence-based overview of rehabilitation of the burned hand across the burn care continuum including a focus on evaluation, pain management, treatment interventions, and outcome assessment. Additionally, various deficits that can put the hand at significant risk for loss of function will be discussed. Finally, the authors will address the special considerations and treatment caveats of addressing the pediatric hand burn.
Collapse
Affiliation(s)
- Brooke Murtaugh
- Department of Rehabilitation Programs, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506, USA.
| | - Renee Warthman
- Arizona Burn Center, Valleywise Health Medical Center, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Trudy Boulter
- Children's Hospital Colorado Burn Center, 13123 East 16th Avenue, Aurora, CO 80045, USA
| |
Collapse
|
78
|
Rennekampff HO, Kremer T. [Surgical management of burn injury patients : Comments on the guidelines on treatment of thermal injuries in adults]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:968-978. [PMID: 37535094 DOI: 10.1007/s00104-023-01922-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 08/04/2023]
Abstract
The treatment of burn injury patients is a unique challenge for clinicians. The extent of thermal injuries ranges from very small burns to life-threatening burn injuries. Insufficient treatment can result in a substantial impairment in the quality of life. In order to avoid such sequelae a targeted treatment must be carried out. A precise diagnosis determines the necessary treatment. Superficial second-degree burns (2a) not involving the face, hand or joints with a total body surface area smaller than 10% can usually be treated with modern wound dressings in an outpatient setting. Deep second-degree burns (2b) are an indication for debridement. In addition to the classical surgical procedures with tangential excision, enzymatic debridement can also be employed. Similarly, indeterminate burns (2a/2b) are also considered to be an indication for enzymatic debridement. Third-degree burns are treated with early debridement and skin grafting. These patients can also benefit from special dermal replacement procedures for an improvement of the functional and esthetic results. Due to the long-term visible sequelae of burns, aftercare of these patients is indicated.
Collapse
Affiliation(s)
- Hans-Oliver Rennekampff
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Rhein Maas Klinikum, Mauerfelchen 25, 52146, Würselen, Deutschland.
| | - Thomas Kremer
- Klinik für Plastische und Handchirurgie mit Schwerbrandverletztenzentrum, Klinikum St. Georg, Leipzig, Deutschland
| |
Collapse
|
79
|
Bharadia SK, Burnett L, Gabriel V. Hypertrophic Scar. Phys Med Rehabil Clin N Am 2023; 34:783-798. [PMID: 37806697 DOI: 10.1016/j.pmr.2023.05.002] [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: 10/10/2023]
Abstract
Hypertrophic scars frequently develop post-burn, and are characterized by their pruritic, painful, raised, erythematous, dyschromic, and contractile qualities. This article aims to synthesize knowledge on the clinical and molecular development, evolution, management, and measurement of hypertrophic burn scar for both patient and clinician knowledge.
Collapse
Affiliation(s)
- Shyla Kajal Bharadia
- Cumming School of Medicine, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada
| | - Lindsay Burnett
- Alberta Health Services, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada
| | - Vincent Gabriel
- Department of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada; Department of Surgery, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada; Medical Director, Calgary Firefighters Burn Treatment Centre, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada.
| |
Collapse
|
80
|
Rivas E, Foster J, Crandall CG, Finnerty CC, Suman-Vejas OE. Key Exercise Concepts in the Rehabilitation from Severe Burns. Phys Med Rehabil Clin N Am 2023; 34:811-824. [PMID: 37806699 PMCID: PMC10731385 DOI: 10.1016/j.pmr.2023.05.003] [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] [Indexed: 10/10/2023]
Abstract
This article presents information on the benefits of exercise in counteracting the detrimental effects of bed rest, and/or severe burns. Exercise is key for maintaining physical function, lean body mass, metabolic recovery, and psychosocial health after major burn injuries. The details of an exercise training program conducted in severely burned persons are presented, as well as information on the importance of proper regulation of body temperature during exercise or physical activity. The sections on exercise and thermoregulation are followed by a section on the role of exercise in scarring and contractures. Finally, gaps in the current knowledge of exercise, thermoregulation, and contractures are presented.
Collapse
Affiliation(s)
- Eric Rivas
- Microgravity Research, In-Space Solutions, Axiom Space Headquarters, 1290 Hercules Avenue, Houston, TX 77058, USA
| | - Josh Foster
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine (IEEM), Texas Health Presbyterian Hospital Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Craig G Crandall
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine (IEEM), Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Suite 435, Dallas, TX 75231, USA
| | - Celeste C Finnerty
- Department of Surgery, Division of Surgical Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1220, USA
| | - Oscar E Suman-Vejas
- Department of Surgery, Division of Surgical Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1220, USA.
| |
Collapse
|
81
|
Cai Y, Tian J, Li J, Liu X, Li F, Zhang L, Xiao S, Jia C, Deng C. A novel combined technology for treating hypertrophic scars: adipose tissue extract combined with fractional CO 2 laser. Front Physiol 2023; 14:1284312. [PMID: 37965106 PMCID: PMC10642933 DOI: 10.3389/fphys.2023.1284312] [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: 08/28/2023] [Accepted: 10/17/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction: Owing to the need for liposuction and its unsuitability for allogeneic transplantation, the clinical application of stromal vascular fraction gel (SVF-gel) combined with fractional CO2 laser for scar treatment is limited. Adipose tissue extract (ATE), rich in cytokines and growth factors, offers a more convenient option for clinical practice as it can be easily prepared using purely physical methods and has low immunogenicity. We aimed to evaluate the effectiveness of ATE combined with fractional CO2 laser in the treatment of hypertrophic scars. Methods: ATE was prepared using discarded liposuction fluid from patients undergoing liposuction. A rabbit ear hypertrophic scar model was established and treated with ATE, fractional CO2 laser, or a combination. PBS was used as a control. The scar appearance and histological changes were observed. The immunohistochemistry method was used to evaluate the expression of α-SMA, while perilipin was detected using immunofluorescence. Additionally, the level of adipogenic signal C/EBPα and PPARγ mRNA was studied. Results: Following treatment, the volume of hypertrophic scar decreased, resulting in a softer texture and thinner dermis. Additionally, there was a decrease in the infiltration of inflammatory cells, and the collagen arrangement became looser and more regular, and the expression of α-SMA also decreased, with the combination of ATE and fractional laser showing the most significant improvement. Moreover, the combination group was found to promote subcutaneous fat regeneration and increase the expression of adipogenic signals C/EBPα and PPARγ. Conclusion: The combination of ATE and fractional CO2 laser treatment has been shown to inhibit the development of hypertrophic scars. This effect may be attributed to the enhancement of adipogenesis and decrease in collagen deposition.
Collapse
Affiliation(s)
- Yuan Cai
- Department of Dermatology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jiao Tian
- Department of Surgery, Zunyi Medical College, Zunyi, Guizhou, China
- Department of Clinical Medicine, Zunyi Medical College, Zunyi, Guizhou, China
| | - Jianyi Li
- Department of Burns and Plastic Surgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, Guangxi, China
| | - Xing Liu
- Department of Burns and Plastic Surgery, Afliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Fang Li
- Department of Dermatology, Guiyang First People’s Hospital, Guiyang, Guizhou, China
| | - Lanfang Zhang
- Department of Dermatology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Shune Xiao
- Department of Burns and Plastic Surgery, Afliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Changsha Jia
- Department of Dermatology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Chengliang Deng
- Department of Burns and Plastic Surgery, Afliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| |
Collapse
|
82
|
Siani A, Infante-Teixeira L, d'Arcy R, Roberts IV, El Mohtadi F, Donno R, Tirelli N. Polysulfide nanoparticles inhibit fibroblast-to-myofibroblast transition via extracellular ROS scavenging and have potential anti-fibrotic properties. BIOMATERIALS ADVANCES 2023; 153:213537. [PMID: 37406516 DOI: 10.1016/j.bioadv.2023.213537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/06/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023]
Abstract
This paper is about the effects of reactive oxygen species (ROS) - and of their nanoparticle-mediated extracellular removal - in the TGF-β1-induced differentiation of fibroblasts (human dermal fibroblasts - HDFa) to more contractile myofibroblasts, and in the maintenance of this phenotype. Here, poly(propylene sulfide) (PPS) nanoparticles have been employed on 2D and 3D in vitro models, showing extremely low toxicity and undergoing negligible internalization, thereby ensuring an extracellular-only action. Firstly, PPS nanoparticles abrogated ROS-mediated downstream molecular events such as glutathione oxidation, NF-κB activation, and heme oxidase-1 (HMOX) overexpression. Secondly, PPS nanoparticles were also capable to inhibit, prevent and reverse the TGF-β1-induced upregulation of key biomechanical elements, such as ED-a fibronectin (EF-A FN) and alpha-smooth muscle actin (α-SMA), respectively markers of protomyofibroblastic and of myofibroblastic differentiation. We also confirmed that ROS alone are ineffective promoters of the myofibroblastic transition, although their presence contributes to its stabilization. Finally, the particles also countered TGF-β1-induced matrix- and tissue-level phenomena, e.g., the upregulation of collagen type 1, the development of aberrant collagen type 1/3 ratios and the contracture of HDFa 3D-seeded fibrin constructs. In short, experimental data at molecular, cellular and tissue levels show a significant potential in the use of PPS nanoparticles as anti-fibrotic agents.
Collapse
Affiliation(s)
- Alessandro Siani
- Division of Pharmacy and Optometry, School of Health Sciences, Stopford Building, The University of Manchester, Manchester M13 9PL, UK
| | - Lorena Infante-Teixeira
- Laboratory of Polymers and Biomaterials, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Richard d'Arcy
- Division of Pharmacy and Optometry, School of Health Sciences, Stopford Building, The University of Manchester, Manchester M13 9PL, UK; Laboratory of Polymers and Biomaterials, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy.
| | - Iwan V Roberts
- Division of Pharmacy and Optometry, School of Health Sciences, Stopford Building, The University of Manchester, Manchester M13 9PL, UK
| | - Farah El Mohtadi
- Division of Pharmacy and Optometry, School of Health Sciences, Stopford Building, The University of Manchester, Manchester M13 9PL, UK
| | - Roberto Donno
- Laboratory of Polymers and Biomaterials, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Nicola Tirelli
- Division of Pharmacy and Optometry, School of Health Sciences, Stopford Building, The University of Manchester, Manchester M13 9PL, UK; Laboratory of Polymers and Biomaterials, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy.
| |
Collapse
|
83
|
Raktoe R, Kwee AKAL, Rietveld M, Marsidi N, Genders R, Quint K, van Doorn R, van Zuijlen P, Ghalbzouri AEL. Mimicking fat grafting of fibrotic scars using 3D-organotypic skin cultures. Exp Dermatol 2023; 32:1752-1762. [PMID: 37515391 DOI: 10.1111/exd.14893] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
Wound healing of deep burn injuries is often accompanied by severe scarring, such as hypertrophic scar (HTS) formation. In severe burn wounds, where the subcutis is also damaged, the scars adhere to structures underneath, resulting in stiffness of the scar and impaired motion. Over the recent years, a promising solution has emerged: autologous fat grafting, also known as lipofilling. Previous clinical reports have shown that the anti-fibrotic effect has been attributed to the presence of adipose-derived stromal cells (ADSC). In the proposed study, we aim to investigate the effect of fat grafting in 3D organotypic skin cultures mimicking an HTS-like environment. To this end, organotypic skin cultures were embedded with normal skin fibroblasts (NF) or HTS-derived fibroblasts with or without incorporation of human adipose subcutaneous tissue (ADT) and one part was thermally wounded to examine their effect on epithelialization. The developed skin cultures were analysed on morphology and protein level. Analysis revealed that ADT-containing organotypic skin cultures comprise an improved epidermal homeostasis, and a fully formed basement membrane, similar to native human skin (NHS). Furthermore, the addition of ADT significantly reduced myofibroblast presence, which indicates its anti-fibrotic effect. Finally, re-epithelialization measurements showed that ADT reduced re-epithelialization in skin cultures embedded with NFs, whereas HTS-fibroblast-embedded skin cultures showed complete wound closure. In conclusion, we succeeded in developing a 3D organotypic HTS-skin model incorporated with subcutaneous tissue that allows further investigation on the molecular mechanism of fat grafting.
Collapse
Affiliation(s)
- Rajiv Raktoe
- Department of Dermatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Anastasia K A L Kwee
- Department of Dermatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Marion Rietveld
- Department of Dermatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Nick Marsidi
- Department of Dermatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Roel Genders
- Department of Dermatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
- Department of Dermatology, Roosevelt Clinics, Leiden, The Netherlands
| | - Koen Quint
- Department of Dermatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
- Department of Dermatology, Roosevelt Clinics, Leiden, The Netherlands
| | - Remco van Doorn
- Department of Dermatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Paul van Zuijlen
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
- Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | | |
Collapse
|
84
|
Heitzmann W, Mossing M, Fuchs PC, Akkan J, Seyhan H, Grieb G, Opländer C, Schiefer JL. Comparative Clinical Study of Suprathel ® and Jelonet ® Wound Dressings in Burn Wound Healing after Enzymatic Debridement. Biomedicines 2023; 11:2593. [PMID: 37892967 PMCID: PMC10603925 DOI: 10.3390/biomedicines11102593] [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: 08/09/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
Following the enzymatic debridement of deep dermal burns, the choice of wound dressing is crucial for providing an adequate environment and suitable conditions for rapid wound healing. As Suprathel® and fatty gauze (Jelonet®) are the most commonly used dressings in burn centers, the aim of this study is to compare Suprathel® and Jelonet® in the treatment of deep dermal burns after enzymatic debridement with respect to wound healing, patient comfort, and pain. A total of 23 patients with deep dermal burns of the hand or foot (mean total body surface area of 4.31%) were included in this prospective, unicentric, open, comparative, and intra-individual clinical study. After enzymatic debridement, wounds were divided into two areas: one was treated with Suprathel® and the other with Jelonet®. Suprathel® remained on the wounds without dressing changes while Jelonet® was regularly changed. Wound healing, infection, bleeding, exudation, time for dressing changes, and pain were documented (from days 2 to 48) after injury. Satisfactory results were obtained in 22 cases; only one patient had to undergo a second debridement followed by skin grafting. No significant difference in time to final wound healing could be observed (18-19 d). Patients reported significantly less pain during the dressing changes for Suprathel® compared to Jelonet®. Furthermore, the wound areas treated with Suprathel® showed significantly less exudation and bleeding. Wound infections rarely occurred in both groups. In conclusion, the authors found that both wound dressings could be used to achieve safe and rapid wound healing after the enzymatic debridement of deep dermal burns of the hands and feet. However, compared to Jelonet®, Suprathel® showed superior results in terms of patient comfort and pain reduction.
Collapse
Affiliation(s)
- Wolfram Heitzmann
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Cologne-Merheim Hospital, Witten/Herdecke University, 51109 Cologne, Germany; (W.H.); (J.A.)
| | - Mitja Mossing
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Cologne-Merheim Hospital, Witten/Herdecke University, 51109 Cologne, Germany; (W.H.); (J.A.)
| | - Paul Christian Fuchs
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Cologne-Merheim Hospital, Witten/Herdecke University, 51109 Cologne, Germany; (W.H.); (J.A.)
| | - Jan Akkan
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Cologne-Merheim Hospital, Witten/Herdecke University, 51109 Cologne, Germany; (W.H.); (J.A.)
| | - Harun Seyhan
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Cologne-Merheim Hospital, Witten/Herdecke University, 51109 Cologne, Germany; (W.H.); (J.A.)
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Teaching Hospital of the Charité Berlin, Kladower Damm 221, 14089 Berlin, Germany;
- Clinic of Plastic Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Christian Opländer
- Institute for Research in Operative Medicine (IFOM), Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Jennifer Lynn Schiefer
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Cologne-Merheim Hospital, Witten/Herdecke University, 51109 Cologne, Germany; (W.H.); (J.A.)
| |
Collapse
|
85
|
Chen J, Yu W, Xiao C, Su N, Han Y, Zhai L, Hou C. Exosome from adipose-derived mesenchymal stem cells attenuates scar formation through microRNA-181a/SIRT1 axis. Arch Biochem Biophys 2023; 746:109733. [PMID: 37652148 DOI: 10.1016/j.abb.2023.109733] [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: 06/09/2023] [Revised: 08/17/2023] [Accepted: 08/27/2023] [Indexed: 09/02/2023]
Abstract
Pathological scarring is the greatest challenge after injury. Exosome from adipose-derived mesenchymal stem cells has been reported effective to improve hypertrophic scar. This study focused on the possible mechanisms during this process. Exosomes from adipose-derived mesenchymal stem cells were extracted first. Hypertrophic scar tissue and paired normal skin tissue were collected from patients. Mice skin incision model and fibroblasts model were established. TGF-β1 was used to stimulate fibroblasts to myofibroblasts transdifferentiation. It was found that exosomes injection could decrease collagen sediment after wound healing. During which, the expression of microRNA-181a decreased. Further, we found that expression of microRNA-181a in scar tissue was higher than in normal skin. Then hypertrophic scar-derived fibroblasts were used for in vitro study. It was found that similar to the use of exosomes, microRNA-181a inhibitor decreased the expression of collagen and α-SMA. While microRNA-181a mimics suppressed the effects of exosomes. During fibroblast to myofibroblast trans-differentiation, level of microRNA-181a well as levels of scar-related molecules also decreased with the use of exosomes and vice versa. SIRT1 was confirmed one of the downstream targets of microRNA-181a. Suppression of SIRT1 led to diminished effects of exosomes in hypertrophic scar derived fibroblasts. In mice skin incision model, injection of SIRT1 inhibitor led to increased collagen synthesis. In conclusion, exosomes from Adipose-derived mesenchymal stem cells are promising to antagonize scarring through the regulation of microRNA-181a/SIRT1 axis.
Collapse
Affiliation(s)
- Jie Chen
- Department of Plastic Surgery, The Second Affiliated Hospital of Xi'an Medical College, China; Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, China
| | - Wenjuan Yu
- Department of Plastic Surgery, The Second Affiliated Hospital of Xi'an Medical College, China
| | - Chao Xiao
- Department of Plastic Surgery, The Second Affiliated Hospital of Xi'an Medical College, China
| | - Na Su
- Department of Plastic Surgery, The Second Affiliated Hospital of Xi'an Medical College, China
| | - Yubo Han
- Department of Plastic Surgery, The Second Affiliated Hospital of Xi'an Medical College, China
| | - Liang Zhai
- Department of Plastic Surgery, The Second Affiliated Hospital of Xi'an Medical College, China
| | - Chen Hou
- Shaanxi Provincial People's Hospital, China.
| |
Collapse
|
86
|
Li M, Wang P, Li J, Zhou F, Huang S, Qi S, Shu B. NRP1 transduces mechanical stress inhibition via LATS1/YAP in hypertrophic scars. Cell Death Discov 2023; 9:341. [PMID: 37704618 PMCID: PMC10499927 DOI: 10.1038/s41420-023-01635-3] [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: 08/17/2022] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
Hypertrophic scar (HS) is an abnormal fibrous hyperplasia of the skin caused by excessive tissue repair in response to skin burns and trauma, which restricts physical function and impairs patients' quality of life. Numerous studies have shown that pressure garment therapy (PGT) is an effective treatment for preventing hypertrophic scars. Herein, we found that mechanical stress stimulates the neuropilin 1 (NRP1) expression through screening GSE165027, GSE137210, and GSE120194 from Gene Expression Omnibus (GEO) database and bioinformatics analysis. We verified this stimulation in the human hypertrophic scar, pressure culture cell model, and rat tail-scar model. Mechanical compression increased LATS1 and pYAP enrichment, thus repressing the expression of YAP. Functionally, the knockdown of NRP1 promoted the expression of LATS1, thus decreasing the expression of YAP and inhibiting endothelial cell proliferation. Furthermore, co-immunoprecipitation analysis confirmed that NRP1 binds to YAP, and mechanical compression disrupted this binding, which resulted in the promotion of YAP relocation to nuclear. In conclusion, our results indicated that NRP1 transduces mechanical force inhibition by inhibiting YAP expression. Mechanical pressure can release YAP bound to NRP1, which explains the phenomenon that mechanical stress increases YAP in the nucleus. Strategies targeting NRP1 may promote compression therapy with optimal and comfortable pressures.
Collapse
Affiliation(s)
- Mengzhi Li
- Department of Burns, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Peng Wang
- Department of Burns, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jingting Li
- Department of Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fei Zhou
- Department of Burns, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shixin Huang
- Department of Burns, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaohai Qi
- Department of Burns, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Bin Shu
- Department of Burns, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
87
|
Chen YY, Patel KM, Imran R, Hassouna T, Amirize E, Abdulsalam A, Bishop J, Slade A, Ventura M, Yarrow J, Lord JM, Wilson Y, Moiemen NS. SMOOTH protocol: A pilot randomised prospective intra-patient single-blinded observational study for examining the mechanistic basis of ablative fractional carbon dioxide laser therapy in treating hypertrophic scarring. PLoS One 2023; 18:e0285230. [PMID: 37682920 PMCID: PMC10490849 DOI: 10.1371/journal.pone.0285230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Burn injuries are the fourth most common type of trauma and are associated with substantial morbidity and mortality. The impact of burn injury is clinically significant as burn injuries often give rise to exuberant scarring. Hypertrophic scarring (HTS) is a particular concern as up to 70% of burns patients develop HTS. Laser therapy is used for treating HTS and has shown positive clinical outcomes, although the mechanisms remain unclear limiting approaches to improve its effectiveness. Emerging evidence has shown that fibroblasts and senescent cells are important modifiers of scarring. This study aims to investigate the cellular kinetics in HTS after laser therapy, with a focus on the association of scar reduction with the presence of senescent cells. METHODS We will conduct a multicentre, intra-patient, single-blinded, randomised controlled longitudinal pilot study with parallel assignments to achieve this objective. 60 participants will be recruited to receive 3 interventional ablative fractional CO2 laser treatments over a 12-month period. Each participant will have two scars randomly allocated to receive either laser treatment or standard care. Biopsies will be obtained from laser-treated, scarred-no treatment and non-scarred tissues for immune-histological staining to investigate the longitudinal kinetics of p16INK4A+-senescent cells and fibroblast subpopulations (CD90+/Thy1+ and αSMA+). Combined subjective scar assessments including Modified Vancouver Scar Scale, Patient and Observer Scar Assessment Scale and Brisbane Burn Scar Impact Profile; and objective assessment tools including 3D-Vectra-H1 photography, DermaScan® Cortex, Cutometer® and ColoriMeter®DSMIII will be used to evaluate clinical outcomes. These will then be used to investigate the association between senescent cells and scar reduction after laser therapy. This study will also collect blood samples to explore the systemic biomarkers associated with the response to laser therapy. DISCUSSION This study will provide an improved understanding of mechanisms potentially mediating scar reduction with laser treatment, which will enable better designs of laser treatment regimens for those living with HTS. TRIAL REGISTRATION ClinicalTrials.gov: NCT04736251.
Collapse
Affiliation(s)
- Yung-Yi Chen
- The Scar Free Foundation Centre for Conflict Wound Research, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Krupali M. Patel
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Rizwana Imran
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Tarek Hassouna
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ezekwe Amirize
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Abdulrazak Abdulsalam
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Jonathan Bishop
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Anita Slade
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Maximina Ventura
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Jeremy Yarrow
- Welsh Centre for Burns and Plastic Surgery Morriston Hospital, Swansea, United Kingdom
| | - Janet M. Lord
- The Scar Free Foundation Centre for Conflict Wound Research, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Yvonne Wilson
- The Scar Free Foundation Centre for Conflict Wound Research, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Birmingham Children’s Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Naiem S. Moiemen
- The Scar Free Foundation Centre for Conflict Wound Research, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
88
|
Hartl G, Fletchall S, Velamuri SR. Burn Injury Cutaneous Functional Units: Allocating Occupational Therapy Resources and Influencing Practice. J Burn Care Res 2023; 44:1117-1124. [PMID: 36918955 DOI: 10.1093/jbcr/irad037] [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: 10/02/2022] [Indexed: 03/16/2023]
Abstract
Burn injury severity is currently determined by estimating the total body surface area (TBSA) burned, but this method fails to capture the severity of subsequent functional consequences. Alternatively, cutaneous functional units (CFUs)--skin segments that accommodate for movement and commonly become contracted--can be used to more accurately estimate burn severity based on functional consequences. Bilateral hands account for 81.3% of the body's CFUs, though only account for 5% of TBSA. However, hand burn survivors can have worse physical outcomes (ie, contractures, deformities) after burn injury, leading to subsequent loss of function, global occupational participation deficits, and poor psychosocial outcomes. This study, conducted at a verified American Burn Association burn center, explores how CFU involvement among adult burn survivors with uni and bilateral hand and upper extremity burns influenced occupational therapy practice in regards to time spent completing scar and soft tissue elongation techniques from the elbow to the digit tips per patient. The data showed, on average, burn occupational therapists require 0.8 minutes per CFU for an average total of 38.7 (SD = 29.5) minutes each session to complete scar and soft tissue elongation techniques to the upper extremities. The results of this study can be used to educate burn centers on the clinical utility of CFUs, burn occupational therapists regarding best-practice in terms of utilization of therapist time and resources, as well as support the justification for increasing occupational therapy services for patients with upper extremity and hand burns, and increasing staffing to meet patient need.
Collapse
Affiliation(s)
- Grace Hartl
- Sargent College of Health and Rehabilitation Sciences at Boston University, Boston, Massachusetts, USA
| | - Sandra Fletchall
- Regional One Health, Firefighters Burn Center, Memphis, Tennessee, USA
| | | |
Collapse
|
89
|
Zhang J, Ding L, Wu Y, Yao M, Ma Q. Perceived stigma in burn survivors: Associations with resourcefulness and alexithymia. Burns 2023; 49:1448-1456. [PMID: 36646574 DOI: 10.1016/j.burns.2022.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Burn survivors often have severe scarring and distorted body image, and they are commonly given new perceptions and even receive a variety of negative labels from individuals, families and society. This study aimed to explore the association between stigma, resourcefulness and alexithymia, and identifies whether resourcefulness in burn survivors is mediating the relationship between resourcefulness and alexithymia. METHOD This correlational study was conducted from December 2021 to July 2022 in a comprehensive tertiary Grade A hospital in Ningxia, China. A convenience sample of 159 burn survivors was recruited. Data were collected using demographics, Social Impact Scale(SIC),Toronto Alexithymia Scale, and Resourcefulness Scale (RS). Descriptive analysis, Hierarchical Regression analysis, Pearson Correlation analysis, and Mediation analysis were used for data analysis. RESULTS Finally, a data set of 148 responses was determined for analysis. The effective rate was 95.9%. We found significant correlation between stigma, resourcefulness and alexithymia. Sociodemographic characteristics (gender, spouse states), clinical characteristics (body surface burned area, scar areas), resourcefulness and alexithymia of burn survivors were significant predictors of stigma among burn survivors. The mediating effect of resourcefulness between stigma and alexithymia in burns survivors accounted for 36.03% of the total effect. CONCLUSION Resourcefulness partially mediates the relationship between stigma and alexithymia. These findings suggest medical staff should strengthen the management of the mental health of burn survivors and eliminate the negative cognition and tendency of burn survivors by regularly promoting stigma counseling measures based on cognitive behavioral therapy. Based on the resourcefulness theory, psychological counseling and intervention are carried out in various ways to fully mobilize their internal factors for positive emotional regulation and enhance the ability of individuals to cope with adversity. In addition, an attempt was made to establish an "anti-stigma coalition" or "peer support group" for burn survivors to provide networked information support and emotional support to facilitate further the smooth return of patients to their families and society.
Collapse
Affiliation(s)
- Juan Zhang
- Department of Burns and Plastic Surgery, General Hospital of Ningxia Medical University, Yinchuan City, Ningxia Hui Autonomous Region, China.
| | - Liyan Ding
- Department of Endocrinology, General Hospital of Ningxia Medical University, Yinchuan City, Ningxia Hui Autonomous Region, China
| | - Yuexiang Wu
- Wound Stomy Clinic, General Hospital of Ningxia Medical University, Yinchuan City, Ningxia Hui Autonomous Region, China
| | - Miao Yao
- Department of Burns and Plastic Surgery, General Hospital of Ningxia Medical University, Yinchuan City, Ningxia Hui Autonomous Region, China
| | - Qiang Ma
- Department of Burns and Plastic Surgery, General Hospital of Ningxia Medical University, Yinchuan City, Ningxia Hui Autonomous Region, China
| |
Collapse
|
90
|
Wang M, Cao L. Hydrolysable tannins as a potential therapeutic drug for the human fibrosis-associated disease. Drug Dev Res 2023; 84:1096-1113. [PMID: 37386756 DOI: 10.1002/ddr.22089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 07/01/2023]
Abstract
Fibrosis is a pathological change with abnormal tissue regeneration due to a response to persistent injury, which is extensively related to organ damage and failure, leading to high morbidity and mortality worldwide. Although the pathogenesis of fibrosis has been comprehensively elucidated, there are few effective therapies for treating fibrotic diseases. Natural products are increasingly regarded as an effective strategy for fibrosis with numerous favorable functions. Hydrolysable tannins (HT) are a type of natural products that have the potential to treat the fibrotic disease. In this review, we describe some biological activities and the therapeutic prospects of HT in organ fibrosis. Furthermore, the underlying mechanisms of inhibition of HT on fibrotic organs in relation to inflammation, oxidative stress, epithelial-mesenchymal transition, fibroblast activation and proliferation, and extracellular matrix accumulation are discussed. Understanding the mechanism of HT against fibrotic diseases will provide a new strategy for the prevention and attenuation of fibrosis progression.
Collapse
Affiliation(s)
- Meiwei Wang
- The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, China
| | - Linghui Cao
- The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, China
| |
Collapse
|
91
|
Gong YR, Zhang C, Xiang X, Wang ZB, Wang YQ, Su YH, Zhang HQ. Baicalin, silver titanate, Bletilla striata polysaccharide and carboxymethyl chitosan in a porous sponge dressing for burn wound healing. JOURNAL OF INTEGRATIVE MEDICINE 2023; 21:487-495. [PMID: 37544834 DOI: 10.1016/j.joim.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/18/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE This study tests the efficacy of Bletilla striata polysaccharide (BSP), carboxymethyl chitosan (CMC), baicalin (BA) and silver titanate (ST) in a wound dressings to fight infection, promote healing and provide superior biocompatibility. METHODS The antibacterial activity of BA and ST was evaluated in vitro using the inhibition zone method. BA/ST/BSP/CMC porous sponge dressings were prepared and characterized. The biocompatibility of BA/ST/BSP/CMC was assessed using the cell counting kit-8 assay. The therapeutic effect of BA/ST/BSP/CMC was further investigated using the dorsal skin burn model in Sprague-Dawley rats. RESULTS The wound dressing had good antibacterial activity against Escherichia coli and Staphylococcus aureus through BA and ST, while the combination of BSP and CMC played an important role in promoting wound healing. The BA/ST/BSP/CMC porous sponge dressings were prepared using a freeze-drying method with the concentrations of BA and ST at 20 and 0.83 mg/mL, respectively, and the optimal ratio of 5% BSP to 4% CMC was 1:3. The average porosity, water absorption and air permeability of BA/ST/BSP/CMC porous sponge dressings were measured to be 90.43%, 746.1% and 66.60%, respectively. After treatment for 3 and 7 days, the healing rates of the BA/ST/BSP/CMC group and BA/BSP/CMC group were significantly higher than those of the normal saline (NS) group and silver sulfadiazine (SSD) group (P < 0.05). Interleukin-1β expression in the BA/ST/BSP/CMC group at 1 and 3 days was significantly lower than that in the other three groups (P < 0.05). After being treated for 3 days, vascular endothelial growth factor expression in the BA/BSP/CMC group and BA/ST/BSP/CMC group was significantly higher than that in the NS group and SSD group (P < 0.05). Inspection of histological sections showed that the BA/ST/BSP/CMC group and BA/BSP/CMC group began to develop scabbing and peeling of damaged skin after 3 days of treatment, indicating accelerated healing relative to the NS group and SSD group. CONCLUSION The optimized concentration of BA/ST/BSP/CMC dressing was as follows: 6 mg BSP, 14.4 mg CMC, 0.5 mg ST and 12 mg BA. The BA/ST/BSP/CMC dressing, containing antibacterial constituents, was non-cytotoxic and effective in accelerating the healing of burn wounds, making it a promising candidate for wound healing. Please cite this article as: Gong YR, Zhang C, Xiang X, Wang ZB, Wang YQ, Su YH, Zhang HQ. Baicalin, silver titanate, Bletilla striata polysaccharide and carboxymethyl chitosan in a porous sponge dressing for burn wound healing. J Integr Med. 2023; 21(5): 487-495.
Collapse
Affiliation(s)
- Yan-Rong Gong
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China
| | - Cheng Zhang
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China; Department of Dermatology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Xing Xiang
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China
| | - Zhi-Bo Wang
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China
| | - Yu-Qing Wang
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China
| | - Yong-Hua Su
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China; Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Hui-Qing Zhang
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China.
| |
Collapse
|
92
|
Peng Y, Jiang Y, Fu X. Next-generation skin regeneration: opportunities and challenges in biomaterials and bioengineering. Sci Bull (Beijing) 2023; 68:1722-1725. [PMID: 37474446 DOI: 10.1016/j.scib.2023.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Affiliation(s)
- Yu Peng
- Key Laboratory of Tissue Repair and Regeneration, PLA General Hospital, Beijing 100037, China; School of Medicine, Nankai University, Tianjin 300071, China
| | - Yufeng Jiang
- Key Laboratory of Tissue Repair and Regeneration, PLA General Hospital, Beijing 100037, China; Department of Tissue Regeneration and Wound Repair, PLA General Hospital, Beijing 100039, China.
| | - Xiaobing Fu
- Key Laboratory of Tissue Repair and Regeneration, PLA General Hospital, Beijing 100037, China; School of Medicine, Nankai University, Tianjin 300071, China.
| |
Collapse
|
93
|
Zheng Y, Huang Q, Zhang Y, Geng L, Wang W, Zhang H, He X, Li Q. Multimodal roles of transient receptor potential channel activation in inducing pathological tissue scarification. Front Immunol 2023; 14:1237992. [PMID: 37705977 PMCID: PMC10497121 DOI: 10.3389/fimmu.2023.1237992] [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: 06/10/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023] Open
Abstract
Transient receptor potential (TRP) channels are a class of transmembrane proteins that can sense a variety of physical/chemical stimuli, participate in the pathological processes of various diseases and have attracted increasing attention from researchers. Recent studies have shown that some TRP channels are involved in the development of pathological scarification (PS) and directly participate in PS fibrosis and re-epithelialization or indirectly activate immune cells to release cytokines and neuropeptides, which is subdivided into immune inflammation, fibrosis, pruritus and mechanical forces increased. This review elaborates on the characteristics of TRP channels, the mechanism of PS and how TRP channels mediate the development of PS, summarizes the important role of TRP channels in the different pathogenesis of PS and proposes that therapeutic strategies targeting TRP will be important for the prevention and treatment of PS. TRP channels are expected to become new targets for PS, which will make further breakthroughs and provide potential pharmacological targets and directions for the in-depth study of PS.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Xiang He
- Department of Dermatology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qiannan Li
- Department of Dermatology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
94
|
Hao M, Wang D, Duan M, Kan S, Li S, Wu H, Xiang J, Liu W. Functional drug-delivery hydrogels for oral and maxillofacial wound healing. Front Bioeng Biotechnol 2023; 11:1241660. [PMID: 37600316 PMCID: PMC10434880 DOI: 10.3389/fbioe.2023.1241660] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
The repair process for oral and maxillofacial injuries involves hemostasis, inflammation, proliferation, and remodeling. Injury repair involves a variety of cells, including platelets, immune cells, fibroblasts, and various cytokines. Rapid and adequate healing of oral and maxillofacial trauma is a major concern to patients. Functional drug-delivery hydrogels play an active role in promoting wound healing and have shown unique advantages in wound dressings. Functional hydrogels promote wound healing through their adhesive, anti-inflammatory, antioxidant, antibacterial, hemostatic, angiogenic, and re-epithelialization-promoting properties, effectively sealing wounds and reducing inflammation. In addition, functional hydrogels can respond to changes in temperature, light, magnetic fields, pH, and reactive oxygen species to release drugs, enabling precise treatment. Furthermore, hydrogels can deliver various cargos that promote healing, including nucleic acids, cytokines, small-molecule drugs, stem cells, exosomes, and nanomaterials. Therefore, functional drug-delivery hydrogels have a positive impact on the healing of oral and maxillofacial injuries. This review describes the oral mucosal structure and healing process and summarizes the currently available responsive hydrogels used to promote wound healing.
Collapse
Affiliation(s)
- Ming Hao
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, China
| | - Dongxu Wang
- Laboratory Animal Center, College of Animal Science, Jilin University, Changchun, China
| | - Mengna Duan
- Department of Prosthodontics, Hospital of Stomatology, Jilin University, Changchun, China
| | - Shaoning Kan
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, China
| | - Shuangji Li
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, China
| | - Han Wu
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, China
| | - Jingcheng Xiang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, China
| | - Weiwei Liu
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, China
| |
Collapse
|
95
|
Xia W, Wang Q, Lin S, Wang Y, Zhang J, Wang H, Yang X, Hu Y, Liang H, Lu Y, Zhu Z, Liu D. A high-salt diet promotes hypertrophic scarring through TRPC3-mediated mitochondrial Ca 2+ homeostasis dysfunction. Heliyon 2023; 9:e18629. [PMID: 37588604 PMCID: PMC10425910 DOI: 10.1016/j.heliyon.2023.e18629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/13/2023] [Accepted: 07/21/2023] [Indexed: 08/18/2023] Open
Abstract
Diet High in salt content have been associated with cardiovascular disease and chronic inflammation. We recently demonstrated that transient receptor potential canonical 3 (TRPC3) channels regulate myofibroblast transdifferentiation in hypertrophic scars. Here, we examined how high salt activation of TRPC3 participates in hypertrophic scarring during wound healing. In vitro, we confirmed that high salt increased the TRPC3 protein expression and the marker of myofibroblast alpha smooth muscle actin (α-SMA) in wild-type mice (WT) primary cultured dermal fibroblasts but not Trpc3-/- mice. Activation of TRPC3 by high salt elevated cytosolic Ca2+ influx and mitochondrial Ca2+ uptake in dermal fibroblasts in a TRPC3-dependent manner. High salt activation of TRPC3 enhanced mitochondrial respiratory dysfunction and excessive ROS production by inhibiting pyruvate dehydrogenase action, that activated ROS-triggered Ca2+ influx and the Rho kinase/MLC pathway in WT mice but not Trpc3-/- mice. In vivo, a persistent high-salt diet promoted myofibroblast transdifferentiation and collagen deposition in a TRPC3-dependent manner. Therefore, this study demonstrates that high salt enhances myofibroblast transdifferentiation and promotes hypertrophic scar formation through enhanced mitochondrial Ca2+ homeostasis, which activates the ROS-mediated pMLC/pMYPT1 pathway. TRPC3 deficiency antagonizes high salt diet-induced hypertrophic scarring. TRPC3 may be a novel target for hypertrophic scarring during wound healing.
Collapse
Affiliation(s)
- Weijie Xia
- Department of Plastic & Cosmetic Surgery, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing 400042, PR China
| | - Qianran Wang
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing 400042, PR China
| | - Shaoyang Lin
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing 400042, PR China
| | - Yuanyuan Wang
- Department of Plastic & Cosmetic Surgery, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing 400042, PR China
| | - Junbo Zhang
- Department of Plastic & Cosmetic Surgery, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing 400042, PR China
| | - Hailin Wang
- Department of Plastic & Cosmetic Surgery, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing 400042, PR China
| | - Xia Yang
- Department of Wound Infection and Drug, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing 400042, PR China
| | - Yingru Hu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing 400042, PR China
| | - Huaping Liang
- Department of Wound Infection and Drug, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing 400042, PR China
| | - Yuangang Lu
- Department of Plastic & Cosmetic Surgery, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing 400042, PR China
| | - Zhiming Zhu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing 400042, PR China
| | - Daoyan Liu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing 400042, PR China
- Department of Wound Infection and Drug, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing 400042, PR China
| |
Collapse
|
96
|
Li J, Yin Y, Zou J, Zhang E, Li Q, Chen L, Li J. The adipose-derived stem cell peptide ADSCP2 alleviates hypertrophic scar fibrosis via binding with pyruvate carboxylase and remodeling the metabolic landscape. Acta Physiol (Oxf) 2023; 238:e14010. [PMID: 37366253 DOI: 10.1111/apha.14010] [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: 03/28/2023] [Revised: 05/29/2023] [Accepted: 06/04/2023] [Indexed: 06/28/2023]
Abstract
AIM The purpose of this study was to investigate the function and mechanism of a novel peptide derived from adipose-derived stem cell-conditioned medium (ADSC-CM). METHODS Mass spectrometry was applied to identify expressed peptides in ADSC-CM obtained at different time points. The cell counting kit-8 assay and quantitative reverse transcription polymerase chain reactions were performed to screen the functional peptides contained within ADSC-CM. RNA-seq, western blot, a back skin excisional model of BALB/c mice, the peptide pull-down assay, rescue experiments, untargeted metabolomics, and mixOmics analysis were performed to thoroughly understand the functional mechanism of selected peptide. RESULTS A total of 93, 827, 1108, and 631 peptides were identified in ADSC-CM at 0, 24, 48, and 72 h of conditioning, respectively. A peptide named ADSCP2 (DENREKVNDQAKL) derived from ADSC-CM inhibited collagen and ACTA2 mRNAs in hypertrophic scar fibroblasts. Moreover, ADSCP2 facilitated wound healing and attenuated collagen deposition in a mouse model. ADSCP2 bound with the pyruvate carboxylase (PC) protein and inhibited PC protein expression. Overexpressing PC rescued the reduction in collagen and ACTA2 mRNAs caused by ADSCP2. Untargeted metabolomics identified 258 and 447 differential metabolites in the negative and positive mode, respectively, in the ADSCP2-treated group. The mixOmics analysis, which integrated RNA-seq and untargeted metabolomics data, provided a more holistic view of the functions of ADSCP2. CONCLUSION Overall, a novel peptide derived from ADSC-CM, named ADSCP2, attenuated hypertrophic scar fibrosis in vitro and in vivo, and the novel peptide ADSCP2 might be a promising drug candidate for clinical scar therapy.
Collapse
Affiliation(s)
- Jingyun Li
- Nanjing Maternal and Child Health Medical Institute, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Yiliang Yin
- Department of Plastic & Cosmetic Surgery, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Jijun Zou
- Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Enyuan Zhang
- Department of Plastic & Cosmetic Surgery, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Qian Li
- Department of Plastic & Cosmetic Surgery, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Ling Chen
- Department of Plastic & Cosmetic Surgery, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Jun Li
- Department of Plastic & Cosmetic Surgery, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| |
Collapse
|
97
|
Thomas R, Wicks S, Toose C, Dale M, Pacey V. Reliability, Validity, and Predictive Validity of Cutaneous Functional Units Predicted to Scar Following Palmar Burn Injury in Young Children. J Burn Care Res 2023; 44:918-924. [PMID: 36478206 DOI: 10.1093/jbcr/irac179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Identification of children at risk of palmar burn scar is important for early initiation of scar management. This study determined the interrater reliability of face-to-face and photographic assessments of 29 palmar cutaneous functional units (CFUs) predicted to scar following palmar burn. The validity of photographic compared to face-to-face assessment, and the predictive validity of both assessment types to identify scarring at 3 to 6 months following burn, was also established. Thirty-nine children (40 hands) post burn injury were assessed face-to-face in the clinical setting, following healing of their palmar burn, by three burn therapists. Photographs of the children's hands at initial assessment were assessed by the same therapists a minimum of 6 months later. To determine which CFUs scarred, children were reassessed face-to-face in the clinical setting 3 to 6 months following their burn. For analysis, 29 CFUs were merged into eight separate groups to determine the number of CFUs predicted to scar per CFU group for face-to-face and photographic assessments. The range of agreement for individual CFUs within CFU groups was also calculated for both assessment types. Excellent interrater reliability was established for face-to-face assessment in all eight CFU groups (ICC2,1 0.83-0.96). Photographic assessment demonstrated good to excellent interrater reliability in six CFU groups (ICC2,1 0.69-0.90) and validity in seven CFU groups (ICC2,1 0.66-0.87). Good to excellent predictive validity was established for both assessment types in seven CFU groups (face-to-face ICC2,1 0.60-0.95, photographic ICC2,1 0.69-0.89). Experienced therapists can reliably assess CFUs face-to-face or via photographs and predict future scar development.
Collapse
Affiliation(s)
- Rhianydd Thomas
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Burns Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Stephanie Wicks
- Burns Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Claire Toose
- Burns Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Marita Dale
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Verity Pacey
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
98
|
Wasson E, Thandi C, Hitchens E, Thomas K, Keith D. An audit of the use of fractional CO2 laser for hypertrophic burn scars: a real-life perspective. Lasers Med Sci 2023; 38:144. [PMID: 37347311 DOI: 10.1007/s10103-023-03814-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Elizabeth Wasson
- Foundation School, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
| | - Charankumal Thandi
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
| | - Emma Hitchens
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
| | - Kay Thomas
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
| | - Daniel Keith
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
| |
Collapse
|
99
|
Song B, Liu W, Zhu Y, Peng Y, Cui Z, Gao B, Chen L, Yu Z, Song B. Deciphering the contributions of cuproptosis in the development of hypertrophic scar using single-cell analysis and machine learning techniques. Front Immunol 2023; 14:1207522. [PMID: 37409114 PMCID: PMC10318401 DOI: 10.3389/fimmu.2023.1207522] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/06/2023] [Indexed: 07/07/2023] Open
Abstract
Hypertrophic scar (HS) is a chronic inflammatory skin disease characterized by excessive deposition of extracellular matrix, but the exact mechanisms related to its formation remain unclear, making it difficult to treat. This study aimed to investigate the potential role of cuproptosis in the information of HS. To this end, we used single-cell sequencing and bulk transcriptome data, and screened for cuproptosis-related genes (CRGs) using differential gene analysis and machine learning algorithms (random forest and support vector machine). Through this process, we identified a group of genes, including ATP7A, ULK1, and MTF1, as novel therapeutic targets for HS. Furthermore, quantitative real-time polymerase chain reaction (qRT-PCR) was conducted to confirm the mRNA expression of ATP7A, ULK1, and MTF1 in both HS and normal skin (NS) tissues. We also constructed a diagnostic model for HS and analyzed the immune infiltration characteristics. Additionally, we used the expression profiles of CRGs to perform subgroup analysis of HS. We focused mainly on fibroblasts in the transcriptional profile at single-cell resolution. By calculating the cuproptosis activity of each fibroblast, we found that cuproptosis activity of normal skin fibroblasts increased, providing further insights into the pathogenesis of HS. We also analyzed the cell communication network and transcription factor regulatory network activity, and found the existence of a fibroblast-centered communication regulation network in HS, where cuproptosis activity in fibroblasts affects intercellular communication. Using transcription factor regulatory activity network analysis, we obtained highly active transcription factors, and correlation analysis with CRGs suggested that CRGs may serve as potential target genes for transcription factors. Overall, our study provides new insights into the pathophysiological mechanisms of HS, which may inspire new ideas for the diagnosis and treatment.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Lin Chen
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zhou Yu
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Baoqiang Song
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| |
Collapse
|
100
|
Herndon DN. Introduction: The Multidisciplinary Team Approach to Burn Care. Surg Clin North Am 2023; 103:369-376. [PMID: 37149374 DOI: 10.1016/j.suc.2023.01.004] [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: 05/08/2023]
Abstract
Since the first burn units were established following World War II, great advances in understanding and treating burn shock, smoke inhalation injury, pneumonia, and invasive burn wound infections, and in achieving early burn-wound closure, have greatly decreased postburn morbidity and mortality. These advances were the result of closely integrated multidisciplinary teams of clinicians and researchers. The team approach to burns is a model for success in the care of any challenging clinical problem.
Collapse
|