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Sierra-Sánchez Á, Montero-Vilchez T, Quiñones-Vico MI, Sanchez-Diaz M, Arias-Santiago S. Current Advanced Therapies Based on Human Mesenchymal Stem Cells for Skin Diseases. Front Cell Dev Biol 2021; 9:643125. [PMID: 33768095 PMCID: PMC7985058 DOI: 10.3389/fcell.2021.643125] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/18/2021] [Indexed: 12/17/2022] Open
Abstract
Skin disease may be related with immunological disorders, external aggressions, or genetic conditions. Injuries or cutaneous diseases such as wounds, burns, psoriasis, and scleroderma among others are common pathologies in dermatology, and in some cases, conventional treatments are ineffective. In recent years, advanced therapies using human mesenchymal stem cells (hMSCs) from different sources has emerged as a promising strategy for the treatment of many pathologies. Due to their properties; regenerative, immunomodulatory and differentiation capacities, they could be applied for the treatment of cutaneous diseases. In this review, a total of thirteen types of hMSCs used as advanced therapy have been analyzed, considering the last 5 years (2015-2020). The most investigated types were those isolated from umbilical cord blood (hUCB-MSCs), adipose tissue (hAT-MSCs) and bone marrow (hBM-MSCs). The most studied diseases were wounds and ulcers, burns and psoriasis. At preclinical level, in vivo studies with mice and rats were the main animal models used, and a wide range of types of hMSCs were used. Clinical studies analyzed revealed that cell therapy by intravenous administration was the advanced therapy preferred except in the case of wounds and burns where tissue engineering was also reported. Although in most of the clinical trials reviewed results have not been posted yet, safety was high and only local slight adverse events (mild nausea or abdominal pain) were reported. In terms of effectiveness, it was difficult to compare the results due to the different doses administered and variables measured, but in general, percentage of wound's size reduction was higher than 80% in wounds, Psoriasis Area and Severity Index and Severity Scoring for Atopic Dermatitis were significantly reduced, for scleroderma, parameters such as Modified Rodnan skin score (MRSC) or European Scleroderma Study Group activity index reported an improvement of the disease and for hypertrophic scars, Vancouver Scar Scale (VSS) score was decreased after applying these therapies. On balance, hMSCs used for the treatment of cutaneous diseases is a promising strategy, however, the different experimental designs and endpoints stablished in each study, makes necessary more research to find the best way to treat each patient and disease.
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Affiliation(s)
- Álvaro Sierra-Sánchez
- Cell Production and Tissue Engineering Unit, Andalusian Network of Design and Translation of Advanced Therapies, Virgen de las Nieves University Hospital, Granada, Spain.,Biosanitary Institute of Granada (ibs.GRANADA), Granada, Spain
| | - Trinidad Montero-Vilchez
- Biosanitary Institute of Granada (ibs.GRANADA), Granada, Spain.,Department of Dermatology, Virgen de las Nieves University Hospital, Granada, Spain
| | - María I Quiñones-Vico
- Cell Production and Tissue Engineering Unit, Andalusian Network of Design and Translation of Advanced Therapies, Virgen de las Nieves University Hospital, Granada, Spain.,Biosanitary Institute of Granada (ibs.GRANADA), Granada, Spain.,Department of Dermatology, Faculty of Medicine, University of Granada, Granada, Spain
| | - Manuel Sanchez-Diaz
- Biosanitary Institute of Granada (ibs.GRANADA), Granada, Spain.,Department of Dermatology, Virgen de las Nieves University Hospital, Granada, Spain
| | - Salvador Arias-Santiago
- Cell Production and Tissue Engineering Unit, Andalusian Network of Design and Translation of Advanced Therapies, Virgen de las Nieves University Hospital, Granada, Spain.,Biosanitary Institute of Granada (ibs.GRANADA), Granada, Spain.,Department of Dermatology, Virgen de las Nieves University Hospital, Granada, Spain.,Department of Dermatology, Faculty of Medicine, University of Granada, Granada, Spain
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Stone R, Saathoff EC, Larson DA, Wall JT, Wienandt NA, Magnusson S, Kjartansson H, Natesan S, Christy RJ. Accelerated Wound Closure of Deep Partial Thickness Burns with Acellular Fish Skin Graft. Int J Mol Sci 2021; 22:ijms22041590. [PMID: 33557424 PMCID: PMC7915828 DOI: 10.3390/ijms22041590] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/01/2021] [Indexed: 02/07/2023] Open
Abstract
Thermal injuries are caused by exposure to a variety of sources, and split thickness skin grafts are the gold standard treatment for severe burns; however, they may be impossible when there is no donor skin available. Large total body surface area burns leave patients with limited donor site availability and create a need for treatments capable of achieving early and complete coverage that can also retain normal skin function. In this preclinical trial, two cellular and tissue based products (CTPs) are evaluated on twenty-four 5 × 5 deep partial thickness (DPT) burn wounds. Using appropriate pain control methods, DPT burn wounds were created on six anesthetized Yorkshire pigs. Wounds were excised one day post-burn and the bleeding wound beds were subsequently treated with omega-3-rich acellular fish skin graft (FSG) or fetal bovine dermis (FBD). FSG was reapplied after 7 days and wounds healed via secondary intentions. Digital images, non-invasive measurements, and punch biopsies were acquired during rechecks performed on days 7, 14, 21, 28, 45, and 60. Multiple qualitative measurements were also employed, including re-epithelialization, contraction rates, hydration, laser speckle, and trans-epidermal water loss (TEWL). Each treatment produced granulated tissue (GT) that would be receptive to skin grafts, if desired; however, the FSG induced GT 7 days earlier. FSG treatment resulted in faster re-epithelialization and reduced wound size at day 14 compared to FBD (50.2% vs. 23.5% and 93.1% vs. 106.7%, p < 0.005, respectively). No differences in TEWL measurements were observed. The FSG integrated into the wound bed quicker as evidenced by lower hydration values at day 21 (309.7 vs. 2500.4 µS, p < 0.05) and higher blood flow at day 14 (4.9 vs. 3.1 fold change increase over normal skin, p < 0.005). Here we show that FSG integrated faster without increased contraction, resulting in quicker wound closure without skin graft application which suggests FSG improved burn wound healing over FBD.
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Affiliation(s)
- Randolph Stone
- Burn and Soft Tissue Injury Research Department, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Houston, TX 78234, USA; (E.C.S.); (D.A.L.); (J.T.W.); (S.N.); (R.J.C.)
- Correspondence:
| | - Emily C. Saathoff
- Burn and Soft Tissue Injury Research Department, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Houston, TX 78234, USA; (E.C.S.); (D.A.L.); (J.T.W.); (S.N.); (R.J.C.)
| | - David A. Larson
- Burn and Soft Tissue Injury Research Department, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Houston, TX 78234, USA; (E.C.S.); (D.A.L.); (J.T.W.); (S.N.); (R.J.C.)
| | - John T. Wall
- Burn and Soft Tissue Injury Research Department, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Houston, TX 78234, USA; (E.C.S.); (D.A.L.); (J.T.W.); (S.N.); (R.J.C.)
| | - Nathan A. Wienandt
- Comparative Pathology Department, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Houston, TX 78234, USA;
| | | | | | - Shanmugasundaram Natesan
- Burn and Soft Tissue Injury Research Department, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Houston, TX 78234, USA; (E.C.S.); (D.A.L.); (J.T.W.); (S.N.); (R.J.C.)
| | - Robert J. Christy
- Burn and Soft Tissue Injury Research Department, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Houston, TX 78234, USA; (E.C.S.); (D.A.L.); (J.T.W.); (S.N.); (R.J.C.)
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Lima Júnior EM, de Moraes Filho MO, Costa BA, Fechine FV, Rocha MBS, Vale ML, Diógenes AKDL, Uchôa AMDN, Silva Júnior FR, Martins CB, Bandeira TDJPG, Rodrigues FAR, Paier CRK, de Moraes MEA. A Randomized Comparison Study of Lyophilized Nile Tilapia Skin and Silver-Impregnated Sodium Carboxymethylcellulose for the Treatment of Superficial Partial-Thickness Burns. J Burn Care Res 2021; 42:41-48. [PMID: 32603408 DOI: 10.1093/jbcr/iraa099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Glycerolized Nile tilapia skin (NTS) showed promising results when used for burn treatment in phases II and III randomized controlled trials. This pilot study aims to evaluate the effectiveness of lyophilized NTS (LNTS) as a temporary skin substitute for superficial partial-thickness burns by comparing it with silver-impregnated sodium carboxymethylcellulose dressing. This was a randomized, prospective, open-label, and controlled pilot study conducted in Fortaleza, Brazil, from April 2019 to December 2019. The 24 participants had ≥18 and ≤70 years of age and superficial partial-thickness burns affecting up to 10% of TBSA. Primary outcomes were the number of dressings performed and pain intensity, assessed via the Visual Analogue Scale and the Electronic von Frey. Secondary outcomes were the level of pain-related anxiety, assessed via the Burns Specific Pain Anxiety Scale, and analgesic consumption. In the test group, the number of dressings and the patient-reported pain after dressing-related procedures were lower. Analgesic intake, pain-related anxiety, and both patient-reported and objectively measured pain before dressing-related procedures were similar for the treatment groups. No adverse effects were detected. LNTS shares the same characteristics of an "'ideal'" wound dressing demonstrated by glycerolized NTS in previous studies. Also, it demonstrated noninferiority for burn management when compared with silver-impregnated sodium carboxymethylcellulose dressing. The safety and efficacy of LNTS demonstrated in this pilot study may allow the development of larger phases II and III RCTs in a near future.
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Affiliation(s)
| | - Manoel Odorico de Moraes Filho
- Clinical Pharmacology Unit, Drug Research and Development Center, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Bruno Almeida Costa
- Clinical Pharmacology Unit, Drug Research and Development Center, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Francisco Vagnaldo Fechine
- Clinical Pharmacology Unit, Drug Research and Development Center, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Marina Becker Sales Rocha
- Clinical Pharmacology Unit, Drug Research and Development Center, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Mariana Lima Vale
- Clinical Pharmacology Unit, Drug Research and Development Center, Federal University of Ceará (UFC), Fortaleza, CE, Brazil.,Graduate Program in Morphofunctional Sciences, School of Medicine, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Ana Kely de Loyola Diógenes
- Graduate Program in Morphofunctional Sciences, School of Medicine, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | | | | | - Camila Barroso Martins
- Clinical Pharmacology Unit, Drug Research and Development Center, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | | | - Felipe Augusto Rocha Rodrigues
- Clinical Pharmacology Unit, Drug Research and Development Center, Federal University of Ceará (UFC), Fortaleza, CE, Brazil.,Federal Institute of Education, Science and Technology of Ceará (IFCE), Campus Jaguaribe, CE, Brazil
| | - Carlos Roberto Koscky Paier
- Clinical Pharmacology Unit, Drug Research and Development Center, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
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Veronese S, Picelli A, Smania N, Sbarbati A. Hypodermis involvement in skin disorders: Imaging and functional imaging diagnostic tools. Skin Res Technol 2020; 27:641-643. [PMID: 33373056 DOI: 10.1111/srt.12990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/04/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Sheila Veronese
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Picelli
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola Smania
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Sbarbati
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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55
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Nie C, Yu H, Wang X, Li X, Wei Z, Shi X. Pro-inflammatory effect of obesity on rats with burn wounds. PeerJ 2020; 8:e10499. [PMID: 33354433 PMCID: PMC7731656 DOI: 10.7717/peerj.10499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/15/2020] [Indexed: 12/12/2022] Open
Abstract
Objective A burn is an inflammatory injury to the skin or other tissue due to contact with thermal, radioactive, electric, or chemical agents. Burn injury is an important cause of disability and death worldwide. Obesity is a significant public health problem, often causing underlying systemic inflammation. Studying the combined impact of burn injuries on obese patients has become critical to the successful treatment of these patients. The aim of this paper is to highlight the effect of inflammation associated with burn injuries on several body weight group in a rat study. Materials and methods Different degrees of obesity and burns were established in rats and divided into a normal weight group, overweight group, obese group, second-degree burn group, third-degree burn group, over-weight second-degree burn group, over-weight third-degree burn group, obese second-degree burn group, and obese third-degree burn group (20 rats per group). Changes in inflammatory factors and growth factor were measured on the 1st, 3rd, 7th and 14th days after burns were inflicted. Results The ELISA test showed that in the unburned control group, MCP-1, IL-1β and TNF-α protein expressions in the obese and over-weight groups were higher than the normal-weight group (P < 0.05). RT-PCR test showed that the expressions of MCP-1, IL-1β and TNF-α genes in the obese group were higher compared to the overweight and normal weight groups (P < 0.05). Three and 7 days after burns were inflicted, the level of VEGF in the normal weight group was higher than the obese group (P < 0.05), however increased VEGF was not observed on days 1 and 14. Conclusion Burn injury and obesity have a mutually synergistic effect on the body’s inflammatory response.
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Affiliation(s)
- Chan Nie
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China.,Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, China
| | - Huiting Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xue Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiahong Li
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Zairong Wei
- Burns & Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiuquan Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
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56
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Gibson ALF, Smiell J, Yu TC, Böing EA, McClure EB, Merikle E, Holmes JH. Determining clinically meaningful thresholds for innovative burn care products to reduce autograft: A US burn surgeon Delphi panel. Burns 2020; 47:1066-1073. [PMID: 33303264 DOI: 10.1016/j.burns.2020.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/24/2020] [Accepted: 10/21/2020] [Indexed: 12/29/2022]
Abstract
Reducing the amount of donor skin needed for definitive wound closure can improve outcomes in patients with severe burns. This Delphi Consensus Panel (DCP) aimed to achieve expert consensus on the percentage reduction in donor skin for autograft that constitutes a clinically meaningful benefit. A two-round DCP of fifteen US burn surgeons was conducted via a web-based survey platform. Fourteen panelists (93.3%) completed both rounds. In Round 2, consensus, defined as ≥70% agreement, was achieved for five of the seven consensus statements. All panelists agreed that a clinically meaningful reduction in the amount of donor skin required would facilitate wound management and decrease donor site morbidity experienced by patients. Furthermore, based on three treatment scenarios, consensus was achieved for a clinically meaningful reduction in the amount of donor skin required for autograft for the adult population in deep partial-thickness and full-thickness burns. Findings from this DCP indicate that an innovative cellular and/or tissue product that would reduce the needed amount of donor skin, by the identified thresholds, has the potential to improve the outcomes for patients with severe burn injuries in a meaningful way.
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Affiliation(s)
- Angela L F Gibson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Janice Smiell
- Mallinckrodt Pharmaceuticals, Bedminster, NJ, United States
| | - Tzy-Chyi Yu
- Mallinckrodt Pharmaceuticals, Bedminster, NJ, United States.
| | - Elaine A Böing
- Mallinckrodt Pharmaceuticals, Bedminster, NJ, United States
| | | | | | - James H Holmes
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, United States
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Abstract
Abstract
Purpose
Burns depth evaluation is a lifesaving task and very challenging that requires objective techniques to accomplish. While the visual assessment is the most commonly used by surgeons, its accuracy reliability ranges between 60 and 80% and subjective that lacks any standard guideline. Currently, the only standard adjunct to clinical evaluation of burn depth is Laser Doppler Imaging (LDI) which measures microcirculation within the dermal tissue, providing the burns potential healing time which correspond to the depth of the injury achieving up to 100% accuracy. However, the use of LDI is limited due to many factors including high affordability and diagnostic costs, its accuracy is affected by movement which makes it difficult to assess paediatric patients, high level of human expertise is required to operate the device, and 100% accuracy possible after 72 h. These shortfalls necessitate the need for objective and affordable technique.
Method
In this study, we leverage the use of deep transfer learning technique using two pretrained models ResNet50 and VGG16 for the extraction of image patterns (ResFeat50 and VggFeat16) from a a burn dataset of 2080 RGB images which composed of healthy skin, first degree, second degree and third-degree burns evenly distributed. We then use One-versus-One Support Vector Machines (SVM) for multi-class prediction and was trained using 10-folds cross validation to achieve optimum trade-off between bias and variance.
Results
The proposed approach yields maximum prediction accuracy of 95.43% using ResFeat50 and 85.67% using VggFeat16. The average recall, precision and F1-score are 95.50%, 95.50%, 95.50% and 85.75%, 86.25%, 85.75% for both ResFeat50 and VggFeat16 respectively.
Conclusion
The proposed pipeline achieved a state-of-the-art prediction accuracy and interestingly indicates that decision can be made in less than a minute whether the injury requires surgical intervention such as skin grafting or not.
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Kalsi R, Messner F, Brandacher G. Skin xenotransplantation: technological advances and future directions. Curr Opin Organ Transplant 2020; 25:464-476. [PMID: 32773504 DOI: 10.1097/mot.0000000000000798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW To summarize the evolution of skin xenotransplantation and contextualize technological advances and the status of clinically applicable large animal research as well as prospects for translation of this work as a viable future treatment option. RECENT FINDINGS Porcine xenografts at the start of the millennium were merely biologic dressings subject to rapid rejection. Since then, numerous important advances in swine to nonhuman primate models have yielded xenotransplant products at the point of clinical translation. Critical genetic modifications in swine from a designated pathogen-free donor herd have allowed xenograft survival reaching 30 days without preconditioning or maintenance immunosuppression. Further, xenograft coverage appears not to sensitize the recipient to subsequent allograft placement and vice versa, allowing for temporary coverage times to be doubled using both xeno and allografts. SUMMARY Studies in large animal models have led to significant progress in the creation of living, functional skin xenotransplants with clinically relevant shelf-lives to improve the management of patients with extensive burns.
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Affiliation(s)
- Richa Kalsi
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine.,Department of General Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Franka Messner
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine.,Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine
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Kotliarova MS, Soldatenko AS, Arkhipova AY, Bessonov IV, Davydova LI, Moysenovich AM, Bogush VG, Debabov VG, Shtil AA, Moisenovich MM, Shaitan KV. Photocurable Films Based on Fibroin and Gelatin for Skin Regeneration. ACTA ACUST UNITED AC 2020. [DOI: 10.3103/s0096392520010046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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60
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Esposito E, Nastruzzi C, Sguizzato M, Cortesi R. Nanomedicines to Treat Skin Pathologies with Natural Molecules. Curr Pharm Des 2020; 25:2323-2337. [PMID: 31584367 DOI: 10.2174/1381612825666190709210703] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/24/2019] [Indexed: 12/11/2022]
Abstract
The skin and mucous membranes are subjected to many disorders and pathological conditions. Nature offers a wide range of molecules with antioxidant activity able to neutralize, at least in part, the formation of free radicals and therefore to counteract the phenomena of cellular aging. Since synthetic drugs for the treatment of skin diseases can induce resistance, it is particularly interesting to use compounds of plant origin, transporting them in pharmaceutical forms capable of controlling their release and absorption. This review provides an overview of new findings about the use of lipid-based nanosystems for the delivery of natural molecules useful on the topical treatment of skin disorders. Several natural molecules encapsulated in lipid nanosystems have been considered in the treatment of some skin pathologies or diseases. Particularly, the use of rosemary and eucalyptus essential oil, saffron derivatives, curcumin, eugenol, capsaicin, thymol and lycopene has been reported. The molecules have been alternatively encapsulated in viscous systems, such as the organogels, or in liquid systems, such as ethosomes, transferosomes, solid lipid nanoparticles and monoolein based dispersions thickened by inclusion in carbomer gels. The nanostructured forms have been in vitro and in vivo investigated for the treatment of skin disorders due to dehydration, inflammation, melanoma, wound healing, fungal infections or psoriasis. The data reported in the different studies have suggested that the cutaneous application of lipid nanosystems allows a deep interaction between lipid matrix and skin strata, promoting a prolonged release and efficacy of the loaded natural molecules. This review suggests that the application of natural molecules onto the skin by lipid-based nanosystems can provide numerous clinician benefits in dermatology and cosmetics.
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Affiliation(s)
- Elisabetta Esposito
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Via Fossato di Mortara, 19, 44121-Ferrara, Italy
| | - Claudio Nastruzzi
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Via Fossato di Mortara, 19, 44121-Ferrara, Italy
| | - Maddalena Sguizzato
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Via Fossato di Mortara, 19, 44121-Ferrara, Italy
| | - Rita Cortesi
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Via Fossato di Mortara, 19, 44121-Ferrara, Italy
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Zhang D, Wang B, Sun Y, Wang C, Mukherjee S, Yang C, Chen Y. Injectable Enzyme-Based Hydrogel Matrix with Precisely Oxidative Stress Defense for Promoting Dermal Repair of Burn Wound. Macromol Biosci 2020; 20:e2000036. [PMID: 32239626 DOI: 10.1002/mabi.202000036] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/10/2020] [Indexed: 12/18/2022]
Abstract
Burn wound healing remains a challenging health problem worldwide due to the lack of efficient and precise therapy. Inherent oxidative stress following burn injury is importantly responsible for prolonged inflammation, fibrotic scar, and multiple organ failure. Herein, a bioinspired antioxidative defense system coupling with in situ forming hydrogel, namely, multiresponsive injectable catechol-Fe3+ coordination hydrogel (MICH) matrix, is engineered to promote burn-wound dermal repair by inhibiting tissue oxidative stress. This MICH matrix serves as the special traits of "Fe-superoxide dismutases," small molecular antioxidant (vitamin E), and extracellular matrix (ECM) in alleviating cellular oxidative damage, which demonstrates precise scavenging on reactive oxygen species (ROS) of different cellular locations, blocking lipid peroxidation and cell apoptosis. In in vivo burn-wound treatment, this MICH promptly integrates with injured surrounding tissue to provide hydration microenvironment and physicochemical ECM for burn wounds. Importantly, the MICH matrix suppresses tissue ROS production, reducing the inflammatory response, prompting re-epithelization and neoangiogenesis during wound healing. Meanwhile, the remodeling skin treated with MICH matrix demonstrates low collagen deposition and normal dermal collagen architecture. Overall, the MICH prevents burn wound progression and enhances skin regeneration, which might be a promising biomaterial for burn-wound care and other disease therapy induced by oxidative stress.
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Affiliation(s)
- Dongmei Zhang
- Key Laboratory of Synthetic and Biological Colloids, Ministry of Education, School of Chemical and Material Engineering, Jiangnan University, Wuxi, 214122, China
| | - Bulei Wang
- Key Laboratory of Medicinal Resources and Natural Pharmaceutical Chemistry, Ministry of Education, College of Life Sciences, Shaanxi Normal University, Xi'an, 710119, China
| | - Yajuan Sun
- Key Laboratory of Synthetic and Biological Colloids, Ministry of Education, School of Chemical and Material Engineering, Jiangnan University, Wuxi, 214122, China
| | - Changhao Wang
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
| | - Somnath Mukherjee
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
| | - Cheng Yang
- Key Laboratory of Synthetic and Biological Colloids, Ministry of Education, School of Chemical and Material Engineering, Jiangnan University, Wuxi, 214122, China
| | - Yashao Chen
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
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Kruger E, Kowal S, Bilir SP, Han E, Foster K. Relationship Between Patient Characteristics and Number of Procedures as well as Length of Stay for Patients Surviving Severe Burn Injuries: Analysis of the American Burn Association National Burn Repository. J Burn Care Res 2020; 41:1037-1044. [PMID: 32221517 PMCID: PMC7510847 DOI: 10.1093/jbcr/iraa040] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study establishes important, national benchmarks for burn centers to assess length of stay (LOS) and number of procedures across patient profiles. We examined the relationship between patient characteristics such as age and total body surface area (TBSA) burned and number of procedures and LOS in the United States, using the American Burn Association National Burn Repository (NBR) database version 8.0 (2002–2011). Among 21,175 surviving burn patients (TBSA > 10–60%), mean age was 33 years, and mean injury size was 19.9% TBSA. Outcomes included the number of debridement, excision, autograft procedures, and LOS. Independent variables considered were: age (linear, squared, and cubed to account for nonlinearity), TBSA, TBSAs of partial-thickness and mixed/full-thickness burns, sex, hospital-acquired infection, other infection, inhalation injury, and diabetes status. Regression methods included a mixed-effects model for LOS and ordinary least squares for number of procedures. A backward stepwise procedure (P <0.2) was used to select variables. Number of excision and autografting procedures increased with TBSA; however, this relationship did not hold for debridement. After adjusting for sex, age, and comorbidities, predicted LOS for adults (18+) was 12.1, 21.7, 32.2, 43.7, and 56.1 days for 10, 20, 30, 40, and 50% TBSA, respectively. Similarly, predicted LOS for pediatrics (age < 18) was 8.1, 18.8, 33.2, 47.6, and 56.1 days for the same TBSA groups, respectively. While average estimates for adults (1.12 days) and pediatrics (1.01) are close to the one day/TBSA rule-of-thumb, consideration of other important patient and burn features in the NBR can better refine predictions for LOS.
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Smith R, Russo J, Fiegel J, Brogden N. Antibiotic Delivery Strategies to Treat Skin Infections When Innate Antimicrobial Defense Fails. Antibiotics (Basel) 2020; 9:E56. [PMID: 32024064 PMCID: PMC7168299 DOI: 10.3390/antibiotics9020056] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 12/14/2022] Open
Abstract
The epidermal skin barrier protects the body from a host of daily challenges, providing protection against mechanical insults and the absorption of chemicals and xenobiotics. In addition to the physical barrier, the epidermis also presents an innate defense against microbial overgrowth. This is achieved through the presence of a diverse collection of microorganisms on the skin (the "microbiota") that maintain a delicate balance with the host and play a significant role in overall human health. When the skin is wounded, the local tissue with a compromised barrier can become colonized and ultimately infected if bacterial growth overcomes the host response. Wound infections present an immense burden in healthcare costs and decreased quality of life for patients, and treatment becomes increasingly important because of the negative impact that infection has on slowing the rate of wound healing. In this review, we discuss specific challenges of treating wound infections and the advances in drug delivery platforms and formulations that are under development to improve topical delivery of antimicrobial treatments.
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Affiliation(s)
- R. Smith
- Department of Chemical and Biochemical Engineering, The University of Iowa, Iowa City, IA 52242, USA; (R.S.); (J.F.)
| | - J. Russo
- Department of Pharmaceutical Sciences and Experimental Therapeutics, The University of Iowa, Iowa City, IA 52242, USA;
| | - J. Fiegel
- Department of Chemical and Biochemical Engineering, The University of Iowa, Iowa City, IA 52242, USA; (R.S.); (J.F.)
- Department of Pharmaceutical Sciences and Experimental Therapeutics, The University of Iowa, Iowa City, IA 52242, USA;
| | - N. Brogden
- Department of Pharmaceutical Sciences and Experimental Therapeutics, The University of Iowa, Iowa City, IA 52242, USA;
- Department of Dermatology, The University of Iowa, Iowa City, IA 52242, USA
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Boyce S, Chang P, Warner P. Burn Dressings and Skin Substitutes. Biomater Sci 2020. [DOI: 10.1016/b978-0-12-816137-1.00074-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ferreira DW, Ulecia-Morón C, Alvarado-Vázquez PA, Cunnane K, Moracho-Vilriales C, Grosick RL, Cunha TM, Romero-Sandoval EA. CD163 overexpression using a macrophage-directed gene therapy approach improves wound healing in ex vivo and in vivo human skin models. Immunobiology 2020; 225:151862. [PMID: 31711674 PMCID: PMC7864009 DOI: 10.1016/j.imbio.2019.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 12/15/2022]
Abstract
Large tissue damage or wounds cause serious comorbidities and represent a major burden for patients, families, and health systems. Due to the pivotal role of immune cells in the proper resolution of inflammation and tissue repair, we focus our current study on the interaction of macrophages with skin cells, and specifically on the effects of CD163 gene induction in macrophages in wound healing. We hypothesize that the over-expression of the scavenger receptor gene CD163 in human macrophages would result in a more efficient wound healing process. Using 3D human wounded skin organotypic tissues, we observed that CD163 overexpression in THP-1 and human primary macrophages induced a more efficient re-epithelization when compared to control cells. Using human primary skin cells and an in vitro scratch assay we observed that CD163 overexpression in THP-1 macrophages promoted a more rapid and efficient wound healing process through a unique interaction with fibroblasts. The addition of CD163-blocking antibody, but not isotype control, blocked the efficient wound healing process induced by CD163 overexpression in macrophages. We found that the co-culture of skin cells and CD163 overexpressing macrophages reduced monocyte chemoattractant protein (MCP)-1 and enhanced tumor growth factor (TGF)-α, without altering interleukin (IL)-6 or TGF-β. Our findings show that CD163 induces a more efficient wound healing and seems to promote a wound milieu with a pro-resolution molecular profile. Our studies set the foundation to study this approach in in vivo clinically relevant settings to test its effects in wound healing processes such as acute major injuries, large surgeries, or chronic ulcers.
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Affiliation(s)
- David Wilson Ferreira
- Department of Pharmacology, University of São Paulo, Ribeirao Preto Medical School, 3900 Bandeirantes Ave., Ribeirão Preto, SP, 14049-900, Brazil; Department of Neurobiology, University of Pittsburgh School of Medicine, 3501 Fifth Ave - BST3, 6th floor, Pittsburgh, PA, 15260, USA.
| | - Cristina Ulecia-Morón
- Center for Biomedical Research Network on Mental Health (CIBERSAM), Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029, Madrid, Spain; Department of Pharmacology and Toxicology, School of Medicine, and Instituto Universitario de Investigación en Neuroquímica (IUIN), Complutense University of Madrid, Avenida Complutense s/n., 28040, Madrid, Spain.
| | - Perla Abigail Alvarado-Vázquez
- Department of Anesthesiology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA; Department of Medical Biochemistry and Microbiology, BMC, Uppsala University, Husargatan 3, Uppsala, 75123, Sweden.
| | - Katharine Cunnane
- Department of Anesthesiology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Carolina Moracho-Vilriales
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, 307 N Broad St., Clinton, SC, 29325, USA.
| | - Rachel L Grosick
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, 307 N Broad St., Clinton, SC, 29325, USA.
| | - Thiago Mattar Cunha
- Department of Pharmacology, University of São Paulo, Ribeirao Preto Medical School, 3900 Bandeirantes Ave., Ribeirão Preto, SP, 14049-900, Brazil.
| | - E Alfonso Romero-Sandoval
- Department of Anesthesiology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
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Kennedy GT, Stone R, Kowalczewski AC, Rowland R, Chen JH, Baldado ML, Ponticorvo A, Bernal N, Christy RJ, Durkin AJ. Spatial frequency domain imaging: a quantitative, noninvasive tool for in vivo monitoring of burn wound and skin graft healing. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-9. [PMID: 31313538 PMCID: PMC6630099 DOI: 10.1117/1.jbo.24.7.071615] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 06/27/2019] [Indexed: 05/12/2023]
Abstract
There is a need for noninvasive, quantitative methods to characterize wound healing in the context of longitudinal investigations related to regenerative medicine. Such tools have the potential to inform the assessment of wound status and healing progression and aid the development of new treatments. We employed spatial frequency domain imaging (SFDI) to characterize the changes in optical properties of tissue during wound healing progression in a porcine model of split-thickness skin grafts and also in a model of burn wound healing with no graft intervention. Changes in the reduced scattering coefficient measured using SFDI correlated with structural changes reported by histology of biopsies taken concurrently. SFDI was able to measure spatial inhomogeneity in the wounds and predicted heterogeneous healing. In addition, we were able to visualize differences in healing rate, depending on whether a wound was debrided and grafted, versus not debrided and left to heal without intervention apart from topical burn wound care. Changes in the concentration of oxy- and deoxyhemoglobin were also quantified, giving insight into hemodynamic changes during healing.
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Affiliation(s)
- Gordon T. Kennedy
- University of California, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Randolph Stone
- Combat Trauma and Burn Injury Research, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, United States
| | - Andrew C. Kowalczewski
- Combat Trauma and Burn Injury Research, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, United States
| | - Rebecca Rowland
- University of California, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Jeffrey H. Chen
- University of California, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Melissa L. Baldado
- University of California, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Adrien Ponticorvo
- University of California, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Nicole Bernal
- UC Irvine Regional Burn Center, Department of Surgery, Orange, California, United States
| | - Robert J. Christy
- Combat Trauma and Burn Injury Research, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, United States
| | - Anthony J. Durkin
- University of California, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Department of Biomedical Engineering, Irvine, California, United States
- Address all correspondence to Anthony J. Durkin, E-mail:
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Alexaline MM, Magne B, Zuleta Rodríguez A, Nivet M, Bacqueville D, Lataillade J, Trouillas M. Influence of fibrin matrices and their released factors on epidermal substitute phenotype and engraftment. J Tissue Eng Regen Med 2019; 13:1362-1374. [DOI: 10.1002/term.2879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Maia M. Alexaline
- Unité mixte Inserm U1197 ‐ Institut de Recherche Biomédicale des Armées (IRBA), Antenne Centre de Transfusion Sanguine des Armées Clamart France
- Celogos Paris France
| | - Brice Magne
- Unité mixte Inserm U1197 ‐ Institut de Recherche Biomédicale des Armées (IRBA), Antenne Centre de Transfusion Sanguine des Armées Clamart France
- Scarcell therapeutics Paris France
| | - Amparo Zuleta Rodríguez
- Unité mixte Inserm U1197 ‐ Institut de Recherche Biomédicale des Armées (IRBA), Antenne Centre de Transfusion Sanguine des Armées Clamart France
| | - Muriel Nivet
- Unité mixte Inserm U1197 ‐ Institut de Recherche Biomédicale des Armées (IRBA), Antenne Centre de Transfusion Sanguine des Armées Clamart France
| | - Daniel Bacqueville
- Unité mixte Inserm U1197 ‐ Institut de Recherche Biomédicale des Armées (IRBA), Antenne Centre de Transfusion Sanguine des Armées Clamart France
- Service Pharmacologie Division 2 et Pharmacocinétique cutanée, Département PharmacologieCentre R&D Pierre Fabre Dermo‐Cosmétique Toulouse France
| | - Jean‐Jacques Lataillade
- Unité mixte Inserm U1197 ‐ Institut de Recherche Biomédicale des Armées (IRBA), Antenne Centre de Transfusion Sanguine des Armées Clamart France
| | - Marina Trouillas
- Unité mixte Inserm U1197 ‐ Institut de Recherche Biomédicale des Armées (IRBA), Antenne Centre de Transfusion Sanguine des Armées Clamart France
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Stone R, Wall JT, Natesan S, Christy RJ. PEG-Plasma Hydrogels Increase Epithelialization Using a Human Ex Vivo Skin Model. Int J Mol Sci 2018; 19:ijms19103156. [PMID: 30322172 PMCID: PMC6213988 DOI: 10.3390/ijms19103156] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/06/2018] [Accepted: 10/12/2018] [Indexed: 12/27/2022] Open
Abstract
In vitro cell culture methods are used extensively to study cellular migration, proliferation, and differentiation, which play major roles in wound healing but the results often do not translate to the in vivo environment. One alternative would be to establish an ex vivo model utilizing human discarded skin to evaluate therapies in a more natural setting. The purpose of this study was to institute such a model by creating ‘wounds’ in the center of a piece of discarded skin and treating them with three different biomaterials: collagen, polyethylene glycol (PEG)-fibrin, or PEG-platelet free plasma (PFP). Explants were cultured for 14 days with supernatant and microscopy images collected every 3 days to assess cytotoxicity and epithelialization. After 14 days, the explants were fixed, sectioned, and stained for cytokeratin-10 (CK-10), alpha-smooth muscle actin (α-SMA), and wheat germ (WG). Compared to controls, similar levels of cytotoxicity were detected for 12 days which decreased slightly at day 14. The PEG-PFP hydrogel-treated wounds epithelialized faster than other treatments at days 6 to 14. A 6-8 cell layer thick CK-10+ stratified epidermis had developed over the PEG-PFP hydrogel and cells co-stained by WG and α-SMA were observed within the hydrogel. An ex vivo model was established that can be used practically to screen different therapies exploring wound healing.
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Affiliation(s)
- Randolph Stone
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234-6315, USA.
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