Factors affecting wound healing

Phytochemical analysis and wound healing properties of Malva parviflora L. ethanolic extract

ETHNOPHARMACOLOGICAL RELEVANCE

Scientific publications documented the use of plants from Genus Malva to treat inflammatory diseases and skin disorders by our ancestors. Malva parviflora L. has reported benefits for wound healing in traditional medicine; however, there is a lack of experimental study to validate these claims.

AIM

We initiated this study to explore the metabolites and verify the wound healing properties of M. parviflora using in vivo and in vitro models.

MATERIALS AND METHODS

Liquid chromatography electrospray ionization tandem mass spectrometry (LC/ESI-MS/MS) was used to identify the ethanolic extract different metabolites. Additionally, total phenolic content was determined using Folin-Ciocalteu reagent. To verify the extract wound healing potential, an in vivo rat wound excision model was employed. Round wounds (5 mm in diameter) were created by a sterile biopsy punch needle. The wounds were treated with plant extracts (2.5% and 5%) as well as a commercially available wound healing product (Mebo®) for 10 days. The results were assessed as follows: 1) Measuring the reduction% in wound area compared to the original wound size. 2) Evaluation of the levels of wound healing biomarkers, namely collagen type I (Col-1), alpha smooth muscle actin (α-SMA), extracellular signal-regulated kinases-1 (ERK1), and matrix metalloproteinase-9 (MMP9) levels. 3) Performing histopathological examination of the wound tissue. The antioxidant properties of the M. parviflora leaves ethanolic extract were investigated using various assays: total antioxidant capacity (TAC), iron reducing power (IRP), 1,1-Diphenyl-2-picryl-hydrazyl (DPPH), and 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radicals scavenging assays. Furthermore, the anti-inflammatory activity was confirmed by calculating the inhibition percentages of protein denaturation and the activity of the proteinase enzyme.

RESULTS

Liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis revealed the presence of various secondary metabolites in M. parviflora ethanolic extract, including phenolic acids (cinnamic and ferulic acids), flavonoids (quercetin and "iso"rhamnetin monoglucuronides), fatty acids (hydroxy-octadecatrienoic and oxo-octadecatrienoic acids), in addition to chlorophyll derivatives and carotenoids (pheophorbide-a and lutein, respectively). Malva extracts significantly reduced wound size compared to untreated control group. The extracts also promoted wound healing by upregulating collagen I, α-SMA, and ERK1 levels, while downregulating MMP9 expression. Notably, the effect of 2.5% and 5% extracts was similar or exceeds those of Mebo®, supported by histopathological results. Finally, M. parviflora ethanolic extract exhibited antioxidant and anti-inflammatory potentials comparable to the used standards.

CONCLUSION

Our study provides evidence-based support for the wound healing properties of M. parviflora L. leaves ethanolic extract. This is further strengthened by the fact that many of the identified metabolites possess wound healing, antioxidant, and/or anti-inflammatory activities.

The Association of Geriatric Nutritional Risk Index and Chronic Kidney Disease Stages on Survival and Cardiovascular or Limb Events Following Endovascular Therapy

BACKGROUND

There are little available data about the impact of geriatric nutritional risk index (GNRI) on clinical outcomes following endovascular therapy (EVT) in chronic limb-threatening ischemia (CLTI) regarding the severities of renal dysfunction (RD).

AIMS

The aim of this study is to evaluate the impact of GNRI on clinical outcomes following EVT in CLTI regarding the severities of RD.

METHODS

We enrolled 705 consecutive CLTI cases treated with EVT between January 2010 and December 2019 at our hospital. The GNRI on admission was calculated as follows: [14.89 × albumin (g/dL)] + [41.7 × (body weight/ideal body weight)]. Study population were divided into 2 groups based on the median GNRI: low group (GNRI < 92) and high group (GNRI ≥ 92). Next, study population was divided to 3 groups according to estimate glomerular filtration rate (eGFR), which was defined as early RD group (60 ≤ eGFR), advanced RD group (15 ≤ eGFR < 60), and end-stage renal dysfunction (ESRD) group (eGFR < 15). The primary endpoint was 2-year amputation-free survival (AFS).

RESULTS

The median follow-up duration was 25.2 months. Amputation-free survival was significantly lower in the low GNRI group regardless of any severities of RD (59.1% vs 90.2%, Log Rank P<0.001 in early RD group, 59.6% vs 80.8%, Log Rank P=0.011 in advanced RD group, 32.8% vs 61.1%, Log Rank P<0.001 in ESRD group).

CONCLUSION

The decrease of GNRI could predict clinical outcomes in CLTI following EVT regardless of any severities of RD based on eGFR.

CLINICAL IMPACT

The decrease of geriatric nutritional risk index was associated with worse outcomes in chronic limb-threatening ischemia following endovascular therapy regardless of any severities of renal dysfunction. Because both renal dysfunction and chronic limb-threatening ischemia could potentially have any inflammation, the geriatric nutritional risk index, which can reflect both nutrition-related risks and inflammation severity, can be a plausible marker in predicting adverse events after endovascular therapy in chronic limb-threatening ischemia patients with renal dysfunction.

Piezoelectric hydrogels for accelerating healing of diverse wound types

The skin, as the body's largest organ, plays a crucial role in protecting against mechanical forces and infections, maintaining fluid balance, and regulating body temperature. Therefore, skin wounds can significantly threaten human health and cause a heavy economic burden on society. Recently, bioelectric fields and electrical stimulation (ES) have been recognized as a promising pathway for modulating tissue engineering and regeneration of wounded skin. However, conventional hydrogel dressing lacks electrical generation capabilities and usually requires external stimuli to initiate the cell regeneration process, and the role of ES in different stages of healing is not fully understood. Therefore, to endow hydrogel-based wound dressings with piezoelectric properties, which can accelerate wound healing and potentially suppress infection via introducing ES, piezoelectric hydrogels (PHs) have emerged recently, combining the advantages of both piezoelectric nanomaterials and hydrogels beneficial for wound healing. Given the scarcity of systematic literature on the application of PHs in wound healing, this paper systematically discusses the principles of the piezoelectric effects, the design and fabrication of PHs, their piezoelectric properties, the way PHs trigger ES and the mechanisms by which they promote wound healing. Additionally, it summarizes the recent applications of PHs in various types of wounds, including traumatic wounds, pressure injuries, diabetic wounds, and infected wounds. Finally, the paper proposes future directions and challenges for the development of PH wound dressings for wound healing.

Recent advances in the role of neuroregulation in skin wound healing

Neuroregulation during skin wound healing involves complex interactions between the nervous system and intricate tissue repair processes. The skin, the largest organ, depends on a complex system of nerves to manage responses to injury. Recent research has emphasized the crucial role of neuroregulation in maximizing wound healing outcomes. Recently, researchers have also explained the interactive contact between the peripheral nervous system and skin cells during the different phases of wound healing. Neurotransmitters and neuropeptides, once observed as simple signalling molecules, have since been recognized as effective regulators of inflammation, angiogenesis, and cell proliferation. The significance of skin innervation and neuromodulators is underscored by the delayed wound healing observed in patients with diabetes and the regenerative capabilities of foetal skin. Foetal skin regeneration is influenced by the neuroregulatory environment, immature immune system, abundant growth factors, and increased pluripotency of cells. Foetal skin cells exhibit greater flexibility and specialized cell types, and the extracellular matrix composition promotes regeneration. The extracellular matrix composition of foetal skin promotes regeneration, making it more capable than adult skin because neuroregulatory signals affect skin regeneration. The understanding of these systems can facilitate the development of therapeutic strategies to alter the nerve supply to the skin to enhance the process of wound healing. Neuroregulation is being explored as a potential therapeutic strategy for enhancing skin wound repair. Bioelectronic strategies and neuromodulation techniques can manipulate neural signalling, optimize the neuroimmune axis, and modulate inflammation. This review describes the function of skin innervation in wound healing, emphasizing the importance of neuropeptides released by sensory and autonomic nerve fibres. This article discusses significant discoveries related to neuroregulation and its impact on skin wound healing.

Autogenous Tooth Transplantation of Canines-A Prospective Clinical Study on the Influence of Adjunctive Antibiosis and Patient-Related Risk Factors During Initial Healing

Objectives: This prospective clinical study investigated the efficacy of adjunctive antibiotic therapy (doxycycline) and the patient's risk factors during initial healing of autogenous canine tooth transplantations. Methods: Sixty-seven patients (ranging from 11 to 37 years of age) treated with tooth transplantations were allocated to three parallel groups based on the tooth's intraoperative extraoral storage time (EST 0-3, 4-6, and 7-15 min) receiving different antibiotic regimens: (1) no antibiotics; (2) intraoperative intravenous (i.v.) single-shot antibiotics; and (3) intraoperative i.v. single-shot plus postoperative oral antibiotics for five days. Initial healing was rated according to pain intensity and clinical signs of pathology over a 21-day period. The influence of the following parameters was investigated using RStudio (linear regression and partial eta squared statistics): group, sex, age, nicotine abuse, tooth apex condition, preoperative ankylosis, displacement severity, jaw location, the number of simultaneous transplantations and other interventions, preoperative orthodontic extrusion, EST, and intraoperative complications. Results: No significant influence for sex (43 females, 24 males), tooth apex condition (19 open, 48 closed), displacement severity, jaw location (51 upper, 16 lower jaw), EST (mean 4.99 min), intraoperative complications (n = 13), or antibiotic regimen on pathology signs or pain intensity were found. Six patients reported medication side effects. Preoperative ankylosis (n = 15) and unsuccessful orthodontic extrusion (n = 16) increased postoperative pain (p = 0.020, ηP2 = 0.08; p = 0.035, ηP2 = 0.07). Multiple transplants (n = 14) and interventions in multiple regions (n = 27) affected pain and pathology (p = 0.002, ηP2 = 0.14; p = 0.001, ηP2 = 0.17). Increased age and nicotine abuse (n = 6) were associated with increased pathology signs (p = 0.024, ηP2 = 0.08; p = 0.029, ηP2 = 0.07). Conclusions: The results suggest that personalized rather than routine antibiotic therapy might be sufficient for initial healing in canine tooth transplantation. Deteriorating factors include preoperative ankylosis, orthodontic extrusion, an increased number of surgical sites, age, and nicotine abuse. Clinical Significance: Routine antibiotic prevention regimes may not be mandatory for initial healing in autogenous tooth transplantation, but a nuanced antibiotic strategy tailored to each patient's specific risk factors, which is in line with the principle of antibiotic stewardship, is needed.

Fibrotic Changes in Rhegmatogenous Retinal Detachment

Rhegmatogenous retinal detachment (RRD) is a sight-threatening condition involving retinal detachment and the accumulation of fluid in the subretinal space. Proliferative vitreoretinopathy (PVR) is a pathologic complication that develops after RRD surgery, and approximately 5-10% of RRD cases develop post-operative PVR. Prolonged inflammation in the wound healing process, epithelial-mesenchymal transition (EMT), retinal pigment epithelial (RPE) cell migration and proliferation, and epiretinal, intraretinal, and subretinal fibrosis are typical in the formation of PVR. RPE cells undergo EMT and become fibroblast-like cells that migrate to the retina and vitreous, promoting PVR formation. Fibroblasts transform into myofibroblasts, which promote fibrosis by overproducing the extracellular matrix (ECM). RPE cells, fibroblasts, glial cells, macrophages, T lymphocytes, and increased ECM production form contractile epiretinal membranes. Cytokine release, complement activation, RPE cells, glial cells, and endothelial cells are all involved in retinal immune responses. Normally, wounds heal within 4 to 6 weeks, including hemostasis, inflammation, proliferation, and remodeling phases. Properly initiated inflammation, complement activation, and the function of neutrophils and glial cells heal the wound in the first stage. In a retinal wound, glial cells proliferate and fill the injured area. Gliosis tries to protect the neurons and prevent damage, but it becomes harmful when it causes scarring. If healing is complicated, prolonged inflammation leads to pathological fibrosis. Currently, there is no preventive treatment for the formation of PVR, and it is worth studying in the future.

Healing progression of tail docking and ear tag wounds in lambs

Tail docking and ear tagging are common husbandry practices in lambs, but little is known about subsequent wound healing or how it may be affected by performing both procedures concurrently. Our objectives were to: (1) describe wound healing following tail docking and ear tagging, and (2) compare healing of ear wounds in docked and undocked lambs. Within 28 female Polypay twin pairs, one lamb was docked using a rubber ring between 1 and 2 days of age and the other lamb's tail was left intact. Tags were attached to both ears of all lambs. We photographed tail and ear wounds twice weekly until weaning (mean ± SD; 64 ± 5 days of age). Tail wounds took 43 ± 9 days to heal (range: 30-60 days). Pus, a sign of infection, was present at least once in 89% of tail wounds and was associated with delayed healing. Only 49% of ear wounds had healed by weaning, and tail docking did not predict the probability of healing. Pus and sanguineous exudate (i.e., bleeding) were present at least once in 21% and 96% of ear wounds, respectively. Pus was not associated with the probability of ear wound healing, but ears with more frequent bleeding were less likely to have healed by weaning. The duration of healing and likelihood of infection following both procedures raise welfare concerns and suggest refinements or alternatives are warranted.

Mechanistic Wound Healing of Ficus trijuja Leaf Extract and Its Lipid Nanocapsule Supported by Metabolomic Profiling and In Vivo Studies

This study explores the metabolic profile and wound-healing capabilities of Ficus trijuja, a species within the Moraceae family, for the first time. Ficus plants contain a variety of secondary metabolites such as flavonoids, triterpenoids, and alkaloids, known for their antioxidant, anti-inflammatory, and cytotoxic properties. Previous studies demonstrated the effectiveness of Ficus extracts in wound healing, with evidence of improved wound contraction, strength, and faster epithelization. This study shows the impact of F. trijuja extract in a gel base as well as when delivered through a lipid nanocapsules (LNCs) formula, on all phases of wound-healing in rats, by determining the expression levels of their key markers. The results indicated that treatment with F. trijuja extract accelerated wound healing, particularly when applied through lipid nanocapsulation, which shows comparable efficacy to standard treatments like MEBO® with approximately 2.62% improvement in wound healing when compared to MEBO® itself. Understanding these molecular markers offers insights for developing targeted therapies to optimize wound healing and prevent complication development. To unravel the phytochemical composition of F. trijuja extract, LC-HRESIMS analysis was implemented, which revealed 24 secondary metabolites belonging to different classes of flavonoids, terpenoids, and megastigmane. In conclusion, both Ficus trijuja gel and its nanoformulation have proven efficacy in wound healing in vivo and can be further investigated for potential clinical use.

A Comparative Analysis of Cell Proliferation and Wound Closure in Cultured Gingival Epithelial Cells Using Plasma Rich in Growth Factors and Platelet-Rich Plasma Containing Leukocytes

OBJECTIVES

 Plasma rich in growth factors (PRGF) is presumed to be able to stimulate the regeneration of skin and periodontal tissue. This effect can be attributed to the fact that PRGF contains fewer leukocyte-derived interleukins in comparison to platelet-rich plasma (PRP). However, a comparison of the effects of PRGF and PRP on gingival epithelial cells has not been conducted yet. Therefore, our objective was to clarify and compare the effects of PRGF and PRP on gingival epithelial cell proliferation, wound healing, and gene expression.

MATERIALS AND METHODS

 PRGF and PRP were obtained from three donors. A complete medium containing bovine pituitary extract (BPE) and growth factors was used as a positive control (PC), while a medium without BPE was used as a negative control (NC). We evaluated the presence of platelets and leukocytes, as well as the number of leukocytes, in PRP and PRGF using the cell block method and a cell counting chamber. We assessed gingival epithelial cell proliferation with WST-1 and wound healing by using cell-free culture inserts. To examine the mRNA expression of tumor necrosis factor-α (TNF-α), which is related to cell growth inhibition, and integrin β4, which contributes to cell adhesion, we used quantitative reverse transcription polymerase chain reactions (RT-PCRs) under PRGF and PRP samples in vitro. The nonparametric data were analyzed using the Kruskal-Wallis test.

RESULTS

 Large quantities of platelets were observed in both PRGF and PRP. The leukocyte concentration in PRGF was generally lower than that in PRP. Our report indicated that cell proliferation was significantly higher in PRGF than in PRP on day 1 and 2. We found that there was no significant difference in the wound closure rate between PRGF and PRP in comparison to their respective control groups. The quantitative RT-PCR revealed insignificant differences in mRNA expression as TNF-α and integrin β4 between PRGF and PRP in comparison to the each of their respective control groups.

CONCLUSION

 Our research indicated that PRGF can promote the proliferation of gingival epithelium more than PRP, contributing to the healing of periodontal tissue. TNF-α and integrin β4 mRNA expression may not be significantly involved in wound closure within the gingival epithelium under the influence of PRGF and PRP.

Photobiomodulation therapy in diabetes: Benefits for pain relief, quality of life, and wound healing

Globally, 537 million people suffer from diabetes mellitus (DM), a condition often associated with sensory disturbances, wound development, and chronic pain, which significantly affects the quality of life and imposes a substantial economic burden. This study evaluated the effects of photobiomodulation (PBM) therapy on nociceptive and sensory changes in diabetic patients to understand pain manifestations and explore PBM's molecular mechanisms on wound healing. Twenty patients with type 2 DM underwent clinical assessments, completed pain and quality of life questionnaires, and had their pain sensitivity evaluated using the quantitative sensory test (QST). A 5 mm skin biopsy was taken for fibroblast culture. PBM therapy, using 660 nm red light, was administered twice weekly for 7 weeks on lower limb wounds. Results indicated that DM patients faced significant sensory impairments, impacting their quality of life. PBM therapy improved pain scores, alleviated neuropathic pain, and enhanced sensory function, leading to better quality of life and reduced anxiety and depression. It also accelerated wound healing, enhancing mobility and autonomy. In vitro studies showed PBM therapy increased cell proliferation through the ERK signaling pathway and modulation of matrix metalloproteinases (MMP-1/8 and 2) and tissue inhibitors of metalloproteinases (TIMP).

Relationship Between Perilesional Skin Condition and Survival in Terminally Ill Patients with Pressure Ulcers

Background and Objectives: In the context of palliative care, the aim is to alleviate suffering and improve quality of life, with particular attention to PUs, which have a significant impact on quality of life and survival. This study examines the relationship between perilesional skin condition and survival in terminally ill patients with pressure ulcers (PUs). Materials and Methods: A descriptive and observational study was conducted in two hospitals in Valencia with a sample of 100 terminally ill patients. Sociodemographic, clinical and PPU-specific variables were assessed using validated scales such as FEDPALLA-II and the Barthel Index. Results: Although it is a study of an observational nature, which may preclude establishing causality, the results showed that functional capacity, perilesional tissue epithelialization, and albumin levels were significant predictors of survival, while the number and location of PUs had no direct impact. Perilesional tissue epithelialization was highlighted as a critical indicator reflecting the systemic stability of the patient. Conclusions: The study highlights the importance of a comprehensive approach to palliative care that addresses both the local aspects of the lesions and the patient's systemic and functional status. These findings support the implementation of therapeutic interventions based on a structured perilesional tissue assessment to improve quality of life and prolong survival in terminally ill patients. In addition, a positive correlation was found between Barthel Score and survival, suggesting that patients with greater functional independence have a longer life expectancy. On the other hand, the negative correlation between total lymphocyte count and survival suggests that lymphocytopenia may be a marker of adaptive immunosuppression. Perilesional tissue epithelialization, overall functionality and serum albumin levels are key factors in predicting survival, highlighting the need for a comprehensive palliative care approach to optimize quality of life and prolong survival in terminally ill patients with PUs.

The temporal relationship between mitochondrial quality and renal tissue recovery following ischemia-reperfusion injury

Background

Growing evidence indicates that disruptions in mitochondrial quality management contribute to the development of acute kidney injury (AKI), incomplete or maladaptive kidney repair, and chronic kidney disease. However, the temporal dynamics of mitochondrial quality control alterations in relation to renal injury and its recovery remain poorly understood and are addressed in this manuscript.

Method

ology: Male Wistar rats (n = 60) were subjected to varying durations of ischemia and reperfusion. Ischemia was instigated by clamping both renal arteries and for reperfusion, the clamps were removed to restore the blood flow. Renal injury, physiological function, mitochondrial assessment, and cellular mediators were analyzed.

Results

Prolonging ischemia duration reduces bioenergetic function while disrupting the balance of mitochondrial fusion, fission, and mitophagy at the gene expression level while maintaining intact mitochondrial copy number. However, reperfusing a kidney after 45 min of ischemia with varying reperfusion times exacerbates mitochondrial dysfunction and significantly decreases mitochondrial copy number. These declines are particularly evident at 24 h of reperfusion, with some parameters improving by 7 days of reperfusion. Despite these improvements, 7 days of reperfusion did not correlate with renal injury indicators (CrCl- 0.46 ± 0.01, BUN-86.29 ± 4.9, Cr-1.75 ± 0.16) following 45 min of ischemia. Conversely, 15 min of ischemia followed by 7 days of reperfusion restored mitochondrial quality and renal function (CrCl- 7.33 ± 0.59, BUN-43.6 ± 3.16, Cr-0.93 ± 0.14).

Conclusion

The above findings emphasize that mitochondrial quality control alters with the extent of ischemia and subsequent reperfusion time, impacting not only mitochondrial copy number but also the resilience of mitochondria during tissue repair.

Microbiome and Inflammatory Biomarkers Associated With Palatal Wound Healing

AIM

The clinical outcomes of a variety of surgical procedures highly depend on tissue repair and show high variability among patients. There is a gap in the literature on how the host inflammatory response, the microbiome, and the interplay between them can influence oral mucosa healing. In this pilot study, we aimed to evaluate the microbiome and biomarkers profiles in patients who had desired versus undesired wound healing in the palatal mucosa.

METHODS

Seventeen patients underwent a free gingival graft (FGG) for socket preservation. Palatal wound closure (WC) and epithelization (EPT) were assessed clinically. Biofilm from the palatal wound was collected before the surgical procedure and 3, 7, 14, and 30 days postoperatively. The inflammatory exudate was sampled on Days 3 and 7. At 14 days posttreatment, patients were classified into two groups based on EPT rates: (1) undesired healing (UH) and (2) desired healing (DH).

RESULTS

No difference was observed in alfa diversity over time or between groups. In beta diversity, both UH and DH showed microbiome changes on Days 3-7 and 7, respectively, compared with the baseline (p = 0.01), returning to its initial condition 30 days later. There was a trend toward a different microbiome profile between groups on Day 7 (p = 0.08). Bacterium composition in DH showed a balance between healthy species and oral pathogens over time, whereas UH composition was characterized by microorganisms correlated with epithelium invasion/cytotoxicity; virulence factor upregulation; and oral diseases, such as periodontitis and aphthous stomatitis, until Day 30. UH showed an increase in IL-6, MCP-1, and MIP-1α over time, and DH showed a decrease in TIMP-1, IL-1β, and MIP-1α. On Days 3 and 7, MIP-1α and MMP-2 showed greater concentrations of DH in the intergroup assessment, and MCP-1 increased on Day 7 in UH.

CONCLUSION

Specific microbiome/inflammatory profiles are associated with DH and UH.

TRIAL REGISTRATION

NCT05171400.

Evaluation of the Effects of Autologous Leukocyte- and Platelet-Rich Fibrin Membranes for Treating Chronic Wounds: A Prospective Study

(1) Background: The aim of this prospective study was to evaluate the efficacy of topical application of leukocyte- and platelet-rich fibrin (L-PRF) membranes for treating chronic cutaneous wounds in dogs. (2) Methods: Chronic wounds unresponsive to conventional treatments were assessed on digital photographs and classified using the Bates-Jensen Wound Assessment Tool (BWAT). Each lesion was treated with L-PRF membranes. Epithelialization, granulation tissue formation, wound healing rate, and contraction were statistically analyzed during follow-up. (3) Results: All but one of the cases were treated with a single application of L-PRF for a median of 30 days after onset. All wounds healed after a median of 22 days. The BWAT score, total wound area, and granulation tissue decreased significantly over time while wound contraction increased. The most significant reduction in the total wound area was observed within the first 3 weeks after treatment. None of the dogs required the administration of antibiotics. (4) Conclusions: L-PRF membrane promoted the wound healing process in dogs and is a valuable and cost-effective tool for treating chronic wounds, thereby reducing the need for antibiotics administration.

Hybrid thermosensitive hydrogel/amniotic membrane structure incorporating S-nitrosothiol microparticles: potential uses for controlled nitric oxide delivery

Insufficient levels of nitric oxide may lead to chronic and acute wounds. Additionally, it is crucial that nitric oxide is prepared in a controlled-release manner due to its gaseous nature and short half-life. To address this issue, utilizing nitric oxide donors, particularly S-nitrosothiols such as S-nitrosoglutathione (GSNO), could efficiently overcome instability and aid in biomedical applications. Decellularized human amniotic membranes are also best known for their anti-inflammatory, angiogenic, and antimicrobial properties to promote wound epithelization. In this study, a novel nitric oxide-generated wound dressing based on an amniotic membrane was investigated. This construct consisted of a chitosan/β-glycerophosphate thermosensitive hydrogel covered with a decellularized human amniotic layer embedded with GSNO-loaded polylactic acid microparticles. The structure of GSNO was confirmed by spectrometric, elemental, and chemical analyses. The GSNO-loaded microparticles had a diameter of 40.66 ± 6.92 µm, and an encapsulation efficiency of 45.6 ± 6.74%. The hybrid construct and GSNO-loaded microparticles enhanced the long-term stable release of GSNO compared to free GSNO. The construct released nitric oxide ranging from 24 to 68 nM/mg during 7 days. The thermosensitive hydrogel was formed at 32.7 ± 1 °C and had a porous structure with a pore size of 41.76 ± 9.76 µm. The MTT and live/dead assays performed on human dermal fibroblast cells demonstrated suitable cell viability and adhesion to the final construct. Further, hemolysis analysis revealed less than a 5% hemolysis rate due to negligible blood cell adhesion. Overall, the prepared hybrid construct demonstrated suitable characteristics as a potential active wound dressing capable of controlled nitric oxide delivery.

Opportunities and challenges of bacterial extracellular vesicles in regenerative medicine

Extracellular vesicles (EVs) are membrane-bound vesicles that are shed or secreted from the cell membrane and enveloped by a lipid bilayer. They possess stability, low immunogenicity, and non-cytotoxicity, exhibiting extensive prospects in regenerative medicine (RM). However, natural EVs pose challenges, such as insufficient targeting capabilities, potential biosafety concerns, and limited acquisition pathways. Although engineered EVs demonstrate excellent therapeutic efficacy, challenges such as low production yield and the complexity of engineering modifications constrain their further clinical applications. Bacteria have advantages such as rapid proliferation, diverse gene editing methods, mature cultivation techniques, and relatively easy preparation of bacterial EVs (BEVs), which can be used to effectively address the challenges currently encountered in the field of EVs. This review provides a description of the biogenesis and pathophysiological functions of BEVs, and strategies for optimizing BEVs preparation to attain efficiency and safety are discussed. An analysis of natural characteristics of BEVs is also conducted to explore how to leverage their advantages or mitigate their limitations, thereby overcoming constraints on the application of BEVs in RM. In summary, engineered BEVs possess characteristics such as high production yield, excellent stability, and high drug-delivering capabilities, laying the foundation for their application in RM.

Chitooligosaccharides promote diabetic wound healing by mediating fibroblast proliferation and migration

Diabetic wounds are notoriously difficult to heal due to impaired cell repair mechanisms, reduced angiogenesis, and a heightened risk of infection. Fibroblasts play a vital role in wound healing by producing extracellular matrix (ECM) components and various growth factors, but their function is inhibited in diabetic wounds. Chitooligosaccharides (COS), intermediate products of chitosan degradation, have shown efficacy in promoting tissue repair, yet their role in diabetic wound healing remains underexplored. In a mouse model of diabetic wounds, COS treatment demonstrated substantial bioactivity in accelerating wound healing by enhancing fibroblast proliferation and migration. Additionally, COS increased collagen III deposition and angiogenesis at the wound sites. The COS also mitigated inflammatory responses by controlling leukocyte infiltration and bacterial infection. Mechanistically, COS regulated fibroblast activity via the PI3K/Akt signaling pathway, providing a novel bioactive material for chronic wound healing.

A suction blister model to characterize epidermal wound healing and evaluate the efficacy of the topical wound healing agent INM-755 in healthy volunteers

Non-healing wounds represent a substantial medical burden with few effective treatments available. To address this challenge, we developed a novel epidermal wound healing model using suction blisters in healthy volunteers. This model allowed for the comprehensive assessment of wound healing dynamics and the evaluation of INM-755, a topical cream containing cannabinol, as a potential therapeutic agent. Two clinical studies were conducted: an observational study and an interventional study. In both studies, healthy volunteers underwent a suction blister procedure on their lower back, creating open epidermal wounds. Wound healing parameters were assessed using advanced imaging systems. Skin barrier function and perfusion were evaluated through trans epidermal water loss (TEWL) and dynamic optical coherence tomography (D-OCT), respectively. The observational study demonstrated the successful and reproducible induction of blisters and the removal of epidermal sheet, enabling quantifiable measurements of wound healing parameters over time. Re-epithelialization was observed, revealing recovery of skin barrier function and perfusion. In the interventional study, differences of treatments over time were quantified using the above-described techniques. Despite differences from disease-specific blistering, our developed model provides a valuable platform for studying wound healing mechanisms and assessing novel therapeutic interventions. The sensitivity to treatment effects demonstrated in our study underscores the potential utility of this model in early-phase clinical drug development programs targeting wound healing disorders.

Potentilla fulgens root extract rich in polyphenols ameliorate diabetic foot ulcers in wistar rats via regulating oxidative stress and connective tissue markers

BACKGROUND

Potentilla fulgens (Wall.) ex Hook. (Rosaceae), commonly known as 'Bajradanti' is native to the lower Himalayan regions inclusive of the North-East India. Traditionally, the plant is used to treat chronic ailments like diabetes and diverse wounds, including gastric and mouth ulcers, and injuries from tiger bites.

OBJECTIVE

This study aims to assess the efficacy of P. fulgens root extract rich in polyphenolics in healing diabetic foot ulcer (DFU) in rats.

METHODS

DFU was induced in streptozotocin-nicotinamide diabetic rat feet by open excision wound model. Rats were divided into eight groups (n = 6/group): normal, negative control, plain gel (placebo) control, 1% silver sulfadiazine, and P. fulgens treated with topical ethyl acetate (EAPF, 5% and 10%) and methanol extract (MEPF, 5% and 10%). The morphological, histological and various biochemical parameters associated with the wound healing process such as connective tissue repair and oxidative stress biomarkers were evaluated.

RESULTS

Topical application of EAPF 10% and MEPF 10% over 21 days significantly (p < 0.05) reduced ulcer area in DFU rats compared to negative control. Furthermore, the extracts treated group notably (p < 0.05) increased levels of connective tissue biomarkers (total protein, hydroxyproline, hexosamine, and hexuronic acid) and antioxidant components (SOD and GSH), while significantly (p < 0.05) decreasing levels of lipid peroxidation (LPO) in foot tissue homogenate. Histological analysis of rats treated with the extracts revealed significant evidence of tissue repair, characterised by enhanced epithelial and collagen formation, along with decreased polymorphonuclear infiltration and edema.

CONCLUSION

In summary, treatment with EAPF 10% significantly improved foot ulcers by modulating oxidative stress and connective tissue biomarkers in DFU animals.

Implications of Biomaterials for Chronic Wounds

The use of biomaterials in treating and managing chronic wounds represents a significant challenge in global healthcare due to the complex nature of these wounds, which are slow to heal and can lead to complications such as frequent infections and diminished quality of life for patients. Chronic wounds, which can arise from conditions like diabetes, poor circulation, and pressure sores, pose distinct challenges in wound care, necessitating the development of specialized dressings. The pathophysiology of chronic wounds is thoroughly examined in this article, with particular attention paid to the cellular and molecular defects at work and the therapeutic guidelines. It also identifies key issues in the field, such as biocompatibility, cost-effectiveness, immune reactions, and regulatory obstacles, while suggesting future research focuses on improving biocompatibility, integrating drug delivery systems, and exploring cellular treatments. Ethical implications, such as patient safety, informed consent, and equitable access to technology, are also discussed. Finally, this review highlights the transformative potential of biomaterials in chronic wound management, urging for continued research and clinical integration to fully harness their capabilities in improving patient care.

Recent advancements in drug delivery system of flavonoids with a special emphasis on the flavanone naringenin: exploring their application in wound healing and associated processes

Numerous flavonoids have been identified in citrus fruits which show potential to cure several complex diseases. These natural polyphenolic bioactive compounds are the secondary metabolites of various plants, among which naringenin has been explored in several pre-clinical research for its beneficial role in promoting health by modulating various biochemical processes. Its antioxidant, anti-inflammatory, and anti-microbial effects have been projected toward healing of wounds. Further, its application has also been shown to regrow vascular networks, which are known to facilitate the healing of chronic wounds. Thus, the potential of naringenin to modulate various molecular pathways aids in the healing process of wounds. Considering the recent literature, an update has been attempted to present the correlation between the healing mechanisms of wounds by the application of naringenin. Furthermore, the application of naringenin is challenging because of its properties of poor solubility and limited permeability, which can be overcome by the nanotechnology platform. Thus, several nanocarriers that have been employed for the improvement of naringenin delivery are highlighted. Thereby, it can be concluded that a suitable nanocarrier of naringenin could be an effective tool in treating wounds to improve the quality of life of such patients.

Molecular mechanisms of ubiquitination in wound healing

Wound healing is a complex biological process involving multiple cellular and molecular mechanisms. Ubiquitination, a crucial post-translational modification, plays a vital role in regulating various aspects of wound healing through protein modification and degradation. This review comprehensively examines the molecular mechanisms of ubiquitination in wound healing, focusing on its regulation of inflammatory responses, macrophage polarization, angiogenesis, and the activities of fibroblasts and keratinocytes. We discuss how ubiquitination modifies key signaling pathways, including TGF-β/Smad3, NF-κB, and HIF-α, which are essential for proper wound healing. Understanding these mechanisms provides insights into potential therapeutic strategies for treating impaired wound healing, particularly in conditions such as diabetes. The review highlights recent advances in understanding ubiquitination's role in wound healing and discusses future research directions for developing targeted therapeutic approaches.

A Ratiometric Time-Gated Luminescence Probe for Imaging H2O2 in Endoplasmic Reticulum of Living Cells and Its Application to Smartphone-Guided Bioimaging

The significance of H2O2 as a marker of reactive oxygen species (ROS) and oxidative stress in living organisms has spurred growing interest in its roles in inflammation and disease progression. In this report, a ratiometric time-gated luminescence (RTGL) probe is proposed based on mixed lanthanide complexes, ER-BATTA-Tb3+/Eu3+, for imaging the H2O2 generation both in vitro and in vivo. Upon exposure to H2O2, the probe undergoes cleavage of the benzyl boric acid group, releasing hydroxyl (─OH) groups, which significantly reduces the emission of the Eu3+ complex while slightly increasing the emission of the Tb3+ complex. This response allows the I540/I610 ratio to be used as an indicator for monitoring the H2O2 level changes. The probes are capable of selectively accumulating in the endoplasmic reticulum (ER), allowing effective imaging of H2O2 in the ER of living cells and liver-injured mice under oxidative stress. Moreover, by integrating ER-BATTA-Tb3+/Eu3+ into (polyethylene glycol) PEG hydrogels, the H2O2-responsive smart sensor films, PEG-H2O2-Sensor films, are created, which enable the real-time monitoring of H2O2 levels in various wounds using a smartphone imaging platform and R/G channel evaluation. The sensor films are also innovatively applied for the in situ monitoring of H2O2 in brains of epileptic rats, facilitating the precise assessment of brain damage. This study provides a valuable tool for the quantitative detection of H2O2 in vitro and in vivo, as well as for the clinical monitoring and treatment of H2O2-related diseases in multiple scenarios.

Epigenetic regulatory mechanism of macrophage polarization in diabetic wound healing (Review)

Diabetic wounds represent a significant complication of diabetes and present a substantial challenge to global public health. Macrophages are crucial effector cells that play a pivotal role in the pathogenesis of diabetic wounds, through their polarization into distinct functional phenotypes. The field of epigenetics has emerged as a rapidly advancing research area, as this phenomenon has the potential to markedly affect gene expression, cellular differentiation, tissue development and susceptibility to disease. Understanding epigenetic mechanisms is crucial to further exploring disease pathogenesis. A growing body of scientific evidence has highlighted the pivotal role of epigenetics in the regulation of macrophage phenotypes. Various epigenetic mechanisms, such as DNA methylation, histone modification and non‑coding RNAs, are involved in the modulation of macrophage phenotype differentiation in response to the various environmental stimuli present in diabetic wounds. The present review provided an overview of the various changes that take place in macrophage phenotypes and functions within diabetic wounds and discussed the emerging role of epigenetic modifications in terms of regulating macrophage plasticity in diabetic wounds. It is hoped that this synthesis of information will facilitate the elucidation of diabetic wound pathogenesis and the identification of potential therapeutic targets.

Orchestration of Macrophage Polarization Dynamics by Fibroblast-Secreted Exosomes during Skin Wound Healing

Macrophages undertake pivotal yet dichotomous functions during skin wound healing, mediating both early proinflammatory immune activation and late anti-inflammatory tissue remodeling processes. The timely phenotypic transition of macrophages from inflammatory M1 to proresolving M2 activation states is essential for efficient healing. However, the endogenous mechanisms calibrating macrophage polarization in accordance with the evolving tissue milieu remain undefined. In this study, we reveal an indispensable immunomodulatory role for fibroblast-secreted exosomes in directing macrophage activation dynamics. Fibroblast-derived exosomes permitted spatiotemporal coordination of macrophage phenotypes independent of direct intercellular contact. Exosomes enhanced macrophage sensitivity to both M1 and M2 polarizing stimuli, yet they also accelerated timely switching from M1 to M2 phenotypes. Exosome inhibition dysregulated macrophage responses, resulting in aberrant inflammation and impaired healing, whereas provision of exogenous fibroblast-derived exosomes corrected defects. Topical application of fibroblast-derived exosomes onto chronic diabetic wounds normalized dysregulated macrophage activation to resolve inflammation and restore productive healing. Our findings elucidate fibroblast-secreted exosomes as remote programmers of macrophage polarization that calibrate immunological transitions essential for tissue repair. Harnessing exosomes represents a previously unreported approach to steer productive macrophage activation states with immense therapeutic potential for promoting healing in chronic inflammatory disorders.

Unlocking the Healing Potential: A Comprehensive Review of Ecology and Biology of Medical-Grade Honey in Wound Management and Tissue Regeneration

Background and Aims

Honey has long been studied for its healing abilities in wound care. This narrative review examines its properties and their impact on wound healing, particularly its ability to accelerate wound closure and promote tissue regeneration. The review focuses on how honey's botanical origins affect its medical properties and wound-healing capabilities. Finally, clinical studies on honey's effectiveness in wound healing were reviewed compared to traditional treatments.

Methods

Relevant keywords were searched in databases, yielding 1250 documents. After excluding nonrelevant sources, 450 documents were refined, and 167 articles were selected based on thematic alignment and originality. Data extraction focused on study design, intervention details, and outcomes, with quality assessed using standardized criteria. The study adhered to CONSORT and SANRA guidelines to ensure methodological rigor and reporting transparency.

Results

Honey-based medical products have demonstrated significant antibacterial, anti-inflammatory, and tissue-regenerative properties, making them highly effective in improving wound healing outcomes, particularly in chronic and burn wounds. These products have also been shown to reduce infection rates and hospital stays. While some studies have reported positive outcomes in accelerating the healing process, others have found no significant difference compared to conventional treatments.

Conclusion

Medical-grade honey (MGH) holds potential for wound care due to its versatility, though variations in its composition present challenges. Further research is needed to optimize its clinical use. The effectiveness of MGH in wound healing remains debated, with mixed results from trials. Genetic modification of bees to enhance MGH's properties could make it more competitive against conventional treatments. Honey-based medications could reduce costs, improve energy efficiency, and have minimal side effects. Rigorous research is necessary to determine optimal use and fully unlock MGH's potential, which could revolutionize wound management globally.

Therapeutic Indices of Topical Antiseptics in Wound Care: A Systematic Review

GENERAL PURPOSE

To review the therapeutic indices of topical antiseptics for bacterial species commonly isolated from chronic wounds.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:1. Explain the mechanisms underlying chronic wound physiology and their implications for effective wound healing and management.2. Evaluate the role of therapeutic index values for topical antiseptics in chronic wound management.3. Apply evidence-based treatment strategies for chronic wound management.

Macromolecular Crowding Supports the Generation of Basal Membrane-Rich Pericyte-Based Cell Sheets Useful for Cell Therapy of Diabetic Wounds

Diabetic foot ulcers (DFUs) are associated with a high risk of amputations and a 50% 5-year survival rate due at least in part to the limited angiogenic and wound healing capacity of patients with diabetes. Cell therapy via intramuscular injection of peripheral blood mononuclear cells showed encouraging but limited results. Such limitations may arise from the limited ability of therapeutic cells to adhere to the target tissue. The development of a methodology able to support the targeted delivery of viable angiogenic cells would improve cell therapy outcomes in DFU. Here, we optimized a protocol for the production of autologous extracellular matrix (ECM)-rich pericyte-based cell sheets for cell delivery. Pericytes were isolated from skeletal muscle biopsies of DFU patients and non-diabetic controls and characterized by flow cytometry and immunofluorescence. Human umbilical vein endothelial cells used for the optimization of collagen IV deposition showed a positive correlation with seeding density and a negative one with sub-culture passaging (P < 0.05). Macromolecular crowding significantly increased collagen IV deposition both in human umbilical vein endothelial cells and in patient-derived pericytes (P < 0.01) without affecting proliferation (P > 0.05). Finally, DFU patient-derived pericytes effectively deposited ECM supporting their use for autologous cell sheet production.

Comparative Analysis of Autologous Skin Cell Suspension Technology and Split-Thickness Skin Grafting for Subacute Wounds in Medically Complex Patients: Propensity-Matched Cohort Study

BACKGROUND

Nonhealing wounds are particularly prevalent in older adults and in patients with multiple comorbidities, and they represent a significant medicoeconomic burden. Autologous split-thickness skin grafts (STSGs) are considered the gold standard for wound closure but suffer from high failure rates and complications. Autologous skin cell suspension (ASCS) technology is an autografting technique able to significantly minimize donor site morbidity. This retrospective, propensity-matched cohort study compared outcomes of wounds treated with ASCS vs STSG.

STUDY DESIGN

Seven patients treated with ASCS were propensity-matched to 7 control patients who received STSG according to age and sex. The ASCS was prepared using the RECELL System and applied either alone as spray only ("ASCS alone," off-label) or combined with a widely meshed STSG ("ASCS + STSG," 3:1). The primary outcome was time to complete wound healing. Secondary outcomes included donor site healing, pain, and total number of visits. Statistical analyses included descriptive statistics, univariate analyses, and mixed-effect regression modeling to assess the impact of treatment on wound healing.

RESULTS

A total of 14 patients and 17 wounds (10 treatment vs 7 control) were included. Demographics were well-matched between cohorts. The overall mean wound healing time was 85.6 ± 11.2 days. Wounds treated with ASCS (both ASCS groups) healed faster than STSG (75.9 ± 4.5 vs 99.4 ± 26.7 days). Wounds treated with ASCS alone healed in 80.8 ± 5.1 days, whereas those treated with ASCS and STSG healed in 68.5 ± 7.6 days.

CONCLUSIONS

This study suggests that ASCS may offer clinically significant improvements in wound and donor site healing, with significantly less donor skin requirements, and comparable pain levels, compared with traditional STSG. Further research with a prospective study and larger sample size is needed to validate these findings.

The paradigm of stem cell secretome in tissue repair and regeneration: Present and future perspectives

As the number of patients requiring organ transplants continues to rise exponentially, there is a dire need for therapeutics, with repair and regenerative properties, to assist in alleviating this medical crisis. Over the past decade, there has been a shift from conventional stem cell treatments towards the use of the secretome, the protein and factor secretions from cells. These components may possess novel druggable targets and hold the key to profoundly altering the field of regenerative medicine. Despite the progress in this field, clinical translation of secretome-containing products is limited by several challenges including but not limited to ensuring batch-to-batch consistency, the prevention of further heterogeneity, production of sufficient secretome quantities, product registration, good manufacturing practice protocols and the pharmacokinetic/pharmacodynamic profiles of all the components. Despite this, the secretome may hold the key to unlocking the regenerative blockage scientists have encountered for years. This review critically analyses the secretome derived from different cell sources and used in several tissues for tissue regeneration. Furthermore, it provides an overview of the current delivery strategies and the future perspectives for the secretome as a potential therapeutic. The success and possible shortcomings of the secretome are evaluated.

Effects of Gamma Irradiation on Structural, Chemical, Bioactivity and Biocompatibility Characteristics of Bioactive Glass-Polymer Composite Film

Gamma irradiation is an effective technique for biocomposite films intended for application in tissue engineering (TE) to ensure sterility and patient safety prior to clinical applications. This study proposed a biocomposite film composed of natural polymer chitosan (CS) and synthetic polymer poly-Ɛ-caprolactone (PCL) reinforced with sol-gel-derived bioactive glass (BG) for potential application in TE. The BG/PCL/CS biocomposite film was sterilized using 25 kGy gamma rays, and subsequent changes in its characteristics were analyzed through mechanical and physical assessment, bioactivity evaluation via immersion in simulated body fluid (SBF) and biocompatibility examination using human primary dermal fibroblasts (HPDFs). Results indicated a homogeneous distribution of BG particles within the BG/PCL/CS polymer matrix which enhanced bioactivity, and the polymer blend provide a structurally stable film. Gamma irradiation induced an increase in the film's surface roughness due to photo-oxidative degradation; however, this did not adversely affect the integrity of glass particles and polymer chains. In vitro assessments demonstrated hydroxyapatite formation on the film's surface, suggesting bioactivity. Biocompatibility testing confirmed enhanced cell adhesion and proliferation. These multifunctional properties highlight the potential of the fabricated BG/PCL/CS biocomposite film for TE and regenerative medicine applications.

Dynamics of Human Palatal Wound Healing and the Associated Microbiome

Wound healing in the oral mucosa is superior to that in the skin, with faster wound closure accompanied by reduced inflammation, less angiogenesis, and minimal scar formation. A well-characterized oral wound model is critical to investigating the mechanisms of oral wound closure and the efficacy of various clinical interventions. Currently, there are a few human oral wound models, although none of them are well characterized. In the present study, we describe and characterize a human hard palate wound healing model. A 3.5-mm circular and two 1 × 5-mm rectangular full-thickness wounds were made in the first and second molar region, 5 mm from the gingival margin, on the hard palate of human subjects. The circular wound was used to monitor wound closure and collect swabs for a microbiome analysis via 16s rRNA sequencing. The rectangular wounds were biopsied and the tissue was used to evaluate the gene expression of wound healing-related mediators by real-time polymerase chain reaction. Saliva was also collected to examine the protein levels of similar molecules by enzyme-linked immunosorbent assays. Circular wounds were nearly closed on day 7 after wounding. Significant changes in the gene expression of inflammatory cytokines, growth factors, antimicrobial peptides, and extracellular matrix-related molecules were identified in day 1 and day 3 wound tissue and compared with unwounded tissue on day 0. Changes in the protein levels of various mediators were limited in the saliva. In addition, alpha diversity, beta diversity, and differential microbiome analysis demonstrated significant changes in bacterial colonization of the wound surface over time compared with unwounded mucosa. In summary, we comprehensively characterize a human hard palate wound-healing model that details the dynamic changes of wound closure, levels of wound healing-related mediators in the wound and saliva, and the oral wound microbiome.

Differential effects of macrophage subtype-specific cytokines on fibroblast proliferation and endothelial cell function in co-culture system

Macrophages are involved in several critical activities associated with tissue repair and regeneration. Current approaches in regenerative medicine are focusing on leveraging the innate immune response to accelerate tissue regeneration and improve long-term healing outcomes. Of particular interest in this regard are the currently known, four main M2 macrophage subtypes: M2interleukin (IL)-4,IL-13, M2IC, M2IL-10, M2non-selective adenosine receptor agonists (NECA) (M2IL-4,IL-13 → M2NECA). In this study, rat bone marrow-derived macrophages (M0) were polarized to each of the four subtypes M2IL-4,IL-13 → M2NECA and cultured for 72 h in vitro. Luminex assay results highlighted increased production of tissue inhibitor of metalloproteinases-1 (TIMP-1) for M2IL-4,IL-13, higher amounts of transforming growth factor-beta 1 (TGF-β1) for M2IL-10, and elevated vascular endothelial growth factor A (VEGF-A) from M2NECA. Co-culture experiments performed with M2IL-10 macrophages and L929 fibroblasts highlighted the increased production of soluble collagen within the media as well as higher amounts of collagen in the extracellular matrix. Human umbilical vein endothelial cells (HUVECs) were co-cultured with M2NECA macrophages, which demonstrated an increase in intercellular adhesion molecule (ICAM) and platelet endothelial cell adhesion molecule (PECAM), as well as increased formation of endothelial tubes. The findings of this study emphasize a critical demand for further characterization and analyses of distinct M2 subtypes and careful selection of specific macrophage populations for regeneration of specific tissue types. The current, broad classification of "M2" may be sufficient in many general tissue engineering applications, but, as conditions are constantly in flux within the microenvironment in vivo, a higher degree of specificity and control over the initial M2 subtype could result in more consistent long-term outcomes where macrophages are utilized as part of an overall regenerative strategy.

Patient and wound factors associated with WOUND-Q scales measuring health-related quality of life: An international cross-sectional study

The WOUND-Q is a patient-reported outcome measure for individuals with any type of chronic wound. This study aimed to identify patient and wound factors associated with the four WOUND-Q health-related quality of life (HRQL) scales: Life impact, Psychological, Sleep, and Social. Adults with a chronic wound were recruited internationally through clinical settings between August 2018 and May 2020, and through an online platform (i.e. Prolific) in September 2022. Multivariable linear regression analyses were conducted to identify factors significantly associated with the WOUND-Q scales. The assessments obtained were 1273, 1275, 706, and 1256 for the Life Impact, Psychological, Sleep, and Social scales, respectively. The mean age of participants was 55 (SD = 18) years; most (66%) had a single wound, and most (56%) wounds had lasted more than 6 months. The most common causes were trauma, surgery, and diabetic foot ulcer. Wound characteristics associated with worse scores on at least one of the scales were drainage, vacuum treatment, aetiologies (i.e. diabetic foot ulcer, trauma, other, multiple), duration (i.e. 10-11 months), having four or more wounds, smell, and sleep interference, while wound location different from the face or neck was associated with better scores (p < 0.05). Patient factors associated with worse scores included having diabetes or a comorbidity, whereas increasing age or male gender were associated with better scores (p < 0.05). Sleep disturbances had the largest negative influence on HRQL scores. This study identified factors affecting HRQL in individuals with chronic wounds. Understanding these associations can inform better management and treatment strategies to improve HRQL for these patients.

Decellularized porcine dermal hydrogel enhances implant-based wound healing in the setting of irradiation

Acellular Dermal Matrix (ADM) provides mechanical and soft tissue support in implant-based breast reconstruction, and has shown to modulate the healing response. However, skin flap necrosis, edema, and previous radiation therapy can hinder ADM integration. Effective biomaterial integration requires regulating the immune response, fibrosis, and adipocyte-driven functionalization. Extracellular matrix (ECM) hydrogels have demonstrated utility in tissue regeneration, and decreasing inflammation and fibrosis in various tissues. Therefore, we hypothesized that a Decellularized Porcine Dermal (DPD) hydrogel to support ADM integration would prevent excessive fibrosis, regulate the macrophage response, and promote adipogenesis. Exploration of DPD hydrogel during ADM implantation in mice (healthy and radiated) revealed long-term effects of irradiation on implant wound healing. DPD hydrogel rescued radiation-induced fibrosis, restoring capsule thickness of healthy mice, and did not increase the fibroblast migration into the ADM. As a modulating soft tissue filler, DPD hydrogel also promoted adipocyte infiltration in healthy and irradiated mice. Detailed macrophage analysis showed that radiation led to the increase in pro-inflammatory, transition, and reparative markers. Despite relatively subtle effects on individual macrophage phenotype markers, multidimensional flow cytometry analysis revealed that DPD hydrogel temporally regulated two subpopulations. he presence of DPD resulted in significantly reduced CD9HiArg1HiCD301bLo and CD163HiCD38HiCD301bHi macrophages in healthy mice at one week, and a significant increase in CD9High macrophages with low expression of other markers at 6 weeks in irradiated mice. DPD hydrogel promotes a decreased fibrotic, and adipocyte-promoting coordination of wound healing in healthy and irradiated wound beds while not disrupting the immunomodulatory effects of ADM. STATEMENT OF SIGNIFICANCE: Acellular Dermal Matrix (ADM) provides mechanical and soft tissue support in post-mastectomy implant-based breast reconstruction, and positively affects wound healing. Following breast reconstruction, skin flap necrosis, edema, and previous radiation therapy can hinder ADM integration. Effective wound healing and biomaterial integration requires regulating the cellular immune response. Extracellular matrix hydrogels have demonstrated utility in tissue regeneration and decreasing inflammation and fibrosis in various tissues, but has yet to be utilized in the setting of breast reconstruction. Here, we demonstrated that a decellularized dermal hydrogel as an adjunct to ADM, decreases fibrosis and promotes adipogenesis during the coordination of wound healing in healthy and clinically relevant microenvironments that have received radiation therapy while not disrupting the immunomodulatory effects of implanted ADM.

Specific Non-Coding RNAs Involve in and Regulate the Transcriptional Network during Keloid Formation

Keloid formation is an undesirable outcome of wound healing and is detrimental to patients' physical and mental health, while the molecular regulators of its pathogenesis, especially non-coding RNAs (ncRNAs), are largely unknown. In this study, we integrated and analyzed RNA-seq and miRNA microarray datasets of skin samples from keloid-prone and healthy normal individuals to detect the dysregulated long ncRNAs (lncRNAs) and miRNAs. We excavated 583 and 104 keloid-specific lncRNAs and miRNAs, respectively. Moreover, the molecular functions of these ln-cRNAs and miRNAs are all related to ossification. Next, we constructed the relationship between lncRNAs and immune cell infiltration, and found the macrophages, NK cells, and dendritic cells were specifically dysregulated in keloid-prone or normal groups during wound healing. We constructed the potential regulatory network between these cell types and 20 dysregulated lncRNAs, suggesting their regulatory function in keloid formation. At last, we constructed the competitive endogenous RNA network and found two hub lncRNAs and five miRNAs, including DLEU1 and SLC25A21-AS1, miR-197-5p, miR-940, miR-6765-5p, miR-711, and miR-4284, which were highly dysregulated during keloid formation. In summary, these results demonstrate that lncRNAs and miRNAs play important roles and form a regulatory network in the pathogenesis, immune infiltration, and development of keloid formation.

Local Treatment of Wound Infections: A Review of Clinical Trials from 2013 to 2024

Significance: Management of infection is a critical aspect of wound care. It involves the application of various interventions to treat the wound and prevent the infection from spreading to other parts of the body, which may lead to serious complications, including sepsis. Local treatment of skin wound infections is the favored route of administration, reducing the risk of adverse systemic effects while providing very high therapeutic concentrations at the target site. The purpose of this article was to review clinical trials from 2013 and onward, focusing on local treatment of acute wounds and burns as well as chronic wounds as their primary outcome measurement. Recent Advances: Based on our literature search, 49 clinical trials were focusing on treating infected chronic wounds, and 6 trials studied infection as their primary outcome in acute wounds during the last 10 years. Critical Issues: Currently commercially available local treatments do not prevent the onset of invasive infection. Therefore, there is a need for more effective local therapies. Future Directions: Despite multiple preclinical studies introducing novel and promising strategies in terms of novel antimicrobial agents and delivery methods to prevent and treat skin wound infections locally, many have yet to be tested in a clinical setting. These preclinically tested approaches could still be valuable additions to today's care of infected skin wounds.

Risk factors for surgical site infections following hepatobiliary surgery: An umbrella review and meta-analyses

BACKGROUND

In the hepatobiliary (HPB) surgical cohort, surgical site infections (SSI) can extend hospital stays, result in higher morbidity, and poor patient outcomes. This umbrella review and meta-analysis aimed to synthesise the evidence for the association between clinical and patient risk factors and SSI in patients following HPB surgery.

METHODS

We searched MEDLINE, CINAHL, EMBASE and Scopus from January 2000 to April 2023 to identify systematic reviews and meta-analyses where patient and/or clinical factors of SSIs following HPB surgery were reported. The summary effect size, its 95 % CI and the 95 % PI were calculated for each meta-analysis using random-effects models. 30-day cumulative SSI incidence was presented as the pooled estimate with 95 % CIs. Between-study heterogeneity was explored using the I2 statistic.

RESULTS

Nine systematic reviews and meta-analyses were included. Our findings suggest open surgical approach, type of pancreas procedure, preoperative biliary drainage, older age, male sex and high BMI (>25mg/k2) as statistically significant factors for increasing a patient's risk of SSI following HPB surgery. The cumulative incidence of SSI in the HPB cohort of 43,296 was 11 % (95 % CI 6%-20 %), with substantial variation between the reviews.

CONCLUSION

We identified several patient and clinical factors, however only one was graded as a high level of evidence.

Effects of Cautery-Assisted Palatal Stiffening With and Without Uvulectomy on Quality of Life in Patients With Obstructive Sleep Apnea and Snoring: A Retrospective Cohort Study

INTRODUCTION

Obstructive sleep apnea (OSA) and snoring are common conditions that disrupt sleep, leading to significant physical and emotional challenges that affect daily life and overall well-being. While non-surgical treatments like continuous positive airway pressure (CPAP) are effective, many patients find them challenging to maintain. Cautery-assisted palatal stiffening (CAPS), with or without uvulectomy, offers a minimally invasive surgical alternative to improve symptoms and enhance quality of life (QoL).

AIM

This study aims to assess and compare the effects of CAPS, with and without uvulectomy, on post-surgical QoL in patients with OSA or snoring.

MATERIALS AND METHODS

This retrospective cohort study included 94 patients who underwent CAPS, with or without uvulectomy, at King Hamad University Hospital in Bahrain to treat OSA or snoring. QoL was assessed using the Short-Form Health Survey (SF-36), evaluating physical and emotional well-being.

RESULTS

Among the 94 patients, CAPS improved physical functioning (mean score: 83.03) and general health (72.98). A trend toward greater emotional well-being was observed in the CAPS-only group compared to the uvulectomy group (p = 0.057). Over half of the participants (53.2%) reported feeling significantly better overall. CAPS effectively enhanced physical QoL, with some limitations remaining in emotional health.

CONCLUSIONS

CAPS and CAPS with uvulectomy significantly improve post-surgical QoL, especially in physical functioning, though some emotional challenges may persist. These findings support CAPS as a beneficial option for patients, particularly for enhancing physical well-being.

Hydrogen-Rich Saline Combined With Vacuum Sealing Drainage Promotes Wound Healing by Altering Biotin Metabolism

Impaired wound healing affects the life quality of patients and causes a substantial financial burden. Hydrogen-rich medium is reported to have antioxidant and anti-inflammatory effects. However, the role of hydrogen-rich saline (HRS) in cutaneous wound healing remains largely unexplored, especially by metabolomics. Thus, untargeted metabolomics profiling was analysed to study the effects and mechanism of HRS combined with vacuum sealing drainage (VSD) in a rabbit full-thickness wound model. Our results indicated that the combination treatment of HRS and VSD could accelerate wound healing. In vitro experiments further confirmed its effects on HaCaT keratinocytes. We found that 45 metabolites were significantly changed between the VSD + HRS group and the VSD + saline-treated group. Pathway enrichment analysis indicated that biotin metabolism was the potential target pathway. The biochemical interpretation analysis demonstrated that combining HRS and VSD might enhance mitochondrial function, ATP synthesis, and GSH homeostasis by altering biotin metabolism. The detection of representative indicators of oxidative stress supported the critical metabolic pathway analysis as well. In summary, VSD combined with HRS might provide a new strategy to enhance wound healing.

HLA Awareness in tissue decellularization: A paradigm shift for enhanced biocompatibility, studied on the model of the human fascia lata graft

Last twenties, tissue engineering has rapidly advanced to address the shortage of organ donors. Decellularization techniques have been developed to mitigate immune rejection and alloresponse in transplantation. However, a clear definition of effective decellularization remains elusive. This study compares various decellularization protocols using the human fascia lata model. Morphological, structural and cytotoxicity/viability analyses indicated that all the five tested protocols were equivalent and met Crapo's criteria for successful decellularization. Interestingly, only the in vivo immunization test on rats revealed differences. Only one protocol exhibited Human Leucocyte Antigen (HLA) content below 1% residual threshold, the only criterion preventing rat immunization with an absence of rat anti-human IgG switch after one month (N=4 donors for each of the 7 groups, added by negative and positive controls, n=28). By respecting a refined set of criteria, i.e. lack of visible nuclear material, <50ng DNA/mg dry weight of extracellular matrix, and <1% residual HLA content, the potential for adverse host reactions can be drastically reduced. In conclusion, this study emphasizes the importance of considering not only nuclear components but also major histocompatibility complex in decellularization protocols and proposes new guidelines to promote safer clinical development and use of bioengineered scaffolds.

Evaluation of wound healing activity of the crude extract and solvent fractions of Rumex nervosus Vahl (Polygonaceae) leaves in mice

Background

In Ethiopian traditional medicine, Rumex nervosus Vahl leaves are used to treat wounds. However, despite traditional claims and supportive in vitro findings, no scientific study has been conducted to evaluate the in vivo wound healing activity of R. nervosus Vahl leaves.

Aim of the study

To evaluate the wound healing activity of crude extract of the leaves of R. nervosus Vahl and its solvent fractions in mice.

Methods

R. nervosus Vahl leaves were extracted with 80% methanol, and then the crude extract was fractionated using ethyl acetate, chloroform, and water. Ointments at 5% and 10% strengths were formulated from the crude extract and its fractions. The healing activity of the crude extract was evaluated using linear incision, circular excision, and burn wound models in mice. Additionally, the activity of solvent fractions was assessed using circular excision wounds in mice.

Results

Treatment of wounds with ointments containing 5% and 10% crude extract showed significantly increased wound contraction rate, shorter epithelialization period, and higher skin-breaking strength (P < 0.05) compared with the negative control. Both 5% and 10% formulations of the aqueous and ethyl acetate fractions significantly increased wound contraction and decreased the period of epithelialization in the excision wound model (p < 0.05), however, the chloroform fraction showed no significant wound healing effect compared with the negative control.

Conclusion

The 80% methanol crude extract as well as the aqueous and ethyl acetate fractions of R. nervosus Vahl leaves possess wound healing activity as evidenced by improved wound contraction rate and tensile strength and decreased epithelialization period.

Nutritional Status in a Group of Patients with Wounds Due to Diabetic Foot Disease and Chronic Venous Insufficiency

Background: Wound healing is a complex physiological process that begins immediately upon injury. Nutritional status significantly affects the course of regenerative processes. Malnutrition can prolong the inflammatory phase, limit collagen synthesis, and increase the risk of new wound formation. The issue of malnutrition is becoming increasingly prevalent and remains a significant concern, particularly among older adults dealing with chronic conditions. Methods: The study was conducted at the Wound Treatment Clinic of the Specialist Hospital at the Podkarpackie Oncology Center in Brzozów, Poland, over 12 months (31 December 2022 to 31 December 2023). A prospective assessment was carried out on 106 patients with chronic wounds. The sample selection was purposeful, based on the following criteria: individuals with hard-to-heal vascular wounds related to diabetic foot disease or venous insufficiency, who provided informed consent to participate after reviewing the study concept. The assessment included a questionnaire and biochemical blood analysis. Further evaluations covered wound characteristics and classification based on clinical scales. The morphotic and biochemical blood parameter assessment included albumin concentration, hemoglobin, C-reactive protein (CRP), and the nutritional risk index (NRI). Results: A larger wound area was associated with lower morphotic values in both groups. Exudate levels and severity in chronic venous insufficiency (CVI) patients and diabetic foot disease (DFD) were associated with lower hemoglobin, albumin, and NRI values. At the same time, the depth of tissue structure damage correlated with the measured biochemical parameters. Conclusions: NRI values and morphotic blood parameters, along with albumin, hemoglobin, and CRP levels, are closely associated with wound characteristics, including surface area, exudate level, and the severity of tissue destruction. The greater the destruction of tissue structures, the higher the risk of malnutrition and wound infection, as indicated by biochemical assessment.

Histatins, proangiogenic molecules with therapeutic implications in regenerative medicine

Recent studies show that a group of salivary peptides, collectively known as histatins, are potent inducers of wound healing in both soft and hard tissues. Among these molecules, histatin-1 stands out for its ability to stimulate the repair of skin, oral mucosal, and osseous tissue. Remarkably, all these effects are associated with the capacity of histatin-1 to promote angiogenesis via inducing endothelial cell adhesion, migration, and signaling. These findings have opened new opportunities in the field of regenerative medicine, leading to an increasing number of articles and patents proposing therapeutic uses of histatin-1. However, this scenario raises a relevant concern regarding the appropriate use of these molecules, since, unlike the mode of action, little is known about the molecular mechanism by which they promote angiogenesis and wound healing. Recent studies shed light on the pharmacodynamics of histatin-1, by identifying the endothelial receptor that it binds and downstream signaling. This perspective will discuss current evidence on the role of histatins in wound healing and angiogenesis, emphasizing their impact on regenerative medicine.

Skin layer-specific spatiotemporal assessment of micrometabolism during wound angiogenesis

Proper oxygen delivery through the microvasculature to injury site is essential to ensure the metabolic cascade during wound healing. Adaptation of vascular structure and oxygenation is key to unravel the regulation of blood perfusion, oxygen distribution and new tissue formation. Yet, visualizing micrometabolic responses at large scale in unperturbed living tissue remains challenging. We studied full-thickness excisional wounds in the mouse dorsal skin in vivo using ultrasound-aided spectroscopic large-scale optoacoustic microscopy. Skin layer-specific vascularization is visualized at capillary resolution over centimeter-scale field-of-view in a non-invasive, label-free manner. Different vascular parameters, including oxygenation, diameter and its irregularity, tortuosity and angular alignment, show distinct spatial and temporal variations. Elevated oxygenation is manifested close to the wound at day 4 with the trend accompanied by reduction in diameter over time. Angular alignment increases over time, indicating a more directed blood supply towards the wound. Our observations indicate that wound angiogenesis initiates as capillary sprouting with enlarged newborn vessels and elevated oxygenation around the wound, with the vessels normalizing in size and oxygenation during remodeling. Our study provides insight into micrometabolic profiles surrounding the healing wound, setting the stage for preclinical studies on oxygen delivery mechanisms in pathological skin conditions and during pharmacological interventions.

Hijacking plant skeletons for biomedical applications: from regenerative medicine and drug delivery to biosensing

The field of biomedical engineering continually seeks innovative technologies to address complex healthcare challenges, ranging from tissue regeneration to drug delivery and biosensing. Plant skeletons offer promising opportunities for these applications due to their unique hierarchical structures, desirable porosity, inherent biocompatibility, and adjustable mechanical properties. This review comprehensively discusses chemical principles underlying the utilization of plant-based scaffolds in biomedical engineering. Highlighting their structural integrity, tunable properties, and possibility of chemical modification, the review explores diverse preparation strategies to tailor plant skeleton properties for bone, neural, cardiovascular, skeletal muscle, and tendon tissue engineering. Such applications stem from the cellulosic three-dimensional structure of different parts of plants, which can mimic the complexity of native tissues and extracellular matrices, providing an ideal environment for cell adhesion, proliferation, and differentiation. We also discuss the application of plant skeletons as carriers for drug delivery due to their structural diversity and versatility in encapsulating and releasing therapeutic agents with controlled kinetics. Furthermore, we present the emerging role played by plant-derived materials in biosensor development for diagnostic and monitoring purposes. Challenges and future directions in the field are also discussed, offering insights into the opportunities for future translation of sustainable plant-based technologies to address critical healthcare needs.

Mupirocin-Doped α-Cellulose Nanopaper for Wound Dressing: Development, In Vitro Characterization and Antimicrobial Studies

This research aimed to develop a mupirocin-doped α-cellulose nanopaper (MDAC-NP) as a wound dressing to accelerate wound healing while limiting localized bacterial growth. The α-cellulose nanofibrils suspension was prepared by ultrasonication followed by microfluidization and subsequently doped with 0.05% w/v mupirocin to prepare nanopaper (MDAC-NP-A). The optimized batch of MDAC-NP had a porosity of 47.46 ± 0.60%, a thickness of 30 μm and a tensile strength of 0.113 MPa. The transmission electron microscopy images revealed long, slender, intertwined nanofibrillar structures and the scanning electron microscopy confirmed stable lamellar structures with tight nanofibrillar networks, giving them translucency. MDAC-NP-A had an excellent water vapor transmission rate of 2963 ± 10.26 g/m2/day, providing an optimal moist environment locally to promote wound healing. The mupirocin inclusion in the nanopapers was corroborated by the Fourier transform infrared spectroscopy and its crystallinity by X-ray diffraction, and differential scanning calorimetry results. The 100% drug release, was observed at 12 h from optimized MDAC-NP-A with a controlled release pattern. The MDAC-NP showed better antimicrobial activity, against S. aureus (41 mm) than E. coli (25 mm) and P. aeruginosa (17 mm) and was found to be better than marketed ointment. Thus, mupirocin-doped α-cellulose nanopapers emerge as a potential wound dressing for treating primary and secondary skin infections caused by external wounds.

Self-assembled Arginine-Glycine-Aspartic Acid Mimic Peptide Hydrogels as Multifunctional Biomaterials for Wound Healing

Clinical management of nonhealing ulcers requires advanced materials that can enhance wound closure rates without relying on the release of drugs or other growth factors to obviate systemic deleterious side effects. In our previous work, we synthesized an integrin-binding cell adhesive MNH2 {Fmoc-FFβAR(K)βA-NH2 consisting of an RGD mimic, [R(K)], with an amide terminus}, MOH {Fmoc-FFβAR(K)βA-OH consisting of an RGD mimic, [R(K)], with acid terminus}, and MR (Fmoc-FFβARGDβA-NH2 consisting of an RGD peptide, reference) with multifunctional activity. Here, we reported the synthesis, characterization, and performance of a reversed derivative, R-MNH2 (Fmoc-FFβA(K)RβA-NH2 consisting of an RGD mimic, [K(R)], with an amide terminus) of an antimicrobial cell adhesive peptide, MNH2. Both peptides (MNH2 and R-MNH2) were found to interact with αvβ3 integrin, as shown by docking studies; however, they differed in cell adhesive properties, hydrogel formation, and antimicrobial efficacy. Later, the wound healing ability of a series of RGD/RGD peptide mimics (MR, R-MNH2, MNH2, and MOH) was studied in a methicillin-resistant Staphylococcus aureus (MRSA)-infected Balb/c mouse model. All studied peptides showed cell adhesion and wound healing properties; however, only the amide-terminal RGD peptide mimic, MNH2, and its reversed derivative, R-MNH2, showed antimicrobial activity in both in vitro and in vivo studies. Of these, MNH2 showed the highest integrin-mediated spreading, migration, and proliferation of dermal cells in vitro as well as in vivo. Therefore, the MNH2 peptide mimic represents a paradigm shift in the development of dermoconductive strategies to treat chronic wounds.

Wound management, healing, and early prosthetic rehabilitation: Part 2 - A scoping review of physical biomarkers

BACKGROUND

The timely provision of load-bearing prostheses significantly reduces healthcare costs and lowers post-amputation mortality risk. However, current methods for assessing residuum health remain subjective, underscoring the need for standardized, evidence-based approaches incorporating physical biomarkers to evaluate residual limb healing and determine readiness for prosthetic rehabilitation.

OBJECTIVES

This review aimed to identify predictive, diagnostic, and indicative physical biomarkers of healing of the tissues and structures found in the residual limbs of adults with amputation.

METHODOLOGY

A scoping review was conducted following Joanna Briggs Institute (JBI) and PRISMA-ScR guidance. Searches using "biomarkers", "wound healing", and "amputation" were performed on May 6, 2023, on Web of Science, Ovid MEDLINE, Ovid Embase, Scopus, Cochrane, PubMed, and CINAHL databases. Inclusion criteria were: 1) References to physical biomarkers and healing; 2) Residuum tissue healing; 3) Clear methodology with ethical approval; 4) Published from 2017 onwards. Articles were assessed for quality (QualSyst tool) and evidence level (JBI system), and categorized by study, wound, and model type. Physical biomarkers that were repeated not just within categories, but across more than one of the study categories were reported on.

FINDINGS

The search strategy identified 3,306 sources, 157 of which met the inclusion criteria. Histology was the most frequently repeated physical biomarker used in 64 sources, offering crucial diagnostic insights into cellular healing processes. Additional repeated indicative and predictive physical biomarkers, including ankle-brachial index, oxygenation measures, perfusion, and blood pulse and pressure measurements, were reported in 25, 19, 13, and 12 sources, respectively, providing valuable data on tissue oxygenation and vascular health.

CONCLUSION

Ultimately, adopting a multifaceted approach that integrates a diverse array of physical biomarkers (accounting for physiological factors and comorbidities known to influence healing) may substantially enhance our understanding of the healing process and inform the development of effective rehabilitation strategies for individuals undergoing amputation.