Histological patterns in healing chronic wounds using Cochliomyia macellaria (Diptera: Calliphoridae) larvae and other therapeutic measures

Unravelling the potential of insects for medicinal purposes - A comprehensive review

Entomotherapy, the use of insects for medicinal purposes, has been practised for centuries in many countries around the world. More than 2100 edible insect species are eaten by humans, but little is known about the possibility of using these insects as a promising alternative to traditional pharmaceuticals for treating diseases. This review offers a fundamental understanding of the therapeutic applications of insects and how they might be used in medicine. In this review, 235 insect species from 15 orders are reported to be used as medicine. Hymenoptera contains the largest medicinal insect species, followed by Coleoptera, Orthoptera, Lepidoptera, and Blattodea. Scientists have examined and validated the potential uses of insects along with their products and by-products in treating various diseases, and records show that they are primarily used to treat digestive and skin disorders. Insects are known to be rich sources of bioactive compounds, explaining their therapeutic features such as anti-inflammatory, antimicrobial, antiviral, and so on. Challenges associated with the consumption of insects (entomophagy) and their therapeutic uses include regulation barriers and consumer acceptance. Moreover, the overexploitation of medicinal insects in their natural habitat has led to a population crisis, thus necessitating the investigation and development of their mass-rearing procedure. Lastly, this review suggests potential directions for developing insects used in medicine and offers advice for scientists interested in entomotherapy. In future, entomotherapy may become a sustainable and cost-effective solution for treating various ailments and has the potential to revolutionize modern medicine.

A human tissue-based assay identifies a novel carrion blowfly strain for maggot debridement therapy

Maggot debridement therapy (MDT) is a form of therapeutic wound treatment in which live fly larvae are used intentionally to debride necrotic tissues. MDT has been widely used to treat chronic wounds in humans or animals, such as diabetic foot ulcers. Larvae of a carrion blowfly, Lucilia sericata (green bottle fly), debride wounds by consuming necrotic tissue and removing pathogenic bacteria, promoting effective wound healing. Most medical L. sericata strains were initially collected from natural environments using animal meat as bait and reared on artificial protein-rich media or ground meat. It remains to be examined which strain would be more appropriate for MDT, whereas any method for evaluating the fly’s therapeutic potential in humans has not been available. A feeding assay was developed using minced human tissues obtained from surgical waste. To establish L. sericata strains highly eligible for MDT, carrion fly larvae were collected from 45 corpses subjected to forensic autopsy (such as decomposed bodies). Four corpse-derived L. sericata strains were obtained and evaluated using the feeding assay. One strain showed that its feeding activity was 1.4 times higher than the control strain used in conventional MDT. The body length of the adult fly of the corpse-derived strain was longer than the control, which was consistent with the observation that its cell size was enlarged. The human tissue-based assay developed in this study accurately evaluated the ability of fly larvae to debride necrotic wounds. The L. sericata strain newly established from human corpses harboring high feeding activity may offer a clinically significant improvement in MDT.

Safety and efficacy of Lucilia cuprina maggots on treating an induced infected wound in Wistar rats

Infection is one of the main complications that hinder wound healing. Currently, antibiotic-resistant bacteria, such as Methicilin-resistant Staphylococcus aureus (MRSA), are a concern worldwide for both humans and animals. Maggot therapy is re-emerging as an alternative to intractable wounds and may be an option to the traditional antibiotic treatment. Although the species of choice is Lucilia sericata, reports of clinical use have led us to evaluate the efficacy and safety of using Lucilia cuprina larvae on induced infected wounds in Wistar rats. In short, 32 male Wistar rats were divided into 4 groups: Group I - saline solution treated; Group II - antibiotic-treated; Group III - treated with larval debridement, and Group IV - without wound and treatment. Skin wounds were induced in groups I, II and III. All treatments were performed once and held for 48 h. Clinical, microbiological, histopathological, hematological, and biochemical analyses were done. Significant wound area contraction was found (>95%) in group III on day 9 compared to day 15 in group II. Complete elimination (0.0 ± 0.0 CFU/mL) of bioburden was achieved after the second treatment (day 6) in both the II and III groups, compared to an increase in Group I (6.51 ± 0.37 CFU/mL). A cleaner wound was also observed in the histopathological evaluation of group III, with adequate collagen formation and re-epithelialization on day 15. Furthermore, larvae increased blood platelet levels after the first treatment. L. cuprina larvae have proven safe and effective in accelerating wound treatment and eliminating MRSA.

The maggot therapy supply chain: a review of the literature and practice

Maggot therapy (MT) is the clinical application of living fly larvae for the treatment of non-healing wounds and wounds that require debridement. This systematized and expanded literature review is the first study to investigate MT through the conceptual and disciplinary framework of supply chain management. The review of 491 selected academic papers was expanded to include the grey literature and online information resources to construct a first-pass theory of the medicinal maggot supply chain. It shows that the literature to date has focused on isolated discussions of echelon-specific issues such as diet improvement and sterilization protocols in the production echelon, and the relative effectiveness of medicinal maggot application methods in the treatment echelon. There is little knowledge in the public domain regarding the transport and distribution of medicinal maggots, but existing supply chains for vaccines, blood and pathology specimens may provide learning and supply chain integration opportunities. Maggot therapy knowledge across the treatment echelon is generally substantive but there is still insufficient knowledge regarding patients' and health care providers' attitudes toward the therapy, and their experiences of receiving and administering MT. Moreover, there is no research concerned with the humane disposal of medicinal flies during production and after treatment.

In vitro evaluation of the association of medicinal larvae (Insecta, Diptera, Calliphoridae) and topical agents conventionally used for the treatment of wounds

Wound healing is a complex process involving multiple biochemical and cellular events and represents a neglected public health issue. As a consequence, millions of people worldwide suffer from chronic wounds. The search for new treatment alternatives is therefore an important issue. In the context of wound healing, Maggot Debridement Therapy (MDT) is an inexpensive treatment with few contraindications and very promising results. This study aimed to evaluate the in vitro feasibility and implications of larvae (= MDT) use when combined with topical agents as a strategy to identify additive or synergistic combinations. The weight and survival rate of Cochliomyia macellaria (Fabricius) (Insecta, Diptera, Calliphoridae) larvae reared in an in vitro wound with either honey, hydrogel, 10% papain gel, essential fatty acids (EFA), collagenase, or silver sulfadiazine were evaluated after 24, 48 and 72 h. Hydrogel (for weight: 24 and 72 h; for survival: 24 h) and 10% papain gel (for weight: 48 h; for survival: 48 and 72 h) demonstrated the least interference in larval weight gain and survival rate, when compared to the control group. The results obtained in this study showed that the combined use of larvae and hydrogel or 10% papain gel may be promising to maximize the tissue repair. Honey, EFA and collagenase could be used to prepare the bed of the dry wounds to receive the MDT.

First Record of Larval Secretions of Cochliomyia macellaria (Fabricius, 1775) (Diptera: Calliphoridae) Inhibiting the Growth of Staphylococcus aureus and Pseudomonas aeruginosa

Maggot debridement therapy (MDT) consists on the intentional and controlled application of sterilized larvae of the order Diptera on necrotic skin lesions with the purpose of cleaning necrotic tissue and removing pathogenic bacteria. During MDT, a marked antimicrobial activity has been reported in literature specially associated with antibacterial substances from Lucilia sericata (Meigen); however, regarding Cochliomyia macellaria (Fabricius), little is known. This study aimed to evaluate in vitro inhibition of bacterial growth of Pseudomonas aeruginosa and Staphylococcus aureus in contact with excretions and secretions (ES) from C. macellaria larvae. Larval ES were extracted in sterile distilled water and divided in three groups: ES, containing 400 μL of autoclaved ES; ES+BAC, containing 400 μL of autoclaved ES+0.5-μL bacterial inoculum; and CONT-BAC, containing 400 μL of sterile distilled water +0.5 μL of bacterial inoculum. Aliquots of each experimental group were plated by spreading onto Petri dishes. Seedings were made at 0, 1, 2, 4, and 12 h after the extraction of ES. In ES+BAC groups, inhibition of S. aureus was verified between times 1 and 2 h and P. aeruginosa was inhibited between 0 and 4 h. There was no growth observed in any ES group. In the CONT-BAC groups, the number of colonies from time 4 h became countless for S. aureus and decreased for P. aeruginosa. As reported in the literature, we note here that ES have excellent bactericidal activity for both gram-positive and gram-negative bacteria, and this study shows for the first time the action of the bactericidal activity of exosecretions of C. macellaria against S. aureus and P. aeruginosa.

Collagen nanofiber containing silver nanoparticles for improved wound-healing applications

Electrospun nanofibers showing great promise for fabricating nanostructured materials might help to improve the quality of wound care. The present study aimed to investigate the wound-healing potential of collagen nanofiber mats containing silver nanoparticles. Silver nanoparticles (AgNPs) synthesized by the chemical reduction method were incorporated in collagen nanofibers during the electrospinning process. Characterization of electrospun nanofiber mats revealed a mean fiber diameters in the range of 300-700 nm with a sustained release of silver ions shown to follow pseudo-order kinetics. MIC of AgNPs against Staphylococcus aureus and Pseudomonas aeruginosa were evaluated using micro-dilution assay and further antimicrobial activity of fabricated nanofibers was performed. Finally, in vivo studies were performed to demonstrate the wound-healing efficacy of composite nanofibers. In vitro results confirmed the potential antimicrobial efficacy provided by AgNPs and AgNPs composite nanofibers, essential to provide an aseptic environment at the wound site. In vivo study revealed that the rate of wound healing of the composite nanofiber mats was found to be accelerated compared with plain collagen nanofibers. Histology analysis revealed an accelerated re-epithelization, collagen production, and better wound contraction with AgNPs composite collagen nanofibers.

Evaluation of larval density Cochliomyia macellaria F. (Diptera: Calliphoridae) for therapeutic use in the recovery of tegumentar injuries

Larval therapy (LT) is the application of carrion flies (Diptera) sterile larvae on chronic or infected wounds to promote or accelerate the healing process. High cost and the development of resistance by certain groups of pathogenic bacteria to these drugs encouraged the resurgence of LT, currently used in approximately 20 countries and more recently in Brazil. This study evaluated the behavior and larval density of Cochliomyia macellaria F. (Calliphoridae), one of the most appropriate species for debridement of injuries with necrotic tissue. Tegumentar lesions were induced in Wistar rats by subcutaneously application of 0.2 ml of a 1:4 hydrochloric acid and sterile distilled water in the dorsal region. Five experimental groups were set up: (LT 5) treatment with 5 larvae/cm(2); (LT 15) 15 larvae/cm(2); (LT 25) 25 larvae/cm(2); (DEB) mechanical debridement, and (NUL) animals that did not receive any treatment. In the LT groups, larvae used were sterilized with sodium hypochlorite (NaClO) and maintained for 12 h in the lesions. The healing process was assessed qualitatively (macroscopically and microscopically) and quantitatively (time interval to complete healing). It was observed that the immature fed only on necrotic tissue, thus C. macellaria is an excellent candidate for use in LT. There was no significant difference in healing time between experimental groups. However, it was observed that in LT 25, there was greater vascularization in tissues when compared to the other treatments. The mechanisms involved in this process are unknown, but it is evident that the larvae have an important role in modulating the host immune response. It is essential that future applications of larval therapy consider using a higher density of larvae (minimum of 25 larvae/cm(2)) than is currently recommended.