1
|
Ma Y, He C, Gong Y, Qian L, Lu Q, Li J, Zong LJ, Song J, Yin Z, Shen Y. Effects of low-frequency pulsed electrical stimulation at the common peroneal nerve on chronic refractory wounds of the lower limb: A randomized controlled trial. Health Sci Rep 2024; 7:e70023. [PMID: 39253351 PMCID: PMC11381316 DOI: 10.1002/hsr2.70023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/10/2024] [Accepted: 08/13/2024] [Indexed: 09/11/2024] Open
Abstract
Background and aims Electrical stimulation (ES) has been shown to substantially enhance the quality of life by alleviating pain in patients with chronic wounds. This study aimed to observe the effects of low-frequency pulsed wearable ES at the common peroneal nerve on chronic refractory wounds of the lower limb. Methods Forty-eight participants were randomly divided into control group (n = 24) and treatment group (n = 24) in this study. The control group received standard wound care (SWC) exclusively, whereas the treatment group was administered both SWC and the wearable low-frequency ES targeting the common peroneal nerve. Measurements of wound area, pain intensity, wound status, and quality of life scores were systematically recorded both before and after 4 weeks treatment. Results After 4 weeks of intervention, the percentage area reduction was significantly higher in the treatment group compared to the control group (Z = -3.9, p < 0.001), and the healing rate of the treatment group was significantly higher than that of the control group (33% vs. 4%). Moreover, the visual Analog Scale for Pain score (β = -0.65, p = 0.019), the Bates-Jensen Wound Assessment Tool score (p < 0.05), and the questionnaire on quality of life with chronic wounds (Wound-Qol) score (β = -4.23, p = 0.003) were significantly decreased in the patients in the treatment group compared to the control group. Conclusion The wearable low-frequency pulsed ES at the common peroneal nerve for the treatment of chronic refractory wounds showed significant improvement and were far superior compared to SWC. Future research should broaden its scope to include a diverse range of wound types and benefit from collaboration across multiple research centers.
Collapse
Affiliation(s)
- Yu Ma
- Rehabilitation Medicine Center The First Affiliated Hospital of Nanjing Medical University Nanjing China
- Department of Rehabilitation Medicine The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University Suzhou China
| | - Chuan He
- Department of Rehabilitation Medicine The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University Suzhou China
| | - Youhui Gong
- Department of Rehabilitation Medicine The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University Suzhou China
| | - Lifang Qian
- Oncology Center The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University Suzhou China
| | - Qian Lu
- Department of Rehabilitation Medicine The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University Suzhou China
| | - Jinhua Li
- Oncology Center The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University Suzhou China
| | - Li-Juan Zong
- Department of Rehabilitation Medicine Zhongda Hospital of Southeast University Nanjing China
| | - Jie Song
- Rehabilitation Medicine Center The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Zhifei Yin
- Rehabilitation Medicine Center The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Ying Shen
- Rehabilitation Medicine Center The First Affiliated Hospital of Nanjing Medical University Nanjing China
| |
Collapse
|
2
|
George RE, Bay CC, Thornton SM, Knazze JT, Kane NC, Ludwig KA, Donnelly DT, Poore SO, Dingle AM. Can Electrical Stimulation Prevent Recurrence of Keloid Scars? A Scoping Review. Adv Wound Care (New Rochelle) 2024. [PMID: 38888004 DOI: 10.1089/wound.2023.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
Objective: Keloids represent a symptomatic, aberrant healing process that is difficult to treat with high recurrence rates spanning from 55% to 100% if treated via excision without adjuvant therapy. Electrical stimulation (ES) has demonstrated findings that suggest it could reduce the recurrence rate of keloids after resection. Therefore, the aim of this study is to conduct a scoping review to investigate ES as an adjuvant therapy for decreasing keloid recurrence after excision. Approach: A scoping review was performed using PubMed and Web of Science databases. The search strategy encompassed terms linking keloids and various aspects of electrical stimulation. Results: Our search yielded 2,229 articles, of which 115 articles were analyzed as full text and 1 article met inclusion criteria. Despite this, ES has demonstrated other evidence that suggests its utility. ES has been shown to counter keloidic features by reducing mast cell counts, shifting wound composition from M2 to M1 macrophages, promoting angiogenesis, and controlling fibroblast orientation and location. An alternating current will orient fibroblasts perpendicular to the current without unintended migration. Innovation: Our study indicates that, based on a compilation of clinical and preclinical in vitro data, the optimal scenario for ES in the role of keloid treatment is after excision with a biphasic pulsed application and square waveform. Conclusions: ES could serve as a multifaceted, adjuvant treatment after keloid excision, steering the healing process away from keloid-associated characteristics. Its cost-effectiveness means it could be adopted globally, providing a strategy to mitigate the burden of keloids irrespective of other available treatments or economic conditions.
Collapse
Affiliation(s)
- Robert E George
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Caroline C Bay
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sarah M Thornton
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jessieka T Knazze
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nicole C Kane
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kip A Ludwig
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin Institute for Translational Neuroengineering, Madison, Wisconsin, USA
| | - D'Andrea T Donnelly
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Samuel O Poore
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Aaron M Dingle
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
3
|
Tian Y, Jiang F, Xie H, Chi Z, Liu C. Conductive Hyaluronic Acid/Deep Eutectic Solvent Composite Hydrogel as a Wound Dressing for Promoting Skin Burn Healing Under Electrical Stimulation. Adv Healthc Mater 2024; 13:e2304117. [PMID: 38567543 DOI: 10.1002/adhm.202304117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/23/2024] [Indexed: 04/04/2024]
Abstract
Burns can cause severe damage to the skin due to bacterial infection and severe inflammation. Although conductive hydrogels as electroactive burn-wound dressings achieve remarkable effects on accelerating wound healing, issues such as imbalance between their high conductivity and mechanical properties, easy dehydration, and low transparency must be addressed. Herein, a double-network conductive eutectogel is fabricated by integrating polymerizable deep eutectic solvents (PDESs)including acrylamide/choline chloride/glycerol (acrylamide-polymerization crosslink) and thiolated hyaluronic acid (disulfide-bonding crosslink). The introduction of PDESs provides the eutectogel with a conductivity (up to 0.25 S·m-1) and mechanical strength (tensile strain of 59-77%) simulating those of natural human skin, as well as satisfactory tissue adhesiveness, self-healing ability, and antibacterial properties. When combined with exogenous electrical stimulation, the conductive eutectogel exhibits the ability to reduce inflammation, stimulate cell proliferation and migration, promote collagen deposition and angiogenesis, and facilitate skin tissue remodeling. This conductive eutectogel shows great potential as a dressing for healing major burn wounds.
Collapse
Affiliation(s)
- Yu Tian
- College of Marine Life Sciences, Ocean University of China, No. 5 Yushan Road, Qingdao, 266003, China
| | - Fei Jiang
- College of Marine Life Sciences, Ocean University of China, No. 5 Yushan Road, Qingdao, 266003, China
| | - Haijiao Xie
- Hangzhou Yanqu Information Technology Co., Ltd., Hangzhou, 310003, China
| | - Zhe Chi
- College of Marine Life Sciences, Ocean University of China, No. 5 Yushan Road, Qingdao, 266003, China
| | - Chenguang Liu
- College of Marine Life Sciences, Ocean University of China, No. 5 Yushan Road, Qingdao, 266003, China
| |
Collapse
|
4
|
Fan W, Yang X, Hu X, Huang R, Shi H, Liu G. A novel conductive microtubule hydrogel for electrical stimulation of chronic wounds based on biological electrical wires. J Nanobiotechnology 2024; 22:258. [PMID: 38755644 PMCID: PMC11097419 DOI: 10.1186/s12951-024-02524-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/01/2024] [Indexed: 05/18/2024] Open
Abstract
Electrical stimulation (ES) is considered a promising therapy for chronic wounds via conductive dressing. However, the lack of a clinically suitable conductive dressing is a serious challenge. In this study, a suitable conductive biomaterial with favorable biocompatibility and conductivity was screened by means of an inherent structure derived from the body based on electrical conduction in vivo. Ions condensed around the surface of the microtubules (MTs) derived from the cell's cytoskeleton are allowed to flow in the presence of potential differences, effectively forming a network of biological electrical wires, which is essential to the bioelectrical communication of cells. We hypothesized that MT dressing could improve chronic wound healing via the conductivity of MTs applied by ES. We first developed an MT-MAA hydrogel by a double cross-linking method using UV and calcium chloride to improve chronic wound healing by ES. In vitro studies showed good conductivity, mechanical properties, biocompatibility, and biodegradability of the MT-MAA hydrogel, as well as an elevated secretion of growth factors with enhanced cell proliferation and migration ability in response to ES. The in vivo experimental results from a full-thickness diabetic wound model revealed rapid wound closure within 7d in C57BL/6J mice, and the wound bed dressed by the MT-MAA hydrogel was shown to have promoted re-epithelization, enhanced angiogenesis, accelerated nerve growth, limited inflammation phases, and improved antibacterial effect under the ES treatment. These preclinical findings suggest that the MT-MAA hydrogel may be an ideal conductive dressing for chronic wound healing. Furthermore, biomaterials based on MTs may be also promising for treating other diseases.
Collapse
Affiliation(s)
- Weijing Fan
- Department of Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Zhangheng Street, Pu Dong New District, Shanghai, 201203, China
| | - Xiao Yang
- Department of Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Zhangheng Street, Pu Dong New District, Shanghai, 201203, China.
| | - Xiaoming Hu
- Department of Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Zhangheng Street, Pu Dong New District, Shanghai, 201203, China
| | - Renyan Huang
- Department of Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Zhangheng Street, Pu Dong New District, Shanghai, 201203, China
| | - Hongshuo Shi
- Department of Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Zhangheng Street, Pu Dong New District, Shanghai, 201203, China.
| | - Guobin Liu
- Department of Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Zhangheng Street, Pu Dong New District, Shanghai, 201203, China.
| |
Collapse
|
5
|
Hu Y, Wang Y, Yang F, Liu D, Lu G, Li S, Wei Z, Shen X, Jiang Z, Zhao Y, Pang Q, Song B, Shi Z, Shafique S, Zhou K, Chen X, Su W, Jian J, Tang K, Liu T, Zhu Y. Flexible Organic Photovoltaic-Powered Hydrogel Bioelectronic Dressing With Biomimetic Electrical Stimulation for Healing Infected Diabetic Wounds. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307746. [PMID: 38145346 PMCID: PMC10933690 DOI: 10.1002/advs.202307746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/28/2023] [Indexed: 12/26/2023]
Abstract
Electrical stimulation (ES) is proposed as a therapeutic solution for managing chronic wounds. However, its widespread clinical adoption is limited by the requirement of additional extracorporeal devices to power ES-based wound dressings. In this study, a novel sandwich-structured photovoltaic microcurrent hydrogel dressing (PMH dressing) is designed for treating diabetic wounds. This innovative dressing comprises flexible organic photovoltaic (OPV) cells, a flexible micro-electro-mechanical systems (MEMS) electrode, and a multifunctional hydrogel serving as an electrode-tissue interface. The PMH dressing is engineered to administer ES, mimicking the physiological injury current occurring naturally in wounds when exposed to light; thus, facilitating wound healing. In vitro experiments are performed to validate the PMH dressing's exceptional biocompatibility and robust antibacterial properties. In vivo experiments and proteomic analysis reveal that the proposed PMH dressing significantly accelerates the healing of infected diabetic wounds by enhancing extracellular matrix regeneration, eliminating bacteria, regulating inflammatory responses, and modulating vascular functions. Therefore, the PMH dressing is a potent, versatile, and effective solution for diabetic wound care, paving the way for advancements in wireless ES wound dressings.
Collapse
Affiliation(s)
- Yi‐Wei Hu
- Health Science CenterNingbo UniversityNingbo315211P. R. China
- Orthopaedic Oncology Center of Changzheng HospitalNaval Medical UniversityShanghai200003P. R. China
| | - Yu‐Heng Wang
- Faculty of Electrical Engineering and Computer ScienceNingbo UniversityNingbo315211P. R. China
- State Key Laboratory of Electrical Insulation and Power EquipmentXi'an Jiaotong UniversityXi'an710049P. R. China
- CAS Key Laboratory of Nanosystem and Hierarchical FabricationNational Center for Nanoscience and TechnologyUniversity of Chinese Academy of SciencesBeijing100049P. R. China
| | - Fang Yang
- Health Science CenterNingbo UniversityNingbo315211P. R. China
| | - Ding‐Xin Liu
- State Key Laboratory of Electrical Insulation and Power EquipmentXi'an Jiaotong UniversityXi'an710049P. R. China
| | - Guang‐Hao Lu
- State Key Laboratory of Electrical Insulation and Power EquipmentXi'an Jiaotong UniversityXi'an710049P. R. China
| | - Sheng‐Tao Li
- State Key Laboratory of Electrical Insulation and Power EquipmentXi'an Jiaotong UniversityXi'an710049P. R. China
| | - Zhi‐Xiang Wei
- CAS Key Laboratory of Nanosystem and Hierarchical FabricationNational Center for Nanoscience and TechnologyUniversity of Chinese Academy of SciencesBeijing100049P. R. China
| | - Xiang Shen
- The Research Institute of Advanced TechnologiesNingbo UniversityNingbo315211P. R. China
| | - Zhuang‐De Jiang
- State Key Laboratory for Manufacturing Systems EngineeringXi'an Jiaotong UniversityXi'an710049P. R. China
| | - Yi‐Fan Zhao
- State Key Laboratory for Manufacturing Systems EngineeringXi'an Jiaotong UniversityXi'an710049P. R. China
| | - Qian Pang
- Health Science CenterNingbo UniversityNingbo315211P. R. China
| | - Bai‐Yang Song
- Health Science CenterNingbo UniversityNingbo315211P. R. China
| | - Ze‐Wen Shi
- Health Science CenterNingbo UniversityNingbo315211P. R. China
| | - Shareen Shafique
- School of Physical Science and TechnologyNingbo UniversityNingbo315211P. R. China
| | - Kun Zhou
- Shenzhen Institute of Aggregate Science and TechnologyThe Chinese University of Hong Kong ShenzhenShenzhen518172P. R. China
| | - Xiao‐Lian Chen
- Printable Electronics Research Center & Nano‐Device and Materials DivisionSuzhou Institute of Nano‐Tech and Nano‐BionicsNano Chinese Academy of SciencesSuzhou215123P. R. China
| | - Wen‐Ming Su
- Printable Electronics Research Center & Nano‐Device and Materials DivisionSuzhou Institute of Nano‐Tech and Nano‐BionicsNano Chinese Academy of SciencesSuzhou215123P. R. China
| | - Jia‐Wen Jian
- Faculty of Electrical Engineering and Computer ScienceNingbo UniversityNingbo315211P. R. China
| | - Ke‐Qi Tang
- Institute of Mass SpectrometrySchool of Material Science and Chemical EngineeringNingbo UniversityNingbo315211P. R. China
| | - Tie‐Long Liu
- Orthopaedic Oncology Center of Changzheng HospitalNaval Medical UniversityShanghai200003P. R. China
| | - Ya‐Bin Zhu
- Health Science CenterNingbo UniversityNingbo315211P. R. China
| |
Collapse
|
6
|
Babaluei M, Mojarab Y, Mottaghitalab F, Saeb MR, Farokhi M. Conductive hydrogels based on tragacanth and silk fibroin containing dopamine functionalized carboxyl-capped aniline pentamer: Merging hemostasis, antibacterial, and anti-oxidant properties into a multifunctional hydrogel for burn wound healing. Int J Biol Macromol 2024; 261:129932. [PMID: 38309399 DOI: 10.1016/j.ijbiomac.2024.129932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 02/05/2024]
Abstract
Hydrogels possessing both conductive characteristics and notable antibacterial and antioxidant properties hold considerable significance within the realm of wound healing and recovery. The object of current study is the development of conductive hydrogels with antibacterial and antioxidant properties, emphasizing their potential for effective wound healing, especially in treating third-degree burns. For this purpose, various conductive hydrogels are developed based on tragacanth and silk fibroin, with variable dopamine functionalized carboxyl-capped aniline pentamer (CAP@DA). The FTIR analysis confirms that the CAP powder was successfully synthesized and modified with DA. The results show that the incorporation of CAP@DA into hydrogels can increase the porosity and swellability of the hydrogels. Additionally, the mechanical and viscoelastic properties of the hydrogels are also improved. The release of vancomycin from the hydrogels is sustained over time, and the hydrogels are effective in inhibiting the growth of Methicillin-resistant Staphylococcus aureus (MRSA). In vitro cell studies of the hydrogels show that all hydrogels are biocompatible and support cell attachment. The hydrogels' tissue adhesiveness yielded a satisfactory hemostatic outcome in a rat-liver injury model. The third-degree burn was created on the dorsal back paravertebral region of the rats and then grafted with hydrogels. The burn was monitored for 3, 7, and 14 days to evaluate the efficacy of the hydrogel in promoting wound healing. The hydrogels revealed treatment effect, resulting in enhancements in wound closure, dermal collagen matrix production, new blood formation, and anti-inflammatory properties. Better results were obtained for hydrogel with increasing CAP@DA. In summary, the multifunctional conducive hydrogel, featuring potent antibacterial properties, markedly facilitated the wound regeneration process.
Collapse
Affiliation(s)
| | - Yasamin Mojarab
- National Cell Bank of Iran, Pasteur Institute of Iran, Tehran, Iran
| | - Fatemeh Mottaghitalab
- Nanotechnology Research Centre, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Saeb
- Department of Pharmaceutical Technology, Medical University of Gdańsk, J. Hallera 107, 80-416 Gdańsk, Poland
| | - Mehdi Farokhi
- National Cell Bank of Iran, Pasteur Institute of Iran, Tehran, Iran.
| |
Collapse
|
7
|
Cao J, Wu B, Yuan P, Liu Y, Hu C. Rational Design of Multifunctional Hydrogels for Wound Repair. J Funct Biomater 2023; 14:553. [PMID: 37998122 PMCID: PMC10672203 DOI: 10.3390/jfb14110553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
The intricate microenvironment at the wound site, coupled with the multi-phase nature of the healing process, pose significant challenges to the development of wound repair treatments. In recent years, applying the distinctive benefits of hydrogels to the development of wound repair strategies has yielded some promising results. Multifunctional hydrogels, by meeting the different requirements of wound healing stages, have greatly improved the healing effectiveness of chronic wounds, offering immense potential in wound repair applications. This review summarized the recent research and applications of multifunctional hydrogels in wound repair. The focus was placed on the research progress of diverse multifunctional hydrogels, and their mechanisms of action at different stages of wound repair were discussed in detail. Through a comprehensive analysis, we found that multifunctional hydrogels play an indispensable role in the process of wound repair by providing a moist environment, controlling inflammation, promoting angiogenesis, and effectively preventing infection. However, further implementation of multifunctional hydrogel-based therapeutic strategies also faces various challenges, such as the contradiction between the complexity of multifunctionality and the simplicity required for clinical translation and application. In the future, we should work to address these challenges, further optimize the design and preparation of multifunctional hydrogels, enhance their effectiveness in wound repair, and promote their widespread application in clinical practice.
Collapse
Affiliation(s)
- Juan Cao
- School of Fashion and Design Art, Sichuan Normal University, Chengdu 610066, China;
| | - Bo Wu
- School of Mechanical Engineering, Sichuan University, Chengdu 610065, China; (B.W.); (Y.L.)
| | - Ping Yuan
- School of Mechanical Engineering, Chengdu University, Chengdu 610106, China;
| | - Yeqi Liu
- School of Mechanical Engineering, Sichuan University, Chengdu 610065, China; (B.W.); (Y.L.)
| | - Cheng Hu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610065, China
| |
Collapse
|
8
|
Borges D, Pires R, Ferreira J, Dias-Neto M. The effect of wound electrical stimulation in venous leg ulcer healing-a systematic review. J Vasc Surg Venous Lymphat Disord 2023; 11:1070-1079.e1. [PMID: 37196922 DOI: 10.1016/j.jvsv.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE The benefit of using electric stimulation therapy (EST) to heal venous leg ulcers (VLUs) is not well established. The main aim of this systematic review was to evaluate the effects of ulcer EST in VLU healing. METHODS A systematic search of the literature was conducted using the databases PubMed, Scopus, and Web of Science and included original studies that reported VLU healing after EST. The inclusion criteria were at least two surface electrodes placed on or near the wound or a planar probe covering the ulcer area to be treated. The Cochrane risk of bias tool for randomized control trials (RCTs) and Joanna Briggs Institute critical appraisal checklist for case series were used to evaluate the risk of bias. RESULTS This review included eight RCTs and three case series involving a total of 724 limbs in 716 patients with VLUs. The mean patient age was 64.2 years (95% confidence interval, 62.3-66.2), and 46.2% (95% confidence interval, 41.2%-50.4%) were men. The active electrode was placed on the wound with the passive electrode placed on healthy skin (n = 6), the two electrodes were placed on either side of the wound edges (n = 4), or a planar probe was used (n = 1). The pulsed current was the most used waveform (n = 9). The change in the ulcer size was the main method used to determine ulcer healing (n = 8), followed by the ulcer healing rate (n = 6), exudate levels (n = 4), and the time to healing (n = 3). Five RCTs detected a statistically significant improvement in at least one VLU healing outcome, after EST compared with the control group. In two of these, EST was better than the control but only for patients who had not undergone surgical treatment of VLU. CONCLUSIONS The findings from the present systematic review support the use of EST to accelerate wound healing of VLUs, especially for patients who are not surgical candidates. However, the significant variation in electric stimulation protocols represents an important limitation to its use and should be addressed in future studies.
Collapse
Affiliation(s)
- Daniela Borges
- Faculdade de Medicina da Universidade do Porto, University of Porto, Porto, Portugal.
| | - Raquel Pires
- Escola Superior de Biotecnologia, Universidade Católica do Porto, Porto, Portugal
| | - Joana Ferreira
- Department of Angiology and Vascular Surgery, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Marina Dias-Neto
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| |
Collapse
|
9
|
Evans JP, Sen CK. Electrochemical Devices in Cutaneous Wound Healing. Bioengineering (Basel) 2023; 10:711. [PMID: 37370642 PMCID: PMC10295280 DOI: 10.3390/bioengineering10060711] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
In healthy skin, vectorial ion transport gives rise to a transepithelial potential which directly impacts many physiological aspects of skin function. A wound is a physical defect that breaches the epithelial barrier and changes the electrochemical environment of skin. Electroceutical dressings are devices that manipulate the electrochemical environment, host as well as microbial, of a wound. In this review, electroceuticals are organized into three mechanistic classes: ionic, wireless, and battery powered. All three classes of electroceutical dressing show encouraging effects on infection management and wound healing with evidence of favorable impact on keratinocyte migration and disruption of wound biofilm infection. This foundation sets the stage for further mechanistic as well as interventional studies. Successful conduct of such studies will determine the best dosage, timing, and class of stimulus necessary to maximize therapeutic efficacy.
Collapse
Affiliation(s)
| | - Chandan K. Sen
- Indiana Center for Regenerative Medicine & Engineering, Indiana University Health Comprehensive Wound Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| |
Collapse
|
10
|
Liang Y, Qiao L, Qiao B, Guo B. Conductive hydrogels for tissue repair. Chem Sci 2023; 14:3091-3116. [PMID: 36970088 PMCID: PMC10034154 DOI: 10.1039/d3sc00145h] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/20/2023] [Indexed: 02/23/2023] Open
Abstract
Conductive hydrogels (CHs) combine the biomimetic properties of hydrogels with the physiological and electrochemical properties of conductive materials, and have attracted extensive attention in the past few years. In addition, CHs have high conductivity and electrochemical redox properties and can be used to detect electrical signals generated in biological systems and conduct electrical stimulation to regulate the activities and functions of cells including cell migration, cell proliferation, and cell differentiation. These properties give CHs unique advantages in tissue repair. However, the current review of CHs is mostly focused on their applications as biosensors. Therefore, this article reviewed the new progress of CHs in tissue repair including nerve tissue regeneration, muscle tissue regeneration, skin tissue regeneration and bone tissue regeneration in the past five years. We first introduced the design and synthesis of different types of CHs such as carbon-based CHs, conductive polymer-based CHs, metal-based CHs, ionic CHs, and composite CHs, and the types and mechanisms of tissue repair promoted by CHs including anti-bacterial, antioxidant and anti-inflammatory properties, stimulus response and intelligent delivery, real-time monitoring, and promoted cell proliferation and tissue repair related pathway activation, which provides a useful reference for further preparation of bio-safer and more efficient CHs used in tissue regeneration.
Collapse
Affiliation(s)
- Yongping Liang
- State Key Laboratory for Mechanical Behavior of Materials, and Frontier Institute of Science and Technology, Xi'an Jiaotong University Xi'an 710049 China +86-29-83395131 +86-29-83395340
| | - Lipeng Qiao
- State Key Laboratory for Mechanical Behavior of Materials, and Frontier Institute of Science and Technology, Xi'an Jiaotong University Xi'an 710049 China +86-29-83395131 +86-29-83395340
| | - Bowen Qiao
- State Key Laboratory for Mechanical Behavior of Materials, and Frontier Institute of Science and Technology, Xi'an Jiaotong University Xi'an 710049 China +86-29-83395131 +86-29-83395340
| | - Baolin Guo
- State Key Laboratory for Mechanical Behavior of Materials, and Frontier Institute of Science and Technology, Xi'an Jiaotong University Xi'an 710049 China +86-29-83395131 +86-29-83395340
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University Xi'an 710049 China
| |
Collapse
|
11
|
Bacterial Motility and Its Role in Skin and Wound Infections. Int J Mol Sci 2023; 24:ijms24021707. [PMID: 36675220 PMCID: PMC9864740 DOI: 10.3390/ijms24021707] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Skin and wound infections are serious medical problems, and the diversity of bacteria makes such infections difficult to treat. Bacteria possess many virulence factors, among which motility plays a key role in skin infections. This feature allows for movement over the skin surface and relocation into the wound. The aim of this paper is to review the type of bacterial movement and to indicate the underlying mechanisms than can serve as a target for developing or modifying antibacterial therapies applied in wound infection treatment. Five types of bacterial movement are distinguished: appendage-dependent (swimming, swarming, and twitching) and appendage-independent (gliding and sliding). All of them allow bacteria to relocate and aid bacteria during infection. Swimming motility allows bacteria to spread from 'persister cells' in biofilm microcolonies and colonise other tissues. Twitching motility enables bacteria to press through the tissues during infection, whereas sliding motility allows cocci (defined as non-motile) to migrate over surfaces. Bacteria during swarming display greater resistance to antimicrobials. Molecular motors generating the focal adhesion complexes in the bacterial cell leaflet generate a 'wave', which pushes bacterial cells lacking appendages, thereby enabling movement. Here, we present the five main types of bacterial motility, their molecular mechanisms, and examples of bacteria that utilise them. Bacterial migration mechanisms can be considered not only as a virulence factor but also as a target for antibacterial therapy.
Collapse
|
12
|
Zulbaran-Rojas A, Park C, El-Refaei N, Lepow B, Najafi B. Home-Based Electrical Stimulation to Accelerate Wound Healing-A Double-Blinded Randomized Control Trial. J Diabetes Sci Technol 2023; 17:15-24. [PMID: 34328024 PMCID: PMC9846397 DOI: 10.1177/19322968211035128] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Electrical stimulation (E-Stim) may offer a unique adjunctive treatment to heal complicated diabetic foot ulcers (DFU). Our primary goal is to examine the effectiveness of daily home-based E-Stim therapy to speed-up wound healing. METHODS Patients with chronic DFUs and mild to severe peripheral arterial disease (PAD) were recruited and randomized to either control (CG) or intervention (IG) groups. The IG received 1-hour home-based E-Stim therapy on daily basis for 4 weeks (4W). E-Stim was delivered through electrical pads placed above the ankle joint using a bio-electric stimulation technology (BEST®) platform (Tennant Biomodulator® PRO). The CG was provided with an identical but non-functional device for the same period. The primary outcome included wound area reduction at 4W from baseline (BL). RESULTS Thirty-eight patients were recruited and 5 were removed due to non-compliance or infection, leaving 33 participants (IG, n = 16; CG, n =17). At 4W, the IG showed a significant wound area reduction of 22% (BL: 7.4 ± 8.5 cm2 vs 4W: 5.8 ± 8.0 cm2, P = 0.002). Average of wound area was unchanged in the CG (P = 0.982). The self-report adherence to daily home-therapy was 93.9%. CONCLUSIONS Daily home-based E-Stim provides early results on the feasibility, acceptability, and effectiveness of E-Stim as an adjunctive therapy to speed up wound healings in patients with chronic DFU and mild to severe PAD.
Collapse
Affiliation(s)
- Alejandro Zulbaran-Rojas
- Michael E. DeBakey Department of
Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP),
Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine,
Houston, TX, USA
| | - Catherine Park
- Michael E. DeBakey Department of
Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP),
Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine,
Houston, TX, USA
| | - Nesreen El-Refaei
- Michael E. DeBakey Department of
Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP),
Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine,
Houston, TX, USA
| | - Brian Lepow
- Michael E. DeBakey Department of
Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP),
Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine,
Houston, TX, USA
| | - Bijan Najafi
- Michael E. DeBakey Department of
Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP),
Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine,
Houston, TX, USA
- Bijan Najafi, PhD, MSc, Michael E. DeBakey
Department of Surgery, Interdisciplinary Consortium on Advanced Motion
Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy,
Baylor College of Medicine, 7200 Cambridge St., Houston, TX 77030, USA.
| |
Collapse
|
13
|
Pharmacodynamics of Dracorhodin Perchlorate and Its Inflammation-Targeting Emulsion Gel for Wound Healing. Gels 2022; 8:gels8110712. [DOI: 10.3390/gels8110712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
The mechanism of dracorhodin perchlorate for the repair of rat skin wounds was investigated. In order to screen a more favorable drug delivery system for wound repair, the therapeutic effect of dracorhodin perchlorate inflammation-targeted emulsion gel was compared with that of non-targeted emulsion gel on rat wounds. Compared with non-targeted emulsion gels, inflammation-targeted emulsion gels had a better transdermal penetration and lower potentials (−51.6 mV and −17.1 mV, respectively). The recovery of the wound from the dracorhodin perchlorate inflammation targeted emulsion gel group was better than that of the dracorhodin perchlorate inflammation non-targeted emulsion gel group and the positive drug group. Compared with the no-target emulsion gel group, the bFGF expression on day 7 and the EGF expression on day 14 in the targeted emulsion group showed 45.5% and 49.9% improvement, respectively. Pathological tissue slices showed that the epidermis, dermis, and basal layer inflammatory cells in the inflammation-targeted emulsion gel group and non-targeted emulsion gel group were significantly reduced, the granulation tissue proliferation was obvious, and the inflammation-targeted emulsion gel group was more effective. The results proved that dracorhodin perchlorate had a repairing effect on rat skin wounds, and its mechanism might be related to the promotion of the expression of EGF and bFGF in tissues.
Collapse
|
14
|
Innovative Treatment Strategies to Accelerate Wound Healing: Trajectory and Recent Advancements. Cells 2022; 11:cells11152439. [PMID: 35954282 PMCID: PMC9367945 DOI: 10.3390/cells11152439] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/26/2022] Open
Abstract
Wound healing is highly specialized dynamic multiple phase process for the repair of damaged/injured tissues through an intricate mechanism. Any failure in the normal wound healing process results in abnormal scar formation, and chronic state which is more susceptible to infections. Chronic wounds affect patients’ quality of life along with increased morbidity and mortality and are huge financial burden to healthcare systems worldwide, and thus requires specialized biomedical intensive treatment for its management. The clinical assessment and management of chronic wounds remains challenging despite the development of various therapeutic regimens owing to its painstakingly long-term treatment requirement and complex wound healing mechanism. Various conventional approaches such as cell therapy, gene therapy, growth factor delivery, wound dressings, and skin grafts etc., are being utilized for promoting wound healing in different types of wounds. However, all these abovementioned therapies are not satisfactory for all wound types, therefore, there is an urgent demand for the development of competitive therapies. Therefore, there is a pertinent requirement to develop newer and innovative treatment modalities for multipart therapeutic regimens for chronic wounds. Recent developments in advanced wound care technology includes nanotherapeutics, stem cells therapy, bioengineered skin grafts, and 3D bioprinting-based strategies for improving therapeutic outcomes with a focus on skin regeneration with minimal side effects. The main objective of this review is to provide an updated overview of progress in therapeutic options in chronic wounds healing and management over the years using next generation innovative approaches. Herein, we have discussed the skin function and anatomy, wounds and wound healing processes, followed by conventional treatment modalities for wound healing and skin regeneration. Furthermore, various emerging and innovative strategies for promoting quality wound healing such as nanotherapeutics, stem cells therapy, 3D bioprinted skin, extracellular matrix-based approaches, platelet-rich plasma-based approaches, and cold plasma treatment therapy have been discussed with their benefits and shortcomings. Finally, challenges of these innovative strategies are reviewed with a note on future prospects.
Collapse
|
15
|
A machine learning based model accurately predicts cellular response to electric fields in multiple cell types. Sci Rep 2022; 12:9912. [PMID: 35705588 PMCID: PMC9200721 DOI: 10.1038/s41598-022-13925-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022] Open
Abstract
Many cell types migrate in response to naturally generated electric fields. Furthermore, it has been suggested that the external application of an electric field may be used to intervene in and optimize natural processes such as wound healing. Precise cell guidance suitable for such optimization may rely on predictive models of cell migration, which do not generalize. Here, we present a machine learning model that can forecast directedness of cell migration given a timeseries of previous directedness and electric field values. This model is trained using time series galvanotaxis data of mammalian cranial neural crest cells obtained through time-lapse microscopy of cells cultured at 37 °C in a galvanotaxis chamber at ambient pressure. Next, we show that our modeling approach can be used for a variety of cell types and experimental conditions with very limited training data using transfer learning methods. We adapt the model to predict cell behavior for keratocytes (room temperature, ~ 18–20 °C) and keratinocytes (37 °C) under similar experimental conditions with a small dataset (~ 2–5 cells). Finally, this model can be used to perform in silico studies by simulating cell migration lines under time-varying and unseen electric fields. We demonstrate this by simulating feedback control on cell migration using a proportional–integral–derivative (PID) controller. This data-driven approach provides predictive models of cell migration that may be suitable for designing electric field based cellular control mechanisms for applications in precision medicine such as wound healing.
Collapse
|
16
|
Flexible patch with printable and antibacterial conductive hydrogel electrodes for accelerated wound healing. Biomaterials 2022; 285:121479. [DOI: 10.1016/j.biomaterials.2022.121479] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 02/08/2023]
|
17
|
Melotto G, Tunprasert T, Forss JR. The effects of electrical stimulation on diabetic ulcers of foot and lower limb: A systematic review. Int Wound J 2022; 19:1911-1933. [PMID: 35112496 DOI: 10.1111/iwj.13762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/13/2022] [Indexed: 01/04/2023] Open
Abstract
Diabetic foot ulcer (DFU) is a life-threatening condition affecting a third of diabetic patients. Many adjuvant therapies aimed at improving the healing rate (HR) and accelerating healing time are currently under investigation. Electrical stimulation (ES) is a physical-based therapy able to increase cells activity and migration into wound bed as well as inhibiting bacterial activity. The aim of this paper was to collect and analyse findings on the effects of ES used in combination with standard wound care (SWC) in the treatment of diabetic foot ulceration compared with SWC alone. A systematic review was performed to synthesise data from quantitative studies from eight databases. Article quality was assessed using the Crowe critical appraisal tool. Seven articles out of 560 publications met the inclusion criteria. A meta-analysis was not performed due to the heterogeneity of the studies and the results were narratively synthetised. Findings showed that HR appears to be higher among diabetic ulcers treated with ES; however, the reliability of these findings is affected by the small sample sizes of the studies. Furthermore, four studies are considered as moderate or high risk of bias. The evidence to suggest the systematic usage of ES in the treatment of DFUs is still insufficient.
Collapse
Affiliation(s)
- Gianluca Melotto
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | | | | |
Collapse
|
18
|
Edwick DO, Hince DA, Rawlins JM, Wood FM, Edgar DW. Does electrical stimulation improve healing in acute minor burn injury, as measured by bioimpedance spectroscopy? A single center, randomized, controlled trial. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
19
|
Zulbaran-Rojas A, Park C, Lepow B, Najafi B. Effectiveness of Lower-Extremity Electrical Stimulation to Improve Skin Perfusion. J Am Podiatr Med Assoc 2021; 111. [PMID: 33656524 DOI: 10.7547/20-172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although numerous studies suggest the benefit of electrical stimulation (E-Stim) therapy to accelerate wound healing, the underlying mechanism of action is still debated. In this pilot study, we examined the potential effectiveness of lower-extremity E-Stim therapy to improve tissue perfusion in patients with diabetic foot ulcers. METHODS Thirty-eight patients with diabetic foot ulcers underwent 60 min of active E-Stim therapy on acupuncture points above the level of the ankle joint using a bioelectric stimulation technology platform. Perfusion changes in response to E-Stim were assessed by measuring skin perfusion pressure (SPP) at baseline and during 30 and 60 min of therapy; retention was assessed 10 min after therapy. Tissue oxygen saturation (SatO2) was measured using a noninvasive near-infrared camera. RESULTS Skin perfusion pressure increased in response to E-Stim therapy (P = .02), with maximum improvement observed at 60 min (11%; P = .007) compared with baseline; SPP reduced 10 min after therapy but remained higher than baseline (9%; P = .1). Magnitude of improvement at 60 min was negatively correlated with baseline SPP values (r = -0.45; P = .01), suggesting that those with lower perfusion could benefit more from E-Stim therapy. Similar trends were observed for SatO2, with statistically significant improvement for a subsample (n = 16) with moderate-to-severe peripheral artery disease. CONCLUSIONS This study provides early results on the feasibility and effectiveness of E-Stim therapy to improve skin perfusion and SatO2. The magnitude of benefit is higher in those with poorer skin perfusion. Also, the effects of E-Stim could be washed out after stopping therapy, and regular daily application might be required for effective benefit in wound healing.
Collapse
|
20
|
Yu R, Zhang H, Guo B. Conductive Biomaterials as Bioactive Wound Dressing for Wound Healing and Skin Tissue Engineering. NANO-MICRO LETTERS 2021; 14:1. [PMID: 34859323 PMCID: PMC8639891 DOI: 10.1007/s40820-021-00751-y] [Citation(s) in RCA: 239] [Impact Index Per Article: 79.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/29/2021] [Indexed: 05/06/2023]
Abstract
Conductive biomaterials based on conductive polymers, carbon nanomaterials, or conductive inorganic nanomaterials demonstrate great potential in wound healing and skin tissue engineering, owing to the similar conductivity to human skin, good antioxidant and antibacterial activities, electrically controlled drug delivery, and photothermal effect. However, a review highlights the design and application of conductive biomaterials for wound healing and skin tissue engineering is lacking. In this review, the design and fabrication methods of conductive biomaterials with various structural forms including film, nanofiber, membrane, hydrogel, sponge, foam, and acellular dermal matrix for applications in wound healing and skin tissue engineering and the corresponding mechanism in promoting the healing process were summarized. The approaches that conductive biomaterials realize their great value in healing wounds via three main strategies (electrotherapy, wound dressing, and wound assessment) were reviewed. The application of conductive biomaterials as wound dressing when facing different wounds including acute wound and chronic wound (infected wound and diabetic wound) and for wound monitoring is discussed in detail. The challenges and perspectives in designing and developing multifunctional conductive biomaterials are proposed as well.
Collapse
Affiliation(s)
- Rui Yu
- State Key Laboratory for Mechanical Behavior of Materials, and Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Hualei Zhang
- State Key Laboratory for Mechanical Behavior of Materials, and Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Baolin Guo
- State Key Laboratory for Mechanical Behavior of Materials, and Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.
| |
Collapse
|
21
|
Zajdel TJ, Shim G, Cohen DJ. Come together: On-chip bioelectric wound closure. Biosens Bioelectron 2021; 192:113479. [PMID: 34265520 PMCID: PMC8453109 DOI: 10.1016/j.bios.2021.113479] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/16/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023]
Abstract
There is a growing interest in bioelectric wound treatment and electrotaxis, the process by which cells detect an electric field and orient their migration along its direction, has emerged as a potential cornerstone of the endogenous wound healing response. Despite recognition of the importance of electrotaxis in wound healing, no experimental demonstration to date has shown that the actual closing of a wound can be accelerated solely by the electrotaxis response itself, and in vivo systems are too complex to resolve cell migration from other healing stages such as proliferation and inflammation. This uncertainty has led to a lack of standardization between stimulation methods, model systems, and electrode technology required for device development. In this paper, we present a 'healing-on-chip' approach that is a standardized, low-cost, model for investigating electrically accelerated wound healing. Our device provides a biomimetic convergent field geometry that more closely resembles actual wound fields. We validate this device by using electrical stimulation to close a 1.5 mm gap between two large (30 mm2) layers of primary skin keratinocyte to completely heal the gap twice as quickly as in an unstimulated tissue. This demonstration proves that convergent electrotaxis is both possible and can accelerate healing and offers an accessible 'healing-on-a-chip' platform to explore future bioelectric interfaces.
Collapse
Affiliation(s)
- Tom J Zajdel
- Mechanical & Aerospace Engineering, Princeton University, 08544, Princeton, NJ, United States
| | - Gawoon Shim
- Mechanical & Aerospace Engineering, Princeton University, 08544, Princeton, NJ, United States
| | - Daniel J Cohen
- Mechanical & Aerospace Engineering, Princeton University, 08544, Princeton, NJ, United States.
| |
Collapse
|
22
|
Bosanquet DC, Harding KG. Wound healing: potential therapeutic options. Br J Dermatol 2021; 187:149-158. [PMID: 34726774 DOI: 10.1111/bjd.20772] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 12/22/2022]
Abstract
This review highlights the range of therapeutic options available to clinicians treating difficult-to-heal wounds. While certain treatments are established in daily clinical practice, most therapeutic interventions lack robust and rigorous data regarding their efficacy, which would help to determine when, and for whom, they should be used. The purpose of this review is to give a broad overview of the available interventions, with a brief summary of the evidence base for each intervention.
Collapse
Affiliation(s)
- D C Bosanquet
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Cardiff Road, Newport, NP16 2UB, UK
| | - K G Harding
- Clinical Innovation Hub, Cardiff University, Cardiff, CF14 4XN, UK.,Skin Research Institute Singapore (SRIS), Singapore
| |
Collapse
|
23
|
Wang Y, Jia Y, Ren H, Lao C, Peng W, Feng B, Wang J. A mechanical, electrical dual autonomous self-healing multifunctional composite hydrogel. Mater Today Bio 2021; 12:100138. [PMID: 34611622 PMCID: PMC8476776 DOI: 10.1016/j.mtbio.2021.100138] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 01/08/2023] Open
Abstract
The versatile properties make hydrogels a potential multipurpose material that finds wide applications. However, the preparation of multipurpose hydrogels is very challenging. Here, we report a method based on free radical reaction and composite mechanisms to prepare mechanical and electrical self-healing multifunctional hydrogels. In this study, the introduction of imidazolium salt ionic liquids and glycerol in the hydrogel system endows the gels with good antibacterial, conductive, and adhesive properties and excellent antifreeze properties. The testing results show that the as-prepared hydrogel has stable mechanical and electrical properties even under the extremely cold condition of -50°C after self-healing. Moreover, the active esters formed in the dynamic radical reaction have better reducibility, thus further investing the as-prepared hydrogel with high antioxidant activity. The application results show that these comprehensive properties make such hydrogel system very useful in wound repair and wearable strain sensors.
Collapse
Affiliation(s)
- Y. Wang
- Key Laboratory of Advanced Technologies of materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Y. Jia
- Key Laboratory of Advanced Technologies of materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
- Department of Electromechanical Engineering, Sichuan Engineering Technical College, Deyang, Sichuan, 618000, China
| | - H. Ren
- Key Laboratory of Advanced Technologies of materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - C. Lao
- Key Laboratory of Advanced Technologies of materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - W. Peng
- Department of Biochemistry and Molecular Biology, College of Basic and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - B. Feng
- Key Laboratory of Advanced Technologies of materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - J. Wang
- Key Laboratory of Advanced Technologies of materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| |
Collapse
|
24
|
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the basics of biofilm infection and be able to distinguish between planktonic and biofilm modes of growth. 2. Have a working knowledge of conventional and emerging antibiofilm therapies and their modes of action as they pertain to wound care. 3. Understand the challenges associated with testing and marketing antibiofilm strategies and the context within which these strategies may have effective value. SUMMARY The Centers for Disease Control and Prevention estimate for human infectious diseases caused by bacteria with a biofilm phenotype is 65 percent and the National Institutes of Health estimate is closer to 80 percent. Biofilms are hostile microbial aggregates because, within their polymeric matrix cocoons, they are protected from antimicrobial therapy and attack from host defenses. Biofilm-infected wounds, even when closed, show functional deficits such as deficient extracellular matrix and impaired barrier function, which are likely to cause wound recidivism. The management of invasive wound infection often includes systemic antimicrobial therapy in combination with débridement of wounds to a healthy tissue bed as determined by the surgeon who has no way of visualizing the biofilm. The exceedingly high incidence of false-negative cultures for bacteria in a biofilm state leads to missed diagnoses of wound infection. The use of topical and parenteral antimicrobial therapy without wound débridement have had limited impact on decreasing biofilm infection, which remains a major problem in wound care. Current claims to manage wound biofilm infection rest on limited early-stage data. In most cases, such data originate from limited experimental systems that lack host immune defense. In making decisions on the choice of commercial products to manage wound biofilm infection, it is important to critically appreciate the mechanism of action and significance of the relevant experimental system. In this work, the authors critically review different categories of antibiofilm products, with emphasis on their strengths and limitations as evident from the published literature.
Collapse
Affiliation(s)
- Chandan K Sen
- From the Indiana University Health Comprehensive Wound Center, the Indiana Center for Regenerative Medicine & Engineering, and the Indiana University School of Medicine
| | - Sashwati Roy
- From the Indiana University Health Comprehensive Wound Center, the Indiana Center for Regenerative Medicine & Engineering, and the Indiana University School of Medicine
| | - Shomita S Mathew-Steiner
- From the Indiana University Health Comprehensive Wound Center, the Indiana Center for Regenerative Medicine & Engineering, and the Indiana University School of Medicine
| | - Gayle M Gordillo
- From the Indiana University Health Comprehensive Wound Center, the Indiana Center for Regenerative Medicine & Engineering, and the Indiana University School of Medicine
| |
Collapse
|
25
|
Milne J, Swift A, Smith J, Martin R. Electrical stimulation for pain reduction in hard-to-heal wound healing. J Wound Care 2021; 30:568-580. [PMID: 34256596 DOI: 10.12968/jowc.2021.30.7.568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Despite treatment advances over the past 30 years, the societal impact of hard-to-heal wounds is increasingly burdensome. An unresolved issue is wound pain, which can make many treatments, such as compression in venous leg ulcers, intolerable. The aim of this review is to present the evidence and stimulate thinking on the use of electrical stimulation devices as a treatment technology with the potential to reduce pain, improve adherence and thus hard-to-heal wound outcomes. METHOD A literature search was conducted for clinical studies up to August 2020 reporting the effects of electrical stimulation devices on wound pain. Devices evoking neuromuscular contraction or direct spinal cord stimulation were excluded. RESULTS A total of seven publications (three non-comparative and four randomised trials) were identified with four studies reporting a rapid (within 14 days) reduction in hard-to-heal wound pain. Electrical stimulation is more widely known for accelerated healing and is one of the most evidence-based technologies in wound management, supported by numerous in vitro molecular studies, five meta-analyses, six systematic reviews and 30 randomised controlled trials (RCTs). Despite this wealth of supportive evidence, electrical stimulation has not yet been adopted into everyday practice. Some features of electrical stimulation devices may have hampered adoption in the past. CONCLUSION As new, pocket-sized, portable devices allowing convenient patient treatment and better patient adherence become more widely available and studied in larger RCTs, the evidence to date suggests that electrical stimulation should be considered part of the treatment options to address the challenges of managing and treating painful hard-to-heal wounds.
Collapse
|
26
|
Zheng M, Wang X, Yue O, Hou M, Zhang H, Beyer S, Blocki AM, Wang Q, Gong G, Liu X, Guo J. Skin-inspired gelatin-based flexible bio-electronic hydrogel for wound healing promotion and motion sensing. Biomaterials 2021; 276:121026. [PMID: 34298443 DOI: 10.1016/j.biomaterials.2021.121026] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/27/2021] [Accepted: 07/12/2021] [Indexed: 01/29/2023]
Abstract
Next generation tissue-engineered skin scaffolds promise to provide sensory restoration through electrical stimulation in addition to effectively rebuilding and repairing skin. The integration of real-time monitoring of the injury motion activities can fundamentally improve the therapeutic efficacy by providing detailed data to guide the clinical practice. Herein, a mechanically-flexible, electroactive, and self-healable hydrogels (MESGel) was engineered for the combinational function of electrically-stimulated accelerated wound healing and motion sensing. MESGel shows outstanding biocompatibility and multifunctional therapeutic properties including flexibility, self-healing characteristics, biodegradability, and bioelectroactivity. Moreover, MESGel shows its potential of being a novel flexible electronic skin sensor to record the injury motion activities. Comprehensive in vitro and in vivo experiments prove that MESGel can facilitate effective electrical stimulation, actively promoting proliferation in Chinese hamster lung epithelial cells and therefore can accelerate favorable epithelial biology during skin wound healing, demonstrating an effective therapeutic strategy for a full-thickness skin defect model and leading to new-type flexible bioelectronics.
Collapse
Affiliation(s)
- Manhui Zheng
- College of Bioresources Chemical and Materials Engineering, Institute of Biomass & Functional Materials, Shaanxi University of Science &Technology, Xi'an, 710021, China
| | - Xuechuan Wang
- College of Bioresources Chemical and Materials Engineering, Institute of Biomass & Functional Materials, Shaanxi University of Science &Technology, Xi'an, 710021, China.
| | - Ouyang Yue
- College of Bioresources Chemical and Materials Engineering, Institute of Biomass & Functional Materials, Shaanxi University of Science &Technology, Xi'an, 710021, China
| | - Mengdi Hou
- College of Bioresources Chemical and Materials Engineering, Institute of Biomass & Functional Materials, Shaanxi University of Science &Technology, Xi'an, 710021, China
| | - Huijie Zhang
- College of Bioresources Chemical and Materials Engineering, Institute of Biomass & Functional Materials, Shaanxi University of Science &Technology, Xi'an, 710021, China
| | - Sebastian Beyer
- Institute for Tissue Engineering and Regenerative Medicine & Department of Biomedical Engineering, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Anna Maria Blocki
- Institute for Tissue Engineering and Regenerative Medicine & Department of Biomedical Engineering, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Qin Wang
- BMI Center for Biomass Materials and Nanointerfaces, School of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan, 610065, China; School of Pharmacy, Southwest University for Nationalities, Chengdu, Sichuan, 610051, China
| | - Guidong Gong
- BMI Center for Biomass Materials and Nanointerfaces, School of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan, 610065, China
| | - Xinhua Liu
- College of Bioresources Chemical and Materials Engineering, Institute of Biomass & Functional Materials, Shaanxi University of Science &Technology, Xi'an, 710021, China.
| | - Junling Guo
- BMI Center for Biomass Materials and Nanointerfaces, School of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan, 610065, China; John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02115, United States; State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, Sichuan, 610065, China.
| |
Collapse
|
27
|
Rajendran SB, Challen K, Wright KL, Hardy JG. Electrical Stimulation to Enhance Wound Healing. J Funct Biomater 2021; 12:40. [PMID: 34205317 PMCID: PMC8293212 DOI: 10.3390/jfb12020040] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022] Open
Abstract
Electrical stimulation (ES) can serve as a therapeutic modality accelerating the healing of wounds, particularly chronic wounds which have impaired healing due to complications from underlying pathology. This review explores how ES affects the cellular mechanisms of wound healing, and its effectiveness in treating acute and chronic wounds. Literature searches with no publication date restrictions were conducted using the Cochrane Library, Medline, Web of Science, Google Scholar and PubMed databases, and 30 full-text articles met the inclusion criteria. In vitro and in vivo experiments investigating the effect of ES on the general mechanisms of healing demonstrated increased epithelialization, fibroblast migration, and vascularity around wounds. Six in vitro studies demonstrated bactericidal effects upon exposure to alternating and pulsed current. Twelve randomized controlled trials (RCTs) investigated the effect of pulsed current on chronic wound healing. All reviewed RCTs demonstrated a larger reduction in wound size and increased healing rate when compared to control groups. In conclusion, ES therapy can contribute to improved chronic wound healing and potentially reduce the financial burden associated with wound management. However, the variations in the wound characteristics, patient demographics, and ES parameters used across studies present opportunities for systematic RCT studies in the future.
Collapse
Affiliation(s)
- Saranya B. Rajendran
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire LA1 4AT, UK;
| | - Kirsty Challen
- Emergency Department, Lancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Sharoe Green Lane, Preston, Lancashire PR2 9HT, UK;
| | - Karen L. Wright
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire LA1 4YG, UK
| | - John G. Hardy
- Department of Chemistry, Faculty of Science and Technology, Lancaster University, Lancaster, Lancashire LA1 4YB, UK
- Materials Science Institute, Lancaster University, Lancaster, Lancashire LA1 4YB, UK
| |
Collapse
|
28
|
Rueda-Gensini L, Serna JA, Cifuentes J, Cruz JC, Muñoz-Camargo C. Graphene Oxide-Embedded Extracellular Matrix-Derived Hydrogel as a Multiresponsive Platform for 3D Bioprinting Applications. Int J Bioprint 2021; 7:353. [PMID: 34286147 PMCID: PMC8287511 DOI: 10.18063/ijb.v7i3.353] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
Decellularized extracellular matrices (dECMs) have shown enormous potential for the biofabrication of tissues due to their biomimetic properties that promote enhanced cellular interaction and tissue regeneration. However, biofabrication schemes requiring electrostimulation pose an additional constraint due to the insulating properties of natural materials. Here, we propose a methacryloyl-modified decellularized small intestine submucosa (SISMA) hydrogel, embedded with graphene oxide (GO) nanosheets, for extrusion-based 3D bioprinting applications that require electrostimulation. Methacryloyl biochemical modification is performed to enhance the mechanical stability of dECM constructs by mediating photo-crosslinking reactions, and a multistep fabrication scheme is proposed to harness the bioactive and hydrophilic properties of GO and electroconductive properties of reduced GO. For this, GO was initially dispersed in SISMA hydrogels by exploiting its hydrophilicity and protein adsorption capabilities, and in situ reduction was subsequently performed to confer electroconductive abilities. SISMA-GO composite hydrogels were successfully prepared with enhanced structural characteristics, as shown by the higher crosslinking degree and increased elastic response upon blue-light exposure. Moreover, GO was homogeneously dispersed without affecting photocrosslinking reactions and hydrogel shear-thinning properties. Human adipose-derived mesenchymal stem cells were successfully bioprinted in SISMA-GO with high cell viability after 1 week and in situ reduction of GO during this period enhanced the electrical conductivity of these nanostructures. This work demonstrates the potential of SISMA-GO bioinks as bioactive and electroconductive scaffolds for electrostimulation applications in tissue engineering and regenerative medicine.
Collapse
Affiliation(s)
- Laura Rueda-Gensini
- Department of Biomedical Engineering, Universidad de Los Andes, Bogotá, 11171, Colombia
| | - Julian A. Serna
- Department of Biomedical Engineering, Universidad de Los Andes, Bogotá, 11171, Colombia
| | - Javier Cifuentes
- Department of Biomedical Engineering, Universidad de Los Andes, Bogotá, 11171, Colombia
| | - Juan C. Cruz
- Department of Biomedical Engineering, Universidad de Los Andes, Bogotá, 11171, Colombia
| | | |
Collapse
|
29
|
Deivasigamani R, Maidin NNM, Wee MFMR, Mohamed MA, Buyong MR. Dielectrophoresis Prototypic Polystyrene Particle Synchronization toward Alive Keratinocyte Cells for Rapid Chronic Wound Healing. SENSORS (BASEL, SWITZERLAND) 2021; 21:3007. [PMID: 33922993 PMCID: PMC8123363 DOI: 10.3390/s21093007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/25/2021] [Accepted: 04/09/2021] [Indexed: 12/12/2022]
Abstract
Diabetes patients are at risk of having chronic wounds, which would take months to years to resolve naturally. Chronic wounds can be countered using the electrical stimulation technique (EST) by dielectrophoresis (DEP), which is label-free, highly sensitive, and selective for particle trajectory. In this study, we focus on the validation of polystyrene particles of 3.2 and 4.8 μm to predict the behavior of keratinocytes to estimate their crossover frequency (fXO) using the DEP force (FDEP) for particle manipulation. MyDEP is a piece of java-based stand-alone software used to consider the dielectric particle response to AC electric fields and analyzes the electrical properties of biological cells. The prototypic 3.2 and 4.8 μm polystyrene particles have fXO values from MyDEP of 425.02 and 275.37 kHz, respectively. Fibroblast cells were also subjected to numerical analysis because the interaction of keratinocytes and fibroblast cells is essential for wound healing. Consequently, the predicted fXO from the MyDEP plot for keratinocyte and fibroblast cells are 510.53 and 28.10 MHz, respectively. The finite element method (FEM) is utilized to compute the electric field intensity and particle trajectory based on DEP and drag forces. Moreover, the particle trajectories are quantified in a high and low conductive medium. To justify the simulation, further DEP experiments are carried out by applying a non-uniform electric field to a mixture of different sizes of polystyrene particles and keratinocyte cells, and these results are well agreed. The alive keratinocyte cells exhibit NDEP force in a highly conductive medium from 100 kHz to 25 MHz. 2D/3D motion analysis software (DIPP-MotionV) can also perform image analysis of keratinocyte cells and evaluate the average speed, acceleration, and trajectory position. The resultant NDEP force can align the keratinocyte cells in the wound site upon suitable applied frequency. Thus, MyDEP estimates the Clausius-Mossotti factors (CMF), FEM computes the cell trajectory, and the experimental results of prototypic polystyrene particles are well correlated and provide an optimistic response towards keratinocyte cells for rapid wound healing applications.
Collapse
Affiliation(s)
| | | | | | | | - Muhamad Ramdzan Buyong
- Institute of Microengineering and Nanoelectronics, Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia; (R.D.); (N.N.M.M.); (M.F.M.R.W.); (M.A.M.)
| |
Collapse
|
30
|
Analysis of the Differential Gene and Protein Expression Profiles of Corneal Epithelial Cells Stimulated with Alternating Current Electric Fields. Genes (Basel) 2021; 12:genes12020299. [PMID: 33672614 PMCID: PMC7924190 DOI: 10.3390/genes12020299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022] Open
Abstract
In cells, intrinsic endogenous direct current (DC) electric fields (EFs) serve as morphogenetic cues and are necessary for several important cellular responses including activation of multiple signaling pathways, cell migration, tissue regeneration and wound healing. Endogenous DC EFs, generated spontaneously following injury in physiological conditions, directly correlate with wound healing rate, and different cell types respond to these EFs via directional orientation and migration. Application of external DC EFs results in electrode polarity and is known to activate intracellular signaling events in specific direction. In contrast, alternating current (AC) EFs are known to induce continuous bidirectional flow of charged particles without electrode polarity and also minimize electrode corrosion. In this context, the present study is designed to study effects of AC EFs on corneal epithelial cell gene and protein expression profiles in vitro. We performed gene and antibody arrays, analyzed the data to study specific influence of AC EFs, and report that AC EFs has no deleterious effect on epithelial cell function. Gene Ontology results, following gene and protein array data analysis, showed that AC EFs influence similar biological processes that are predominantly responsive to organic substance, chemical, or external stimuli. Both arrays activate cytokine–cytokine receptor interaction, MAPK and IL-17 signaling pathways. Further, in comparison to the gene array data, the protein array data show enrichment of diverse activated signaling pathways through several interconnecting networks.
Collapse
|
31
|
Li M, Wang X, Rajagopalan P, Zhang L, Zhan S, Huang S, Li W, Zeng X, Ye Q, Liu Y, Zhong K, Kim JM, Luo J, Dong S, Gu R, Wang X, Tan WQ. Toward Controlled Electrical Stimulation for Wound Healing Based on a Precision Layered Skin Model. ACS APPLIED BIO MATERIALS 2020; 3:8901-8910. [DOI: 10.1021/acsabm.0c01190] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Menglu Li
- Key Lab. of Advanced Micro/Nano Electronic Devices & Smart Systems of Zhejiang, College of ISEE, Zhejiang University, Hangzhou 310027, China
- Hangzhou Global Scientific and Technological Innovation Center, Zhejiang University, Hangzhou 310018, China
| | - Xiaofeng Wang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province PR China
| | - Pandey Rajagopalan
- Key Lab. of Advanced Micro/Nano Electronic Devices & Smart Systems of Zhejiang, College of ISEE, Zhejiang University, Hangzhou 310027, China
- Hangzhou Global Scientific and Technological Innovation Center, Zhejiang University, Hangzhou 310018, China
| | - Liang Zhang
- Key Lab. of Advanced Micro/Nano Electronic Devices & Smart Systems of Zhejiang, College of ISEE, Zhejiang University, Hangzhou 310027, China
- Hangzhou Global Scientific and Technological Innovation Center, Zhejiang University, Hangzhou 310018, China
| | - Shijie Zhan
- Department of Engineering, University of Cambridge, Cambridge CB3 0FA, United Kingdom
| | - Shuyi Huang
- Key Lab. of Advanced Micro/Nano Electronic Devices & Smart Systems of Zhejiang, College of ISEE, Zhejiang University, Hangzhou 310027, China
- Hangzhou Global Scientific and Technological Innovation Center, Zhejiang University, Hangzhou 310018, China
| | - Wei Li
- Key Lab. of Advanced Micro/Nano Electronic Devices & Smart Systems of Zhejiang, College of ISEE, Zhejiang University, Hangzhou 310027, China
- Hangzhou Global Scientific and Technological Innovation Center, Zhejiang University, Hangzhou 310018, China
| | - Xiangyu Zeng
- Key Lab. of Advanced Micro/Nano Electronic Devices & Smart Systems of Zhejiang, College of ISEE, Zhejiang University, Hangzhou 310027, China
- Hangzhou Global Scientific and Technological Innovation Center, Zhejiang University, Hangzhou 310018, China
| | - Qikai Ye
- Key Lab. of Advanced Micro/Nano Electronic Devices & Smart Systems of Zhejiang, College of ISEE, Zhejiang University, Hangzhou 310027, China
- Hangzhou Global Scientific and Technological Innovation Center, Zhejiang University, Hangzhou 310018, China
| | - Yulu Liu
- Key Lab. of Advanced Micro/Nano Electronic Devices & Smart Systems of Zhejiang, College of ISEE, Zhejiang University, Hangzhou 310027, China
- Hangzhou Global Scientific and Technological Innovation Center, Zhejiang University, Hangzhou 310018, China
| | - Kai Zhong
- Key Lab. of Advanced Micro/Nano Electronic Devices & Smart Systems of Zhejiang, College of ISEE, Zhejiang University, Hangzhou 310027, China
- Hangzhou Global Scientific and Technological Innovation Center, Zhejiang University, Hangzhou 310018, China
| | - Jong Min Kim
- Department of Engineering, University of Cambridge, Cambridge CB3 0FA, United Kingdom
| | - Jikui Luo
- Key Lab. of Advanced Micro/Nano Electronic Devices & Smart Systems of Zhejiang, College of ISEE, Zhejiang University, Hangzhou 310027, China
- Hangzhou Global Scientific and Technological Innovation Center, Zhejiang University, Hangzhou 310018, China
| | - Shurong Dong
- Key Lab. of Advanced Micro/Nano Electronic Devices & Smart Systems of Zhejiang, College of ISEE, Zhejiang University, Hangzhou 310027, China
- Hangzhou Global Scientific and Technological Innovation Center, Zhejiang University, Hangzhou 310018, China
| | - Rongcheng Gu
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, Michigan 48824, United States
| | - Xiaozhi Wang
- Key Lab. of Advanced Micro/Nano Electronic Devices & Smart Systems of Zhejiang, College of ISEE, Zhejiang University, Hangzhou 310027, China
- Hangzhou Global Scientific and Technological Innovation Center, Zhejiang University, Hangzhou 310018, China
| | - Wei-Qiang Tan
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province PR China
| |
Collapse
|
32
|
Miguel MMV, Mathias-Santamaria IF, Rossato A, Ferraz LFF, Figueiredo-Neto AM, de Marco AC, Casarin RCV, Wallet SM, Tatakis DN, Mathias MA, Santamaria MP. Microcurrent electrotherapy improves palatal wound healing: Randomized clinical trial. J Periodontol 2020; 92:244-253. [PMID: 32783220 DOI: 10.1002/jper.20-0122] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/07/2020] [Accepted: 05/31/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study was conducted to assess the clinical, immunological, and patient-centered outcomes of microcurrent electrotherapy on palatal wound healing. METHODS This was a parallel, double-masked randomized clinical trial, in which 53 patients with ridge preservation indications were selected and randomly assigned to one of two groups. In the control (sham) group (n = 27), palatal wounds, after free gingival grafts (FGG) harvest, received sham application of electrotherapy. In the test (electrotherapy treatment [EE]) group (n = 26), palatal wounds, after FGG harvest, received application of microcurrent electrotherapy protocol. Clinical parameters, patient-centered outcomes, and inflammatory markers were evaluated, up to 90 days postoperatively. RESULTS The EE group achieved earlier wound closure (P <0.001) and epithelialization (P <0.05; P = 0.03) at 7 and 14 days after harvest when compared with the sham group. Painful symptomatology was reported less frequently in the EE group than in the sham group at 3-day follow-up (P = 0.008). Likewise, an improvement in Oral Health Impact Profile was reported 2 days after the procedure by the EE group (P = 0.04). In addition, favorable modulation of inflammatory wound healing markers occurred when electrotherapy was applied. CONCLUSION Within the limits of the present study, it can be concluded that the use of a low-intensity electrotherapy protocol may accelerate palatal wound healing and decrease patient discomfort after FGG harvest.
Collapse
Affiliation(s)
- Manuela Maria Viana Miguel
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | - Ingrid Fernandes Mathias-Santamaria
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil.,National Institute of Science and Technology-Complex Fluids, São Paulo, Brazil
| | - Amanda Rossato
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | - Laís Fernanda Ferreira Ferraz
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | | | - Andrea Carvalho de Marco
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | - Renato Corrêa Viana Casarin
- Department of Prosthodontics and Periodontics, Division of Periodontics, University of Campinas Piracicaba Dental School Piracicaba, São Paulo, Brazil
| | | | - Dimitris N Tatakis
- College of Dentistry, Division of Periodontology, The Ohio State University, Columbus, OH, USA
| | - Marcio Antonio Mathias
- FEI University, Department of Electrical Engineering, São Bernardo do Campo, São Paulo, Brazil
| | - Mauro Pedrine Santamaria
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| |
Collapse
|
33
|
Highly Stretchable and Conductive Self-Healing Hydrogels for Temperature and Strain Sensing and Chronic Wound Treatment. ACS APPLIED MATERIALS & INTERFACES 2020; 12:40990-40999. [PMID: 32808753 DOI: 10.1021/acsami.0c08291] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
34
|
Ofstead CL, Buro BL, Hopkins KM, Eiland JE. The impact of continuous electrical microcurrent on acute and hard-to-heal wounds: a systematic review. J Wound Care 2020; 29:S6-S15. [PMID: 32654615 DOI: 10.12968/jowc.2020.29.sup7.s6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Wound infections result in considerable morbidity, mortality and healthcare costs. Antibiotic resistance has complicated wound healing, and new, non-antibiotic-based treatment methods are being developed. AIMS To evaluate evidence on the safety, efficacy and real-world effectiveness of electroceutical devices (ECDs) that provide continuous electrical stimulation to wounds. METHOD A systematic search was conducted to identify primary studies published between 2009 and 2019 that described therapeutic wound treatment using portable ECDs. Studies were included if the ECD delivered continuous electrical current directly to the wound area for the duration of treatment. RESULTS Of 171 citations identified in the search, 13 articles met the inclusion criteria and were analysed. Nine studies evaluated dressings embedded with zinc and silver particles that generated electricity electrochemically, and four evaluated electrode-based units with external batteries. ECDs were effective in healing complex, hard-to-heal wounds that had not responded to other treatments. Four studies showed that ECDs led to complete closure of wounds without complications, and in some cases healed wounds faster than standard of care (SOC). One study found that ECDs resulted in higher ratings by both patients and surgeons than SOC for the progression of wound healing and scar appearance. Additionally, three studies found ECD treatment was less expensive than SOC, due to patients requiring fewer dressing changes or nurse visits. CONCLUSION ECDs appeared to be a safe, effective and cost-effective method for treating severe, complex and challenging wounds, including hard-to-heal wounds, surgical incisions and skin graft donor sites.
Collapse
Affiliation(s)
- Cori L Ofstead
- Ofstead & Associates, Inc., 1360 Energy Park Drive, Suite 300, St. Paul, MN 55102
| | - Brandy L Buro
- Ofstead & Associates, Inc., 1360 Energy Park Drive, Suite 300, St. Paul, MN 55102
| | - Krystina M Hopkins
- Ofstead & Associates, Inc., 1360 Energy Park Drive, Suite 300, St. Paul, MN 55102
| | - John E Eiland
- Ofstead & Associates, Inc., 1360 Energy Park Drive, Suite 300, St. Paul, MN 55102
| |
Collapse
|
35
|
Liu S, Li J, Zhang S, Zhang X, Ma J, Wang N, Wang S, Wang B, Chen S. Template-Assisted Magnetron Sputtering of Cotton Nonwovens for Wound Healing Application. ACS APPLIED BIO MATERIALS 2019; 3:848-858. [DOI: 10.1021/acsabm.9b00942] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Shangpeng Liu
- Industrial Research Institute of Nonwovens and Technical Textiles, College of Textiles and Clothing, Qingdao University, Qingdao 266071, P. R. China
| | - Jiwei Li
- Industrial Research Institute of Nonwovens and Technical Textiles, College of Textiles and Clothing, Qingdao University, Qingdao 266071, P. R. China
- Department of Biochemistry and Microbiology, Qingdao University, Qingdao 266071, P. R. China
| | - Shaohua Zhang
- Department of Pediatrics, The Affiliated Hospital of Qingdao University, Qingdao 266003, P. R. China
| | - Xiying Zhang
- Department of Pathology, The Second Hospital of Shandong University, Jinan 250033, P. R. China
| | - Jianwei Ma
- Industrial Research Institute of Nonwovens and Technical Textiles, College of Textiles and Clothing, Qingdao University, Qingdao 266071, P. R. China
| | - Na Wang
- Industrial Research Institute of Nonwovens and Technical Textiles, College of Textiles and Clothing, Qingdao University, Qingdao 266071, P. R. China
| | - Shuang Wang
- Department of Biochemistry and Microbiology, Qingdao University, Qingdao 266071, P. R. China
| | - Bin Wang
- Department of Biochemistry and Microbiology, Qingdao University, Qingdao 266071, P. R. China
| | - Shaojuan Chen
- Industrial Research Institute of Nonwovens and Technical Textiles, College of Textiles and Clothing, Qingdao University, Qingdao 266071, P. R. China
| |
Collapse
|
36
|
Wireless Direct Microampere Current in Wound Healing: Clinical and Immunohistological Data from Two Single Case Reports. BIOSENSORS-BASEL 2019; 9:bios9030107. [PMID: 31492004 PMCID: PMC6784371 DOI: 10.3390/bios9030107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/01/2019] [Accepted: 09/02/2019] [Indexed: 01/22/2023]
Abstract
Chronic pressure ulcers are hard-to-heal wounds that decrease the patient’s quality of life. Wireless Micro Current Stimulation (WMCS) is an innovative, non-invasive, similar to electrode-based electrostimulation (ES) technology, that generates and transfers ions that are negatively-charged to the injured tissue, using accessible air gases as a transfer medium. WMCS is capable of generating similar tissue potentials, as electrode-based ES, for injured tissue. Here, through immunohistochemistry, we intended to characterize the induced tissue healing biological mechanisms that occur during WMCS therapy. Two single cases of bedridden due to serious stroke white men with chronic non-healing pressure ulcers have been treated with WMCS technology. WMCS suppresses inflammatory responses by decreasing the aggregation of granulocytes, followed by stimulating myofibroblastic activity and a new formation of collagen fibers, as depicted by immunohistochemistry. As a result, WMCS provides a special adjunct or stand-alone therapy choice for chronic and non-healing injuries, similar to electrode-based ES, but with added (i.e., contactless) benefits towards its establishment as a routine clinical wound healing regime.
Collapse
|
37
|
Souza AK, Souza TR, Siqueira das Neves LM, de Paula Marcondes Ferreira Leite G, Garcia SB, Roberto de Jesus Guirro R, Barbosa RI, Caldeira de Oliveira Guirro E. Effect of High Voltage Pulsed Current on the integration of total skin grafts in rats submitted to nicotine action. J Tissue Viability 2019; 28:161-166. [DOI: 10.1016/j.jtv.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/14/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
|
38
|
Lu Y, Wang Y, Zhang J, Hu X, Yang Z, Guo Y, Wang Y. In-situ doping of a conductive hydrogel with low protein absorption and bacterial adhesion for electrical stimulation of chronic wounds. Acta Biomater 2019; 89:217-226. [PMID: 30862548 DOI: 10.1016/j.actbio.2019.03.018] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 02/19/2019] [Accepted: 03/07/2019] [Indexed: 12/23/2022]
Abstract
Electrical stimulation (ES) via electrodes is promising for treating chronic wounds, but this electrode-based strategy is unable to stimulate the whole wound area and the therapeutic outcome may be compromised. In this study, a conductive poly(2-hydroxyethyl methacrylate) (polyHEMA)/polypyrrole (PPY) hydrogel was developed, and 3-sulfopropyl methacrylate was covalently incorporated in the hydrogel's network to in-situ dope the PPY and maintain the hydrogel's conductivity in the weak alkaline physiological environment. The obtained hydrogel was superior to the commercial Hydrosorb® dressing for preventing bacterial adhesion and protein absorption, and this is helpful to reduce the possibilities of infection and secondary damage during dressing replacement. The in vitro scratch assay demonstrates that ES through the hydrogel enhanced fibroblast migration, and this enhancement effect remained even after the ES was ended. The in vivo assay using diabetic rats shows that when ES was conducted with this polyHEMA/PPY hydrogel, the healing rate was faster than that achieved by the electrode-based ES strategy. Therefore, this polyHEMA/PPY hydrogel shows a great potential for developing the next generation of ES treatment for chronic wounds. STATEMENT OF SIGNIFICANCE: Electrical stimulation (ES) via separated electrodes is promising for treating chronic wounds, but this electrode-based strategy is unable to stimulate the whole wound area, compromising the therapeutic outcome. Herein, a hydrogel was developed with stable electrical conductivity in the physiological environment and strong resistance to protein absorption and bacterial adhesion. The in vitro and in vivo tests proved that ES applied through the flexible and conductive hydrogel that covered the wound was superior to ES through electrodes for promoting the healing of the chronic wound. This hydrogel-based ES strategy combines the advantages of ES and hydrogel dressing and will pave the way for the next generation of ES treatment for chronic wounds.
Collapse
|
39
|
The Dynamics of the Skin's Immune System. Int J Mol Sci 2019; 20:ijms20081811. [PMID: 31013709 PMCID: PMC6515324 DOI: 10.3390/ijms20081811] [Citation(s) in RCA: 310] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 12/12/2022] Open
Abstract
The skin is a complex organ that has devised numerous strategies, such as physical, chemical, and microbiological barriers, to protect the host from external insults. In addition, the skin contains an intricate network of immune cells resident to the tissue, crucial for host defense as well as tissue homeostasis. In the event of an insult, the skin-resident immune cells are crucial not only for prevention of infection but also for tissue reconstruction. Deregulation of immune responses often leads to impaired healing and poor tissue restoration and function. In this review, we will discuss the defensive components of the skin and focus on the function of skin-resident immune cells in homeostasis and their role in wound healing.
Collapse
|
40
|
Roy S, Prakash S, Mathew-Steiner SS, Das Ghatak P, Lochab V, Jones TH, Mohana Sundaram P, Gordillo GM, Subramaniam VV, Sen CK. Disposable Patterned Electroceutical Dressing (PED-10) Is Safe for Treatment of Open Clinical Chronic Wounds. Adv Wound Care (New Rochelle) 2019; 8:149-159. [PMID: 31016066 DOI: 10.1089/wound.2018.0915] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/03/2019] [Indexed: 12/26/2022] Open
Abstract
Objective: To evaluate if patterned electroceutical dressing (PED) is safe for human chronic wounds treatment as reported by wound care providers. Approach: This work reports a pilot feasibility study with the primary objective to determine physically observable effects of PED application on host tissue response from a safety evaluation point of view. For this pilot study, patients receiving a lower extremity amputation with at least one open wound on the part to be amputated were enrolled. Patients were identified through the Ohio State University Wexner Medical Center (OSUWMC) based on inclusion and exclusion criteria through prescreening through the Comprehensive Wound Center's (CWC) Limb Preservation Program and wound physicians and/or providers at OSUWMC. Wounds were treated with the PED before amputation surgery. Results: The intent of the study was to identify if PED was safe for clinical application based on visual observations of adverse or lack of adverse events on skin and wound tissue. The pilot testing performed on a small cohort (N = 8) of patients showed that with engineered voltage regulation of current flow to the open wound, the PED can be used with little to no visually observable adverse effects on chronic human skin wounds. Innovation: The PED was developed as a second-generation tunable electroceutical wound care dressing, which could potentially be used to treat wounds with deeper infections compared with current state of the art that treats wounds with treatment zone limited to the surface near topical application. Conclusion: Technology advances in design and fabrication of electroceutical dressings were leveraged to develop a tunable laboratory prototype that could be used as a disposable low-cost electroceutical wound care dressing on chronic wounds. Design revisions of PED-1 (1 kΩ ballast resistor) circumvented previously observed adverse effects on the skin in the vicinity of an open wound. PED-10 (including a 10 kΩ ballast resistor) was well tolerated in the small cohort of patients (N = 8) on whom it was tested, and the observations reported here warrant a larger study to determine the clinical impact on human wound healing and infection control.
Collapse
Affiliation(s)
- Sashwati Roy
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering (ICRME), Indiana University School of Medicine, Indianapolis, Indiana
| | - Shaurya Prakash
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio
| | - Shomita S. Mathew-Steiner
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering (ICRME), Indiana University School of Medicine, Indianapolis, Indiana
| | - Piya Das Ghatak
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering (ICRME), Indiana University School of Medicine, Indianapolis, Indiana
| | - Varun Lochab
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio
| | - Travis H. Jones
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio
| | | | - Gayle M. Gordillo
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering (ICRME), Indiana University School of Medicine, Indianapolis, Indiana
| | - Vish V. Subramaniam
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio
| | - Chandan K. Sen
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering (ICRME), Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
41
|
Ashrafi M, Novak-Frazer L, Morris J, Baguneid M, Rautemaa-Richardson R, Bayat A. Electrical stimulation disrupts biofilms in a human wound model and reveals the potential for monitoring treatment response with volatile biomarkers. Wound Repair Regen 2018; 27:5-18. [DOI: 10.1111/wrr.12679] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 10/08/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Mohammed Ashrafi
- Plastic & Reconstructive Surgery Research, Division of Musculoskeletal & Dermatological Sciences; School of Biological Sciences, University of Manchester; Manchester United Kingdom
- Manchester University NHS Foundation Trust; Wythenshawe Hospital; Manchester United Kingdom
- Bioengineering Group, School of Materials; University of Manchester; Manchester United Kingdom
| | - Lilyann Novak-Frazer
- Manchester University NHS Foundation Trust; Wythenshawe Hospital; Manchester United Kingdom
- Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Division of Infection, Immunity and Respiratory Medicine; School of Biological Sciences, The University of Manchester and Manchester University NHS Foundation Trust; Manchester United Kingdom
| | - Julie Morris
- Honorary Reader in Medical Statistics; Manchester University NHS Foundation Trust, Wythenshawe Hospital; Manchester United Kingdom
| | - Mohamed Baguneid
- Manchester University NHS Foundation Trust; Wythenshawe Hospital; Manchester United Kingdom
| | - Riina Rautemaa-Richardson
- Manchester University NHS Foundation Trust; Wythenshawe Hospital; Manchester United Kingdom
- Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Division of Infection, Immunity and Respiratory Medicine; School of Biological Sciences, The University of Manchester and Manchester University NHS Foundation Trust; Manchester United Kingdom
| | - Ardeshir Bayat
- Plastic & Reconstructive Surgery Research, Division of Musculoskeletal & Dermatological Sciences; School of Biological Sciences, University of Manchester; Manchester United Kingdom
- Manchester University NHS Foundation Trust; Wythenshawe Hospital; Manchester United Kingdom
| |
Collapse
|
42
|
Eming SA, Tomic-Canic M. Updates in wound healing: Mechanisms and translation. Exp Dermatol 2018; 26:97-98. [PMID: 28133858 DOI: 10.1111/exd.13281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Sabine A Eming
- Department of Dermatology, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Marjana Tomic-Canic
- Department of Dermatology and Cutaneous Surgery, Wound Healing and Regenerative Medicine Research Program, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
43
|
Spear AM, Lawton G, Staruch RMT, Rickard RF. Regenerative medicine and war: a front-line focus for UK defence. NPJ Regen Med 2018; 3:13. [PMID: 30155273 PMCID: PMC6104070 DOI: 10.1038/s41536-018-0053-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 06/19/2018] [Accepted: 07/24/2018] [Indexed: 12/15/2022] Open
Abstract
The recent prolonged conflicts in Iraq and Afghanistan saw the advancement of deployed trauma care to a point never before seen in war. The rapid translation of lessons from combat casualty care research, facilitated by an appetite for risk, contributed to year-on-year improvements in care of the injured. These paradigms, however, can only ever halt the progression of damage. Regenerative medicine approaches, in contrast, hold a truly disruptive potential to go beyond the cessation of damage from blast or ballistic trauma, to stimulate its reversal, and to do so from a very early point following injury. The internationally distributed and, in parts austere environments in which operational medical care is delivered provide an almost unique challenge to the development and translation of regenerative medicine technologies. In parallel, however, an inherent appetite for risk means that Defence will always be an early adopter. In focusing our operational priorities for regenerative medicine, the authors conducted a review of the current research landscape in the UK and abroad and sought wide clinical opinion. Our priorities are all applicable very far forward in the patient care pathway, and are focused on three broad and currently under-researched areas, namely: (a) blood, as an engineered tissue; (b) the mechanobiology of deep tissue loss and mechanobiological approaches to regeneration, and; (c) modification of the endogenous response. In focusing on these areas, we hope to engender the development of regenerative solutions for improved functional recovery from injuries sustained in conflict.
Collapse
Affiliation(s)
- Abigail M. Spear
- Defence Science & Technology Laboratory, Porton Down, Salisbury, UK
| | - Graham Lawton
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Robert M. T. Staruch
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Rory F. Rickard
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| |
Collapse
|
44
|
Tai G, Tai M, Zhao M. Electrically stimulated cell migration and its contribution to wound healing. BURNS & TRAUMA 2018; 6:20. [PMID: 30003115 PMCID: PMC6036678 DOI: 10.1186/s41038-018-0123-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 06/15/2018] [Indexed: 12/29/2022]
Abstract
Naturally occurring electric fields are known to be morphogenetic cues and associated with growth and healing throughout mammalian and amphibian animals and the plant kingdom. Electricity in animals was discovered in the eighteenth century. Electric fields activate multiple cellular signaling pathways such as PI3K/PTEN, the membrane channel of KCNJ15/Kir4.2 and intracellular polyamines. These pathways are involved in the sensing of physiological electric fields, directional cell migration (galvanotaxis, also known as electrotaxis), and possibly other cellular responses. Importantly, electric fields provide a dominant and over-riding signal that directs cell migration. Electrical stimulation could be a promising therapeutic method in promoting wound healing and activating regeneration of chronic and non-healing wounds. This review provides an update of the physiological role of electric fields, its cellular and molecular mechanisms, its potential therapeutic value, and questions that still await answers.
Collapse
Affiliation(s)
- Guangping Tai
- 1Centre of Advanced Biofabrication, Department of Bioengineering and Environmental Sciences, Hefei University, Hefei City, China
| | - Michael Tai
- 2St Catherine's College, Medical Sciences Division, University of Oxford, Oxford, OX1 3UJ UK
| | - Min Zhao
- 3Departments of Dermatology and Ophthalmology, School of Medicine, University of California, Davis, CA 95817 USA
| |
Collapse
|
45
|
Lebonvallet N, Laverdet B, Misery L, Desmoulière A, Girard D. New insights into the roles of myofibroblasts and innervation during skin healing and innovative therapies to improve scar innervation. Exp Dermatol 2018; 27:950-958. [DOI: 10.1111/exd.13681] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Nicolas Lebonvallet
- Department of Dermatology and EA4685 “Laboratory Interactions Neurons-Keratinocytes”; Faculty of Medicine and Health Sciences; University of Western Brittany; Brest France
| | - Betty Laverdet
- Department of Physiology and EA6309 “Myelin Maintenance and Peripheral Neuropathies”; Faculty of Pharmacy; University of Limoges; Limoges France
| | - Laurent Misery
- Department of Dermatology and EA4685 “Laboratory Interactions Neurons-Keratinocytes”; Faculty of Medicine and Health Sciences; University of Western Brittany; Brest France
| | - Alexis Desmoulière
- Department of Physiology and EA6309 “Myelin Maintenance and Peripheral Neuropathies”; Faculty of Pharmacy; University of Limoges; Limoges France
| | - Dorothée Girard
- Department of Physiology and EA6309 “Myelin Maintenance and Peripheral Neuropathies”; Faculty of Pharmacy; University of Limoges; Limoges France
| |
Collapse
|
46
|
Khouri C, Kotzki S, Roustit M, Blaise S, Gueyffier F, Cracowski JL. Hierarchical evaluation of electrical stimulation protocols for chronic wound healing: An effect size meta-analysis. Wound Repair Regen 2017; 25:883-891. [DOI: 10.1111/wrr.12594] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 09/07/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Charles Khouri
- Pharmacovigilance Unit, Grenoble Alps University Hospital; Grenoble France
- Clinical Pharmacology Department, INSERM CIC1406; Grenoble Alps University Hospital; Grenoble France
| | - Sylvain Kotzki
- UMR 1042-HP2, INSERM, University of Grenoble Alpes; Grenoble France
| | - Matthieu Roustit
- Clinical Pharmacology Department, INSERM CIC1406; Grenoble Alps University Hospital; Grenoble France
- UMR 1042-HP2, INSERM, University of Grenoble Alpes; Grenoble France
| | - Sophie Blaise
- UMR 1042-HP2, INSERM, University of Grenoble Alpes; Grenoble France
- Department of Vascular Medicine; Grenoble Alps University Hospital; Grenoble France
| | - Francois Gueyffier
- Department of Clinical Pharmacology; Lyon University Hospital; Lyon France
- UMR 5558, Biometry and Evolutionary Biology Laboratory; Claude-Bernard Lyon 1 University, CNRS; Lyon France
| | - Jean-Luc Cracowski
- Clinical Pharmacology Department, INSERM CIC1406; Grenoble Alps University Hospital; Grenoble France
- UMR 1042-HP2, INSERM, University of Grenoble Alpes; Grenoble France
| |
Collapse
|
47
|
Kai H, Yamauchi T, Ogawa Y, Tsubota A, Magome T, Miyake T, Yamasaki K, Nishizawa M. Accelerated Wound Healing on Skin by Electrical Stimulation with a Bioelectric Plaster. Adv Healthc Mater 2017; 6. [PMID: 28929631 DOI: 10.1002/adhm.201700465] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/25/2017] [Indexed: 12/31/2022]
Abstract
Wound healing on skin involves cell migration and proliferation in response to endogenous electric current. External electrical stimulation by electrical equipment is used to promote these biological processes for the treatment of chronic wounds and ulcers. Miniaturization of the electrical stimulation device for wound healing on skin will make this technology more widely available. Using flexible enzymatic electrodes and stretchable hydrogel, a stretchable bioelectric plaster is fabricated with a built-in enzymatic biofuel cell (EBFC) that fits to skin and generates ionic current along the surface of the skin by enzymatic electrochemical reactions for more than 12 h. To investigate the efficacy of the fabricated bioelectric plaster, an artificial wound is made on the back skin of a live mouse and the wound healing is observed for 7 d in the presence and absence of the ionic current of the bioelectric plaster. The time course of the wound size as well as the hematoxylin and eosin staining of the skin section reveals that the ionic current of the plaster leads to faster and smoother wound healing. The present work demonstrates a proof of concept for the electrical manipulation of biological functions by EBFCs.
Collapse
Affiliation(s)
- Hiroyuki Kai
- Department of Finemechanics; Graduate School of Engineering; Tohoku University; 6-6-01 Aramaki Aoba-ku, Sendai 980-8579 Japan
| | - Takeshi Yamauchi
- Department of Dermatology; Graduate School of Medicine; Tohoku University; 1-1 Seiryo-machi Aoba-ku, Sendai 980-8574 Japan
| | - Yudai Ogawa
- Department of Finemechanics; Graduate School of Engineering; Tohoku University; 6-6-01 Aramaki Aoba-ku, Sendai 980-8579 Japan
| | - Ayaka Tsubota
- Department of Finemechanics; Graduate School of Engineering; Tohoku University; 6-6-01 Aramaki Aoba-ku, Sendai 980-8579 Japan
| | - Takahiro Magome
- Department of Finemechanics; Graduate School of Engineering; Tohoku University; 6-6-01 Aramaki Aoba-ku, Sendai 980-8579 Japan
| | - Takeo Miyake
- Department of Finemechanics; Graduate School of Engineering; Tohoku University; 6-6-01 Aramaki Aoba-ku, Sendai 980-8579 Japan
| | - Kenshi Yamasaki
- Department of Dermatology; Graduate School of Medicine; Tohoku University; 1-1 Seiryo-machi Aoba-ku, Sendai 980-8574 Japan
| | - Matsuhiko Nishizawa
- Department of Finemechanics; Graduate School of Engineering; Tohoku University; 6-6-01 Aramaki Aoba-ku, Sendai 980-8579 Japan
| |
Collapse
|