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Song M, Zhang C, Yang S, Lu J, Sun T, Li H, Tang L, Dai K, Liu C, Meng H, Wang J. Animal healer for refractory diseases: Myth or reality? Heliyon 2024; 10:e33056. [PMID: 39027544 PMCID: PMC11255451 DOI: 10.1016/j.heliyon.2024.e33056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 07/20/2024] Open
Abstract
A vast amount of knowledge has been acquired through human activities such as farming, hunting, and fishing. Throughout history, humans have utilized living creatures for disease treatment, relying on the natural world's healing powers. The special "healers" may be able to treat patients via the power of nature. However, there was no systematic introduction or summary of these treatments. Therefore, we conducted a literature review based on PubMed, Google Scholar, Web of Science, Scopus, CNKI and WanFang DATA. Here, we defined this unique method as "animal healer" and six common kinds of animal healers were reviewed. These are fish therapy, pet therapy, worm therapy, leech therapy, maggot therapy, and bee therapy. According to the different characteristics of healers, treatment methods mainly included bite, parasitism, contact and communication. With the advantages of green and effectiveness, animal healers have great therapy potential against a variety of refractory diseases. The main purpose of this review is to draw people's attention to animal healer, promote it to become a possible clinical treatment strategy, and make further exploration in species cultivation, mechanism research, animal welfare, standard setting, safety evaluation and other aspects. In the future, animal healers will play an increasingly important role in medicine and hopefully solve more medical problems and dilemmas.
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Affiliation(s)
- Mingzhi Song
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Changru Zhang
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Simengge Yang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jialin Lu
- College of Humanities and Social Sciences, Dalian Medical University, Dalian, China
| | - Tianze Sun
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Heyue Li
- Department of Obstetrics and Gynecology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liang Tang
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kerong Dai
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Southwest Jiaotong University College of Medicine, Chengdu, China
| | - Chaozong Liu
- Institute of Orthopaedic & Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, London, United Kingdom
| | - He Meng
- School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai, China
| | - Jinwu Wang
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Southwest Jiaotong University College of Medicine, Chengdu, China
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James P, Kaushal D, Beaumont Wilson R. NETosis in Surgery: Pathophysiology, Prevention, and Treatment. Ann Surg 2024; 279:765-780. [PMID: 38214150 PMCID: PMC10997183 DOI: 10.1097/sla.0000000000006196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To provide surgeons with an understanding of the latest research on NETosis, including the pathophysiology and treatment of conditions involving neutrophil extracellular traps (NETs) in the care of surgical patients. BACKGROUND A novel function of neutrophils, the formation of NETs, was described in 2004. Neutrophils form mesh-like structures of extruded decondensed chromatin, comprising DNA and histones decorated with bactericidal proteins. These NETs exert antimicrobial action by trapping microorganisms and preventing their wider dissemination through the body. RESULTS A narrative review of the existing literature describing NETosis was conducted, including NET pathophysiology, conditions related to NET formation, and treatments relevant to surgeons. CONCLUSIONS In addition to its canonical antimicrobial function, NETosis can exacerbate inflammation, resulting in tissue damage and contributing to numerous diseases. NETs promote gallstone formation and acute pancreatitis, impair wound healing in the early postoperative period and in chronic wounds, and facilitate intravascular coagulation, cancer growth, and metastasis. Agents that target NET formation or removal have shown promising efficacy in treating these conditions, although large clinical trials are required to confirm these benefits.
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Affiliation(s)
- Philippa James
- Department of General Surgery, Campbelltown Hospital, Sydney, NSW, Australia
| | - Devesh Kaushal
- Department of General Surgery, Campbelltown Hospital, Sydney, NSW, Australia
| | - Robert Beaumont Wilson
- Faculty of Medicine, University of New South Wales, Liverpool Clinical School, Sydney, NSW, Australia
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Bazaliński D, Przybek-Mita J, Pytlak K, Kardyś D, Bazaliński A, Kucharzewski M, Więch P. Larval Wound Therapy: Possibilities and Potential Limitations-A Literature Review. J Clin Med 2023; 12:6862. [PMID: 37959326 PMCID: PMC10647679 DOI: 10.3390/jcm12216862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Patient-centered care (PCC) is recognized as a standard in healthcare for determining high quality. Honoring patients' values, experiences, needs, and preferences in devising, coordinating, and delivering care underscores the enhancement of the therapeutic rapport between patients and healthcare providers. Wound treatment involves a multi-stage process encompassing diagnostics and local wound dressing, which reduces the risk of infection through a coordinated interdisciplinary team. Within this team, nurses undertake specific professional functions and roles. The implementation of local therapy using innovative and scientifically substantiated methods may be hindered by a deficit of knowledge or inappropriate knowledge among staff and patients themselves. This study presents the challenges concerning the care of patients with chronic wounds treated using Lucilia sericata larvae, based on a review of the current scientific literature. A critical analysis of the literature spanning from 2002 to 2022 was conducted using the Medline, PubMed, Cochrane, and Termedia databases, employing keywords such as "maggot debridement therapy" in relation to acceptance and perception. As a result of the preliminary selection, 472 papers were identified, of which 12 publications were included in the development of this concept. The acquired data were organized and presented in the concluding section in the form of tables, accompanied by descriptions and references to individual studies. Negative psychological and somatic sensations were among the most prominent challenges among patients treated with Maggot Debridement Therapy (MDT). Pain related to peripheral ischemia or infection in this group of patients requires pain prophylaxis, including hyperalgesia and allodynia, in order to improve method tolerance. On the other hand, augmenting patients' understanding of MDT diminishes negative emotions, reinforces positive behaviors, and mitigates anxiety levels. MDT constitutes an effective and safe method. Its widespread use for chronic wounds requires substantial knowledge among healthcare professionals and patient education, along with that of their caregivers, to develop a positive attitude.
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Affiliation(s)
- Dariusz Bazaliński
- Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów, 36-200 Brzozów, Poland; (D.B.); (K.P.)
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland;
| | - Joanna Przybek-Mita
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland;
- Postgraduate Nursing and Midwifery Education Centre, 35-083 Rzeszów, Poland
| | - Kamila Pytlak
- Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów, 36-200 Brzozów, Poland; (D.B.); (K.P.)
| | - Daria Kardyś
- Frederic Chopin Provincial Clinical Hospital No. 1, 35-055 Rzeszów, Poland;
| | - Adrian Bazaliński
- Student Scientific Association of Nurses, Sanok State University, 38-500 Sanok, Poland;
| | - Marek Kucharzewski
- Collegium Medicum, Jan Długosz Częstochowa University, 42-200 Częstochowa, Poland;
| | - Paweł Więch
- Institute of Health Protection, State University of Applied Sciences in Przemyśl, 37-700 Przemyśl, Poland
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Siddiqui SA, Li C, Aidoo OF, Fernando I, Haddad MA, Pereira JA, Blinov A, Golik A, Câmara JS. Unravelling the potential of insects for medicinal purposes - A comprehensive review. Heliyon 2023; 9:e15938. [PMID: 37206028 PMCID: PMC10189416 DOI: 10.1016/j.heliyon.2023.e15938] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/21/2023] Open
Abstract
Entomotherapy, the use of insects for medicinal purposes, has been practised for centuries in many countries around the world. More than 2100 edible insect species are eaten by humans, but little is known about the possibility of using these insects as a promising alternative to traditional pharmaceuticals for treating diseases. This review offers a fundamental understanding of the therapeutic applications of insects and how they might be used in medicine. In this review, 235 insect species from 15 orders are reported to be used as medicine. Hymenoptera contains the largest medicinal insect species, followed by Coleoptera, Orthoptera, Lepidoptera, and Blattodea. Scientists have examined and validated the potential uses of insects along with their products and by-products in treating various diseases, and records show that they are primarily used to treat digestive and skin disorders. Insects are known to be rich sources of bioactive compounds, explaining their therapeutic features such as anti-inflammatory, antimicrobial, antiviral, and so on. Challenges associated with the consumption of insects (entomophagy) and their therapeutic uses include regulation barriers and consumer acceptance. Moreover, the overexploitation of medicinal insects in their natural habitat has led to a population crisis, thus necessitating the investigation and development of their mass-rearing procedure. Lastly, this review suggests potential directions for developing insects used in medicine and offers advice for scientists interested in entomotherapy. In future, entomotherapy may become a sustainable and cost-effective solution for treating various ailments and has the potential to revolutionize modern medicine.
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Affiliation(s)
- Shahida Anusha Siddiqui
- Technical University of Munich Campus Straubing for Biotechnology and Sustainability, Essigberg 3, 94315 Straubing, Germany
- German Institute of Food Technologies (DIL e.V.), Prof.-von-Klitzing Str. 7, 49610 D-Quakenbrück, Germany
- Corresponding author. Technical University of Munich Campus Straubing for Biotechnology and Sustainability, Essigberg 3, 94315 Straubing, Germany.
| | - Chujun Li
- Guangzhou Unique Biotechnology Co., Ltd, 510663, Guangzhou, China
- State Key Laboratory of Biocontrol, School of Life Science, Sun Yat-sen University, Guangzhou, 510006, China
| | - Owusu Fordjour Aidoo
- Department of Biological, Physical and Mathematical Sciences, University of Environment and Sustainable Development, 00233, Somanya, Ghana
| | - Ito Fernando
- Department of Plant Pest and Diseases, Faculty of Agriculture, Universitas Brawijaya, Malang, 65145, East Java, Indonesia
| | - Moawiya A. Haddad
- Department of Nutrition and Food Processing, Faculty of Agricultural Technology, Al-Balqa Applied University, 19117, Al-Salt, Jordan
| | - Jorge A.M. Pereira
- CQM – Centro de Química da Madeira, Universidade da Madeira, Campus da Penteada, 9020-105 Funchal, Portugal
| | - Andrey Blinov
- North Caucasus Federal University, Pushkina Street 1, 355009, Stavropol, Russia
| | - Andrey Golik
- North Caucasus Federal University, Pushkina Street 1, 355009, Stavropol, Russia
| | - José S. Câmara
- CQM – Centro de Química da Madeira, Universidade da Madeira, Campus da Penteada, 9020-105 Funchal, Portugal
- Departamento de Química, Faculdade de Ciências Exatas e Engenharia, Universidade da Madeira, Campus da Penteada, 9020-105 Funchal, Portugal
- Corresponding author. CQM – Centro de Química da Madeira, Universidade da Madeira, Campus da Penteada, 9020-105 Funchal, Portugal.
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Bazaliński D, Przybek-Mita J, Lisowicz K, Skórka M, Więch P. Defensins of Lucilia sericata Larvae and Their Influence on Wound Repair Processes in Practical Assessment-A Study of Three Cases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5357. [PMID: 37047972 PMCID: PMC10094115 DOI: 10.3390/ijerph20075357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
Bacteria inhabiting chronic wounds form a biofilm that prolongs and slows down the healing process. Increasingly common antibiotic resistance requires clinicians to search for effective and alternative treatment methods. Defensins are the most common antimicrobial peptides capable of eradicating pathogens. Their discovery in maggot secretions allowed for a broader understanding of the healing mechanisms, and approving the use of Lucilia sericata fly larvae in the treatment of infected wounds resulted in an effective and safe procedure. The aim of the study was to present the possibility of biofilm elimination in a chronic wound by means of medical maggots (Lucilia sericata) with the example of three selected clinical cases. The observation included three women who met the inclusion criterion of having venous insufficiency ulcers with inhibited regeneration processes. Medical maggots were applied in a biobag for three days, and observation was conducted for 21 consecutive days. In 2 cases, a significant elimination of necrotic tissue from the wound bed with local granulation tissue was observed 72 h after application of a larvae colony on the wounds. In 1 case, the application of the larvae accelerated the repair process by reducing the wound area by approximately 40% at the time of observation. The formation of biofilm in a chronic wound is one of the main causes of disturbances in its effective healing. Combining procedures (scraping, antiseptic compresses, MDT, NPWT) related to wound debridement increases the effectiveness of biofilm elimination. The use of medical maggots is a safe and effective method of choice, and it enhances the processes of debridement. However, confirmed indisputable data on their effectiveness and frequency of use in the process of stimulating healing processes are still not available in the literature.
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Affiliation(s)
- Dariusz Bazaliński
- Father B. Markiewicz Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów, 36-200 Brzozów, Poland
- Department of Nursing and Public Health, Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland
| | - Joanna Przybek-Mita
- Department of Medical Rescue, Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland
- Postgraduate Nursing and Midwifery Education Centre, 35-083 Rzeszów, Poland
| | - Katarzyna Lisowicz
- Department of Nursing, Institute of Health and Economy, Carpathian State University in Krosno, 38-400 Krosno, Poland
| | - Mateusz Skórka
- St Hedvig Clinical Provincial Hospital No. 2 in Rzeszów, 35-301 Rzeszów, Poland
| | - Paweł Więch
- Department of Nursing and Public Health, Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland
- Department of Nursing, Institute of Health Protection, State University of Applied Sciences in Przemyśl, 37-700 Przemyśl, Poland
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Morris D, Flores M, Harris L, Gammon J, Nigam Y. Larval Therapy and Larval Excretions/Secretions: A Potential Treatment for Biofilm in Chronic Wounds? A Systematic Review. Microorganisms 2023; 11:microorganisms11020457. [PMID: 36838422 PMCID: PMC9965881 DOI: 10.3390/microorganisms11020457] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/24/2023] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
Chronic wounds present a global healthcare challenge and are increasing in prevalence, with bacterial biofilms being the primary roadblock to healing in most cases. A systematic review of the to-date knowledge on larval therapy's interaction with chronic-wound biofilm is presented here. The findings detail how larval therapy-the controlled application of necrophagous blowfly larvae-acts on biofilms produced by chronic-wound-relevant bacteria through their principle pharmacological mode of action: the secretion and excretion of biologically active substances into the wound bed. A total of 12 inclusion-criteria-meeting publications were identified following the application of a PRISMA-guided methodology for a systematic review. The findings of these publications were qualitatively analyzed to provide a summary of the prevailing understanding of larval therapy's effects on bacterial biofilm. A further review assessed the quality of the existing evidence to identify knowledge gaps and suggest ways these may be bridged. In summary, larval therapy has a seemingly unarguable ability to inhibit and degrade bacterial biofilms associated with impaired wound healing. However, further research is needed to clarify and standardize the methodological approach in this area of investigation. Such research may lead to the clinical application of larval therapy or derivative treatments for the management of chronic-wound biofilms and improve patient healing outcomes at a time when alternative therapies are desperately needed.
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Affiliation(s)
- Daniel Morris
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
- BioMonde, Bridgend CF31 3BG, UK
| | | | - Llinos Harris
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
| | - John Gammon
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
| | - Yamni Nigam
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
- Correspondence:
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Beyond the Risk of Biofilms: An Up-and-Coming Battleground of Bacterial Life and Potential Antibiofilm Agents. Life (Basel) 2023; 13:life13020503. [PMID: 36836860 PMCID: PMC9959329 DOI: 10.3390/life13020503] [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: 01/03/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
Microbial pathogens and their virulence factors like biofilms are one of the major factors which influence the disease process and its outcomes. Biofilms are a complex microbial network that is produced by bacteria on any devices and/or biotic surfaces to escape harsh environmental conditions and antimicrobial effects. Due to the natural protective nature of biofilms and the associated multidrug resistance issues, researchers evaluated several natural anti-biofilm agents, including bacteriophages and their derivatives, honey, plant extracts, and surfactants for better destruction of biofilm and planktonic cells. This review discusses some of these natural agents that are being put into practice to prevent biofilm formation. In addition, we highlight bacterial biofilm formation and the mechanism of resistance to antibiotics.
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Dillmann JB, Lopes TRR, da Rosa G, Fracasso M, Tapia Barraza VC, Barbosa NV, de Andrade CM, Kommers GD, Cargnelutti JF, Monteiro SG. Safety and efficacy of Lucilia cuprina maggots on treating an induced infected wound in Wistar rats. Exp Parasitol 2022; 240:108337. [PMID: 35850276 DOI: 10.1016/j.exppara.2022.108337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022]
Abstract
Infection is one of the main complications that hinder wound healing. Currently, antibiotic-resistant bacteria, such as Methicilin-resistant Staphylococcus aureus (MRSA), are a concern worldwide for both humans and animals. Maggot therapy is re-emerging as an alternative to intractable wounds and may be an option to the traditional antibiotic treatment. Although the species of choice is Lucilia sericata, reports of clinical use have led us to evaluate the efficacy and safety of using Lucilia cuprina larvae on induced infected wounds in Wistar rats. In short, 32 male Wistar rats were divided into 4 groups: Group I - saline solution treated; Group II - antibiotic-treated; Group III - treated with larval debridement, and Group IV - without wound and treatment. Skin wounds were induced in groups I, II and III. All treatments were performed once and held for 48 h. Clinical, microbiological, histopathological, hematological, and biochemical analyses were done. Significant wound area contraction was found (>95%) in group III on day 9 compared to day 15 in group II. Complete elimination (0.0 ± 0.0 CFU/mL) of bioburden was achieved after the second treatment (day 6) in both the II and III groups, compared to an increase in Group I (6.51 ± 0.37 CFU/mL). A cleaner wound was also observed in the histopathological evaluation of group III, with adequate collagen formation and re-epithelialization on day 15. Furthermore, larvae increased blood platelet levels after the first treatment. L. cuprina larvae have proven safe and effective in accelerating wound treatment and eliminating MRSA.
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Affiliation(s)
- Janaína Brand Dillmann
- Programa de Pós-graduação em Medicina Veterinária, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil; Departamento de Microbiologia e Parasitologia, Universidade Federal de Santa Maria, RS, Brazil.
| | - Thaísa Regina Rocha Lopes
- Programa de Pós-graduação em Medicina Veterinária, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil; Setor de Virologia, Departamento de Medicina Veterinária Preventiva, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Gilneia da Rosa
- Departamento de Microbiologia e Parasitologia, Universidade Federal de Santa Maria, RS, Brazil
| | - Mateus Fracasso
- Departamento de Microbiologia e Parasitologia, Universidade Federal de Santa Maria, RS, Brazil
| | | | - Nathália Viana Barbosa
- Laboratório de Análises Clínicas Veterinárias, Departamento de Clínica de Pequenos Animais, Universidade Federal de Santa Maria, RS, Brazil
| | - Cinthia Melazzo de Andrade
- Laboratório de Análises Clínicas Veterinárias, Departamento de Clínica de Pequenos Animais, Universidade Federal de Santa Maria, RS, Brazil
| | | | - Juliana Felipetto Cargnelutti
- Laboratório de Bacteriologia, Departamento de Medicina Veterinária Preventiva do Centro de Ciências Rurais, Universidade Federal de Santa Maria, RS, Brazil
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Pérez-Acevedo G, Bosch-Alcaraz A, Torra-Bou JE. Larval Therapy for Treatment of Chronic Wounds Colonized by Multi-resistant Pathogens in a Pediatric Patient: A Case Study. J Wound Ostomy Continence Nurs 2022; 49:373-378. [PMID: 35809014 DOI: 10.1097/won.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic wounds are susceptible to colonization with gram-positive and gram-negative bacteria that may be resistant to antimicrobial dressings and systemic antibiotics. In January 2004, the US Food and Drugs Administration approved use of medicinal larvae for use in humans and animals for resistant organisms. Despite use in adults, there is a paucity of evidence evaluating its efficacy and safety in the pediatric population. CASE T was a 5-year-old boy with several chronic wounds infected with multidrug-resistant Pseudomonas aeruginosa. The wounds were originally treated with chemical debridement, dressings containing ionic silver, negative-pressure wound therapy (NPWT), and antibiotics without success. Consequently, a multidisciplinary team implemented maggot debridement therapy (MDT). CONCLUSIONS After MDT, one wound completely epithelialized and the other wounds achieved a reduction in size with 70% epithelization. Therapy also led to a reduction in wound odor, exudate, and pain. The other wounds were closed after additional management with dressing containing nanocrystalline silver and NPWT.
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Affiliation(s)
- Gemma Pérez-Acevedo
- Gemma Pérez-Acevedo, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
- Alejandro Bosch-Alcaraz, PhD, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
- Joan Enric Torra-Bou, PhD, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
| | - Alejandro Bosch-Alcaraz
- Gemma Pérez-Acevedo, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
- Alejandro Bosch-Alcaraz, PhD, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
- Joan Enric Torra-Bou, PhD, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
| | - Joan Enric Torra-Bou
- Gemma Pérez-Acevedo, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
- Alejandro Bosch-Alcaraz, PhD, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
- Joan Enric Torra-Bou, PhD, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
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10
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Abdel-Samad MRK, Taher FA. Wound healing and antibacterial activities of water-soluble chitosan nanoparticles and excretion/secretion as a natural combination from medicinal maggots, Lucilia cuprina. J BIOACT COMPAT POL 2021. [DOI: 10.1177/08839115211053921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Wounds management takes a high interest in the medical field and the addition of antimicrobial agents in an assortment of wound dressings leads to delay the wound healing. This study aimed at preparing natural combination between excretion/secretion (ES) and water-soluble chitosan nanoparticles (from Lucilia cuprina maggots) and investigating its antibacterial and wound healing activities. ES of maggots was collected, and the water-soluble chitosan nanoparticles (WSCNPs) were prepared and characterized. Antibacterial activities of combinations were evaluated against Staphylococcus aureus, Bacillus subtilis, Escherichia coli, and Proteus vulgaris. ES-WSC-2 combination that contains 50% ES and 1% WSCNPs showed highest antibacterial activity against all tested bacteria compared to the other combinations. In vitro, the ES-WSC-2 combination was used to study the wound healing activity by scratch assay. The synergism between ES and WSCNPs (in ES-WSC-2 combination) accelerated the wound healing rate which suggests the use of this combination as an effective natural antibacterial and wound healing agent.
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Affiliation(s)
- Mohammad RK Abdel-Samad
- Department of Zoology and Entomology, Faculty of Science, Al-Azhar University, Cairo, Egypt
- Al-Azhar Technology Incubator (ATI), Al-Azhar University, Cairo, Egypt
| | - Fatma A Taher
- Al-Azhar Technology Incubator (ATI), Al-Azhar University, Cairo, Egypt
- Department of Chemistry, Faculty of Science, Al-Azhar University (Girls), Cairo, Egypt
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11
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Gazi U, Taylan-Ozkan A, Mumcuoglu KY. The effect of Lucilia sericata larval excretion/secretion (ES) products on cellular responses in wound healing. MEDICAL AND VETERINARY ENTOMOLOGY 2021; 35:257-266. [PMID: 33314340 DOI: 10.1111/mve.12497] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Chronic wounds are still regarded as a serious public health concern, which are on the increase mainly due to the changes in life styles and aging of the human population. There are different types of chronic wounds, each of which requires slightly different treatment strategies. Nevertheless, wound bed preparation is included in treatment of all types of chronic wounds and involves tissue debridement, inflammation, and infection control, as well as moisture balance and epithelial edge advancement. Maggot therapy (MT) is a form of biological debridement which involves the application of live medical grade Lucilia sericata (Meigen, 1826) (Diptera: Calliphoridae) larvae. Whereas it was initially thought to act mainly through debridement, today MT is known to influence all four overlapping physiological phases of wound repair: homeostasis, inflammation, proliferation, and remodelling/maturing. During MT, medical-grade larvae are applied either freely or enclosed in tea-bag like devices (biobag) inside the wounds, which suggests that larva excretion/secretion (ES) products can facilitate the healing processes directly without the need of direct contact with the larvae. This review summarizes the relevant literature on ES-mediated effects on the cellular responses involved in wound healing.
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Affiliation(s)
- U Gazi
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - A Taylan-Ozkan
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Cyprus
- Department of Medical Microbiology, Faculty of Medicine, Hitit University, Corum, Turkey
| | - K Y Mumcuoglu
- Parasitology Unit, Department of Microbiology and Molecular Genetics, The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
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12
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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.
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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
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13
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Iancu L, Angelescu IR, Paun VI, Henríquez-Castillo C, Lavin P, Purcarea C. Microbiome pattern of Lucilia sericata (Meigen) (Diptera: Calliphoridae) and feeding substrate in the presence of the foodborne pathogen Salmonella enterica. Sci Rep 2021; 11:15296. [PMID: 34315964 PMCID: PMC8316364 DOI: 10.1038/s41598-021-94761-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/16/2021] [Indexed: 12/04/2022] Open
Abstract
The microbial diversity and quantitative dynamics during the insect’s development stages constitute recently developed putative tools in forensic and medical studies. Meanwhile, little is known on the role of insects in spreading foodborne pathogenic bacteria and on the impact of these pathogens on the overall insects and feeding substrate microbiome composition. Here, we provide the first characterization of the bacterial communities harbored in adult and immature stages of Lucilia sericata, one of the first colonizers of decomposed human remains, in the presence of the foodborne pathogen Salmonella enterica using 16S rRNA Illumina sequencing and qPCR. The pathogen transmission from the wild adults to the second generation was observed, with a 101.25× quantitative increase. The microbial patterns from both insect and liver samples were not influenced by the artificial introduction of this pathogenic foodborne bacteria, being dominated by Firmicutes and Proteobacteria. Overall, our results provided a first detailed overview of the insect and decomposed substrate microbiome in the presence of a human pathogen, advancing the knowledge on the role of microbes as postmortem interval estimators and the transmission of pathogenic bacteria.
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Affiliation(s)
- Lavinia Iancu
- Department of Microbiology, Institute of Biology Bucharest of Romanian Academy, Splaiul Independentei, 296, 060031, Bucharest, Romania. .,Department of Criminal Justice, University of North Dakota, Grand Forks, ND, 58202, USA.
| | - Iulia Roxana Angelescu
- Department of Microbiology, Institute of Biology Bucharest of Romanian Academy, Splaiul Independentei, 296, 060031, Bucharest, Romania
| | - Victoria Ioana Paun
- Department of Microbiology, Institute of Biology Bucharest of Romanian Academy, Splaiul Independentei, 296, 060031, Bucharest, Romania
| | - Carlos Henríquez-Castillo
- Laboratorio de Fisiología y Genética Marina, Centro de Estudios Avanzados en Zonas Áridas, 1781421, Coquimbo, Chile.,Facultad de Ciencias del Mar, Universidad Católica del Norte, 1781421, Coquimbo, Chile
| | - Paris Lavin
- Departamento de Biotecnología, Facultad de Ciencias del Mar y Recursos Biológicos, Universidad de Antofagasta, Antofagasta, Chile.,Laboratorio de Complejidad Microbiana y Ecología Funcional, Instituto Antofagasta, Antofagasta, Chile
| | - Cristina Purcarea
- Department of Microbiology, Institute of Biology Bucharest of Romanian Academy, Splaiul Independentei, 296, 060031, Bucharest, Romania
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14
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Harman RM, Theoret CL, Van de Walle GR. The Horse as a Model for the Study of Cutaneous Wound Healing. Adv Wound Care (New Rochelle) 2021; 10:381-399. [PMID: 34042536 DOI: 10.1089/wound.2018.0883] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Significance: Cutaneous wounds are a major problem in both human and equine medicine. The economic cost of treating skin wounds and related complications in humans and horses is high, and in both species, particular types of chronic wounds do not respond well to current therapies, leading to suffering and morbidity. Recent Advances: Conventional methods for the treatment of cutaneous wounds are generic and have not changed significantly in decades. However, as more is learned about the mechanisms involved in normal skin wound healing, and how failure of these processes leads to chronic nonhealing wounds, novel therapies targeting the specific pathologies of hard-to-heal wounds are being developed and evaluated. Critical Issues: Physiologically relevant animal models are needed to (1) study the mechanisms involved in normal and impaired skin wound healing and (2) test newly developed therapies. Future Directions: Similarities in normal wound healing in humans and horses, and the natural development of distinct types of hard-to-heal chronic wounds in both species, make the horse a physiologically relevant model for the study of mechanisms involved in wound repair. Horses are also well-suited models to test novel therapies. In addition, studies in horses have the potential to benefit veterinary, as well as human medicine.
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Affiliation(s)
- Rebecca M. Harman
- Baker Institute for Animal Health, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | | | - Gerlinde R. Van de Walle
- Baker Institute for Animal Health, College of Veterinary Medicine, Cornell University, Ithaca, New York
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15
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Fonseca‐Muñoz A, Sarmiento‐Jiménez HE, Pérez‐Pacheco R, Thyssen PJ, Sherman RA. Clinical study of Maggot therapy for Fournier's gangrene. Int Wound J 2020; 17:1642-1649. [PMID: 32691532 PMCID: PMC7949221 DOI: 10.1111/iwj.13444] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 12/14/2022] Open
Abstract
Fournier's Gangrene is a fulminating necrotizing fasciitis of the perineum and genitalia. Standard treatment involves immediate excision of all necrotic tissue, aggressive antibiotic coverage, and supportive medical care. Still, the infection is commonly fatal or disfiguring. Wound treatment with disinfected blowfly larvae (maggot debridement therapy or MDT) has been shown to be highly effective, with multiple studies demonstrating effective debridement, disinfection, and promotion of granulation tissue. MDT also has been associated with preservation of viable tissue and minimised blood loss. This report describes a prospective clinical study of MDT for Fournier's gangrene aimed to test the hypothesis that early use of maggots could decrease the number of surgical treatments required to treat Fournier's gangrene. Subjects were provided with one initial surgical excision, followed by debridement using only medical grade Lucilia sericata larvae. Only two subjects were enrolled, both diabetic men. Intensive care and culture-directed antimicrobial coverage were administered as usual. Maggot debridement was associated with the disappearance of necrotic tissue, control of infection and granulation tissue growth. In both subjects, wounds healed without requiring further surgical resection or anatomical reconstruction. Maggot therapy decreased the number of surgical procedures that otherwise would have been necessary, and led to favourable outcomes.
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Affiliation(s)
- Alicia Fonseca‐Muñoz
- Centro Interdisciplinario de Investigación para el Desarrollo Integral Regional (CIIDIR)Instituto Politécnico Nacional (IPN), Unidad OaxacaSanta Cruz XoxocotlánMexico
| | | | - Rafael Pérez‐Pacheco
- Centro Interdisciplinario de Investigación para el Desarrollo Integral Regional (CIIDIR)Instituto Politécnico Nacional (IPN), Unidad OaxacaSanta Cruz XoxocotlánMexico
| | - Patricia J. Thyssen
- Department of Animal BiologyInstitute of Biology, University of Campinas (UNICAMP)CampinasBrazil
| | - Ronald A. Sherman
- Board Chair and DirectorBioTherapeutics, Education & Research (BTER) FoundationIrvineCaliforniaUSA
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16
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Fan W, Yang B, Hu X, Yang X, Shi C, Liu G. Safety and efficacy of larval therapy on treating leg ulcers: a protocol for systematic review and meta-analysis. BMJ Open 2020; 10:e039898. [PMID: 33033098 PMCID: PMC7545619 DOI: 10.1136/bmjopen-2020-039898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Leg ulcers (LUs) not only seriously affect life and work of patients, but also bring huge economic burden to the society. As a potential underused biological debridement, larval therapy provides help for the treatment of LUs. The purpose of our research is to assess whether patients with LUs can benefit from larval therapy. METHODS AND ANALYSIS The following electronic databases will be searched: PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure Database, Wanfang Database and Chinese Biological Medicine. Randomised controlled trials are eligible for inclusion. There will be no restrictions with respect to language and search date is up to June 2020. Primary outcomes investigated are complete healing rate after treatment, time to ulcer healing, reduction of wound surface area and adverse events. Risk ratios will be used for categorical data; weighted mean difference will be used for measurement data. Subgroup analysis and sensitivity analysis will be considered if heterogeneity exists. The results of data synthesis will be performed by narrative summary and quantitative analysis. ETHICS AND DISSEMINATION This systematic review does not require the approval of the ethics committee because individual data on patients are not collected. The results of the study will be disseminated in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42020176953.
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Affiliation(s)
- Weijing Fan
- Peripheral vascular disease department, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Baozhong Yang
- Peripheral vascular disease department, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoming Hu
- Peripheral vascular disease department, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao Yang
- Peripheral vascular disease department, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chenyan Shi
- Peripheral vascular disease department, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guobin Liu
- Peripheral vascular disease department, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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17
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Hajmohammadi K, Esmaeili Zabihi R, Akbarzadeh K, Parizad N. Using a combination therapy to combat scalp necrosis: a case report. J Med Case Rep 2020; 14:132. [PMID: 32814571 PMCID: PMC7439622 DOI: 10.1186/s13256-020-02450-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic nonhealing wounds are very expensive to treat and debilitating, and they reduce health-related quality of life. Scalp necrosis is very rare due to its rich vascularity. However, any post-traumatic wounds with secondary infection can lead to scalp necrosis. CASE PRESENTATION We report a case of a 77-year-old Azerbaijani man with a history of diabetes who had a car accident and sustained a scalp wound. He underwent reconstructive surgery for the scalp wound. The wound became infected, and scalp necrosis developed following the surgery. There was no progress in wound healing in spite of conventional wound therapy. We combined maggot debridement therapy with negative-pressure wound therapy and amniotic membrane grafting for 7 months. Necrotic tissues began to be eliminated after the second use of larva therapy, and the wound became free of necrotic tissues with clear increase of granulated tissues after four treatments with maggot debridement therapy. Then, we applied negative-pressure wound therapy and amniotic membrane grafting to accelerate wound healing and improve wound closure. The patient's scalp wound recovered well, and he was discharged to home in good condition. CONCLUSIONS Medical and wound care teams can benefit from this combination therapy when dealing with nonhealing necrotic wounds.
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Affiliation(s)
- Kazem Hajmohammadi
- Imam Khomeini Teaching Hospital, Urmia University of Medical Sciences, Imam Khomeini Hospital, Ershad Ave., Urmia, 571478-3734 Iran
| | - Roghayeh Esmaeili Zabihi
- Department of Nursing, Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Campus Nazlu, 11 KM Road Seru, Urmia, West Azerbaijan 575611-5111 Iran
| | - Kamran Akbarzadeh
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Enqelab Square, Tehran, 1417613151 Iran
| | - Naser Parizad
- Patient Safety Research Center, Faculty of Nursing and Midwifery, Nursing and Midwifery Faculty, Campus Nazlu, 11 KM Road Seru, Urmia, West Azerbaijan 575611-5111 Iran
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18
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Isabela Avila-Rodríguez M, Meléndez-Martínez D, Licona-Cassani C, Manuel Aguilar-Yañez J, Benavides J, Lorena Sánchez M. Practical context of enzymatic treatment for wound healing: A secreted protease approach (Review). Biomed Rep 2020; 13:3-14. [PMID: 32440346 PMCID: PMC7238406 DOI: 10.3892/br.2020.1300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/14/2020] [Indexed: 12/13/2022] Open
Abstract
Skin wounds have been extensively studied as their healing represents a critical step towards achieving homeostasis following a traumatic event. Dependent on the severity of the damage, wounds are categorized as either acute or chronic. To date, chronic wounds have the highest economic impact as long term increases wound care costs. Chronic wounds affect 6.5 million patients in the United States with an annual estimated expense of $25 billion for the health care system. Among wound treatment categories, active wound care represents the fastest-growing category due to its specific actions and lower costs. Within this category, proteases from various sources have been used as successful agents in debridement wound care. The wound healing process is predominantly mediated by matrix metalloproteinases (MMPs) that, when dysregulated, result in defective wound healing. Therapeutic activity has been described for animal secretions including fish epithelial mucus, maggot secretory products and snake venom, which contain secreted proteases (SPs). No further alternatives for use, sources or types of proteases used for wound healing have been found in the literature to date. Through the present review, the context of enzymatic wound care alternatives will be discussed. In addition, substrate homology of SPs and human MMPs will be compared and contrasted. The purpose of these discussions is to identify and propose the stages of wound healing in which SPs may be used as therapeutic agents to improve the wound healing process.
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Affiliation(s)
| | - David Meléndez-Martínez
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico
| | | | - José Manuel Aguilar-Yañez
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico
- Scicore Medical SAPI de CV, Monterrey, Nuevo León 64920, Mexico
| | - Jorge Benavides
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico
| | - Mirna Lorena Sánchez
- Laboratorio de Materiales Biotecnológicos, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes-Imbice-Conicet-Cicpba, Bernal, Buenos Aires B1876BXD, Argentina
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19
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Bazaliński D, Kózka M, Karnas M, Więch P. Effectiveness of Chronic Wound Debridement with the Use of Larvae of Lucilia Sericata. J Clin Med 2019; 8:E1845. [PMID: 31684038 PMCID: PMC6912827 DOI: 10.3390/jcm8111845] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 02/07/2023] Open
Abstract
The process of successful wound healing depends on effective debridement and infection control. One method of wound debridement, known since antiquity, is based on the use of fly larvae. Solid scientific evidence proves that maggot debridement therapy (MDT), like surgical intervention, can be effectively and safely used to remove necrotic tissue. Based on a review of the related literature, this study was designed to assess the effectiveness of chronic wound cleansing with the use of larvae of Lucilia sericata (Phaenicia sericata). Maggot therapy, applied in wound debridement and treatment, is a safe and effective method. Its benefits are associated with debridement, disinfection and faster tissue growth. MDT may reduce the duration of antibiotic therapy and the need for hospitalization, or it may decrease the number of outpatient visits required. It is a relatively cost-effective method, and, in addition to financial gains, it may reduce the frequency of inpatient treatment. In the literature, an increasing amount of scientific evidence confirms that such treatment can effectively reduce the biofilm and bacterial load in a wound.
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Affiliation(s)
- Dariusz Bazaliński
- Father B. Markiewicz Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów, 36-200 Brzozów, Poland.
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszów, University of Rzeszów, 35-959 Rzeszów, Poland.
| | - Maria Kózka
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Krakow, Poland.
| | - Magdalena Karnas
- New Medical Technologies, Holy Family Specialist Hospital, 36-060 Rudna Mała, Poland.
| | - Paweł Więch
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszów, University of Rzeszów, 35-959 Rzeszów, Poland.
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20
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Fonseca-Muñoz A, Pérez-Pacheco R, Ortega-Morales BO, Reyes-Estebanez M, Vásquez-López A, Chan-Bacab M, Ruiz-Vega J, Granados-Echegoyen CA. Bactericidal Activity of Chrysomya rufifacies and Cochliomyia macellaria (Diptera: Calliphoridae) Larval Excretions-Secretions Against Staphylococcus aureus (Bacillales: Staphylococcaceae). JOURNAL OF MEDICAL ENTOMOLOGY 2019; 56:1598-1604. [PMID: 31287880 DOI: 10.1093/jme/tjz109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Indexed: 06/09/2023]
Abstract
The inhibitory effect of Chrysomya rufifacies (Macquart) and Cochliomyia macellaria (Fabricius) larval excretions-secretions (ES) on Staphylococcus aureus was determined using a portable colorimetric method without the need for any dedicated spectral instrument. Polystyrene 96 well microplates were used and 100 μl of the bacterial inoculum (5 × 105 CFU/ml) plus 100 μl of the dipteran exosecretions at different concentrations were added to each well. Subsequently, 50 μl of a 1% solution of the triphenyl tetrazolium chloride stain was added to each well to determine the bacterial viability. The color development in each well was measured with the ImageJ software S. aureus was exposed to different concentrations of the ES of both species individually. At a concentration of 800 ppm ES of C. rufifacies or Co. macellaria, bacterial growth was inhibited 97.45 ± 1.70% and 82.21 ± 1.88%, respectively. As expected, exposure to a lower concentration (i.e., 50 ppm) was less inhibitory (C. rufifacies ES, 77.65 ± 4.25% and Co. macellaria ES, 43.54 ± 4.63%). This study demonstrates for the first time the bactericidal activity of C. rufifacies and Co. macellaria ES against S. aureus. This finding is promising as it could result in the identification and synthesis of proteins capable of suppressing pathogen development in wounds. Additionally, the proposed method can simplify the use of expensive laboratory instruments for antimicrobial activity determination.
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Affiliation(s)
- Alicia Fonseca-Muñoz
- Instituto Politécnico Nacional (IPN), Centro Interdisciplinario de Investigación para el Desarrollo Integral Regional (CIIDIR) Unidad Oaxaca, Calle Hornos, Santa Cruz, Xoxocotlán, Oaxaca, México, CP
- Doctorado en Ciencias en Conservación y Aprovechamiento de Recursos Naturales, CIIDIR-IPN-Oaxaca, Oaxaca, México
| | - Rafael Pérez-Pacheco
- Instituto Politécnico Nacional (IPN), Centro Interdisciplinario de Investigación para el Desarrollo Integral Regional (CIIDIR) Unidad Oaxaca, Calle Hornos, Santa Cruz, Xoxocotlán, Oaxaca, México, CP
| | - Benjamín Otto Ortega-Morales
- Departamento de Microbiología Ambiental y Biotecnología (DEMAB), Universidad Autónoma de Campeche (UAC), Av. Agustín Melgar s/n, Col. Buenavista, Campeche, México, CP
| | - Manuela Reyes-Estebanez
- Departamento de Microbiología Ambiental y Biotecnología (DEMAB), Universidad Autónoma de Campeche (UAC), Av. Agustín Melgar s/n, Col. Buenavista, Campeche, México, CP
| | - Alfonso Vásquez-López
- Instituto Politécnico Nacional (IPN), Centro Interdisciplinario de Investigación para el Desarrollo Integral Regional (CIIDIR) Unidad Oaxaca, Calle Hornos, Santa Cruz, Xoxocotlán, Oaxaca, México, CP
| | - Manuel Chan-Bacab
- Departamento de Microbiología Ambiental y Biotecnología (DEMAB), Universidad Autónoma de Campeche (UAC), Av. Agustín Melgar s/n, Col. Buenavista, Campeche, México, CP
| | - Jaime Ruiz-Vega
- Instituto Politécnico Nacional (IPN), Centro Interdisciplinario de Investigación para el Desarrollo Integral Regional (CIIDIR) Unidad Oaxaca, Calle Hornos, Santa Cruz, Xoxocotlán, Oaxaca, México, CP
| | - Carlos A Granados-Echegoyen
- Departamento de Microbiología Ambiental y Biotecnología (DEMAB), Universidad Autónoma de Campeche (UAC), Av. Agustín Melgar s/n, Col. Buenavista, Campeche, México, CP
- Centro de Estudios de Desarrollo Sustentable y Aprovechamiento de la Vida Silvestre (CEDESU), CONACYT- Universidad Autónoma de Campeche (UAC), Avenida Héroe de Nacozari, Campeche, México, CP
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Cooper R, Kirketerp-Møller K. Non-antibiotic antimicrobial interventions and antimicrobial stewardship in wound care. J Wound Care 2019; 27:355-377. [PMID: 29883284 DOI: 10.12968/jowc.2018.27.6.355] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Control of wound infection today relies largely on antibiotics, but the continual emergence of antibiotic-resistant microorganisms threatens a return to the pre-antibiotic era when physicians used antiseptics to prevent and manage infection. Some of those antiseptics are still used today, and others have become available. A diverse variety of non-antibiotic antimicrobial interventions are found on modern formularies. Unlike the mode of action of antibiotics, which affect specific cellular target sites of pathogens, many non-antibiotic antimicrobials affect multiple cellular target sites in a non-specific way. Although this reduces the likelihood of selecting for resistant strains of microorganisms, some have emerged and cross-resistance between antibiotics and antiseptics has been detected. With the prospect of a post-antibiotic era looming, ways to maintain and extend our antimicrobial armamentarium must be found. In this narrative review, current and emerging non-antibiotic antimicrobial strategies will be considered and the need for antimicrobial stewardship in wound care will be explained.
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Affiliation(s)
- Rose Cooper
- Professor of Microbiology, Department of Biomedical Science, Cardiff School of Health Sciences, Cardiff Metropolitan University, Western Avenue, Cardiff, UK
| | - Klaus Kirketerp-Møller
- Orthopaedic Surgeon, Copenhagen Wound Healing Center, Department of Dermatology and Wounds, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen NV
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22
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Development of an effective fluorescence probe for discovery of aminopeptidase inhibitors to suppress biofilm formation. J Antibiot (Tokyo) 2019; 72:461-468. [PMID: 30894675 DOI: 10.1038/s41429-019-0166-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/28/2019] [Accepted: 02/28/2019] [Indexed: 12/13/2022]
Abstract
The human pathogen Pseudomonas aeruginosa can easily form biofilms. The extracellular matrix produced by the bacterial cells acts as a physical barrier to hinder the antibiotics treatment. It is necessary to destroy the biofilm in order to improve the efficacy of antibiotics. However, it has been a significant challenge to develop effective small molecules targeting the components of biofilm matrix. In this study, we report the development of a new effective fluorescence probe that could be used in the high throughput screening to identify novel small molecule inhibitors targeting the most abundant component in the biofilm formation: P. aeruginosa aminopeptidase (PaAP). Through screening of an in-house chemical library, a commercially available drug, balsalazide, has been identified as a novel PaAP inhibitor, which exhibited remarkable anti-biofilm effect. Our study indicated that the newly developed fluorescence probe is applicable in exploring new aminopeptidase inhibitors, and it also warrants further investigation of balsalazide as a new anti-biofilm agent to treat P. aeruginosa infection in combination with known antibiotics.
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23
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Wilson MR, Nigam Y, Knight J, Pritchard DI. What is the optimal treatment time for larval therapy? A study on incubation time and tissue debridement by bagged maggots of the greenbottle fly, Lucilia sericata. Int Wound J 2019; 16:219-225. [PMID: 30379404 PMCID: PMC7948740 DOI: 10.1111/iwj.13015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/20/2018] [Accepted: 09/25/2018] [Indexed: 01/14/2023] Open
Abstract
The effective use of larvae of the greenbottle fly, Lucilia sericata, in wound debridement requires a working knowledge of how feeding changes over time. Using a laboratory assay and bagged larval dressings, the effect of incubation time on larval feeding rates and body mass was investigated for up to 120 hours at 32°C. The mass of tissue digested increased significantly in incremental 24-hour periods up to 72 hours, with no significant consumption occurring afterwards. Larval mass increased only up to 48 hours. A further test comparing the efficacy of a single 96-hour application of larvae against two consecutive 48-hour applications found that the mass of tissue digested in the latter was 14.3% higher than the former, a difference that was statistically significant. Current clinical guidance suggests a 4-day application period for bagged larvae. Based on these results, an incubation time of 72 hours (3 days) for bagged larvae would be the most effective at the study temperature. However, it is acknowledged that wound temperature can vary, whereby feeding rates would likely differ. In view of this, we conclude that a period of 3 to 4 days is optimum for the application of larvae, and current guidelines should be adhered to.
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Affiliation(s)
| | - Yamni Nigam
- College of Human and Health SciencesSwansea UniversitySwanseaUK
| | - John Knight
- College of Human and Health SciencesSwansea UniversitySwanseaUK
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Schmitz S, Nölle V, Elleuche S. A non-specific nucleolytic enzyme and its application potential in EDTA-containing buffer solutions. Biotechnol Lett 2018; 41:129-136. [PMID: 30390191 DOI: 10.1007/s10529-018-2618-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/25/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Metal-ion independent non-specific nucleases are of high potential for applications in EDTA-containing bioprocessing workflows. RESULTS A novel extracellular non-specific nuclease EcNuc from the enterobacterium Escherichia coli has been identified. The recombinant gene was expressed and the protein was purified. Maximum activity of the enzyme was detected at 41.7 °C and at an acidic pH of 5.8. EcNuc tolerates EDTA in the reaction buffer at concentrations of up to 20 mM and the activity is not impaired by high concentrations of mono- and divalent metal ions in the absence of EDTA. The viscosity of crude protein extracts after cell lysis in EDTA-containing buffers is reduced when supplemented with EcNuc. CONCLUSION Proof-of-concept has been demonstrated that a metal-ion independent non-specific nuclease can be applied for removal of nucleic acids in EDTA-containing buffers for the subsequent purification of proteins from crude extracts.
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Affiliation(s)
- Sarah Schmitz
- Miltenyi Biotec GmbH, Friedrich-Ebert-Straße 68, 51429, Bergisch Gladbach, Germany
| | - Volker Nölle
- Miltenyi Biotec GmbH, Friedrich-Ebert-Straße 68, 51429, Bergisch Gladbach, Germany
| | - Skander Elleuche
- Miltenyi Biotec GmbH, Friedrich-Ebert-Straße 68, 51429, Bergisch Gladbach, Germany.
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Pharmacological Properties of the Medical Maggot: A Novel Therapy Overview. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:4934890. [PMID: 29853956 PMCID: PMC5960508 DOI: 10.1155/2018/4934890] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/05/2018] [Indexed: 02/01/2023]
Abstract
In the last decade, maggot has been hailed as the miraculous “medicinal maggot” for its diverse properties, including antimicrobial, antibiofilm, anti-inflammatory, and wound healing activities. The fact that maggots show so many beneficial properties has increased the interest in these tiny larvae dramatically. Whilst there is relatively abundant clinical evidence to demonstrate the success of maggots as debridement agents, not so much emphasis has been placed on the basic science evidence, which was a combination of physical and biochemical actions. This review differs from those earlier works in that it is undertaken to provide an update of the latest scientific basis published on maggot, particularly active ingredients within maggot excretions/secretions (ES). Further investigations should focus on the isolation, identification, recombination, transgenosis, and mass production of the beneficial molecules within maggots.
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Abstract
Maggot debridement therapy (MDT) is an effective method for debriding wounds such as leg ulcers, supporting the concept of wound bed preparation ( Dumville et al, 2009 ; Soares et al, 2009 ; Mudge et al, 2014 ). New evidence is emerging to suggest that maggots might contribute to wound healing in other ways. For example, the reduction of biofilms and disinfection of wounds ( Van Der Plas et al, 2008 ; Brown et al, 2012 ; Pritchard and Brown, 2015 ) plus regulation of protease levels ( Chambers et al, 2003 ; Van Der Plas et al, 2009a ; Van Der Plas et al, 2009b ). This review will discuss research exploring new benefits of maggots in the management of individuals with chronic leg ulcers.
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Affiliation(s)
- Genevieve Abela
- PgDip Wound Healing and Tissue Repair, Cardiff University, Practice Nurse, Tissue Viabilty, VGH Rehabilitation Hospital Karin Grech, Malta
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Pickles SF, Pritchard DI. Quality control of a medicinal larval (Lucilia sericata) debridement device based on released gelatinase activity. MEDICAL AND VETERINARY ENTOMOLOGY 2017; 31:200-206. [PMID: 28117913 DOI: 10.1111/mve.12220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/26/2016] [Accepted: 11/13/2016] [Indexed: 06/06/2023]
Abstract
Lucilia sericata Meigen (Diptera: Calliphoridae) larvae are manufactured worldwide for the treatment of chronic wounds. Published research has confirmed that the primary clinical effect of the product, debridement (the degradation of non-viable wound tissue), is accomplished by a range of enzymes released by larvae during feeding. The quality assessment of larval activity is currently achieved during production using meat-based assays, which monitor insect growth and/or the reduction in substrate mass. To support this, the present authors developed a complementary radial diffusion enzymatic assay to produce a visual and measureable indication of the activity of larval alimentary products (LAP) collected under standardized conditions, against a gelatin substrate. Using basic laboratory equipment and reagents, the assay is rapid and suited to high throughput. Assay reproducibility is high (standard deviation: 0.06-0.27; coefficient of variation: 0.75-4.31%) and the LAP collection procedure does not adversely affect larval survival (mortality: < 2%). Because it is both cost- and time-effective, this method is suited to both academic and industrial use and supports good manufacturing and laboratory practice as a quality control assay.
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Affiliation(s)
- S F Pickles
- Division of Regenerative Medicine and Cellular Therapies, School of Pharmacy, University of Nottingham, Nottingham, U.K
| | - D I Pritchard
- Division of Regenerative Medicine and Cellular Therapies, School of Pharmacy, University of Nottingham, Nottingham, U.K
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Baumann A, Skaljac M, Lehmann R, Vilcinskas A, Franta Z. Urate Oxidase produced by Lucilia sericata medical maggots is localized in Malpighian tubes and facilitates allantoin production. INSECT BIOCHEMISTRY AND MOLECULAR BIOLOGY 2017; 83:44-53. [PMID: 28235562 DOI: 10.1016/j.ibmb.2017.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 06/06/2023]
Abstract
Lucilia sericata maggots are the only species currently approved for maggot debridement therapy (MDT), an alternative treatment for chronic and recalcitrant wounds. Maggots promote wound debridement, disinfection and healing by producing a complex mixture of proteins, peptides and low-molecular-weight compounds in their secretions and excretions, but the individual components are not well characterized at the molecular level. Here we investigated the purine catabolism pathway in L. sericata, focusing on the production of allantoin by Urate Oxidase (UO), which is thought to promote wound healing. We produced recombinant L. sericata UO in Escherichia coli, and characterized the properties of the pure enzyme in terms of the optimum pH (7-10) and temperature (20-25 °C), its stability, sensitivity to inhibition and ion dependency. We used quantitative RT-PCR and RNA in situ hybridization to monitor the expression of the UO gene, and we used a guinea pig anti-UO antibody to detect the native enzyme by western blot and by florescence immunohistochemistry in larval tissues. We found that L. sericata UO is exclusively present in the larval excretion organ (the Malpighian tubes) and is freely available in the cytoplasm rather than restricted to a specific subcellular compartment. Allantoin is a final product of L. sericata purine catabolism. It is produced by UO in the Malpighian tubes to remove uric acid from the hemolymph and is consequently excreted via the hindgut. Our findings confirm the hypothesis that both actively secreted molecules and excretion products contribute to the beneficial effects of MDT.
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Affiliation(s)
- Andre Baumann
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstraße 2, 35394 Giessen, Germany
| | - Marisa Skaljac
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstraße 2, 35394 Giessen, Germany
| | - Rüdiger Lehmann
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstraße 2, 35394 Giessen, Germany
| | - Andreas Vilcinskas
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstraße 2, 35394 Giessen, Germany; Justus-Liebig-University of Giessen, Institute for Insect Biotechnology, Heinrich-Buff-Ring 26-32, 35392 Giessen, Germany
| | - Zdenӗk Franta
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstraße 2, 35394 Giessen, Germany.
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Masiero FS, Aquino MFK, Nassu MP, Pereira DIB, Leite DS, Thyssen PJ. First Record of Larval Secretions of Cochliomyia macellaria (Fabricius, 1775) (Diptera: Calliphoridae) Inhibiting the Growth of Staphylococcus aureus and Pseudomonas aeruginosa. NEOTROPICAL ENTOMOLOGY 2017; 46:125-129. [PMID: 27696133 DOI: 10.1007/s13744-016-0444-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/05/2016] [Indexed: 06/06/2023]
Abstract
Maggot debridement therapy (MDT) consists on the intentional and controlled application of sterilized larvae of the order Diptera on necrotic skin lesions with the purpose of cleaning necrotic tissue and removing pathogenic bacteria. During MDT, a marked antimicrobial activity has been reported in literature specially associated with antibacterial substances from Lucilia sericata (Meigen); however, regarding Cochliomyia macellaria (Fabricius), little is known. This study aimed to evaluate in vitro inhibition of bacterial growth of Pseudomonas aeruginosa and Staphylococcus aureus in contact with excretions and secretions (ES) from C. macellaria larvae. Larval ES were extracted in sterile distilled water and divided in three groups: ES, containing 400 μL of autoclaved ES; ES+BAC, containing 400 μL of autoclaved ES+0.5-μL bacterial inoculum; and CONT-BAC, containing 400 μL of sterile distilled water +0.5 μL of bacterial inoculum. Aliquots of each experimental group were plated by spreading onto Petri dishes. Seedings were made at 0, 1, 2, 4, and 12 h after the extraction of ES. In ES+BAC groups, inhibition of S. aureus was verified between times 1 and 2 h and P. aeruginosa was inhibited between 0 and 4 h. There was no growth observed in any ES group. In the CONT-BAC groups, the number of colonies from time 4 h became countless for S. aureus and decreased for P. aeruginosa. As reported in the literature, we note here that ES have excellent bactericidal activity for both gram-positive and gram-negative bacteria, and this study shows for the first time the action of the bactericidal activity of exosecretions of C. macellaria against S. aureus and P. aeruginosa.
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Affiliation(s)
- F S Masiero
- Dept of Microbiology and Parasitology, Federal Univ of Pelotas, Pelotas, Brasil
| | - M F K Aquino
- Dept of Animal Biology, State Univ of Campinas, 255 Monteiro Lobato St, 13083-862, Campinas, SP, Brasil.
| | - M P Nassu
- Dept of Animal Biology, State Univ of Campinas, 255 Monteiro Lobato St, 13083-862, Campinas, SP, Brasil
| | - D I B Pereira
- Dept of Microbiology and Parasitology, Federal Univ of Pelotas, Pelotas, Brasil
| | - D S Leite
- Dept of Genetics, Evolution and BioAgents, State Univ of Campinas, Campinas, Brasil
| | - P J Thyssen
- Dept of Animal Biology, State Univ of Campinas, 255 Monteiro Lobato St, 13083-862, Campinas, SP, Brasil
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Tomberlin JK, Crippen TL, Tarone AM, Chaudhury MFB, Singh B, Cammack JA, Meisel RP. A Review of Bacterial Interactions With Blow Flies (Diptera: Calliphoridae) of Medical, Veterinary, and Forensic Importance. ANNALS OF THE ENTOMOLOGICAL SOCIETY OF AMERICA 2017; 110:19-36. [DOI: 10.1093/aesa/saw086] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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Pritchard DI, Čeřovský V, Nigam Y, Pickles SF, Cazander G, Nibbering PH, Bültemann A, Jung W. TIME management by medicinal larvae. Int Wound J 2016; 13:475-84. [PMID: 26179750 PMCID: PMC7950164 DOI: 10.1111/iwj.12457] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/09/2015] [Accepted: 04/13/2015] [Indexed: 12/31/2022] Open
Abstract
Wound bed preparation (WBP) is an integral part of the care programme for chronic wounds. The acronym TIME is used in the context of WBP and describes four barriers to healing in chronic wounds; namely, dead Tissue, Infection and inflammation, Moisture imbalance and a non-migrating Edge. Larval debridement therapy (LDT) stems from observations that larvae of the blowfly Lucilia sericata clean wounds of debris. Subsequent clinical studies have proven debriding efficacy, which is likely to occur as a result of enzymatically active alimentary products released by the insect. The antimicrobial, anti-inflammatory and wound healing activities of LDT have also been investigated, predominantly in a pre-clinical context. This review summarises the findings of investigations into the molecular mechanisms of LDT and places these in context with the clinical concept of WBP and TIME. It is clear from these findings that biotherapy with L. sericata conforms with TIME, through the enzymatic removal of dead tissue and its associated biofilm, coupled with the secretion of defined antimicrobial peptides. This biotherapeutic impact on the wound serves to reduce inflammation, with an associated capacity for an indirect effect on moisture imbalance. Furthermore, larval serine proteinases have the capacity to alter fibroblast behaviour in a manner conducive to the formation of granulation tissue.
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Affiliation(s)
| | - Václav Čeřovský
- Institute of Organic Chemistry and Biochemistry, Prague, Czech Republic
| | - Yamni Nigam
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | | | | | - Peter H Nibbering
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
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Next Generation Sequencing Identifies Five Major Classes of Potentially Therapeutic Enzymes Secreted by Lucilia sericata Medical Maggots. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8285428. [PMID: 27119084 PMCID: PMC4826915 DOI: 10.1155/2016/8285428] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/07/2016] [Indexed: 01/01/2023]
Abstract
Lucilia sericata larvae are used as an alternative treatment for recalcitrant and chronic wounds. Their excretions/secretions contain molecules that facilitate tissue debridement, disinfect, or accelerate wound healing and have therefore been recognized as a potential source of novel therapeutic compounds. Among the substances present in excretions/secretions various peptidase activities promoting the wound healing processes have been detected but the peptidases responsible for these activities remain mostly unidentified. To explore these enzymes we applied next generation sequencing to analyze the transcriptomes of different maggot tissues (salivary glands, gut, and crop) associated with the production of excretions/secretions and/or with digestion as well as the rest of the larval body. As a result we obtained more than 123.8 million paired-end reads, which were assembled de novo using Trinity and Oases assemblers, yielding 41,421 contigs with an N50 contig length of 2.22 kb and a total length of 67.79 Mb. BLASTp analysis against the MEROPS database identified 1729 contigs in 577 clusters encoding five peptidase classes (serine, cysteine, aspartic, threonine, and metallopeptidases), which were assigned to 26 clans, 48 families, and 185 peptidase species. The individual enzymes were differentially expressed among maggot tissues and included peptidase activities related to the therapeutic effects of maggot excretions/secretions.
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Pöppel AK, Kahl M, Baumann A, Wiesner J, Gökçen A, Beckert A, Preissner KT, Vilcinskas A, Franta Z. A Jonah-like chymotrypsin from the therapeutic maggot Lucilia sericata plays a role in wound debridement and coagulation. INSECT BIOCHEMISTRY AND MOLECULAR BIOLOGY 2016; 70:138-147. [PMID: 26773746 DOI: 10.1016/j.ibmb.2015.11.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/27/2015] [Accepted: 11/27/2015] [Indexed: 06/05/2023]
Abstract
Lucilia sericata larvae are used in maggot debridement therapy, a traditional wound healing approach that has recently been approved for the treatment of chronic wounds. Maggot excretion products (MEP) contain many different proteases that promote disinfection, debridement and the acceleration of wound healing, e.g. by activating the host contact phase/intrinsic pathway of coagulation. In order to characterise relevant procoagulant proteases, we analysed MEP and identified a chymotrypsin-like serine protease with similarities to Jonah proteases from Drosophila melanogaster and a chymotrypsin from Lucilia cuprina. A recombinant form of the L. sericata Jonah chymotrypsin was produced in Escherichia coli. The activated enzyme (Jonahm) had a pH optimum of 8.0 and a temperature optimum of 37 °C, based on the cleavage of the chromogenic peptide s-7388 and casein. Jonahm reduced the clotting time of human plasma even in the absence of the endogenous protease kallikrein, factor XI or factor XII and digested the extracellular matrix proteins fibronectin, laminin and collagen IV, suggesting a potential mechanism of wound debridement. Based on these characteristics, the novel L. sericata chymotrypsin-like serine protease appears to be an ideal candidate for the development of topical drugs for wound healing applications.
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Affiliation(s)
- Anne-Kathrin Pöppel
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstrasse 2, 35394, Giessen, Germany
| | - Mareike Kahl
- Institute for Biochemistry, Medical School, Justus-Liebig-University, Friedrichstrasse 24, 35392, Giessen, Germany
| | - Andre Baumann
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstrasse 2, 35394, Giessen, Germany
| | - Jochen Wiesner
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstrasse 2, 35394, Giessen, Germany
| | - Anke Gökçen
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstrasse 2, 35394, Giessen, Germany
| | - Annika Beckert
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstrasse 2, 35394, Giessen, Germany
| | - Klaus T Preissner
- Institute for Biochemistry, Medical School, Justus-Liebig-University, Friedrichstrasse 24, 35392, Giessen, Germany
| | - Andreas Vilcinskas
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstrasse 2, 35394, Giessen, Germany; Institute for Insect Biotechnology, Justus-Liebig-University, Heinrich-Buff-Ring 26-32, 35392, Giessen, Germany
| | - Zdeněk Franta
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstrasse 2, 35394, Giessen, Germany.
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Percival SL, Suleman L. Slough and biofilm: removal of barriers to wound healing by desloughing. J Wound Care 2016; 24:498, 500-3, 506-10. [PMID: 26551642 DOI: 10.12968/jowc.2015.24.11.498] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The presence of non-viable tissue in a chronic wound presents a barrier against effective wound healing, hence removal facilitates healing and reduces areas where microorganisms can attach and form biofilms, effectively reducing the risk of infection. Wound debridement is a necessary process in those wounds that have evidence of cellular debris and non-viable tissue. As slough is a form of non-viable tissue we hypothesise that it will support the attachment and development of biofilms. Biofilms are entities that have serious implications in raising the risk of infection and delaying wound healing. In those wounds that contain only slough, high-risk debridement methods are not considered necessary for its removal. The use of mechanical techniques for removing the slough is regarded as posing a much lower risk to the patient and the wound bed. The process of removing slough from a wound is referred to as 'desloughing'. We propose that mechanical desloughing is a low-risk method of debridement to aid the specific removal of slough. Slough in a wound is a recurrent issue for a large majority of patients. Consequently, desloughing should not be deemed a one-off process but an on-going procedure referred to as 'maintenance desloughing'. Maintenance desloughing will help to achieve and maintain a healthy wound bed and aid the removal of wound biofilms, facilitating wound healing.
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Affiliation(s)
- S L Percival
- 5D Health Protection Group Ltd, Biohub, Alderley Park, Alderley Edge, Cheshire, SK10 4TG, UK.,Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - L Suleman
- 5D Health Protection Group Ltd, Biohub, Alderley Park, Alderley Edge, Cheshire, SK10 4TG, UK.,Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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Baumann A, Lehmann R, Beckert A, Vilcinskas A, Franta Z. Selection and Evaluation of Tissue Specific Reference Genes in Lucilia sericata during an Immune Challenge. PLoS One 2015; 10:e0135093. [PMID: 26252388 PMCID: PMC4529112 DOI: 10.1371/journal.pone.0135093] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/16/2015] [Indexed: 11/30/2022] Open
Abstract
The larvae of the common green bottle fly Lucilia sericata (Diptera: Calliphoridae) have been used for centuries to promote wound healing, but the molecular basis of their antimicrobial, debridement and healing functions remains largely unknown. The analysis of differential gene expression in specific larval tissues before and after immune challenge could be used to identify key molecular factors, but the most sensitive and reproducible method qRT-PCR requires validated reference genes. We therefore selected 10 candidate reference genes encoding products from different functional classes (18S rRNA, 28S rRNA, actin, β-tubulin, RPS3, RPLP0, EF1α, PKA, GAPDH and GST1). Two widely applied algorithms (GeNorm and Normfinder) were used to analyze reference gene candidates in different larval tissues associated with secretion, digestion, and antimicrobial activity (midgut, hindgut, salivary glands, crop and fat body). The Gram-negative bacterium Pseudomonas aeruginosa was then used to boost the larval immune system and the stability of reference gene expression was tested in comparison to three immune genes (lucimycin, defensin-1 and attacin-2), which target different pathogen classes. We observed no differential expression of the antifungal peptide lucimycin, whereas the representative targeting Gram-positive bacteria (defensin-1) was upregulated in salivary glands, crop, nerve ganglion and reached its maximum in fat body (up to 300-fold). The strongest upregulation in all immune challenged tissues (over 50,000-fold induction in the fat body) was monitored for attacin-2, the representative targeting Gram-negative bacteria. Here we identified and validated a set of reference genes that allows the accurate normalization of gene expression in specific tissues of L. sericata after immune challenge.
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Affiliation(s)
- Andre Baumann
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Giessen, Germany
| | - Rüdiger Lehmann
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Giessen, Germany
| | - Annika Beckert
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Giessen, Germany
| | - Andreas Vilcinskas
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Giessen, Germany
- Institute of Phytopathology and Applied Zoology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Zdeněk Franta
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Giessen, Germany
- * E-mail:
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Blenkiron C, Tsai P, Brown LA, Tintinger V, Askelund KJ, Windsor JA, Phillips AR. Characterisation of the small RNAs in the biomedically important green-bottle blowfly Lucilia sericata. PLoS One 2015; 10:e0122203. [PMID: 25803701 PMCID: PMC4372549 DOI: 10.1371/journal.pone.0122203] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 02/08/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The green bottle fly maggot, Lucilia sericata, is a species with importance in medicine, agriculture and forensics. Improved understanding of this species' biology is of great potential benefit to many research communities. MicroRNAs (miRNA) are a short non-protein coding regulatory RNA, which directly regulate a host of protein coding genes at the translational level. They have been shown to have developmental and tissue specific distributions where they impact directly on gene regulation. In order to improve understanding of the biology of L. sericata maggots we have performed small RNA-sequencing of their secretions and tissue at different developmental stages. RESULTS We have successfully isolated RNA from the secretions of L. sericata maggots. Illumina small RNA-sequencing of these secretions and the three tissues (crop, salivary gland, gut) revealed that the most common small RNA fragments were derived from ribosomal RNA and transfer RNAs of both insect and bacterial origins. These RNA fragments were highly specific, with the most common tRNAs, such as GlyGCC, predominantly represented by reads derived from the 5' end of the mature maggot tRNA. Each library also had a unique profile of miRNAs with a high abundance of miR-10-5p in the maggot secretions and gut and miR-8 in the food storage organ the crop and salivary glands. The pattern of small RNAs in the bioactive maggot secretions suggests they originate from a combination of saliva, foregut and hindgut tissues. Droplet digital RT-PCR validation of the RNA-sequencing data shows that not only are there differences in the tissue profiles for miRNAs and small RNA fragments but that these are also modulated through developmental stages of the insect. CONCLUSIONS We have identified the small-RNAome of the medicinal maggots L. sericata and shown that there are distinct subsets of miRNAs expressed in specific tissues that also alter during the development of the insect. Furthermore there are very specific RNA fragments derived from other non-coding RNAs present in tissues and in the secretions. This new knowledge has applicability in diverse research fields including wound healing, agriculture and forensics.
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Affiliation(s)
- Cherie Blenkiron
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Peter Tsai
- Bioinformatics Institute, University of Auckland, Auckland, New Zealand
| | - Lisa A. Brown
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Vernon Tintinger
- Department of Anthropology, University of Auckland, Auckland, New Zealand
| | - Kathryn J. Askelund
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - John A. Windsor
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand
| | - Anthony R. Phillips
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
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Abstract
Maggot debridement therapy is used extensively in the UK in both community and hospital situations, but remains a potentially under-used modality in many wound care markets. It promotes wound healing by performing three key processes: debridement, disinfection and growth-promoting activity. It can be used for the debridement of non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers and non-healing traumatic of post-surgical wounds. With the increase in chronic diabetic foot wounds, maggot debridement therapy is a promising tool for health professionals dealing with difficult wounds. This article presents an overview of the research evidence surrounding maggot debridement therapy that serves as a guide to health professionals who may be users of this form of treatment now and in the future.
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Affiliation(s)
- Eric Shi
- Podiatric Medical Student, Western University of Health Sciences College of Podiatric Medicine, Pomona, CA, USA
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Selective Antibiofilm Effects of Lucilia sericata Larvae Secretions/Excretions against Wound Pathogens. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:857360. [PMID: 25013449 PMCID: PMC4074965 DOI: 10.1155/2014/857360] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/07/2014] [Indexed: 12/18/2022]
Abstract
Background. Maggot debridement therapy (MDT), using Lucilia sericata larvae, represents efficient, simple, and low-cost therapy for the treatment of chronic wounds. Aim. The aim was to investigate the antibiofilm activity of maggot excretions/secretions (ES) against biofilm of wound isolates Staphylococcus aureus (S. aureus), Enterobacter cloacae (E. cloacae), and Proteus mirabilis (P. mirabilis). Methods. Quantification of biofilm formation, was carried out using a microtiter plate assay. Proteolytic activity of maggot ES was performed using skim milk agar plates. A solid phase extraction and reverse phase HPLC C18 chromatography were employed to the isolate of maggot ES antibiofilm compounds. Results. Maggot ES at 100 mg/mL concentration significantly reduced biofilm formation thus disrupting established biofilm of E. cloacae. Heat-treated ES did not show any antibiofilm activity towards E. cloacae. Similar results were obtained in the case of S. aureus; however, the heat-treatment of maggot ES did not affect its antibiofilm activity. Moreover, a compound with molecular weight of 25 kDa exhibiting antibiofilm activity was identified in maggot ES. On the other hand, maggot ES protected and even stimulated P. mirabilis biofilm formation. Conclusions. Our results suggest that maggot ES may act selectively against different bacterial strain.
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Recent advances in developing insect natural products as potential modern day medicines. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:904958. [PMID: 24883072 PMCID: PMC4026837 DOI: 10.1155/2014/904958] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 01/28/2014] [Indexed: 01/01/2023]
Abstract
Except for honey as food, and silk for clothing and pollination of plants, people give little thought to the benefits of insects in their lives. This overview briefly describes significant recent advances in developing insect natural products as potential new medicinal drugs. This is an exciting and rapidly expanding new field since insects are hugely variable and have utilised an enormous range of natural products to survive environmental perturbations for 100s of millions of years. There is thus a treasure chest of untapped resources waiting to be discovered. Insects products, such as silk and honey, have already been utilised for thousands of years, and extracts of insects have been produced for use in Folk Medicine around the world, but only with the development of modern molecular and biochemical techniques has it become feasible to manipulate and bioengineer insect natural products into modern medicines. Utilising knowledge gleaned from Insect Folk Medicines, this review describes modern research into bioengineering honey and venom from bees, silk, cantharidin, antimicrobial peptides, and maggot secretions and anticoagulants from blood-sucking insects into medicines. Problems and solutions encountered in these endeavours are described and indicate that the future is bright for new insect derived pharmaceuticals treatments and medicines.
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van der Plas MJA, Andersen AS, Nazir S, van Tilburg NH, Oestergaard PR, Krogfelt KA, van Dissel JT, Hensbergen PJ, Bertina RM, Nibbering PH. A novel serine protease secreted by medicinal maggots enhances plasminogen activator-induced fibrinolysis. PLoS One 2014; 9:e92096. [PMID: 24647546 PMCID: PMC3960166 DOI: 10.1371/journal.pone.0092096] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 02/19/2014] [Indexed: 11/23/2022] Open
Abstract
Maggots of the blowfly Lucilia sericata are used for the treatment of chronic wounds. As haemostatic processes play an important role in wound healing, this study focused on the effects of maggot secretions on coagulation and fibrinolysis. The results showed that maggot secretions enhance plasminogen activator-induced formation of plasmin and fibrinolysis in a dose- and time-dependent manner. By contrast, coagulation was not affected by secretions. Biochemical studies indicated that a novel serine protease within secretions, designated Sericase, cleaved plasminogen to several fragments. Recombinant Sericase degraded plasminogen leading amongst others to the formation of the mini-plasminogen like fragment Val454-plasminogen. In addition, the presence of a non-proteolytic cofactor in secretions was discovered, which plays a role in the enhancement of plasminogen activator-induced fibrinolysis by Sericase. We conclude from our in vitro studies that the novel serine protease Sericase, with the aid of a non-proteolytic cofactor, enhances plasminogen activator-induced fibrinolysis.
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Affiliation(s)
- Mariena J. A. van der Plas
- Department of Infectious Disease, Leiden University Medical Center, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Anders S. Andersen
- Department of Microbiology and Infection Control, Statens Serum Institute, Copenhagen, Denmark
- Novozymes A/S, Bagsvaerd, Denmark
- Copenhagen Wound Healing Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - Sheresma Nazir
- Department of Infectious Disease, Leiden University Medical Center, Leiden, The Netherlands
| | - Nico H. van Tilburg
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Karen A. Krogfelt
- Department of Microbiology and Infection Control, Statens Serum Institute, Copenhagen, Denmark
| | - Jaap T. van Dissel
- Department of Infectious Disease, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul J. Hensbergen
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rogier M. Bertina
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter H. Nibbering
- Department of Infectious Disease, Leiden University Medical Center, Leiden, The Netherlands
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Sherman RA. Mechanisms of maggot-induced wound healing: what do we know, and where do we go from here? EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:592419. [PMID: 24744812 PMCID: PMC3976885 DOI: 10.1155/2014/592419] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/15/2014] [Indexed: 12/18/2022]
Abstract
MEDICINAL MAGGOTS ARE BELIEVED TO HAVE THREE MAJOR MECHANISMS OF ACTION ON WOUNDS, BROUGHT ABOUT CHEMICALLY AND THROUGH PHYSICAL CONTACT: debridement (cleaning of debris), disinfection, and hastened wound healing. Until recently, most of the evidence for these claims was anecdotal; but the past 25 years have seen an increase in the use and study of maggot therapy. Controlled clinical studies are now available, along with laboratory investigations that examine the interaction of maggot and host on a cellular and molecular level. This review was undertaken to extract the salient data, make sense, where possible, of seemingly conflicting evidence, and reexamine our paradigm for maggot-induced wound healing. Clinical and laboratory data strongly support claims of effective and efficient debridement. Clinical evidence for hastened wound healing is meager, but laboratory studies and some small, replicated clinical studies strongly suggest that maggots do promote tissue growth and wound healing, though it is likely only during and shortly after the period when they are present on the wound. The best way to evaluate-and indeed realize-maggot-induced wound healing may be to use medicinal maggots as a "maintenance debridement" modality, applying them beyond the point of gross debridement.
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Affiliation(s)
- Ronald A. Sherman
- BioTherapeutics, Education & Research (BTER) Foundation, 36 Urey Court, Irvine, CA 92617, USA
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Mudge E, Price P, Walkley N, Neal W, Harding KG. A randomized controlled trial of larval therapy for the debridement of leg ulcers: results of a multicenter, randomized, controlled, open, observer blind, parallel group study. Wound Repair Regen 2013; 22:43-51. [PMID: 24299513 DOI: 10.1111/wrr.12127] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 09/09/2013] [Indexed: 12/01/2022]
Abstract
It has been known for centuries that the application of larvae is useful to heal certain wounds by facilitating debridement of necrotic tissue,(1) yet the efficacy of larval therapy continues to be debatable. This study compared the clinical effectiveness of a larval therapy dressing (BioFOAM) with a standard debridement technique (Purilon gel; hydrogel) in terms of time to debridement of venous (VLU) or mixed arterial/venous (MLU) leg ulcers. Data analyses were conducted on 88 subjects. Sixty-four subjects completed the full study. Of these, 31 of the 32 (96.9%) patients who completed treatment in the larvae arm debrided fully, compared with 11 of the 32 (34.4%) patients who completed the hydrogel arm. In addition, 42 (48%) ulcers fully debrided within the 21-day intervention phase, 31 (67.4%) from the larvae arm (n = 46), and 11 (26.2%) from the hydrogel arm (n = 42), which was statistically significant (p = 0.001) in support of larvae. A statistically significant difference was also observed between treatment arms with regard to numbers of dressing changes during the intervention phase of the study (p < 0.001) in that subjects in the larvae arm required significantly fewer dressing changes(mean = 2.83) than those in the hydrogel arm (mean = 5.40). There were no statistically significant differences in the clinical condition of the wound bed and surrounding skin by intervention. Subjects in the larvae arm experienced more ulcer-related pain or discomfort than subjects in the hydrogel arm (p < 0.001). This study provided good evidence to show that larval therapy, in the form of a BioFOAM dressing, debrided VLU and MLU considerably more quickly than a hydrogel, although the possibility of resloughing should be closely monitored.
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Affiliation(s)
- Elizabeth Mudge
- Wound Healing Research Unit, Cardiff University School of Medicine, Cardiff, United Kingdom
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Dutta S, Bhattacharyya D. Enzymatic, antimicrobial and toxicity studies of the aqueous extract of Ananas comosus (pineapple) crown leaf. JOURNAL OF ETHNOPHARMACOLOGY 2013; 150:451-457. [PMID: 24076462 DOI: 10.1016/j.jep.2013.08.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 07/29/2013] [Accepted: 08/10/2013] [Indexed: 06/02/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Various parts of the plant pineapple (Ananas comosus) are used in traditional medicine worldwide for treatment of a number of diseases and disorders. In folk medicine, pineapple leaf extract was used as an antimicrobial, vermicide, purgative, emmenagoogue, abortifacient, anti-oedema and anti-inflammatory agent. Compared to the fruit and stem extracts of pineapple, information about its leaf extract is limited. The potential of pineapple crown leaf extract as an ethno-medicine has been evaluated in terms of its enzymatic activities related to wound healing, antimicrobial property and toxicity. MATERIALS AND METHODS Major protein components of the extract were revealed by 2-D gel electrophoresis followed by MS/MS analysis. Zymography, DQ-gelatin assay were performed to demonstrate proteolytic, fibrinolytic, gelatinase and collagenase activities. DNase and RNase activities were revealed from agarose gel electrophoresis. Antimicrobial activity was evaluated spectrophotometrically from growth inhibition. Sprague-Dawley rat model was used to measure acute and sub-acute toxicity of the extract by analyzing blood markers. RESULT The extract contains several proteins that were clustered under native condition. Proteomic studies indicated presence of fruit bromelain as major protein constituent of the extract. It showed nonspecific protease activity, gelatinolytic, collagenase, fibrinolytic, acid and alkaline phosphatase, peroxidase, DNase and RNase activities along with considerable anti-microbial property. The leaf extract did not induce any toxicity in rats after oral administration of acute and sub-acute doses. CONCLUSION Pineapple leaf extract is nontoxic, contains enzymes related to damage tissue repairing, wound healing and possibly prevents secondary infections from microbial organisms.
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Affiliation(s)
- Sangita Dutta
- Division of Structural Biology and Bioinformatics, CSIR-Indian Institute of Chemical Biology, 4, Raja S.C. Mallick Road, Jadavpur, Kolkata 700032, India
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Pritchard D, Nigam Y. Maximising the secondary beneficial effects of larval debridement therapy. J Wound Care 2013; 22:610-11, 614-6. [DOI: 10.12968/jowc.2013.22.11.610] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Y. Nigam
- College of Human and Health Sciences, Swansea University, Swansea, UK
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Cazander G, Pritchard DI, Nigam Y, Jung W, Nibbering PH. Multiple actions ofLucilia sericatalarvae in hard-to-heal wounds. Bioessays 2013; 35:1083-92. [DOI: 10.1002/bies.201300071] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Gwendolyn Cazander
- Department of Surgery; Bronovo Hospital; The Hague The Netherlands
- Department of Surgery; Leiden University Medical Center; Leiden The Netherlands
| | | | - Yamni Nigam
- College of Human and Health Sciences; Swansea University; Swansea UK
| | | | - Peter H. Nibbering
- Department of Infectious Diseases; Leiden University Medical Center; Leiden The Netherlands
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