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Imam MW, Luqman S. Unveiling the mechanism of essential oil action against skin pathogens: from ancient wisdom to modern science. Arch Microbiol 2024; 206:347. [PMID: 38985339 DOI: 10.1007/s00203-024-03986-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 07/11/2024]
Abstract
Essential oils are among the most well-known phyto-compounds, and since ancient times, they have been utilized in medicine. Over 100 essential oils have been identified and utilized as therapies for various skin infections and related ailments. While numerous commercial medicines are available in different dosage forms to treat skin diseases, the persisting issues include their side effects, toxicity, and low efficacy. As a result, researchers are seeking novel classes of compounds as substitutes for synthetic drugs, aiming for minimal side effects, no toxicity, and high efficacy. Essential oils have shown promising antimicrobial activity against skin-associated pathogens. This review presents essential knowledge and scientific information regarding essential oil's antimicrobial capabilities against microorganisms that cause skin infections. Essential oils mechanisms against different pathogens have also been explored. Many essential oils exhibit promising activity against various microbes, which has been qualitatively assessed using the agar disc diffusion experiment, followed by determining the minimum inhibitory concentration for quantitative evaluation. It has been observed that Staphylococcus aureus and Candida albicans have been extensively researched in the context of skin-related infections and their antimicrobial activity, including established modes of action. In contrast, other skin pathogens such as Staphylococcus epidermidis, Streptococcus pyogens, Propionibacterium acnes, and Malassezia furfur have received less attention or neglected. This review report provides an updated understanding of the mechanisms of action of various essential oils with antimicrobial properties. This review explores the anti-infectious activity and mode of action of essential against distinct skin pathogens. Such knowledge can be valuable in treating skin infections and related ailments.
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Affiliation(s)
- Md Waquar Imam
- Bioprospection and Product Development Division, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow, 226015, Uttar Pradesh, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201001, Uttar Pradesh, India
| | - Suaib Luqman
- Bioprospection and Product Development Division, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow, 226015, Uttar Pradesh, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201001, Uttar Pradesh, India.
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Safwan SM, Kumar N, Mehta D, Singh M, Saini V, Pandey N, Khatol S, Batheja S, Singh J, Walia P, Bajaj A. Xanthone Derivatives Enhance the Therapeutic Potential of Neomycin against Polymicrobial Gram-Negative Bacterial Infections. ACS Infect Dis 2024; 10:527-540. [PMID: 38294409 DOI: 10.1021/acsinfecdis.3c00471] [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: 02/01/2024]
Abstract
Gram-negative bacterial infections are difficult to manage as many antibiotics are ineffective owing to the presence of impermeable bacterial membranes. Polymicrobial infections pose a serious threat due to the inadequate efficacy of available antibiotics, thereby necessitating the administration of antibiotics at higher doses. Antibiotic adjuvants have emerged as a boon as they can augment the therapeutic potential of available antibiotics. However, the toxicity profile of antibiotic adjuvants is a major hurdle in clinical translation. Here, we report the design, synthesis, and biological activities of xanthone-derived molecules as potential antibiotic adjuvants. Our SAR studies witnessed that the p-dimethylamino pyridine-derivative of xanthone (X8) enhances the efficacy of neomycin (NEO) against Escherichia coli and Pseudomonas aeruginosa and causes a synergistic antimicrobial effect without any toxicity against mammalian cells. Biochemical studies suggest that the combination of X8 and NEO, apart from inhibiting protein synthesis, enhances the membrane permeability by binding to lipopolysaccharide. Notably, the combination of X8 and NEO can disrupt the monomicrobial and polymicrobial biofilms and show promising therapeutic potential against a murine wound infection model. Collectively, our results unveil the combination of X8 and NEO as a suitable adjuvant therapy for the inhibition of the Gram-negative bacterial infections.
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Affiliation(s)
- Sayed Mohamad Safwan
- Laboratory of Nanotechnology and Chemical Biology, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Third Milestone, Faridabad-Gurgaon Expressway, Faridabad 121001, Haryana, India
| | - Neeraj Kumar
- Lord Shiva College of Pharmacy, Near Civil Hospital, Sirsa 125055, Haryana, India
| | - Devashish Mehta
- Laboratory of Nanotechnology and Chemical Biology, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Third Milestone, Faridabad-Gurgaon Expressway, Faridabad 121001, Haryana, India
| | - Mohit Singh
- Laboratory of Nanotechnology and Chemical Biology, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Third Milestone, Faridabad-Gurgaon Expressway, Faridabad 121001, Haryana, India
| | - Varsha Saini
- Laboratory of Nanotechnology and Chemical Biology, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Third Milestone, Faridabad-Gurgaon Expressway, Faridabad 121001, Haryana, India
| | - Nishant Pandey
- Laboratory of Nanotechnology and Chemical Biology, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Third Milestone, Faridabad-Gurgaon Expressway, Faridabad 121001, Haryana, India
| | - Steffi Khatol
- Laboratory of Nanotechnology and Chemical Biology, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Third Milestone, Faridabad-Gurgaon Expressway, Faridabad 121001, Haryana, India
| | - Shalini Batheja
- Lord Shiva College of Pharmacy, Near Civil Hospital, Sirsa 125055, Haryana, India
| | - Jitender Singh
- Lord Shiva College of Pharmacy, Near Civil Hospital, Sirsa 125055, Haryana, India
| | - Preeti Walia
- Lord Shiva College of Pharmacy, Near Civil Hospital, Sirsa 125055, Haryana, India
| | - Avinash Bajaj
- Laboratory of Nanotechnology and Chemical Biology, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Third Milestone, Faridabad-Gurgaon Expressway, Faridabad 121001, Haryana, India
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Mihai MM, Popa MI, Holban AM, Gheorghe-Barbu I, Popa LG, Chifiriuc MC, Giurcăneanu C, Bleotu C, Cucu CI, Lazăr V. Clinical and microbiological features of host-bacterial interplay in chronic venous ulcers versus other types of chronic skin ulcers. Front Microbiol 2024; 14:1326904. [PMID: 38375067 PMCID: PMC10875999 DOI: 10.3389/fmicb.2023.1326904] [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: 10/24/2023] [Accepted: 12/19/2023] [Indexed: 02/21/2024] Open
Abstract
Introduction Chronic venous ulcers of the lower limbs develop in the context of advanced venous disease and have a significant impact on the patient's quality of life, being associated with depression and worrisome suicide rates, as well as with an economic burden caused by increased medical care costs and high epidemiological risks of healthcare associated infections and emergence of strains resistant to multiple classes of antibiotics and/ or antiseptics. Although numerous studies have investigated the composition of the chronic wounds microbiome, either by culture-dependent or independent methods, there are no data on the association between virulence and resistance profiles of strains isolated from venous ulcers and the clinical picture of this pathology. The elucidation of pathogenic mechanisms, at both phenotypic and molecular level, is crucial in the fight against these important human microbial agents, in order to develop novel biomarkers and discover new therapeutic targets. Methods In this study we aimed to characterize the phenotypic virulence profiles (including the ability to develop biofilms) of microorganisms isolated from chronic skin wounds and to correlate them with the clinical symptomatology. Considering the high incidence of Staphylococcus aureus infections in chronic ulcers, but also the ability of this species to develop multi-drug resistance, we performed an more in-depth study of the phenotypic and genotypic virulence profiles of methicillin-resistant Staphylococcus. Results The study revealed important differences regarding the clinical evolution and virulence profiles of microorganisms isolated from lower limb wounds, as well as between patients diagnosed with chronic venous ulcers and those with lesions of different etiology.
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Affiliation(s)
- Mara Mădălina Mihai
- Department of Oncologic Dermatology–“Elias” University Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Botany-Microbiology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Mircea Ioan Popa
- Department of Microbiology—“Cantacuzino” Institute, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Maria Holban
- Department of Botany-Microbiology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Irina Gheorghe-Barbu
- Department of Botany-Microbiology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Liliana Gabriela Popa
- Department of Oncologic Dermatology–“Elias” University Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Mariana-Carmen Chifiriuc
- Department of Botany-Microbiology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Călin Giurcăneanu
- Department of Oncologic Dermatology–“Elias” University Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Coralia Bleotu
- Department of Botany-Microbiology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Cellular and Molecular Department, “Ştefan S. Nicolau” Institute of Virology, Bucharest, Romania
| | - Corina Ioana Cucu
- Department of Oncologic Dermatology–“Elias” University Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Veronica Lazăr
- Department of Botany-Microbiology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
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Dahshan NA, Abu-Dahab R, Khalil EA, Al-Bakri AG. Bactericidal effect of Iberin combined with photodynamic antimicrobial chemotherapy against Pseudomonas aeruginosa biofilm cultured on ex vivo wound model. Photodiagnosis Photodyn Ther 2023; 44:103841. [PMID: 37832710 DOI: 10.1016/j.pdpdt.2023.103841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023]
Abstract
Wounds infected by Pseudomonas aeruginosa (P. aeruginosa) biofilms are characterized by poor healing and by being long lasting. Pyocyanin and pyoverdine are exotoxins that contribute to P. aeruginosa pathogenicity in wound infections and are known as virulence factors. Despite the usefulness of antimicrobial photodynamic therapy (PDT) in the management of wound infections, biofilms are hurdle for microbial photoinactivation. Quorum sensing (QS) is a cell density-dependent chemical signaling system P. aeruginosa uses to regulate biofilm formation and virulence factors production. In the current study, QS attenuation was used in combination with PDT against P. aeruginosa biofilm cultured on skin explant. Iberin is a QS inhibitor that attenuates P. aeruginosa virulence and affects biofilm integrity. The antibiofilm and QS inhibitory activities of iberin in combination with either riboflavin or 5,10,15,20-Tetrakis(1-methyl-4-pyridinio) porphyrin tetra p-toluenesulfonate (TMP) mediated PDT were investigated using viable count method and pyocyanin and pyoverdine assays, respectively. No bactericidal activity was reported when iberin was added to a mature biofilm (24 h) followed by PDT. When added to a growing biofilm at multiple time points (0 h, 24 h and 48 h), iberin inhibited P. aeruginosa biofilm QS signaling system. This inhibitory effect resulted in an observable decrease in the levels of the QS-regulated virulence factors, pyocyanin and pyoverdine, without any effect on the growth of the biofilm cultures. These changes in biofilm virulence were associated with a decrease in biofilm resistance to PDT and caused bactericidal effect upon photosensitizers treatment and irradiation. Iberin-treated-riboflavin-mediated PDT resulted in a significant 1.3 log reduction in biofilm population. Similarly, iberin-treated-TMP-mediated PDT caused a significant 1.8 log reduction in biofilm population. The combination of QS inhibitor with PDT is a promising alternative antimicrobial therapy for the management of biofilms.
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Affiliation(s)
- Nisreen A Dahshan
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Rana Abu-Dahab
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Enam A Khalil
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Amal G Al-Bakri
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan.
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Zhu G, Gao B, Fan J, Chen J, Su S, Yang X, Li B, Fang C. ICG-mediated fluorescence-assisted debridement to promote wound healing. PLoS One 2023; 18:e0291508. [PMID: 37733658 PMCID: PMC10513195 DOI: 10.1371/journal.pone.0291508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023] Open
Abstract
The purpose of this study was to examine the efficacy of ICG-mediated fluorescence molecular imaging (FMI) in debridement of necrotic tissue. 96 wound-infected rats were randomly divided into control group, ICG group, excitation light (EL)group and FMI group for debridement of necrotic tissue (n = 24). (I) Control group: only debridement; (II) ICG group: ICG injection before debridement; (III) EL group: Debridement under EL; (IV) FMI group: Debridement guided by ICG-mediated FMI. On the 3rd, 6th, and 9th days, the wound tissues of the rats in each group were collected for histological examination, and the levels of serum interleukin-4 (IL-4) and interferon-γ (INF-γ) were analyzed. The wound healing rate, wound score and body weight of the rats in each group were followed up until the wound healed. The results showed that the infected wounds of the rats in the FMI group had significant fluorescence development. The level of serum IL-4 in the FMI group was higher than that in the other three groups on the 6th day (p<0.01), while the level of INF-γ was lower than that in the other three groups on the 6th and 9th day (p<0.05). The results of dynamic wound tissue H&E staining indicated that the wound healing in the FMI group was better than the other three groups. The in vivo follow-up results showed that the wound healing rate and wound score of the FMI group were better than the other three groups, and the growth of rats had no difference with the other groups. ICG-mediated FMI can achieve accurate imaging of necrotic tissue for debridement, and so can accelerate wound healing, which has good clinical application prospects.
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Affiliation(s)
- Gang Zhu
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Department of Hepatobiliary Pancreatic and Splenic Surgery, Luzhou People’s Hospital, Luzhou, China
| | - Benjian Gao
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Jun Fan
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Jianfei Chen
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Song Su
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Xiaoli Yang
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Bo Li
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Cheng Fang
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
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Toader G, Podaru AI, Diacon A, Rusen E, Mocanu A, Brincoveanu O, Alexandru M, Zorila FL, Bacalum M, Albota F, Gavrila AM, Trica B, Rotariu T, Ionita M, Istrate M. Nanocomposite Hydrogel Films Based on Sequential Interpenetrating Polymeric Networks as Drug Delivery Platforms. Polymers (Basel) 2023; 15:3176. [PMID: 37571071 PMCID: PMC10420953 DOI: 10.3390/polym15153176] [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: 06/30/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
In this study, novel materials have been obtained via a dual covalent and ionic crosslinking strategies, leading to the formation of a fully interpenetrated polymeric network with remarkable mechanical performances as drug delivery platforms for dermal patches. The polymeric network was obtained by the free-radical photopolymerization of N-vinylpyrrolidone using tri(ethylene glycol) divinyl ether as crosslinker in the presence of sodium alginate (1%, weight%). The ionic crosslinking was achieved by the addition of Zn2+, ions which were coordinated by the alginate chains. Bentonite nanoclay was incorporated in hydrogel formulations to capitalize on its mechanical reinforcement and adsorptive capacity. TiO2 and ZnO nanoparticles were also included in two of the samples to evaluate their influence on the morphology, mechanical properties and/or the antimicrobial activity of the hydrogels. The double-crosslinked nanocomposite hydrogels presented a good tensile resistance (1.5 MPa at 70% strain) and compression resistance (12.5 MPa at a strain of 70%). Nafcillin was loaded into nanocomposite hydrogel films with a loading efficiency of up to 30%. The drug release characteristics were evaluated, and the profile was fitted by mathematical models that describe the physical processes taking place during the drug transfer from the polymer to a PBS (phosphate-buffered saline) solution. Depending on the design of the polymeric network and the nanofillers included, it was demonstrated that the nafcillin loaded into the nanocomposite hydrogel films ensured a high to moderate activity against S. aureus and S. pyogenes and no activity against E. coli. Furthermore, it was demonstrated that the presence of zinc ions in these polymeric matrices can be correlated with the inactivation of E. coli.
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Affiliation(s)
- Gabriela Toader
- Military Technical Academy “Ferdinand I”, 39-49 G. Cosbuc Blvd., 050141 Bucharest, Romania; (G.T.); (A.I.P.); (T.R.)
| | - Alice Ionela Podaru
- Military Technical Academy “Ferdinand I”, 39-49 G. Cosbuc Blvd., 050141 Bucharest, Romania; (G.T.); (A.I.P.); (T.R.)
- Faculty of Chemical Engineering and Biotechnologies, University Politehnica of Bucharest, 1-7 Gheorghe Polizu Street, 011061 Bucharest, Romania;
| | - Aurel Diacon
- Military Technical Academy “Ferdinand I”, 39-49 G. Cosbuc Blvd., 050141 Bucharest, Romania; (G.T.); (A.I.P.); (T.R.)
- Faculty of Chemical Engineering and Biotechnologies, University Politehnica of Bucharest, 1-7 Gheorghe Polizu Street, 011061 Bucharest, Romania;
| | - Edina Rusen
- Faculty of Chemical Engineering and Biotechnologies, University Politehnica of Bucharest, 1-7 Gheorghe Polizu Street, 011061 Bucharest, Romania;
| | - Alexandra Mocanu
- Faculty of Chemical Engineering and Biotechnologies, University Politehnica of Bucharest, 1-7 Gheorghe Polizu Street, 011061 Bucharest, Romania;
- National Institute for Research and Development in Microtechnologies—IMT Bucharest, 126A Erou Iancu Nicolae Street, 077190 Bucharest, Romania;
| | - Oana Brincoveanu
- National Institute for Research and Development in Microtechnologies—IMT Bucharest, 126A Erou Iancu Nicolae Street, 077190 Bucharest, Romania;
- Research Institute of the University of Bucharest, University of Bucharest, Soseaua Panduri, nr. 90, Sector 5, 050663 Bucharest, Romania
| | - Mioara Alexandru
- Horia Hulubei National Institute of Physics and Nuclear Engineering, 30 Reactorului Street, 077125 Magurele, Romania; (M.A.); (F.L.Z.); (M.B.); (F.A.)
| | - Florina Lucica Zorila
- Horia Hulubei National Institute of Physics and Nuclear Engineering, 30 Reactorului Street, 077125 Magurele, Romania; (M.A.); (F.L.Z.); (M.B.); (F.A.)
- Department of Genetics, Faculty of Biology, University of Bucharest, 91-95 Splaiul Indepententei, 050095 Bucharest, Romania
| | - Mihaela Bacalum
- Horia Hulubei National Institute of Physics and Nuclear Engineering, 30 Reactorului Street, 077125 Magurele, Romania; (M.A.); (F.L.Z.); (M.B.); (F.A.)
| | - Florin Albota
- Horia Hulubei National Institute of Physics and Nuclear Engineering, 30 Reactorului Street, 077125 Magurele, Romania; (M.A.); (F.L.Z.); (M.B.); (F.A.)
| | - Ana Mihaela Gavrila
- National Institute of Research and Development for Chemistry and Petrochemistry, 202 Splaiul Independentei, 060041 Bucharest, Romania; (A.M.G.); (B.T.)
| | - Bogdan Trica
- National Institute of Research and Development for Chemistry and Petrochemistry, 202 Splaiul Independentei, 060041 Bucharest, Romania; (A.M.G.); (B.T.)
| | - Traian Rotariu
- Military Technical Academy “Ferdinand I”, 39-49 G. Cosbuc Blvd., 050141 Bucharest, Romania; (G.T.); (A.I.P.); (T.R.)
| | - Mariana Ionita
- Faculty of Medical Engineering, University Politehnica of Bucharest, Gheorghe Polizu 1-7, 011061 Bucharest, Romania;
- Advanced Polymer Materials Group, University Politehnica of Bucharest, Gheorghe Polizu 1-7, 011061 Bucharest, Romania
- eBio-Hub Research Centre, University Politehnica of Bucharest-Campus, Iuliu Maniu 6, 061344 Bucharest, Romania
| | - Marcel Istrate
- S.C. Stimpex S.A., 46-48 Nicolae Teclu Street, 032368 Bucharest, Romania;
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Toader G, Podaru IA, Rusen E, Diacon A, Ginghina RE, Alexandru M, Zorila FL, Gavrila AM, Trica B, Rotariu T, Ionita M. Nafcillin-Loaded Photocrosslinkable Nanocomposite Hydrogels for Biomedical Applications. Pharmaceutics 2023; 15:1588. [PMID: 37376037 DOI: 10.3390/pharmaceutics15061588] [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: 04/28/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Skin infections are frequently treated via intravenous or oral administration of antibiotics, which can lead to serious adverse effects and may sometimes contribute to the proliferation of resistant bacterial strains. Skin represents a convenient pathway for delivering therapeutic compounds, ensured by the high number of blood vessels and amount of lymphatic fluids in the cutaneous tissues, which are systematically connected to the rest of the body. This study provides a novel, straightforward method to obtain nafcillin-loaded photocrosslinkable nanocomposite hydrogels and demonstrates their performance as drug carriers and antimicrobial efficacy against Gram-positive bacteria. The novel formulations obtained, based on polyvinylpyrrolidone, tri(ethylene glycol) divinyl ether crosslinker, hydrophilic bentonite nanoclay, and/or two types of photoactive (TiO2 and ZnO) nanofillers, were characterized using various analytical methods (transmission electron microscopy (TEM), scanning electron microscopy-energy-dispersive X-ray analysis (SEM-EDX), mechanical tests (tension, compression, and shear), ultraviolet-visible spectroscopy (UV-Vis), swelling investigations, and via specific microbiological assays ("agar disc diffusion method" and "time-kill test"). The results reveal that the nanocomposite hydrogel possessed high mechanical resistance, good swelling abilities, and good antimicrobial activity, demonstrating a decrease in the bacteria growth between 3log10 and 2log10 after one hour of direct contact with S. aureus.
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Affiliation(s)
- Gabriela Toader
- Military Technical Academy, "Ferdinand I", 39-49 G. Cosbuc Blvd., 050141 Bucharest, Romania
| | - Ionela Alice Podaru
- Military Technical Academy, "Ferdinand I", 39-49 G. Cosbuc Blvd., 050141 Bucharest, Romania
- Faculty of Chemical Engineering and Biotechnologies, University Politehnica of Bucharest, 1-7 Gh. Polizu Street, 011061 Bucharest, Romania
| | - Edina Rusen
- Faculty of Chemical Engineering and Biotechnologies, University Politehnica of Bucharest, 1-7 Gh. Polizu Street, 011061 Bucharest, Romania
| | - Aurel Diacon
- Military Technical Academy, "Ferdinand I", 39-49 G. Cosbuc Blvd., 050141 Bucharest, Romania
- Faculty of Chemical Engineering and Biotechnologies, University Politehnica of Bucharest, 1-7 Gh. Polizu Street, 011061 Bucharest, Romania
| | - Raluca Elena Ginghina
- Research and Innovation Centre for CBRN Defense and Ecology, 225 Şos. Olteniţei, 041327 Bucharest, Romania
| | - Mioara Alexandru
- Microbiology Laboratory, Horia Hulubei National Institute for R&D in Physics and Nuclear Engineering, 30 Reactorului St., 077125 Magurele, Romania
| | - Florina Lucica Zorila
- Microbiology Laboratory, Horia Hulubei National Institute for R&D in Physics and Nuclear Engineering, 30 Reactorului St., 077125 Magurele, Romania
- Department of Genetics, Faculty of Biology, University of Bucharest, 91-95 Splaiul Indepententei, 050095 Bucharest, Romania
| | - Ana Mihaela Gavrila
- National Institute of Research, Development for Chemistry and Petrochemistry, 202 Splaiul Independentei, 060041 Bucharest, Romania
| | - Bogdan Trica
- National Institute of Research, Development for Chemistry and Petrochemistry, 202 Splaiul Independentei, 060041 Bucharest, Romania
| | - Traian Rotariu
- Military Technical Academy, "Ferdinand I", 39-49 G. Cosbuc Blvd., 050141 Bucharest, Romania
| | - Mariana Ionita
- Faculty of Chemical Engineering and Biotechnologies, University Politehnica of Bucharest, 1-7 Gh. Polizu Street, 011061 Bucharest, Romania
- eBio-Hub Research Centre, University Politehnica of Bucharest-Campus, Iuliu Maniu 6, 061344 Bucharest, Romania
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Raval YS, Fleming D, Mohamed A, Karau MJ, Mandrekar JN, Schuetz AN, Greenwood Quaintance KE, Beyenal H, Patel R. In Vivo Activity of Hydrogen-Peroxide Generating Electrochemical Bandage Against Murine Wound Infections. ADVANCED THERAPEUTICS 2023; 6:2300059. [PMID: 37485434 PMCID: PMC10361686 DOI: 10.1002/adtp.202300059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Indexed: 03/06/2023]
Abstract
Biofilms formed by antibiotic-resistant bacteria in wound beds present unique challenges in terms of treating wound infections. In this work, the in vivo activity of a novel electrochemical bandage (e-bandage) composed of carbon fabric and controlled by a wearable potentiostat, designed to continuously deliver low amounts of hydrogen peroxide (H2O2) was evaluated against methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Pseudomonas aeruginosa (MDR-PA) and mixed-species (MRSA and MDR-PA) wound infections. Wounds created on Swiss Webster mice were infected with the above-named bacteria and biofilms allowed to establish on wound beds for 3 days. e-Bandages, which electrochemically reduce dissolved oxygen to H2O2 when polarized at -0.6 VAg/AgCl, were placed atop the infected wound bed and polarized continuously for 48 hours. Polarized e-bandage treatment resulted in significant reductions (p <0.001) of both mono-species and mixed-species wound infections. After e-bandage treatment, electron microscopy showed degradation of bacterial cells, and histopathology showed no obvious alteration to the inflammatory host response. Blood biochemistries showed no abnormalities. Taken all together, results of this work suggest that the described H2O2-producing e-bandage can effectively reduce in vivo MRSA, MDR-PA and mixed-species wound biofilms, and should be further developed as a potential antibiotic-free strategy for treatment of wound infections.
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Affiliation(s)
- Yash S. Raval
- Department of Laboratory Medicine and Division of Clinical Microbiology, Mayo Clinic, Rochester, MN
| | - Derek Fleming
- Department of Laboratory Medicine and Division of Clinical Microbiology, Mayo Clinic, Rochester, MN
| | - Abdelrhman Mohamed
- The Gene and Linda Voiland School of Chemical Engineering and Bioengineering, Washington State University, Pullman, WA
| | - Melissa J. Karau
- Department of Laboratory Medicine and Division of Clinical Microbiology, Mayo Clinic, Rochester, MN
| | | | - Audrey N. Schuetz
- Department of Laboratory Medicine and Division of Clinical Microbiology, Mayo Clinic, Rochester, MN
| | | | - Haluk Beyenal
- The Gene and Linda Voiland School of Chemical Engineering and Bioengineering, Washington State University, Pullman, WA
| | - Robin Patel
- Department of Laboratory Medicine and Division of Clinical Microbiology, Mayo Clinic, Rochester, MN
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN
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9
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Cui Y, Liu H, Tian Y, Fan Y, Li S, Wang G, Wang Y, Peng C, Wu D. Dual-functional composite scaffolds for inhibiting infection and promoting bone regeneration. Mater Today Bio 2022; 16:100409. [PMID: 36090611 PMCID: PMC9449864 DOI: 10.1016/j.mtbio.2022.100409] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 12/14/2022] Open
Abstract
The treatment of infected bone defects is an intractable problem in orthopedics. It comprises two critical parts, namely that of infection control and bone defect repair. According to these two core tasks during treatment, the ideal approach of simultaneously controlling infection and repairing bone defects is promising treatment strategy. Several engineered biomaterials and drug delivery systems with dual functions of anti-bacterial action and ostogenesis-promotion have been developed and demonstrated excellent therapeutic effects. Compared with the conventional treatment method, the dual-functional composite scaffold can provide one-stage treatment avoiding multiple surgeries, thereby remarkably simplifying the treatment process and reducing the treatment time, overcoming the disadvantages of conventional bone transplantation. In this review, the impaired bone repair ability and its specific mechanisms in the microenvironment of pathogen infection and excessive inflammation were analyzed, providing a theoretical basis for the treatment of infectious bone defects. Furthermore, we discussed the composite dual-functional scaffold composed of a combination of antibacterial and osteogenic material. Finally, a series of advanced drug delivery systems with antibacterial and bone-promoting capabilities were summarized and discussed. This review provides a comprehensive understanding for the microenvironment of infectious bone defects and leading-edge design strategies for the antibacterial and bone-promoting dual-function scaffold, thus providing clinically significant treatment methods for infectious bone defects. Antibacterial and bone-promoting dual-function scaffolds are ideal strategies for treatment of infectious bone defects. The effect of infection on bone repair was summarized in detail from four important aspects. A variety of dual-function scaffolds based on antibacterial and osteogenic materials were discussed. Dual-function drug delivery systems promoting repair of infectious bone defects by locally releasing functional agents. Leading-edge design strategies, challenges and prospects for dual-functional biomaterials were provided.
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10
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Plazonic F, LuTheryn G, Hind C, Clifford M, Gray M, Stride E, Glynne-Jones P, Hill M, Sutton JM, Carugo D. Bactericidal Effect of Ultrasound-Responsive Microbubbles and Sub-inhibitory Gentamicin against Pseudomonas aeruginosa Biofilms on Substrates With Differing Acoustic Impedance. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1888-1898. [PMID: 35798625 DOI: 10.1016/j.ultrasmedbio.2022.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
The aim of this research was to explore the interaction between ultrasound-activated microbubbles (MBs) and Pseudomonas aeruginosa biofilms, specifically the effects of MB concentration, ultrasound exposure and substrate properties on bactericidal efficacy. Biofilms were grown using a Centre for Disease Control (CDC) bioreactor on polypropylene or stainless-steel coupons as acoustic analogues for soft and hard tissue, respectively. Biofilms were treated with different concentrations of phospholipid-shelled MBs (107-108 MB/mL), a sub-inhibitory concentration of gentamicin (4 µg/mL) and 1-MHz ultrasound with a continuous or pulsed (100-kHz pulse repetition frequency, 25% duty cycle, 0.5-MPa peak-to-peak pressure) wave. The effect of repeated ultrasound exposure with intervals of either 15- or 60-min was also investigated. With polypropylene coupons, the greatest bactericidal effect was achieved with 2 × 5 min of pulsed ultrasound separated by 60 min and a microbubble concentration of 5 × 107 MBs/mL. A 0.76 log (83%) additional reduction in the number of bacteria was achieved compared with the use of an antibiotic alone. With stainless-steel coupons, a 67% (0.46 log) reduction was obtained under the same exposure conditions, possibly due to enhancement of a standing wave field which inhibited MB penetration in the biofilm. These findings demonstrate the importance of treatment parameter selection in antimicrobial applications of MBs and ultrasound in different tissue environments.
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Affiliation(s)
- Filip Plazonic
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Gareth LuTheryn
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK; Department of Pharmaceutics, School of Pharmacy, University College London, London, UK; National Biofilms Innovation Centre, University of Southampton, Southampton, UK
| | - Charlotte Hind
- UK Health Security Agency, Porton Down, Salisbury, Wiltshire, UK
| | - Melanie Clifford
- UK Health Security Agency, Porton Down, Salisbury, Wiltshire, UK
| | - Michael Gray
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Eleanor Stride
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Peter Glynne-Jones
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Martyn Hill
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - J Mark Sutton
- UK Health Security Agency, Porton Down, Salisbury, Wiltshire, UK; Institute of Pharmaceutical Science, King's College London, London, UK
| | - Dario Carugo
- Department of Pharmaceutics, School of Pharmacy, University College London, London, UK.
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11
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Thao NTT, Wijerathna HMSM, Kumar RS, Choi D, Dananjaya SHS, Attanayake AP. Preparation and characterization of succinyl chitosan and succinyl chitosan nanoparticle film: In vitro and in vivo evaluation of wound healing activity. Int J Biol Macromol 2021; 193:1823-1834. [PMID: 34785202 DOI: 10.1016/j.ijbiomac.2021.11.015] [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] [Received: 05/16/2021] [Revised: 10/22/2021] [Accepted: 11/02/2021] [Indexed: 01/09/2023]
Abstract
Development of novel wound dressing materials having the ability to prevent bacterial infections and capable of accelerating the tissue regeneration process is utmost important, since the wounds in patients can cause severe health issues. In the present work, we synthesized novel N-succinyl chitosan nanoparticles (N-SuC NPs) films and tested their antimicrobial, cytotoxicity, and in vitro and in vivo wound healing activity. N-SuC NPs were synthesized by ionic gelation method, and subsequently N-SuC NPs films were prepared by solution casting method using synthesized N-SuC NPs. The prepared N-SuC NPs films showed significant antimicrobial activity against Escherichia coli and Staphylococcus aureus with a minimum inhibitory concentration of 6 mg/mL and <8 mg/mL, respectively. The biocompatibility and the in vitro wound healing activity of N-SuC NPs films were analyzed using human dermal fibroblast (HDF) cells. In vivo cutaneous wound healing of the N-SuC NPs film was investigated using the Wister rat model, and the studies showed that the N-SuC NPs film significantly accelerated the wound healing process by inducing more blood vessels formation and tissue granulation. The experimental results showed that synthesized N-SuC NPs film had excellent antimicrobial, cytotoxicity and wound healing activity, indicating that it could be used in biomedical applications.
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Affiliation(s)
- N T Thu Thao
- Zerone Bio Inc., Dankook University, 3(rd) Floor, Sanhak Building, Dandae-ro 119, Dongnam-gu, Cheonan Si, Chungcheongnam-do 31116, Republic of Korea
| | - H M S M Wijerathna
- Department of Aquaculture and Aquatic Resources Management, University College of Anuradhapura, Sri Lanka
| | - R Saravana Kumar
- Department of Physics, Government College of Arts and Science, Idappadi, Salem 637102, Tamil Nadu, India
| | - Dongrack Choi
- Zerone Bio Inc., Dankook University, 3(rd) Floor, Sanhak Building, Dandae-ro 119, Dongnam-gu, Cheonan Si, Chungcheongnam-do 31116, Republic of Korea
| | - S H S Dananjaya
- Zerone Bio Inc., Dankook University, 3(rd) Floor, Sanhak Building, Dandae-ro 119, Dongnam-gu, Cheonan Si, Chungcheongnam-do 31116, Republic of Korea.
| | - A P Attanayake
- Department of Biochemistry, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
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12
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Singh A, Maqsood Z, Iqubal MK, Ali J, Baboota S. Compendium of Conventional and Targeted Drug Delivery Formulation Used for the Treatment and Management of the Wound Healing. Curr Drug Deliv 2021; 19:192-211. [PMID: 34315364 DOI: 10.2174/1567201818666210727165916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/21/2021] [Accepted: 07/01/2021] [Indexed: 11/22/2022]
Abstract
Wound healing is a complex and dynamic phenomenon that involves the restoration of normal physiology and functioning of injured tissue. The process of wound healing is primarily regulated by various cytokines, inflammatory mediators, and growth factors at the molecular level. Any intervention in the normal wound healing process leads to further tissue damage, which in turn leads to delayed wound healing. Several natural, synthetic drugs and their combinations were used to restored and accelerate the wound healing process. However, the conventional delivery carriers were not much effective, and thus, nowadays, nanocarriers are gaining much popularity since they are playing a pivotal role in drug delivery. Since nanocarriers have their own applicability and benefits (enhance the bioavailability, site-specific targeting) so, they can accelerate wound healing more efficiently. This review briefly discussed about the various events that take place during the wound healing process with emphasis on various natural, synthetic, and combination drug therapy used for accelerating wound healing and the role of nanotechnology-based approaches in chronic wound healing.
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Affiliation(s)
- Ajay Singh
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
| | - Zeba Maqsood
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
| | - Mohammad Kashif Iqubal
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
| | - Javed Ali
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
| | - Sanjula Baboota
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
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13
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Alves PJ, Barreto RT, Barrois BM, Gryson LG, Meaume S, Monstrey SJ. Update on the role of antiseptics in the management of chronic wounds with critical colonisation and/or biofilm. Int Wound J 2021; 18:342-358. [PMID: 33314723 PMCID: PMC8244012 DOI: 10.1111/iwj.13537] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/04/2020] [Accepted: 11/07/2020] [Indexed: 12/22/2022] Open
Abstract
Biofilms play a major role in delaying chronic wounds from healing. A wound infiltrated with biofilm, or "critically colonised" wound, may become clinically infected if the number of microbes exceeds a critical level. Chronic wound biofilms represent a significant treatment challenge by demonstrating recalcitrance towards antimicrobial agents. However, a "window of opportunity" may exist after wound debridement when biofilms are more susceptible to topical antiseptics. Here, we discuss the role of antiseptics in the management of chronic wounds and biofilm, focusing on povidone-iodine (PVP-I) in comparison with two commonly used antiseptics: polyhexanide (PHMB) and silver. This article is based on the literature reviewed during a focus group meeting on antiseptics in wound care and biofilm management, and on a PubMed search conducted in March 2020. Compared with PHMB and silver, PVP-I has a broader spectrum of antimicrobial activity, potent antibiofilm efficacy, no acquired bacterial resistance or cross-resistance, low cytotoxicity, good tolerability, and an ability to promote wound healing. PVP-I represents a viable therapeutic option in wound care and biofilm management, with the potential to treat biofilm-infiltrated, critically colonised wounds. We propose a practical algorithm to guide the management of chronic, non-healing wounds due to critical colonisation or biofilm, using PVP-I.
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Affiliation(s)
- Paulo J. Alves
- Wounds Research LaboratoryUniversidade Católica PortuguesaPortoPortugal
| | | | | | - Luc G. Gryson
- Belgian Defence Military Medical ComponentBrusselsBelgium
| | - Sylvie Meaume
- Department of Geriatrics and Wound Care UnitHospital Rothschild, APHP Assistance Publique Hôpitaux de Paris, Sorbonne UniversitéParisFrance
| | - Stan J. Monstrey
- Department of Plastic SurgeryGhent University HospitalGhentBelgium
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14
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Radhakrishnan MP, Suryaletha K, Shankar A, Savithri AV, George S, Thomas S. Insights into Peptide Mediated Antibiofilm Treatment in Chronic Wound: A Bench to Bedside Approach. Curr Protein Pept Sci 2021; 22:50-59. [PMID: 33143623 DOI: 10.2174/1389203721666201103084727] [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: 07/12/2020] [Revised: 08/08/2020] [Accepted: 08/24/2020] [Indexed: 11/22/2022]
Abstract
Chronic wound biofilm infections are a threat to the population with respect to morbidity and mortality. The presence of multidrug-resistant bacterial pathogens in chronic wound renders the action of antibiotics and antibiofilm agents difficult. Therefore an alternative therapy is essential for reducing bacterial biofilm burden. In this scenario, the peptide-based antibiofilm therapy for chronic wound biofilm management seeks more attention. A synthetic peptide with a broad range of antibiofilm activity against preformed and established biofilms, having the ability to kill multispecies bacteria within biofilms and possessing combinatorial activity with other antimicrobial agents, provides significant insights. In this review, we portray the possibilities and difficulties of peptide-mediated treatment in chronic wounds biofilm management and how it can be clinically translated into a product.
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Affiliation(s)
- Megha P Radhakrishnan
- Cholera and Biofilm Research Laboratory, Pathogen Biology Group, Rajiv Gandhi Centre for Biotechnology, Govt. of India, Trivandrum - 695 014, Kerala, India
| | - Karthika Suryaletha
- Cholera and Biofilm Research Laboratory, Pathogen Biology Group, Rajiv Gandhi Centre for Biotechnology, Govt. of India, Trivandrum - 695 014, Kerala, India
| | - Aparna Shankar
- Cholera and Biofilm Research Laboratory, Pathogen Biology Group, Rajiv Gandhi Centre for Biotechnology, Govt. of India, Trivandrum - 695 014, Kerala, India
| | - Akhila Velappan Savithri
- Cholera and Biofilm Research Laboratory, Pathogen Biology Group, Rajiv Gandhi Centre for Biotechnology, Govt. of India, Trivandrum - 695 014, Kerala, India
| | - Sanil George
- Interdisciplinary Biology, Rajiv Gandhi Centre for Biotechnology, Trivandrum - 695 014, Kerala, India
| | - Sabu Thomas
- Cholera and Biofilm Research Laboratory, Pathogen Biology Group, Rajiv Gandhi Centre for Biotechnology, Govt. of India, Trivandrum - 695 014, Kerala, India
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15
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Wound Repair and Extremely Low Frequency-Electromagnetic Field: Insight from In Vitro Study and Potential Clinical Application. Int J Mol Sci 2021; 22:ijms22095037. [PMID: 34068809 PMCID: PMC8126245 DOI: 10.3390/ijms22095037] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022] Open
Abstract
Wound healing is a complex, staged process. It involves extensive communication between the different cellular constituents of various compartments of the skin and its extracellular matrix (ECM). Different signaling pathways are determined by a mutual influence on each other, resulting in a dynamic and complex crosstalk. It consists of various dynamic processes including a series of overlapping phases: hemostasis, inflammation response, new tissue formation, and tissue remodeling. Interruption or deregulation of one or more of these phases may lead to non-healing (chronic) wounds. The most important factor among local and systemic exogenous factors leading to a chronic wound is infection with a biofilm presence. In the last few years, an increasing number of reports have evaluated the effects of extremely low frequency (ELF) electromagnetic fields (EMFs) on tissue repair. Each experimental result comes from a single element of this complex process. An interaction between ELF-EMFs and healing has shown to effectively modulate inflammation, protease matrix rearrangement, neo-angiogenesis, senescence, stem-cell proliferation, and epithelialization. These effects are strictly related to the time of exposure, waveform, frequency, and amplitude. In this review, we focus on the effect of ELF-EMFs on different wound healing phases.
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16
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Abstract
In the past decade, the frequency of chronic wounds in older population has increased, and their impact on quality of life is substantial. Chronic wounds are a public health problem associated with very high economic and psychosocial costs. These wounds result from various pathologies and comorbidities, such arterial and venous insufficiency, diabetes mellitus and continuous skin pressure. Recently, the role of infection and biofilms in the healing of chronic wounds has been the subject of considerable research. This paper presents an overview of various methods and products used to manage chronic wounds and discusses recent advances in wound care. To decide on the best treatment for any wound, it is crucial to holistically assess the patient and the wound. Additionally, multiple strategies could be used to prevent or treat chronic wounds.
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Affiliation(s)
- Maria Azevedo
- Researcher, Center for Research in Health Technologies and Information Systems and Department of Microbiology, Faculty of Medicine, University of Porto, Portugal
| | - Carmen Lisboa
- Lecturer and Researcher in Medical Microbiology, Center for Research in Health Technologies and Information Systems and Department of Microbiology, Faculty of Medicine, University of Porto, Portugal
| | - Acácio Rodrigues
- Lecturer and Researcher in Medical Microbiology, Faculty of Medicine, Porto; Burn Unit, Department of Plastic and Reconstructive Surgery, Hospital São João, Portugal
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17
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Knackstedt R, Knackstedt T, Gatherwright J. The role of topical probiotics on wound healing: A review of animal and human studies. Int Wound J 2020; 17:1687-1694. [PMID: 32869480 DOI: 10.1111/iwj.13451] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
Pathogenic, opportunistic, and commensal bacterial coexist in the intestinal tract, and imbalances among these strains have been linked to systemic inflammation and a variety of disease states. Similarly, human skin plays an important role as an interface between the body and the environment with an estimated 1 billion microbes per square centimetres. Skin microbiome fluctuations that cause increases in pathologic bacteria, either because of individual and/or environmental factors, can lead to disease states at the skin level ranging from inflammatory conditions to infections. As wounds are inherently associated with perturbations in the local microflora due to injury and activation of the immune responses, the addition of topical probiotics could be a means to prevent infection, regulate inflammation, and potentially augment healing. The goal of this review is to analyse the impact the skin microbiome has on cutaneous wound healing with a focus on developing proposed treatment algorithms and support for their therapeutic potential.
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18
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Juknius T, Juknienė I, Tamulevičius T, Ružauskas M, Pamparienė I, Oberauskas V, Jurkevičiūtė A, Vasiliauskas A, Tamulevičius S. Preclinical Study of a Multi-Layered Antimicrobial Patch Based on Thin Nanocomposite Amorphous Diamond Like Carbon Films with Embedded Silver Nanoparticles. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E3180. [PMID: 32708717 PMCID: PMC7412193 DOI: 10.3390/ma13143180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/29/2022]
Abstract
A growing number of severe infections are related to antibiotic-resistant bacteria, therefore, in recent years, alternative antimicrobial materials based on silver nanoparticles (NPs) attracted a lot of attention. In the current research, we present a medical patch prototype containing diamond-like carbon nanocomposite thin films doped with silver nanoparticles (DLC:Ag), as a source of silver ions, and an aqueous mass of the gelatin/agar mixture as a silver ion accumulation layer. The DLC:Ag thin films with 3.4 at.% of silver were deposited on synthetic silk employing reactive unbalanced DC magnetron sputtering of the silver target with argon ions performed in the acetylene gas atmosphere. The average size of the silver nanoparticles as defined by scanning electron microscope was 24 nm. After the film deposition, the samples were etched with RF oxygen plasma, aiming at efficient silver ion release in aqueous media from the nanocomposite film. In the patch prototype, a mixture of agar and gelatin was applied in silicone carrier with cavities, acting as a silver ion accumulation layer that further enhanced the antimicrobial efficiency. It was found that the DLC:Ag thin film on the silk after soaking in water for 24 h was able to release up to 4 ppm of Ag. The microbiological experiments using S. aureus bacteria were performed with the patch prototype and the silver ion saturated water, demonstrated the inactivation of 99% and 79% of bacteria, respectively. Scanning electron microscopy analysis showed that silver NPs destroyed the bacteria cell and the bacteria affected by Ag ions had spots and perforated cell wall areas with cytoplasm leakage out was obtained. A preliminary preclinical study using the laboratory animals demonstrated that using the patch prototype, the methicillin-resistant S. aureus (MRSA)-infected wound on skin surface healed faster compared with control and was able to kill all MRSA bacteria strains in the wound's bed after 72 h of treatment.
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Affiliation(s)
- Tadas Juknius
- Institute of Materials Science, Kaunas University of Technology, K. Baršausko St. 59, LT-51423 Kaunas, Lithuania; (A.J.); (A.V.); (S.T.)
- Veterinary Academy, Lithuanian University of Health Sciences, Tilžės St. 18, LT-47181 Kaunas, Lithuania; (I.J.); (M.R.); (I.P.); (V.O.)
| | - Indrė Juknienė
- Veterinary Academy, Lithuanian University of Health Sciences, Tilžės St. 18, LT-47181 Kaunas, Lithuania; (I.J.); (M.R.); (I.P.); (V.O.)
| | - Tomas Tamulevičius
- Institute of Materials Science, Kaunas University of Technology, K. Baršausko St. 59, LT-51423 Kaunas, Lithuania; (A.J.); (A.V.); (S.T.)
- Department of Physics, Kaunas University of Technology, Studentų St. 50, LT-51368 Kaunas, Lithuania
| | - Modestas Ružauskas
- Veterinary Academy, Lithuanian University of Health Sciences, Tilžės St. 18, LT-47181 Kaunas, Lithuania; (I.J.); (M.R.); (I.P.); (V.O.)
| | - Ina Pamparienė
- Veterinary Academy, Lithuanian University of Health Sciences, Tilžės St. 18, LT-47181 Kaunas, Lithuania; (I.J.); (M.R.); (I.P.); (V.O.)
| | - Vaidas Oberauskas
- Veterinary Academy, Lithuanian University of Health Sciences, Tilžės St. 18, LT-47181 Kaunas, Lithuania; (I.J.); (M.R.); (I.P.); (V.O.)
| | - Aušrinė Jurkevičiūtė
- Institute of Materials Science, Kaunas University of Technology, K. Baršausko St. 59, LT-51423 Kaunas, Lithuania; (A.J.); (A.V.); (S.T.)
| | - Andrius Vasiliauskas
- Institute of Materials Science, Kaunas University of Technology, K. Baršausko St. 59, LT-51423 Kaunas, Lithuania; (A.J.); (A.V.); (S.T.)
| | - Sigitas Tamulevičius
- Institute of Materials Science, Kaunas University of Technology, K. Baršausko St. 59, LT-51423 Kaunas, Lithuania; (A.J.); (A.V.); (S.T.)
- Department of Physics, Kaunas University of Technology, Studentų St. 50, LT-51368 Kaunas, Lithuania
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19
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Venosi S, Ceccarelli G, de Angelis M, Laghi L, Bianchi L, Martinelli O, Maruca D, Cavallari EN, Toscanella F, Vassalini P, Trinchieri V, Oliva A, d'Ettorre G. Infected chronic ischemic wound topically treated with a multi-strain probiotic formulation: a novel tailored treatment strategy. J Transl Med 2019; 17:364. [PMID: 31706326 PMCID: PMC6842486 DOI: 10.1186/s12967-019-2111-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/26/2019] [Indexed: 12/31/2022] Open
Abstract
Background A wide debate is ongoing regarding the role of cutaneous dysbiosis in the pathogenesis and evolution of difficult-to-treat chronic wounds. Nowadays, probiotic treatment considered as an useful tool to counteract dysbiosis but the evidence in regard to their therapeutic use in the setting of difficult-to-treat cutaneous ulcers is still poor. Aim: clinical report An 83-year-old woman suffering a critical limb ischemia and an infected difficult-to-treat ulcerated cutaneous lesion of the right leg, was complementary treated with local application of a mixture of probiotic bacteria. Methods Microbiological and metabolomic analysis were conducted on wound swabs obtained before and after bacteriotherapy. Results During the treatment course, a progressive healing of the lesion was observed with microbiological resolution of the polymicrobial infection of the wound. Metabolomic analysis showed a significant difference in the local concentration of propionate, 2-hydroxyisovalerate, 2-oxoisocaproate, 2,3-butanediol, putrescine, thymine, and trimethylamine before and after bacteriotherapy. Conclusion The microbiological and metabolomic results seem to confirm the usefulness of complementary probiotic treatment in difficult-to-treat infected wounds. Further investigations are needed to confirm these preliminary findings.
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Affiliation(s)
- Salvatore Venosi
- Department of Cardio-Thoraco-Vascular, Surgery and Transplants, University of Rome Sapienza, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Viale del Policlinico 155, Rome, Italy.
| | - Massimiliano de Angelis
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Viale del Policlinico 155, Rome, Italy
| | - Luca Laghi
- Department of Agri-Food Science and Technology, University of Bologna, Bologna, Italy
| | - Laura Bianchi
- Functional Proteomic Laboratory, Department of Life Sciences, University of Siena, Siena, Italy
| | - Ombretta Martinelli
- Department of Cardio-Thoraco-Vascular, Surgery and Transplants, University of Rome Sapienza, Rome, Italy
| | - Debora Maruca
- Department of Cardio-Thoraco-Vascular, Surgery and Transplants, University of Rome Sapienza, Rome, Italy
| | - Eugenio Nelson Cavallari
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Viale del Policlinico 155, Rome, Italy
| | - Fabrizia Toscanella
- Diabetic Foot Center, Istituto Nazionale Ricovero e Cura Anziani (INRCA), Ancona, Italy
| | - Paolo Vassalini
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Viale del Policlinico 155, Rome, Italy
| | - Vito Trinchieri
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Viale del Policlinico 155, Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Viale del Policlinico 155, Rome, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Viale del Policlinico 155, Rome, Italy
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Viviana Serna González C, Thum M, de Oliveira Ramalho A, Beloto Silva O, Franco Coelho M, Medeiros da Silva Queiroz W, Maria Sebba Tosta de Souza D, Cristina Nogueira P, Lúcia Conceição Gouveia Santos V. Análise da “1a Recomendação Brasileira para o Gerenciamento do Biofilme em Feridas Crônicas e Complexas”. ESTIMA 2019. [DOI: 10.30886/estima.v17.783_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivos: Analisar criticamente a “1ª Recomendação brasileira para o gerenciamento de biofilme em feridas crônicas e complexas”. Método: Realizou-se revisão da literatura atual às informações nele contidas. Resultados: Observou-se que a publicação carece de metodologia compatível com o título, existem lacunas nas recomendações quanto à classificação das evidências e com ausência de fundamentação a partir de importantes consensos internacionais para o tratamento das feridas complexas com suspeita de biofilme, publicados nos últimos três anos. Conclusão: Conclui-se que o manuscrito não deve ser usado como guia de recomendações clínicas, mas como revisão bibliográfica sobre o tema.
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Viviana Serna González C, Thum M, de Oliveira Ramalho A, Beloto Silva O, Franco Coelho M, Medeiros da Silva Queiroz W, Maria Sebba Tosta de Souza D, Cristina Nogueira P, Lúcia Conceição Gouveia Santos V. Analysis of “1st Brazilian Recommendation for Biofilm Management in Chronic and Complex Wounds”. ESTIMA 2019. [DOI: 10.30886/estima.v17.783_in] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives: Analyze critically the “1st Brazilian Recommendation for Biofilm Management in Chronic and Complex Wounds” (from Portuguese, “1a Recomendação Brasileira para o Gerenciamento de Biofilme em Feridas Crônicas e Complexas”). Method: Reviewing information contained in said document according to current literature. Results: The publication was showed to lack methodology compatible with its title; gaps in the recommendations were perceived regarding evidence classification, as well as an absence of grounding from important international consensus, published in the last three years, about treatment of complex wounds with suspected biofilm. Conclusion: The document was concluded to be inadequate for use as a clinical guideline, being considered only a bibliographic review about the theme.
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Knackstedt R, Knackstedt T, Gatherwright J. The role of topical probiotics in skin conditions: A systematic review of animal and human studies and implications for future therapies. Exp Dermatol 2019; 29:15-21. [DOI: 10.1111/exd.14032] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/27/2019] [Accepted: 08/26/2019] [Indexed: 02/06/2023]
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Roy S, Prakash S, Mathew-Steiner SS, Das Ghatak P, Lochab V, Jones TH, Mohana Sundaram P, Gordillo GM, Subramaniam VV, Sen CK. Disposable Patterned Electroceutical Dressing (PED-10) Is Safe for Treatment of Open Clinical Chronic Wounds. Adv Wound Care (New Rochelle) 2019; 8:149-159. [PMID: 31016066 DOI: 10.1089/wound.2018.0915] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/03/2019] [Indexed: 12/26/2022] Open
Abstract
Objective: To evaluate if patterned electroceutical dressing (PED) is safe for human chronic wounds treatment as reported by wound care providers. Approach: This work reports a pilot feasibility study with the primary objective to determine physically observable effects of PED application on host tissue response from a safety evaluation point of view. For this pilot study, patients receiving a lower extremity amputation with at least one open wound on the part to be amputated were enrolled. Patients were identified through the Ohio State University Wexner Medical Center (OSUWMC) based on inclusion and exclusion criteria through prescreening through the Comprehensive Wound Center's (CWC) Limb Preservation Program and wound physicians and/or providers at OSUWMC. Wounds were treated with the PED before amputation surgery. Results: The intent of the study was to identify if PED was safe for clinical application based on visual observations of adverse or lack of adverse events on skin and wound tissue. The pilot testing performed on a small cohort (N = 8) of patients showed that with engineered voltage regulation of current flow to the open wound, the PED can be used with little to no visually observable adverse effects on chronic human skin wounds. Innovation: The PED was developed as a second-generation tunable electroceutical wound care dressing, which could potentially be used to treat wounds with deeper infections compared with current state of the art that treats wounds with treatment zone limited to the surface near topical application. Conclusion: Technology advances in design and fabrication of electroceutical dressings were leveraged to develop a tunable laboratory prototype that could be used as a disposable low-cost electroceutical wound care dressing on chronic wounds. Design revisions of PED-1 (1 kΩ ballast resistor) circumvented previously observed adverse effects on the skin in the vicinity of an open wound. PED-10 (including a 10 kΩ ballast resistor) was well tolerated in the small cohort of patients (N = 8) on whom it was tested, and the observations reported here warrant a larger study to determine the clinical impact on human wound healing and infection control.
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Affiliation(s)
- Sashwati Roy
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering (ICRME), Indiana University School of Medicine, Indianapolis, Indiana
| | - Shaurya Prakash
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio
| | - Shomita S. Mathew-Steiner
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering (ICRME), Indiana University School of Medicine, Indianapolis, Indiana
| | - Piya Das Ghatak
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering (ICRME), Indiana University School of Medicine, Indianapolis, Indiana
| | - Varun Lochab
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio
| | - Travis H. Jones
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio
| | | | - Gayle M. Gordillo
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering (ICRME), Indiana University School of Medicine, Indianapolis, Indiana
| | - Vish V. Subramaniam
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio
| | - Chandan K. Sen
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering (ICRME), Indiana University School of Medicine, Indianapolis, Indiana
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Johnson TR, Gómez BI, McIntyre MK, Dubick MA, Christy RJ, Nicholson SE, Burmeister DM. The Cutaneous Microbiome and Wounds: New Molecular Targets to Promote Wound Healing. Int J Mol Sci 2018; 19:ijms19092699. [PMID: 30208569 PMCID: PMC6164292 DOI: 10.3390/ijms19092699] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 12/16/2022] Open
Abstract
The ecological community of microorganisms in/on humans, termed the microbiome, is vital for sustaining homeostasis. While culture-independent techniques have revealed the role of the gut microbiome in human health and disease, the role of the cutaneous microbiome in wound healing is less defined. Skin commensals are essential in the maintenance of the epithelial barrier function, regulation of the host immune system, and protection from invading pathogenic microorganisms. In this review, we summarize the literature derived from pre-clinical and clinical studies on how changes in the microbiome of various acute and chronic skin wounds impact wound healing tissue regeneration. Furthermore, we review the mechanistic insights garnered from model wound healing systems. Finally, in the face of growing concern about antibiotic-resistance, we will discuss alternative strategies for the treatment of infected wounds to improve wound healing and outcomes. Taken together, it has become apparent that commensals, symbionts, and pathogens on human skin have an intimate role in the inflammatory response that highlights several potential strategies to treat infected, non-healing wounds. Despite these promising results, there are some contradictory and controversial findings from existing studies and more research is needed to define the role of the human skin microbiome in acute and chronic wound healing.
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Affiliation(s)
- Taylor R Johnson
- Department of Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
| | - Belinda I Gómez
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
| | - Matthew K McIntyre
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
- School of Medicine, New York Medical College, Valhalla, New York, NY 10595, USA.
| | - Michael A Dubick
- Department of Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
| | - Robert J Christy
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
| | - Susannah E Nicholson
- Department of Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
| | - David M Burmeister
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
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25
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Cui YC, Wu Q, Teh SW, Peli A, Bu G, Qiu YS, Benelli G, Kumar SS. Bone breaking infections – A focus on bacterial and mosquito-borne viral infections. Microb Pathog 2018; 122:130-136. [DOI: 10.1016/j.micpath.2018.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/04/2018] [Accepted: 06/11/2018] [Indexed: 12/15/2022]
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26
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Schultz GS, Woo K, Weir D, Yang Q. Effectiveness of a monofilament wound debridement pad at removing biofilm and slough: ex vivo and clinical performance. J Wound Care 2018; 27:80-90. [DOI: 10.12968/jowc.2018.27.2.80] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Gregory S. Schultz
- Department of Obstetrics & Gynecology, University of Florida, Gainesville, Florida, US
| | - Kevin Woo
- Associate Professor, School of Nursing, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Dot Weir
- Catholic Health Advanced Wound Healing Centers, Buffalo, NY, US
| | - Qingping Yang
- The Institute for Wound Research at the University of Florida, Department of Obstetrics & Gynecology, University of Florida, Gainesville, FL, US
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27
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Harries RL, Bosanquet DC, Harding KG. Wound bed preparation: TIME for an update. Int Wound J 2017; 13 Suppl 3:8-14. [PMID: 27547958 DOI: 10.1111/iwj.12662] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/16/2016] [Indexed: 12/11/2022] Open
Abstract
While the overwhelming majority of wounds heal rapidly, a significant proportion fail to progress through the wound-healing process. These resultant chronic wounds cause considerable morbidity and are costly to treat. Wound bed preparation, summarised by the TIME (Tissue, Inflammation/infection, Moisture imbalance, Epithelial edge advancement) concept, is a systematic approach for assessing chronic wounds. Each of these components needs to be addressed and optimised to improve the chances of successful wound closure. We present an up-to-date literature review of the most important recent aspects of wound bed preparation. While there are many novel therapies that are available to the treating clinician, often, there are limited data on which to assess their clinical value, and a lack of appreciation for adequate wound bed preparation needed before expensive therapy is used to heal a wound.
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Affiliation(s)
- Rhiannon L Harries
- Royal College of Surgeons/Welsh Wound Initiative Research Fellow, Wound Healing Research Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - David C Bosanquet
- South East Wales Vascular Network, University Hospital of Medicine, Cardiff, UK
| | - Keith G Harding
- Welsh Wound Innovation Initiative, Cardiff University, Cardiff, UK
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Omar A, Wright JB, Schultz G, Burrell R, Nadworny P. Microbial Biofilms and Chronic Wounds. Microorganisms 2017; 5:microorganisms5010009. [PMID: 28272369 PMCID: PMC5374386 DOI: 10.3390/microorganisms5010009] [Citation(s) in RCA: 189] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/04/2017] [Indexed: 12/14/2022] Open
Abstract
Background is provided on biofilms, including their formation, tolerance mechanisms, structure, and morphology within the context of chronic wounds. The features of biofilms in chronic wounds are discussed in detail, as is the impact of biofilm on wound chronicity. Difficulties associated with the use of standard susceptibility tests (minimum inhibitory concentrations or MICs) to determine appropriate treatment regimens for, or develop new treatments for use in, chronic wounds are discussed, with alternate test methods specific to biofilms being recommended. Animal models appropriate for evaluating biofilm treatments are also described. Current and potential future therapies for treatment of biofilm-containing chronic wounds, including probiotic therapy, virulence attenuation, biofilm phenotype expression attenuation, immune response suppression, and aggressive debridement combined with antimicrobial dressings, are described.
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Affiliation(s)
- Amin Omar
- Innovotech Inc., Suite 101, 2011 94 Street, Edmonton, Alberta T6N 1H1, Canada.
| | - J Barry Wright
- Harkynn Consulting, P.O. Box 104, Albertville, Saskatchewan S0J 0A0, Canada.
| | - Gregory Schultz
- Department of Obstetrics and Gynecology, Institute for Wound Research, University of Florida, 1600 South West Archer Road, Room M337F, Gainesville, FL 32610-0294, USA.
| | - Robert Burrell
- Department of Biomedical Engineering, Faculties of Engineering and Medicine & Dentistry, 1101 Research Transition Facility, University of Alberta, Edmonton, Alberta T6G 2G6, Canada.
| | - Patricia Nadworny
- Innovotech Inc., Suite 101, 2011 94 Street, Edmonton, Alberta T6N 1H1, Canada.
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Avishai E, Yeghiazaryan K, Golubnitschaja O. Impaired wound healing: facts and hypotheses for multi-professional considerations in predictive, preventive and personalised medicine. EPMA J 2017; 8:23-33. [PMID: 28620441 PMCID: PMC5471802 DOI: 10.1007/s13167-017-0081-y] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/29/2017] [Indexed: 12/14/2022]
Abstract
Whereas the physiologic wound healing (WH) successfully proceeds through the clearly defined sequence of the individual phases of wound healing, chronic non-healing wounds/ulcers fail to complete the individual stages and the entire healing process. There are many risk factors both modifiable (such as stress, smoking, inappropriate alcohol consumption, malnutrition, obesity, diabetes, cardio-vascular disease, etc.) and non-modifiable (such as genetic diseases and ageing) strongly contributing to the impaired WH. Current statistics demonstrate that both categories are increasingly presented in the populations, which causes dramatic socio-economic burden to the healthcare sector and society at large. Consequently, innovative concepts by predictive, preventive and personalised medicine are crucial to be implemented in the area. Individual risk factors, causality, functional interrelationships, molecular signature, predictive diagnosis, and primary and secondary prevention are thoroughly analysed followed by the expert recommendations in this paper.
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Affiliation(s)
- Eden Avishai
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Kristina Yeghiazaryan
- Radiological Clinic, Medical Faculty, Friedrich-Wilhels-University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Olga Golubnitschaja
- Radiological Clinic, Medical Faculty, Friedrich-Wilhels-University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
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30
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Miller CL, Van Laar TA, Chen T, Karna SLR, Chen P, You T, Leung KP. Global transcriptome responses including small RNAs during mixed-species interactions with methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. Microbiologyopen 2016; 6. [PMID: 27868360 PMCID: PMC5458535 DOI: 10.1002/mbo3.427] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 10/11/2016] [Accepted: 10/13/2016] [Indexed: 12/27/2022] Open
Abstract
Pseudomonas aeruginosa and Staphylococcus aureus mixed‐species biofilm infections are more resilient to biocide attacks compared to their single‐species counterparts. Therefore, this study used an in vitro model recapitulating bacterial burdens seen in in vivo infections to investigate the interactions of P. aeruginosa and S. aureus in biofilms. RNA sequencing (RNA‐seq) was utilized to identify the entire genomic response, both open reading frames (ORFs) and small RNAs (sRNAs), of each species. Using competitive indexes, transposon mutants validated uncharacterized PA1595 of P. aeruginosa and Panton–Valentine leukocidin ORFs of S. aureus are required for competitive success. Assessing spent media on biofilm development determined that the effects of these ORFs are not solely mediated by mechanisms of secretion. Unlike PA1595, leukocidin (lukS‐PV) mutants of S. aureus lack a competitive advantage through contact‐mediated mechanisms demonstrated by cross‐hatch assays. RNA‐seq results suggested that during planktonic mixed‐species growth there is a robust genomic response or active combat from both pathogens until a state of equilibrium is reached during the maturation of a biofilm. In mixed‐species biofilms, P. aeruginosa differentially expressed only 0.3% of its genome, with most ORFs necessary for growth and biofilm development, whereas S. aureus modulated approximately 5% of its genome, with ORFs suggestive of a phenotype of increased virulence and metabolic quiescence. Specific expression of characterized sRNAs aligned with the genomic response to presumably coordinate the adaptive changes necessary for this homeostatic mixed‐species biofilm and sRNAs may provide viable foci for the design of future therapeutics.
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Affiliation(s)
- Christine L Miller
- Microbiology Branch, Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
| | - Tricia A Van Laar
- Microbiology Branch, Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
| | - Tsute Chen
- The Forsyth Institute, Cambridge, MA, USA
| | - S L Rajasekhar Karna
- Microbiology Branch, Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
| | - Ping Chen
- Microbiology Branch, Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
| | - Tao You
- Microbiology Branch, Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
| | - Kai P Leung
- Microbiology Branch, Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
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31
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Ramos-Gallardo G. Chronic Wounds in Burn Injury: A Case Report on Importance of Biofilms. World J Plast Surg 2016; 5:175-80. [PMID: 27579274 PMCID: PMC5003954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
According to the National Institutes of Health and the Center for Disease and Prevention, it is estimated that 65 to 80 percent of the human infectious are caused by biofilms. Antibiotics and drainage of purulent discharge are the main treatment measures. But in chronic infections sometimes these findings are not easy to recognize. Biofilm is an extracellular polymeric conglomeration generally composed of extracellular DNA, proteins, and polysaccharides, which help bacteria to survive into the host. The following case is the example of chronic wound in burn patient, where biofilm gets involved and special attention is given to the relationship biofilm-chronic wound injury in a burn patient.
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Affiliation(s)
- Guillermo Ramos-Gallardo
- Corresponding Author: Guillermo Ramos-Gallardo, MD; Vallarta Medical Center, #5590 Copernico Av. Zapopan, Jalisco, Zip 45070, México, Tel: +52-33-36340043, E-mail:
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Scalise A, Bianchi A, Tartaglione C, Bolletta E, Pierangeli M, Torresetti M, Marazzi M, Di Benedetto G. Microenvironment and microbiology of skin wounds: the role of bacterial biofilms and related factors. Semin Vasc Surg 2016; 28:151-9. [PMID: 27113281 DOI: 10.1053/j.semvascsurg.2016.01.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Wound healing is a systemic response to injury that impacts the entire body and not just the site of tissue damage; it represents one of the most complex biological processes. Our knowledge of wound healing continues to evolve and it is now clear that the wound microenvironment plays a crucial role. The interactions between cells and the surface microenvironment, referred to as the "biofilm," contributes to skin homeostasis and healing. Understanding the functional complexity of the wound microenvironment informs how various factors such as age, ischemia, or bacterial infections can impair or arrest the normal healing processes, and it also allows for the possibility of acting therapeutically on healing defects with microenvironment manipulation. Microbes represent a particularly important factor for influencing the wound microenvironment and therefore wound healing. Moreover, the role of infections, particularly those that are sustained by biofilm-forming bacteria, is mutually related to other microenvironment aspects, such as humidity, pH, metalloproteinases, and reactive oxygen species, on which the modern research of new therapeutic strategies is focused. Today, chronic wounds are a rapidly growing health care burden and it is progressively understood that many non-healing wounds might benefit from therapies that target microorganisms and their biofilm communities. There is no doubt that host factors like perfusion impairments, venous insufficiency, pressure issues, malnutrition, and comorbidities strongly impact the healing processes and therefore must be targeted in the therapeutic management, but this approach might be not enough. In this article, we detail how bacterial biofilms and related factors impair wound healing, the reasons they must be considered a treatment target that is as important as the host's local and systemic pathologic conditions, and the latest therapeutic strategies derived from the comprehension of the wound microenvironment.
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Affiliation(s)
- A Scalise
- Department of Plastic and Reconstructive Surgery, Università Politecnica delle, Marche, Ancona, Italy.
| | - A Bianchi
- Department of Plastic and Reconstructive Surgery, Università Politecnica delle, Marche, Ancona, Italy
| | - C Tartaglione
- Department of Plastic and Reconstructive Surgery, Università Politecnica delle, Marche, Ancona, Italy
| | - E Bolletta
- Department of Plastic and Reconstructive Surgery, Università Politecnica delle, Marche, Ancona, Italy
| | - M Pierangeli
- Department of Plastic and Reconstructive Surgery, Università Politecnica delle, Marche, Ancona, Italy
| | - M Torresetti
- Department of Plastic and Reconstructive Surgery, Università Politecnica delle, Marche, Ancona, Italy
| | - M Marazzi
- Struttura Semplice Terapia Tissutale, A.O. Ospedale Niguarda Ca׳ Granda, Milan, Italy
| | - G Di Benedetto
- Department of Plastic and Reconstructive Surgery, Università Politecnica delle, Marche, Ancona, Italy
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Ward CL, Sanchez CJ, Pollot BE, Romano DR, Hardy SK, Becerra SC, Rathbone CR, Wenke JC. Soluble factors from biofilms of wound pathogens modulate human bone marrow-derived stromal cell differentiation, migration, angiogenesis, and cytokine secretion. BMC Microbiol 2015; 15:75. [PMID: 25886581 PMCID: PMC4381664 DOI: 10.1186/s12866-015-0412-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 03/12/2015] [Indexed: 01/08/2023] Open
Abstract
Background Chronic, non-healing wounds are often characterized by the persistence of bacteria within biofilms - aggregations of cells encased within a self-produced polysaccharide matrix. Biofilm bacteria exhibit unique characteristics from planktonic, or culture-grown, bacterial phenotype, including diminished responses to antimicrobial therapy and persistence against host immune responses. Mesenchymal stromal cells (MSCs) are host cells characterized by their multifunctional ability to undergo differentiation into multiple cell types and modulation of host-immune responses by secreting factors that promote wound healing. While these characteristics make MSCs an attractive therapeutic for wounds, these pro-healing activities may be differentially influenced in the context of an infection (i.e., biofilm related infections) within chronic wounds. Herein, we evaluated the effect of soluble factors derived from biofilms of clinical isolates of Staphylococcus aureus and Pseudomonas aeruginosa on the viability, differentiation, and paracrine activity of human MSCs to evaluate the influence of biofilms on MSC activity in vitro. Results Exposure of MSCs to biofilm-conditioned medias of S. aureus and P. aeruginosa resulted in reductions in cell viability, in part due to activation of apoptosis. Similarly, exposure to soluble factors from biofilms was also observed to diminish the migration ability of cells and to hinder multi-lineage differentiation of MSCs. In contrast to these findings, exposure of MSCs to soluble factors from biofilms resulted in significant increases in the release of paracrine factors involved in inflammation and wound healing. Conclusions Collectively, these findings demonstrate that factors produced by biofilms can negatively impact the intrinsic properties of MSCs, in particular limiting the migratory and differentiation capacity of MSCs. Consequently, these studies suggest use/application of stem-cell therapies in the context of infection may have a limited therapeutic effect. Electronic supplementary material The online version of this article (doi:10.1186/s12866-015-0412-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine L Ward
- Department of Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Fort Sam Houston, San Antonio, TX, USA.
| | - Carlos J Sanchez
- Department of Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Fort Sam Houston, San Antonio, TX, USA.
| | - Beth E Pollot
- Department of Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Fort Sam Houston, San Antonio, TX, USA.
| | - Desiree R Romano
- Department of Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Fort Sam Houston, San Antonio, TX, USA.
| | - Sharanda K Hardy
- Department of Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Fort Sam Houston, San Antonio, TX, USA.
| | - Sandra C Becerra
- Department of Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Fort Sam Houston, San Antonio, TX, USA.
| | - Christopher R Rathbone
- Department of Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Fort Sam Houston, San Antonio, TX, USA.
| | - Joseph C Wenke
- Department of Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Fort Sam Houston, San Antonio, TX, USA.
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Mudge EJ. Recent accomplishments in wound healing. Int Wound J 2015; 12:4-9. [PMID: 24618286 PMCID: PMC7950699 DOI: 10.1111/iwj.12230] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/08/2014] [Accepted: 01/12/2014] [Indexed: 12/20/2022] Open
Abstract
The challenge to balance limited resources with infinite demand has encouraged an evolution in the way health care services are managed and operated. Chronic wound management is complex and prolonged, and places a considerable financial burden on health services. A typical driver of cost includes the necessity to change dressings on a regular basis. Over the last few decades, several scientific and biological advances have furthered the development of wound care products and facilitated wound management. This article investigates some of the major advancements that have occurred within the wound-care arena during the last 5 years and how these advancements are being translated to provide better delivery of clinical care to patients.
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Affiliation(s)
- Elizabeth J Mudge
- Wound Healing Research Unit, Cardiff University School of Medicine, Cardiff, UK
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Vuotto C, Donelli G. Anaerobes in Biofilm-Based Healthcare-Associated Infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 830:97-112. [DOI: 10.1007/978-3-319-11038-7_6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Roy S, Elgharably H, Sinha M, Ganesh K, Chaney S, Mann E, Miller C, Khanna S, Bergdall VK, Powell HM, Cook CH, Gordillo GM, Wozniak DJ, Sen CK. Mixed-species biofilm compromises wound healing by disrupting epidermal barrier function. J Pathol 2014; 233:331-343. [PMID: 24771509 PMCID: PMC4380277 DOI: 10.1002/path.4360] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/18/2014] [Accepted: 04/07/2014] [Indexed: 12/18/2022]
Abstract
In chronic wounds, biofilm infects host tissue for extended periods of time. This work establishes the first chronic preclinical model of wound biofilm infection aimed at addressing the long-term host response. Although biofilm-infected wounds did not show marked differences in wound closure, the repaired skin demonstrated compromised barrier function. This observation is clinically significant, because it leads to the notion that even if a biofilm infected wound is closed, as observed visually, it may be complicated by the presence of failed skin, which is likely to be infected and/or further complicated postclosure. Study of the underlying mechanisms recognized for the first time biofilm-inducible miR-146a and miR-106b in the host skin wound-edge tissue. These miRs silenced ZO-1 and ZO-2 to compromise tight junction function, resulting in leaky skin as measured by transepidermal water loss (TEWL). Intervention strategies aimed at inhibiting biofilm-inducible miRNAs may be productive in restoring the barrier function of host skin.
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Affiliation(s)
- Sashwati Roy
- Comprehensive Wound Center, Davis Heart & Lung Research Institute, Centers for Regenerative Medicine and Cell Based Therapies, The Ohio State University, Columbus, OH 43220 USA
- Department of Surgery, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
| | - Haytham Elgharably
- Comprehensive Wound Center, Davis Heart & Lung Research Institute, Centers for Regenerative Medicine and Cell Based Therapies, The Ohio State University, Columbus, OH 43220 USA
- Department of Surgery, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
| | - Mithun Sinha
- Comprehensive Wound Center, Davis Heart & Lung Research Institute, Centers for Regenerative Medicine and Cell Based Therapies, The Ohio State University, Columbus, OH 43220 USA
- Department of Surgery, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
| | - Kasturi Ganesh
- Comprehensive Wound Center, Davis Heart & Lung Research Institute, Centers for Regenerative Medicine and Cell Based Therapies, The Ohio State University, Columbus, OH 43220 USA
- Department of Surgery, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
| | - Sarah Chaney
- Microbial Interface Biology, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
- Department of Microbial Infection and Immunity, Microbiology, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
- Deparment of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
| | - Ethan Mann
- Microbial Interface Biology, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
- Department of Microbial Infection and Immunity, Microbiology, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
| | - Christina Miller
- Department of Surgery, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
| | - Savita Khanna
- Department of Surgery, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
| | - Valerie K. Bergdall
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
| | - Heather M. Powell
- Department of Materials Science and Engineering, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
| | - Charles H. Cook
- Department of Surgery, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
| | - Gayle M. Gordillo
- Comprehensive Wound Center, Davis Heart & Lung Research Institute, Centers for Regenerative Medicine and Cell Based Therapies, The Ohio State University, Columbus, OH 43220 USA
- Department of Plastic Surgery, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
| | - Daniel J. Wozniak
- Microbial Interface Biology, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
- Department of Microbial Infection and Immunity, Microbiology, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43220 USA
| | - Chandan K. Sen
- Comprehensive Wound Center, Davis Heart & Lung Research Institute, Centers for Regenerative Medicine and Cell Based Therapies, The Ohio State University, Columbus, OH 43220 USA
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Lefebvre E, Lequeux I, Vighetto C, Fromantin I, Thebault P, Seyer D, Picard J, Teot L, Meaume S, Freitas M, Neffati S, Guermah LE, Pelissier S, Giraudier S, Jouenne T, Garde V. From a clinical observation of chronic wound microbiology to the elaboration of an anti-biofilm dressing: The PANSaBIO project strategy. Ing Rech Biomed 2014. [DOI: 10.1016/j.irbm.2014.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
BACKGROUND Chronic wounds cause significant morbidity and mortality and cost our health care system millions of dollars each year. A major impediment to wound healing is the formation of bacterial biofilms. Biofilms are communities of bacteria associated with chronic infections. OBJECTIVE This article reviews the literature on chronic wounds and biofilms. The role of biofilms in chronic wounds is not widely known. The purpose is to increase awareness of their role and to discuss research into novel therapeutic options. METHODS PubMed searches were performed to identify publications on chronic wounds and biofilms. RESULTS Biofilms contribute to chronic wound nonhealing. There is an abundance of research into novel antibiofilm strategies for chronic wounds. CONCLUSION Current research is being targeted at antibiofilm strategies needed to restore an optimal wound-healing environment. A combined treatment approach involving aggressive débridement and the addition of antibiofilm agents is needed.
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Watters C, Kay M. Eradication of Wound Biofilms by Electrical Stimulation. SPRINGER SERIES ON BIOFILMS 2014. [DOI: 10.1007/978-3-642-53833-9_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Insulin treatment modulates the host immune system to enhance Pseudomonas aeruginosa wound biofilms. Infect Immun 2013; 82:92-100. [PMID: 24126517 DOI: 10.1128/iai.00651-13] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Diabetes affects 25.8 million people in the United States, or 8.3% of the population, and these numbers are even higher in developing countries. Diabetic patients are more susceptible to the development of chronic wounds with debilitating bacterial infections than nondiabetics. Previously, we compared the ability of the opportunistic pathogen Pseudomonas aeruginosa to cause biofilm-associated infections in chronic wounds of diabetic and nondiabetic mice (C. Watters, K. DeLeon, U. Trivedi, J. A. Griswold, M. Lyte, K. J. Hampel, M. J. Wargo, and K. P. Rumbaugh, Med. Microbiol. Immunol. 202:131-141, 2013). Unexpectedly, we observed that insulin-treated diabetic mice had significantly more biofilm in their wounds, which correlated with higher antibiotic tolerance. Here, we investigated whether insulin treatment modulates the diabetic immune system to favor P. aeruginosa biofilm formation. Utilizing a murine chronic wound model, we found that DNA protected P. aeruginosa in the wounds of insulin-treated diabetic mice from antibiotic treatment. We also observed increased numbers of neutrophils, reduced numbers of macrophages, and increased cell death in the wounds of diabetic mice on insulin therapy. Taken together, these data suggest that high levels of lysed neutrophils in the wounds of diabetic mice on insulin, combined with fewer macrophages to remove the cellular debris, contribute to increased DNA levels, which enhance P. aeruginosa biofilms.
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Marsch G, Mashaqi B, Burgwitz K, Bisdas T, Knigina L, Stiesch M, Haverich A, Kuehn C. Prevention of pacemaker infections with perioperative antimicrobial treatment: an in vitro study. Europace 2013; 16:604-11. [PMID: 23928734 DOI: 10.1093/europace/eut222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The antimicrobial treatment of pacemaker casings with antiseptics (povidone-iodine or octenidine dihydrochloride) or antibiotics (vancomycin, daptomycin, cefuroxime, Tazobac, or nebacetin) was analysed in vitro for its biocompatibility and efficacy in preventing the bacterial adhesion of Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli to cardiac-implantable electrophysiological devices (CIEDs). METHODS AND RESULTS Titan platelets (0.4 cm²) cut from pacemaker casings were impregnated with seven different antimicrobial solutions: two antiseptics and five antibiotics. Subsequently, they were challenged with bacterial contamination by four test strains over a 24 h incubation period. Bacterial adherence was quantified using the colony-forming-unit method after cell recovery with sonication and examined with confocal laser scanning electron microscopy. Simultaneously, the biocompatibility of the antimicrobial impregnation was assessed using pre-treated titan platelets in a culture of human fibroblasts, skeletal myoblasts, and microvascular endothelial cells. After a 48 h incubation, cell vitality was measured using the 2-(2-methoxy-4-nitrophenyl)-3-(4-nitrophenyl)-5-(2,4-disulfophenyl)-2H/tetrazolium monosodium (WST-8) assay. The immersion of pacemaker casings in antiseptic or antibiotic solutions applies an antimicrobial coating that can significantly reduce bacterial adhesion. The studied impregnations differed in their antimicrobial efficacy and toxicity. CONCLUSION Compared with the two antiseptics and the other tested antibiotics, nebacetin showed the best ratio of efficacy to toxicity. Nebacetin showed good in vitro antibacterial activity against both Gram-positive and Gram-negative pathogens without impairing human cell vitality. It is a safe and effective candidate for CIED impregnation.
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Affiliation(s)
- Georg Marsch
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Street 1, D-30625 Hannover, Germany
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Sanchez CJ, Ward CL, Romano DR, Hurtgen BJ, Hardy SK, Woodbury RL, Trevino AV, Rathbone CR, Wenke JC. Staphylococcus aureus biofilms decrease osteoblast viability, inhibits osteogenic differentiation, and increases bone resorption in vitro. BMC Musculoskelet Disord 2013; 14:187. [PMID: 23767824 PMCID: PMC3691632 DOI: 10.1186/1471-2474-14-187] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/06/2013] [Indexed: 12/25/2022] Open
Abstract
Background Osteomyelitis is a severe and often debilitating disease characterized by inflammatory destruction of bone. Despite treatment, chronic infection often develops which is associated with increased rates of treatment failure, delayed osseous-union, and extremity amputation. Within affected bone, bacteria exist as biofilms, however the impact of biofilms on osteoblasts during disease are unknown. Herein, we evaluated the effect of S. aureus biofilms on osteoblast viability, osteogenic potential, and the expression of the pro-osteoclast factor, receptor activator of NF-kB ligand (RANK-L). Methods Osteoblasts were exposed to biofilm conditioned media (BCM) from clinical wound isolates of Staphylococcus aureus under normal growth and osteogenic conditions to assess cellular viability and osteoblast differentiation, respectively. Cell viability was evaluated using a live/dead assay and by quantifying total cellular DNA at days 0, 1, 3, 5, and 7. Apoptosis following treatment with BCM was measured by flow-cytometry using the annexin V-FITC/PI apoptosis kit. Osteogenic differentiation was assessed by measuring alkaline phosphatase activity and intracellular accumulation of calcium and osteocalcin for up to 21 days following exposure to BCM. Expression of genes involved in osteogenic differentiation and osteoclast regulation, were also evaluated by quantitative real-time PCR. Results BCM from clinical strains of S. aureus reduced osteoblast viability which was accompanied by an increase in apoptosis. Osteogenic differentiation was significantly inhibited following treatment with BCM as indicated by decreased alkaline phosphatase activity, decreased intracellular accumulation of calcium and inorganic phosphate, as well as reduced expression of transcription factors and genes involved in bone mineralization in viable cells. Importantly, exposure of osteoblasts to BCM resulted in up-regulated expression of RANK-L and increase in the RANK-L/OPG ratio compared to the untreated controls. Conclusions Together these studies suggest that soluble factors produced by S. aureus biofilms may contribute to bone loss during chronic osteomyelitis simultaneously by: (1) reducing osteoblast viability and osteogenic potential thereby limiting new bone growth and (2) promoting bone resorption through increased expression of RANK-L by osteoblasts. To our knowledge these are the first studies to demonstrate the impact of staphylococcal biofilms on osteoblast function, and provide an enhanced understanding of the pathogenic role of staphylococcal biofilms during osteomyelitis.
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Affiliation(s)
- Carlos J Sanchez
- Department of Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Ft, Sam Houston, San Antonio, TX, USA.
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Lebeaux D, Chauhan A, Rendueles O, Beloin C. From in vitro to in vivo Models of Bacterial Biofilm-Related Infections. Pathogens 2013; 2:288-356. [PMID: 25437038 PMCID: PMC4235718 DOI: 10.3390/pathogens2020288] [Citation(s) in RCA: 300] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 05/01/2013] [Accepted: 05/08/2013] [Indexed: 12/13/2022] Open
Abstract
The influence of microorganisms growing as sessile communities in a large number of human infections has been extensively studied and recognized for 30–40 years, therefore warranting intense scientific and medical research. Nonetheless, mimicking the biofilm-life style of bacteria and biofilm-related infections has been an arduous task. Models used to study biofilms range from simple in vitro to complex in vivo models of tissues or device-related infections. These different models have progressively contributed to the current knowledge of biofilm physiology within the host context. While far from a complete understanding of the multiple elements controlling the dynamic interactions between the host and biofilms, we are nowadays witnessing the emergence of promising preventive or curative strategies to fight biofilm-related infections. This review undertakes a comprehensive analysis of the literature from a historic perspective commenting on the contribution of the different models and discussing future venues and new approaches that can be merged with more traditional techniques in order to model biofilm-infections and efficiently fight them.
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Affiliation(s)
- David Lebeaux
- Institut Pasteur, Unité de Génétique des Biofilms, 25 rue du Dr. Roux, 75724 Paris cedex 15, France.
| | - Ashwini Chauhan
- Institut Pasteur, Unité de Génétique des Biofilms, 25 rue du Dr. Roux, 75724 Paris cedex 15, France.
| | - Olaya Rendueles
- Institut Pasteur, Unité de Génétique des Biofilms, 25 rue du Dr. Roux, 75724 Paris cedex 15, France.
| | - Christophe Beloin
- Institut Pasteur, Unité de Génétique des Biofilms, 25 rue du Dr. Roux, 75724 Paris cedex 15, France.
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Nusbaum AG, Gil J, Rippy MK, Warne B, Valdes J, Claro A, Davis SC. Effective Method to Remove Wound Bacteria: Comparison of Various Debridement Modalities in an In Vivo Porcine Model. J Surg Res 2012; 176:701-7. [DOI: 10.1016/j.jss.2011.11.1040] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 11/13/2011] [Accepted: 11/30/2011] [Indexed: 11/29/2022]
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Abstract
Barrier wound therapy is commonplace in the health care environment and functions to limit bacterial colonization and infection in both acute wounds and recalcitrant chronic wounds. This article reviews the nature of acute and chronic wounds and their available adjunctive barrier therapies.
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Affiliation(s)
- Luke G Gutwein
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida, Post Office Box 100286, 1600 Southwest Archer Road, Gainesville, FL 32610, USA
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Abstract
BACKGROUND Infection of foot ulcers is a common, often severe and costly complication in diabetes. Many factors linked to the host, mainly immune defects, neuropathy and arteriopathy, as well as bacteria-related factors, interact in a complex way and account for the susceptibility of diabetic individuals to foot infections, the severity of such infections and difficulty to treat them. METHODS This article reviews these factors, in the light of data from the literature and from our own results. RESULTS DFIs are not as simple as previously suggested, and new concepts must be considered, especially the virulence potential of isolates and bacterial communications through biofilms. CONCLUSION The development of new tools from molecular biology is a critical step to better understand and manage these infections.
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Affiliation(s)
- Jean-Louis Richard
- Department of Diabetology and Nutritional Diseases, Medical Centre, University Hospital of Nîmes, 30240, Le Grau du Roi, France.
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Schultz GS, Davidson JM, Kirsner RS, Bornstein P, Herman IM. Dynamic reciprocity in the wound microenvironment. Wound Repair Regen 2011; 19:134-48. [PMID: 21362080 DOI: 10.1111/j.1524-475x.2011.00673.x] [Citation(s) in RCA: 308] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Here, we define dynamic reciprocity (DR) as an ongoing, bidirectional interaction among cells and their surrounding microenvironment. In this review, we posit that DR is especially meaningful during wound healing as the DR-driven biochemical, biophysical, and cellular responses to injury play pivotal roles in regulating tissue regenerative responses. Such cell-extracellular matrix interactions not only guide and regulate cellular morphology, but also cellular differentiation, migration, proliferation, and survival during tissue development, including, e.g., embryogenesis, angiogenesis, as well as during pathologic processes including cancer, diabetes, hypertension, and chronic wound healing. Herein, we examine DR within the wound microenvironment while considering specific examples across acute and chronic wound healing. This review also considers how a number of hypotheses that attempt to explain chronic wound pathophysiology may be understood within the DR framework. The implications of applying the principles of DR to optimize wound care practice and future development of innovative wound healing therapeutics are also briefly considered.
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Affiliation(s)
- Gregory S Schultz
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA
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White R. An approach to assessing evidence that can inform clinical decision-making. J Wound Care 2011; 20:15-19. [PMID: 29480745 DOI: 10.12968/jowc.2011.20.sup2.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Following the Cochrane meta-analyses findings, doubts are being expressed about efficacy of silver dressings. However, the need for topical antimicrobials has not diminished, and the evidence for non-silver agents is no better than that for silver. This article describes an alternative system to Cochrane for analysing the evidence base, and suggests a practical approach to making a case for silver to procurement managers.
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