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Pan SC, Wu YF, Lin YC, Cheng CM. Monocyte chemoattractant protein-1 detection in wound tissue fluids for the assisted diagnosis of wound infection. Surgery 2024; 176:154-161. [PMID: 38599982 DOI: 10.1016/j.surg.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Infections are commonly seen in wounds. The overall infection rate is 1.8% to 4.2%. Improper infection management can lead to serious conditions and may progress to life-threatening sepsis. Because there is a need for assistance in predicting wound infection before obvious clinical symptoms, the measurement of cytokines in wound tissue fluids has attracted our attention for determining the overall status of wound infection. Our intent was to assess the potential biomarkers in the diagnosis of wound infection. METHODS We collected 146 tissue fluids (acute: 59, chronic: 61, and normal: 26) for analysis of biomarkers using a human cytokine array. Serum C-reactive protein was also measured from 104 patients. The sensitivity and specificity of significant wound cytokines and serum C-reactive protein for the diagnosis of wound infection were evaluated. RESULTS Among biomarkers examined, serum C-reactive protein and tissue C-reactive protein were highly expressed in acute infection wounds, whereas monocyte chemoattractant protein-1 was significantly expressed in chronic infection wounds. Because the expression of wound biomarkers varied in different types of wounds, relationships among them were studied. A high correlation between tissue C-reactive protein and interleukin-8 (R2 = 0.7) and a moderate correlation between systemic and local C-reactive protein (R2 = 0.47) were observed. In addition, tissue monocyte chemoattractant protein-1 had better sensitivity (74%) and specificity (65%) in the diagnosis of wound infection. Moreover, combined serum C-reactive protein with monocyte chemoattractant protein-1 examination provided a higher area under the curve in the receiver operator characteristic curve (0.75). CONCLUSION We found that tissue monocyte chemoattractant protein-1 is a superior diagnostic marker for assistance with the diagnosis of wound infection.
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Affiliation(s)
- Shin-Chen Pan
- Section of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; International Center for Wound Repair and Regeneration, National Cheng Kung University, Tainan, Taiwan.
| | - Yu-Feng Wu
- Institute of Biomedical Engineering, National Tsing Hua University, Hsin-Chu, Taiwan; Section of Plastic and Reconstructive Surgery, Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan; International Intercollegiate PhD Program, National Tsing Hua University, Hsin-Chu, Taiwan
| | - Yu-Chen Lin
- Institute of Biomedical Engineering, National Tsing Hua University, Hsin-Chu, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsin-Chu, Taiwan
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Dissemond J, Chadwick P, Weir D, Alves P, Isoherranen K, Lázaro Martínez JL, Swanson T, Gledhill A, Malone M. M.O.I.S.T. Concept for the Local Therapy of Chronic Wounds: An International Update. INT J LOW EXTR WOUND 2024:15347346241245159. [PMID: 38571403 DOI: 10.1177/15347346241245159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Chronic wounds remain a significant clinical challenge both for those affected and for healthcare systems. The treatment is often comprised and complex. All patients should receive wound care that is integrated into a holistic approach involving local management that addresses the underlying etiology and provides for gold standard therapy to support healing, avoid complications and be more cost effective. There have been significant advances in medicine over the last few decades. The development of new technologies and therapeutics for the local treatment of wounds is also constantly increasing. To help standardize clinical practice with regard to the multitude of wound products, the M.O.I.S.T. concept was developed by a multidisciplinary expert group. The M stands for moisture balance, O for oxygen balance, I for infection control, S for supporting strategies, and T for tissue management. Since the M.O.I.S.T. concept, which originated in the German-speaking countries, is now intended to provide healthcare professionals with an adapted instrument to be used in clinical practice, and a recent update to the concept has been undertaken by a group of interdisciplinary experts to align it with international standards. The M.O.I.S.T. concept can now be used internationally both as an educational tool and for the practical implementation of modern local treatment concepts for patients with chronic wounds and can also be used in routine clinical practice.
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Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany
| | | | - Dot Weir
- Saratoga Hospital Center for Wound Healing and Hyperbaric Medicine, Saratoga Springs, NY, USA
| | - Paulo Alves
- Universidade Católica Portuguesa, Institute of Health Sciences - Wounds Research Lab, Lisboa, Portugal
| | - Kirsi Isoherranen
- Department of Dermatology and Allergology, University of Helsinki and Inflammation center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | | | - Terry Swanson
- Wound Education Research Consultancy, Warrnambool, Victoria, Australia
| | - Andrea Gledhill
- Department of Podiatric Surgery, Trauma and Orthopaedics, Great Western Hospital NHSFT, Swindon, UK
| | - Matthew Malone
- Research and Development, Molnlycke Healthcare AB, Gothenburg, Sweden
- Infectious Diseases Microbiology, School of Medicine, Western Sydney University, Sydney, Australia
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3
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Horta-Velázquez A, Mota-Morales JD, Morales-Narváez E. Next-generation of smart dressings: Integrating multiplexed sensors and theranostic functions. Int J Biol Macromol 2024; 254:127737. [PMID: 38287589 DOI: 10.1016/j.ijbiomac.2023.127737] [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: 06/30/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 01/31/2024]
Abstract
Non-healing wounds represent a significant burden for healthcare systems and society, giving rise to severe economic and human issues. Currently, the use of dressings and visual assessment represent the primary and standard care for wounds. Conventional dressings, like cotton gauze, provide only passive physical protection. Besides, they end up paradoxically hampering the wound-healing process by producing tissue damage and pain when removed during routine check-ups. In response to these limitations, researchers, engineers, and technologists are developing innovative dressings that incorporate advanced diagnostic and therapeutic functionalities, coined as "smart dressings". Now, the maturation of smart dressing is bringing them closer to real-life applications, leading to an exciting new generation of these devices. The next generation of smart dressings is capable of monitoring in real-time multiple biomarkers while including pro-healing capabilities in a single platform. Such multiplexed and theranostic smart dressings are expected to offer a timely biomarker-directed diagnosis of non-healing wounds while enabling rapid, automated, and personalized treatments of infection and chronicity. Herein, we provide an insightful overview of these advantageous devices, delving into the diverse spectrum of possible engineering strategies. This encompasses the use of electrochemical and optical platforms with diverse multiplexing architectures, such as multi-zone sensing arrays and multi-layered devices. Open or closed-loop theranostic mechanisms using various stimuli-responsive materials that could be internally or externally controlled are also included. Finally, a critical discussion on the main challenges and future directions of smart dressings is also offered.
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Affiliation(s)
| | - Josué D Mota-Morales
- Centro de Física Aplicada y Tecnología Avanzada (CFATA), Universidad Nacional Autónoma de México (UNAM), Querétaro 76230, Mexico
| | - Eden Morales-Narváez
- Centro de Física Aplicada y Tecnología Avanzada (CFATA), Universidad Nacional Autónoma de México (UNAM), Querétaro 76230, Mexico.
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4
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McDaniel JC, Kim B, McGowan DR. Methods for sampling wound fluid from venous leg ulcers for molecular analyses: A scoping review. Int Wound J 2023; 20:4175-4192. [PMID: 37455090 PMCID: PMC10681520 DOI: 10.1111/iwj.14315] [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: 04/25/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
Determining the precise role of molecular factors present in venous leg ulcer exudate will expedite the identification of biomarkers that can optimally guide treatment. However, there is now no standardized approach for collecting, processing and storing wound fluid samples for molecular analyses. This scoping review was conducted to integrate and summarize the multiple types of methods being used currently in studies of venous leg ulcers for collecting, processing and storing wound fluid prior to analysis. PubMed, CINAHL, EMBASE and Scopus databases were searched for eligible studies between 2012 and 2022. Nineteen studies were selected for this scoping review. Five primary methodological categories for wound fluid sampling were identified. The most commonly used collection method involved extracting the fluid from various absorbent materials, and the majority of studies centrifuged wound fluid before storing it at ultra-low temperatures. This review found the wound fluid sampling methods among the included studies to be heterogeneous. Moreover, the data revealed no definitive patterns. There is a critical need to develop standardized wound fluid sampling methods in research to facilitate accurate comparisons of biomarker data across studies and a more rapid determination of biomarkers that can most effectively guide delivery of tailored venous leg ulcer treatments.
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Affiliation(s)
| | - Bohyun Kim
- College of NursingThe Ohio State UniversityColumbusOhioUSA
| | - Dina Rose McGowan
- Clinical Research CenterThe Ohio State University Wexner Medical CenterColumbusOhioUSA
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5
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Coelho GA, Secretan PH, Tortolano L, Charvet L, Yagoubi N. Evolution of the Chronic Venous Leg Ulcer Microenvironment and Its Impact on Medical Devices and Wound Care Therapies. J Clin Med 2023; 12:5605. [PMID: 37685674 PMCID: PMC10488485 DOI: 10.3390/jcm12175605] [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: 08/02/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Studies have reported that the constituents of the wound microenvironment are likely to have critical roles in the degradation and fate of the polymeric matrix and the compounds dissolved in the wound dressing matrix. Thus, chronic wound assessment and the design of effective medical devices and drug products for wound care partly rely on an in-depth understanding of the wound microenvironment. The main aim of this review is to identify and discuss the different stages of chronic wound progression, focusing on the changes in the biochemical composition of the wound microenvironment, with particular attention given to venous leg ulcers (VLUs), as they are one of the most prevalent chronic wound aetiologies. The pathophysiology of venous ulcers is detailed, followed by a thorough review of what is known about the VLU microenvironment and its changes as a function of the evolution of the VLU. Simulating conditions for VLU are then discussed with the view of highlighting potentially relevant simulating media as a function of VLU evolution for a better assessment of biological safety, in particular medical devices intended to be in contact with these wounds.
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Affiliation(s)
- Gisele Abreu Coelho
- Laboratoire Matériaux et Santé, Université Paris-Saclay, 91400 Orsay, France; (P.-H.S.); (L.T.); (N.Y.)
- Urgo Recherche Innovation et Développement, 21300 Chenove, France;
| | - Philippe-Henri Secretan
- Laboratoire Matériaux et Santé, Université Paris-Saclay, 91400 Orsay, France; (P.-H.S.); (L.T.); (N.Y.)
| | - Lionel Tortolano
- Laboratoire Matériaux et Santé, Université Paris-Saclay, 91400 Orsay, France; (P.-H.S.); (L.T.); (N.Y.)
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, 94000 Créteil, France
| | - Loïc Charvet
- Urgo Recherche Innovation et Développement, 21300 Chenove, France;
| | - Najet Yagoubi
- Laboratoire Matériaux et Santé, Université Paris-Saclay, 91400 Orsay, France; (P.-H.S.); (L.T.); (N.Y.)
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6
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Kim J, Stechmiller J, Weaver M, Gibson DJ, Horgas A, Kelly DL, Lyon DE. The association of wound factors and symptoms of fatigue and pain with wound healing in chronic venous leg ulcers. Int Wound J 2023; 20:1098-1111. [PMID: 36181308 PMCID: PMC10031222 DOI: 10.1111/iwj.13966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/31/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was: (1) to characterise the association of wound area, wound exudate C-reactive protein (CRP), broad-spectrum matrix metalloprotease protein (MMPs), and symptoms of fatigue and pain in individuals with chronic venous leg ulcers (CVLUs) over time and (2) to identify factors associated with the wound healing trajectory in CVLUs. Seventy four participants with CVLU who received weekly sharp debridement were recruited from a wound care clinic during the 8-week study period. To examine associations among wound CRP, MMPs, pain, fatigue, and wound healing trajectory over time, we calculated Bayes factors (BF) based on a linear mixed model. The mean age of participants was 71.8 (SD = 9.8) and the mean wound area was 2278 mm2 (SD = 7085 mm2 ) at baseline. Higher fatigue was strongly associated with higher MMPs (BF = 9, 95% HDI: [-.05, .43]), lower CRP (BF = 11, 95% HDI: [-.02, .002]), and large areas of wound (BF = 20, 95% HDI: [-.001, .01]). Higher CRP and MMPs activity in wound exudate and higher fatigue were associated with a larger wound area. To facilitate wound healing, clinicians need to utilise the multifactorial approach, which includes wound treatment and management of symptoms such as pain and fatigue, because of the molecular and psycho-behavioural factors involved in wound healing.
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Affiliation(s)
- Junglyun Kim
- College of Nursing, Chungnam National University College of Nursing, Daejeon, South Korea
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Joyce Stechmiller
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Michael Weaver
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Daniel J Gibson
- University of Alabama Capstone College of Nursing, Tuscaloosa, Alabama, USA
| | - Ann Horgas
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Debra L Kelly
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Debra E Lyon
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
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7
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Biomarker in der Wundheilung und Wundbehandlung. GEFÄSSCHIRURGIE 2023. [DOI: 10.1007/s00772-022-00968-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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8
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MIKOSIŃSKI J, KALOGEROPOULOS K, BUNDGAARD L, LARSEN CA, SAVICKAS S, HAACK AM, PAŃCZAK K, RYBOŁOWICZ K, GRZELA T, OLSZEWSKI M, CISZEWSKI P, SITEK-ZIÓŁKOWSKA K, TWARDOWSKA-SAUCHA K, KARCZEWSKI M, RABCZENKO D, SEGIET A, BUCZAK-KULA P, SCHOOF EM, EMING SA, SMOLA H, AUF DEM KELLER U. Longitudinal Evaluation of Biomarkers in Wound Fluids from Venous Leg Ulcers and Split-thickness Skin Graft Donor Site Wounds Treated with a Protease-modulating Wound Dressing. Acta Derm Venereol 2022; 102:adv00834. [PMID: 36250733 PMCID: PMC9811302 DOI: 10.2340/actadv.v102.325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Venous leg ulcers represent a clinical challenge and impair the quality of life of patients. This study examines impaired wound healing in venous leg ulcers at the molecular level. Protein expression patterns for biomarkers were analysed in venous leg ulcer wound fluids from 57 patients treated with a protease-modulating polyacrylate wound dressing for 12 weeks, and compared with exudates from 10 acute split-thickness wounds. Wound healing improved in the venous leg ulcer wounds: 61.4% of the 57 patients with venous leg ulcer achieved a relative wound area reduction of ≥ 40%, and 50.9% of the total 57 patients achieved a relative wound area reduction of ≥ 60%. Within the first 14 days, abundances of S100A8, S100A9, neutrophil elastase, matrix metalloproteinase-2, and fibronectin in venous leg ulcer exudates decreased significantly and remained stable, yet higher than in acute wounds. Interleukin-1β, tumour necrosis factor alpha, and matrix metalloproteinase-9 abundance ranges were similar in venous leg ulcers and acute wound fluids. Collagen (I) α1 abundance was higher in venous leg ulcer wound fluids and was not significantly regulated. Overall, significant biomarker changes occurred in the first 14 days before a clinically robust healing response in the venous leg ulcer cohort.
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Affiliation(s)
- Jacek MIKOSIŃSKI
- “MIKOMED”, Clinic for Peripheral Vascular Diseases, Łódź, Poland
| | - Konstantinos KALOGEROPOULOS
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Louise BUNDGAARD
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark,Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Cathrine Agnete LARSEN
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Simonas SAVICKAS
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Aleksander Moldt HAACK
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | | | | | - Tomasz GRZELA
- Clinic of Phlebology,Medical University of Warsaw, Warsaw
| | - Michał OLSZEWSKI
- Pratia Ostrołęka Embedded Hospital Clinical Research Site, Ostrołęka
| | - Piotr CISZEWSKI
- WILMED Specialist Medical Clinic Non-public Healthcare Centre, Warszaw
| | | | | | - Marek KARCZEWSKI
- CSOLUMED Medical Centre,Poland Department of General and Transplant Surgery, Poznan University of Medical Sciences, Poznan
| | | | | | | | - Erwin M. SCHOOF
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | | | - Hans SMOLA
- Department of Dermatology, University of Cologne, Cologne,PAUL HARTMANN AG, Heidenheim, Germany
| | - Ulrich AUF DEM KELLER
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
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9
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Ågren MS. The search for an ideal wound healing biomarker continues…. J Wound Care 2022; 31:623. [PMID: 36001705 DOI: 10.12968/jowc.2022.31.8.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Magnus S Ågren
- Affiliate Professor in Surgery, Department of Health and Medical Sciences, Department of Dermatology and Copenhagen Wound Healing Center, and Digestive Disease Center, University of Copenhagen, Copenhagen, Denmark
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10
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Cytokines and Venous Leg Ulcer Healing-A Systematic Review. Int J Mol Sci 2022; 23:ijms23126526. [PMID: 35742965 PMCID: PMC9224200 DOI: 10.3390/ijms23126526] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 01/01/2023] Open
Abstract
Venous leg ulcers (VLUs) are the most common type of leg ulcers with a significant socioeconomic burden due to slow healing. Cytokines may be involved in the pathogenesis of VLUs. In this systematic review, our objective was to investigate the association between cytokine levels, including growth factors, with the healing of VLUs. PubMed, Embase, Web of Science and Cochrane Library were searched from their inception to August 2021. We retrieved 28 articles investigating 38 different cytokines in 790 patients. Cytokines were most commonly investigated in wound fluid and less frequently in biopsies and serum. The studies were judged as having a moderate to high risk of bias, and the results were often inconsistent and sometimes conflicting. A meta-analysis was not performed due to clinical and methodological heterogeneities. We found weak evidence for elevated IL-1α, IL-6, IL-8, TNF-α and VEGF levels in non-healing VLUs, an elevation that declined with healing. TGF-β1 levels tended to increase with VLU healing. Other cytokines warranting further investigations include EGF, FGF-2, GM-CSF, IL-1β, IL-1Ra and PDGF-AA/PDGF-BB. We conclude that non-healing VLUs may be associated with an elevation of a palette of pro-inflammatory cytokines, possibly reflecting activated innate immunity in these wounds. There is a paucity of reliable longitudinal studies monitoring the dynamic changes in cytokine levels during wound healing.
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11
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Weigelt MA, Lev-Tov HA, Tomic-Canic M, Lee WD, Williams R, Strasfeld D, Kirsner RS, Herman IM. Advanced Wound Diagnostics: Toward Transforming Wound Care into Precision Medicine. Adv Wound Care (New Rochelle) 2022; 11:330-359. [PMID: 34128387 DOI: 10.1089/wound.2020.1319] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Significance: Nonhealing wounds are an ever-growing global pandemic, with mortality rates and management costs exceeding many common cancers. Although our understanding of the molecular and cellular factors driving wound healing continues to grow, standards for diagnosing and evaluating wounds remain largely subjective and experiential, whereas therapeutic strategies fail to consistently achieve closure and clinicians are challenged to deliver individualized care protocols. There is a need to apply precision medicine practices to wound care by developing evidence-based approaches, which are predictive, prescriptive, and personalized. Recent Advances: Recent developments in "advanced" wound diagnostics, namely biomarkers (proteases, acute phase reactants, volatile emissions, and more) and imaging systems (ultrasound, autofluorescence, spectral imaging, and optical coherence tomography), have begun to revolutionize our understanding of the molecular wound landscape and usher in a modern age of therapeutic strategies. Herein, biomarkers and imaging systems with the greatest evidence to support their potential clinical utility are reviewed. Critical Issues: Although many potential biomarkers have been identified and several imaging systems have been or are being developed, more high-quality randomized controlled trials are necessary to elucidate the currently questionable role that these tools are playing in altering healing dynamics or predicting wound closure within the clinical setting. Future Directions: The literature supports the need for the development of effective point-of-care wound assessment tools, such as a platform diagnostic array that is capable of measuring multiple biomarkers at once. These, along with advances in telemedicine, synthetic biology, and "smart" wearables, will pave the way for the transformation of wound care into a precision medicine. Clinical Trial Registration number: NCT03148977.
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Affiliation(s)
- Maximillian A. Weigelt
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hadar A. Lev-Tov
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marjana Tomic-Canic
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - W. David Lee
- Precision Healing, Inc., Newton, Massachusetts, USA
| | | | | | - Robert S. Kirsner
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ira M. Herman
- Precision Healing, Inc., Newton, Massachusetts, USA
- Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
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12
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Harvey J, Mellody KT, Cullum N, Watson REB, Dumville J. Wound fluid sampling methods for proteomic studies: A scoping review. Wound Repair Regen 2022; 30:317-333. [PMID: 35381119 PMCID: PMC9322564 DOI: 10.1111/wrr.13009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/01/2022] [Accepted: 03/08/2022] [Indexed: 01/02/2023]
Abstract
Understanding why some wounds are hard to heal is important for improving care and developing more effective treatments. The method of sample collection used is an integral step in the research process and thus may affect the results obtained. The primary objective of this study was to summarise and map the methods currently used to sample wound fluid for protein profiling and analysis. Eligible studies were those that used a sampling method to collect wound fluid from any human wound for analysis of proteins. A search for eligible studies was performed using MEDLINE, Embase and CINAHL Plus in May 2020. All references were screened for eligibility by one reviewer, followed by discussion and consensus with a second reviewer. Quantitative data were mapped and visualised using appropriate software and summarised via a narrative summary. After screening, 280 studies were included in this review. The most commonly used group of wound fluid collection methods were vacuum, drainage or use of other external devices, with surgical wounds being the most common sample source. Other frequently used collection methods were extraction from absorbent materials, collection beneath an occlusive dressing and direct collection of wound fluid. This scoping review highlights the variety of methods used for wound fluid collection. Many studies had small sample sizes and short sample collection periods; these weaknesses have hampered the discovery and validation of novel biomarkers. Future research should aim to assess the reproducibility and feasibility of sampling and analytical methods for use in larger longitudinal studies.
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Affiliation(s)
- Joe Harvey
- Centre for Dermatology Research, School of Biological Sciences, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kieran T Mellody
- Centre for Dermatology Research, School of Biological Sciences, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Nicky Cullum
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Division of Nursing, Midwifery & Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Rachel E B Watson
- Centre for Dermatology Research, School of Biological Sciences, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Manchester Institute for Collaborative Research on Ageing, The University of Manchester, Manchester, UK
| | - Jo Dumville
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Division of Nursing, Midwifery & Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
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13
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Perumal J, Lim HQ, Attia ABE, Raziq R, Leavesley DI, Upton Z, Dinish US, Olivo M. Novel Cellulose Fibre-Based Flexible Plasmonic Membrane for Point-of-Care SERS Biomarker Detection in Chronic Wound Healing. Int J Nanomedicine 2021; 16:5869-5878. [PMID: 34483659 PMCID: PMC8408532 DOI: 10.2147/ijn.s303130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/06/2021] [Indexed: 12/26/2022] Open
Abstract
Background Wound management is stretching the limits of health systems globally, challenging clinicians to evaluate the effectiveness of their treatments and deliver appropriate care to their patients. Visual inspection and manual measurement of wound size are subjective, often inaccurate and inconsistent. Growth factors, such as pro-inflammatory cytokines and proteases, play important roles in cutaneous wound healing. However, little is known about the point-of-care monitoring of the changes in such markers during the healing process. Here, we explore the capability of surface-enhanced Raman spectroscopy (SERS) as a viable point-of-care platform to monitor the changes of these surrogate indicators of healing status in chronic wounds. Methods We developed a biofunctionalized flexible, cost-effective, scalable and easy-to-fabricate plasmonic SERS substrate using cellulose fibre (CF), which is used for sensing of wound markers based on a modified immunoassay method. Results We evaluated and selected the reliable silver nano-island thickness that will be sputtered onto the CF-based substrate for the highest SERS enhancement. Using this biofunctionalized SERS substrate, we detected varying concentrations of MMP-9 (10–5000 ng/mL) and TNF-α (5–100 ng/mL) proteins to model the wound exudates. This SERS detection method demonstrates a linear response within biologically relevant concentrations, ranging from 10 to 500 ng/mL for MMP-9 and 5 to 25 ng/mL for TNF-α for these surrogate indicators. Conclusion Our SERS sensing platform achieved detection limits in the µM to sub-nM range and displayed high sensitivity and selectivity. This could result in a cheap, point-of-care device that provides a non-invasive measure of cutaneous wound healing in real time. We envision that these flexible substrates after activation may be incorporated into wound dressings in future for routine monitoring of wound healing status.
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Affiliation(s)
- Jayakumar Perumal
- Translational Biophotonics Laboratory, Institute of Bioengineering and Bioimaging, Agency for Science Technology and Research (ASTAR), Singapore
| | - Hann Qian Lim
- Translational Biophotonics Laboratory, Institute of Bioengineering and Bioimaging, Agency for Science Technology and Research (ASTAR), Singapore
| | - Amalina Binte Ebrahim Attia
- Translational Biophotonics Laboratory, Institute of Bioengineering and Bioimaging, Agency for Science Technology and Research (ASTAR), Singapore
| | - Riazul Raziq
- Translational Biophotonics Laboratory, Institute of Bioengineering and Bioimaging, Agency for Science Technology and Research (ASTAR), Singapore
| | - David Ian Leavesley
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (ASTAR), Singapore
| | - Zee Upton
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (ASTAR), Singapore
| | - U S Dinish
- Translational Biophotonics Laboratory, Institute of Bioengineering and Bioimaging, Agency for Science Technology and Research (ASTAR), Singapore
| | - Malini Olivo
- Translational Biophotonics Laboratory, Institute of Bioengineering and Bioimaging, Agency for Science Technology and Research (ASTAR), Singapore
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Pulido T, Velarde MC, Alimirah F. The senescence-associated secretory phenotype: Fueling a wound that never heals. Mech Ageing Dev 2021; 199:111561. [PMID: 34411604 DOI: 10.1016/j.mad.2021.111561] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/29/2021] [Accepted: 08/12/2021] [Indexed: 12/15/2022]
Abstract
Wound healing is impaired with advanced age and certain chronic conditions, such as diabetes and obesity. Moreover, common cancer treatments, including chemotherapy and radiation, can cause unintended tissue damage and impair wound healing. Available wound care treatments are not always effective, as some wounds fail to heal or recur after treatment. Hence, a more thorough understanding of the pathophysiology of chronic, nonhealing wounds may offer new ideas for the development of effective wound care treatments. Cancers are sometimes referred to as wounds that never heal, sharing mechanisms similar to wound healing. We describe in this review how cellular senescence and the senescence-associated secretory phenotype (SASP) contribute to chronic wounds versus cancer.
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Affiliation(s)
- Tanya Pulido
- Buck Institute for Research on Aging, Novato, CA, 94945, USA
| | - Michael C Velarde
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, 1101, Philippines.
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15
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McQuilling JP, Carter MJ, Fulton JA, Patel K, Doner B, Serena TE, Mowry KC. A prospective clinical trial evaluating changes in the wound microenvironment in patients with chronic venous leg ulcers treated with a hypothermically stored amniotic membrane. Int Wound J 2021; 19:144-155. [PMID: 33955178 PMCID: PMC8684864 DOI: 10.1111/iwj.13606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/09/2021] [Indexed: 01/23/2023] Open
Abstract
Amniotic tissues have been long utilised to treat chronic wounds; however, there are few studies evaluating how the wound microenvironment responds to these therapies. The goal of this study was to evaluate the changes in wounds treated with a hypothermically stored amniotic membrane (HSAM). In this prospective single‐arm study, 15 female patients with venous leg ulcers were treated with HSAM from male donors and standard of care for 12 weeks. Over the course of the study, wound exudate was collected and evaluated using proteomic microarrays. Biopsies were collected during the course of treatment to detect the presence of HSAM tissue. By 4 weeks, 60% of subjects achieved 50% or greater reduction in wound size, and by 12 weeks, 53% of subjects achieved 100% re‐epithelialization. HSAM DNA was detected in 20% of biopsies as determined by the detection TSPY4, indicating HSAM was no longer present within the wound bed approximately 7 days from the last treatment for the majority of wounds. Proteomic analysis of wound exudate found that wounds on a healing trajectory had significantly higher levels of MMP‐10, MMP‐7, and TIMP‐4 and significantly lower levels of CX3CL1, FLT‐3 L, IL‐1ra, IL‐1a, IL‐9, IL‐2, IL‐3, MCP‐1, and TNF‐b compared with other wounds.
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Affiliation(s)
| | | | | | - Keyur Patel
- Armstrong CM Hospital, The Snyder Institute, Kittaning, Pennsylvania, USA
| | - Bryan Doner
- SerenaGroup Inc., Cambridge, Massachusetts, USA
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16
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Biomarker directed chronic wound therapy - A new treatment paradigm. J Tissue Viability 2019; 29:180-183. [PMID: 32007337 DOI: 10.1016/j.jtv.2019.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/29/2019] [Accepted: 12/19/2019] [Indexed: 12/13/2022]
Abstract
AIM To develop a treatment paradigm for chronic leg ulcers that incorporates new biomarkers of wound healing with currently available therapies. METHODS Recently published data on GM-CSF and MMP-13 as biomarkers of venous leg ulcer (VLU) healing status with accuracies of 92% and 78% respectively, was reviewed along with the wound bed preparation (WBP) theoretical framework for treatment of chronic wounds. The broad categories of wound treatments that align with the WBP concepts were identified. These were then considered in a hierarchical order that initially improves the wound bed and subsequently incorporates more complex advanced wound therapies. Identification of the non-healing status of the wound is the driver to advance through the different treatments. RESULTS A point of care test of wound healing status is the key to the systematic use of currently available therapies for chronic leg ulcers in a timely fashion. The different therapies address - debridement, moisture control, bacterial contamination, protease inhibition, formation of granulation tissue, application of growth factors, application of matrix constructs, and application of cellular components. Progression through this hierarchical order of therapies is directed by the leg ulcer remaining in a non-healing state with the previous therapies having been implemented. CONCLUSION Combining a validated point of care test of wound healing with a systematic approach to wound therapies, has the potential to create a new paradigm of chronic leg ulcer treatment - biomarker directed wound therapy.
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Kawada T. Biomarkers for healing in adults with venous leg ulcers. Wound Repair Regen 2019; 28:157. [PMID: 31774603 DOI: 10.1111/wrr.12783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/25/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
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