Effect of Extracts of Terminalia chebula on Proliferation of Keratinocytes and Fibroblasts Cells: An Alternative Approach for Wound Healing

Perceived stigma in burn survivors: Associations with resourcefulness and alexithymia

OBJECTIVE

Burn survivors often have severe scarring and distorted body image, and they are commonly given new perceptions and even receive a variety of negative labels from individuals, families and society. This study aimed to explore the association between stigma, resourcefulness and alexithymia, and identifies whether resourcefulness in burn survivors is mediating the relationship between resourcefulness and alexithymia.

METHOD

This correlational study was conducted from December 2021 to July 2022 in a comprehensive tertiary Grade A hospital in Ningxia, China. A convenience sample of 159 burn survivors was recruited. Data were collected using demographics, Social Impact Scale(SIC),Toronto Alexithymia Scale, and Resourcefulness Scale (RS). Descriptive analysis, Hierarchical Regression analysis, Pearson Correlation analysis, and Mediation analysis were used for data analysis.

RESULTS

Finally, a data set of 148 responses was determined for analysis. The effective rate was 95.9%. We found significant correlation between stigma, resourcefulness and alexithymia. Sociodemographic characteristics (gender, spouse states), clinical characteristics (body surface burned area, scar areas), resourcefulness and alexithymia of burn survivors were significant predictors of stigma among burn survivors. The mediating effect of resourcefulness between stigma and alexithymia in burns survivors accounted for 36.03% of the total effect.

CONCLUSION

Resourcefulness partially mediates the relationship between stigma and alexithymia. These findings suggest medical staff should strengthen the management of the mental health of burn survivors and eliminate the negative cognition and tendency of burn survivors by regularly promoting stigma counseling measures based on cognitive behavioral therapy. Based on the resourcefulness theory, psychological counseling and intervention are carried out in various ways to fully mobilize their internal factors for positive emotional regulation and enhance the ability of individuals to cope with adversity. In addition, an attempt was made to establish an "anti-stigma coalition" or "peer support group" for burn survivors to provide networked information support and emotional support to facilitate further the smooth return of patients to their families and society.

Treatment Management of Diabetic Wounds Utilizing Herbalism: An Overview

BACKGROUND AND OBJECTIVES

Diabetes Mellitus, commonly known as DM, is a metabolic disorder which is characterized by high blood glucose level, i.e., chronic hyperglycemia. If it is not managed properly, DM can lead to many severe complexities with time and can cause significant damage to the kidneys, heart, eyes, nerves and blood vessels. Diabetic foot ulcers (DFU) are one of those major complexities which affect around 15-25% of the population diagnosed with diabetes. Due to diabetic conditions, the body's natural healing process slows down leading to longer duration for healing of wounds only when taken care of properly. Herbal therapies are one of the approaches for the management and care of diabetic foot ulcer, which utilizes the concept of synergism for better treatment options. With the recent advancement in the field of nanotechnology and natural drug therapy, a lot of opportunities can be seen in combining both technologies and moving towards a more advanced drug delivery system to overcome the limitations of polyherbal formulations.

METHODS

During the writing of this document, the data was derived from existing original research papers gathered from a variety of sources such as PubMed, ScienceDirect, Google Scholar.

CONCLUSION

Hence, this review includes evidence about the current practices and future possibilities of nano-herbal formulation in treatment and management of diabetic wounds.

Biocompatibility and Mechanical Properties of Carboxymethyl Chitosan Hydrogels

Hydrogels have the properties of solid substances and are useful for medicine, e.g., in systems for the controlled release of drugs or as wound dressings. They isolate the wound from the external environment and constitute a barrier to microorganisms while still being permeable to oxygen. In the current study, hydrogels were formed from concentrated aqueous solutions of carboxymethyl chitosan (CMCS) via electron beam irradiation, with the presence of a crosslinking agent: poly(ethylene glycol)diacrylate. The aim of the study was to compare the properties and action of biopolymer CMCS hydrogels with commercial ones and to select the best compositions for future research towards wound-dressing applications. The elasticity of the gel depended on the component concentrations and the irradiation dose employed to form the hydrogel. Young's modulus for the tested hydrogels was higher than for the control material. The Live/Dead test performed on human fibroblasts confirmed that the analyzed hydrogels are not cytotoxic, and for some concentrations, they cause a slight increase in the number of cells compared to the control. The biocompatibility studies carried out on laboratory rats showed no adverse effect of hydrogels on animal tissues, confirming their biocompatibility and suggesting that CMCS hydrogels could be considered as wound-healing dressings in the future. Ionizing radiation was proven to be a suitable tool for CMCS hydrogel synthesis and could be of use in wound-healing therapy, as it may simultaneously sterilize the product.

A comprehensive review on the diverse pharmacological perspectives of Terminalia chebula Retz

Terminalia chebula Retz, commonly known as 'Haritaki/Myrobalan,' has been utilised as a traditional medicine for a long time. It has been extensively exercised in various indigenous medicine practices like Unani, Tibb, Ayurveda, and Siddha to remedy human ailments such as bleeding, carminative, dysentery, liver tonic, digestive, antidiarrheal, analgesic, anthelmintic, antibacterial and helpful in skin disorders. Studies on the pharmacological effects of T. chebula and its phytoconstituents documented between January, 1996 and December, 2021 were explored using various electronic databases. During the time mentioned above, several laboratory approaches revealed the biological properties of T. chebula, including antioxidative, antiproliferative, anti-microbial, proapoptotic, anti-diabetic, anti-ageing, hepatoprotective, anti-inflammatory, and antiepileptic. It is also beneficial in glucose and lipid metabolism and prevents atherogenesis and endothelial dysfunction. Different parts of T. chebula such as fruits, seeds, galls, barks extracted with various solvent systems (aqueous, ethanol, methanol, chloroform, ethyl-acetate) revealed major bioactive compounds like chebulic acid, chebulinic acid, and chebulaginic acid, which in turn proved to have valuable pharmacological properties through broad scientific investigations. There is a common link between chebulagic acid and chebulanin with its antioxidant property, antiaging activity, antiinflammatory, antidiabetic activity, and cardioprotective activity. The actions may be through neutralizing the free radicals responsible for producing tissue damage alongside interconnecting many other diseases. The current review summarises the scientifically documented literature on pharmacological potentials and chemical compositions of T. chebula, which is expected to investigate further studies on this subject.

Pharmacology and toxicology of tannins

Tannins are an interesting class of polyphenols, characterized, in almost all cases, by a different degree of polymerization, which, inevitably, markedly influences their bioavailability, as well as biochemical and pharmacological activities. They have been used for the process of tanning to transform hides into leather, from which their name derives. For several time, they have not been accurately evaluated, but now researchers have started to unravel their potential, highlighting anti-inflammatory, antimicrobial, antioxidant and anticancer activities, as well as their involvement in cardiovascular, neuroprotective and in general metabolic diseases prevention. The mechanisms underlying their activity are often complex, but the main targets of their action (such as key enzymes modulation, activation of metabolic pathways and changes in the metabolic fluxes) are highlighted in this review, without losing sight of their toxicity. This aspect still needs further and better-designed study to be thoroughly understood and allow a more conscious use of tannins for human health.

Nanoparticle Production of Terminalia Chebula Extracts by Expansion of Supercritical Solution (ESS)

Terminalia chebula pharmaceuticals were extracted by using the supercritical fluid extraction (SFE) technique. Under the optimal conditions of 184 [Formula: see text]L modifier volume, 46 min dynamic extraction time, and 316 atm fluid pressure, the extraction procedure was optimized by central composite design. A modified rapid expansion of supercritical solution (RESS) technique, named expansion of the supercritical solution (ESS) was used to create the extracted pharmaceutical nanoparticles (NPs). In ESS, supercritical carbon dioxide (SC-CO[Formula: see text] was saturated with the extracts at high-pressure. Next, a pressure drop reduced the SC-CO2 solubility power in a way the extracts started to precipitate. In contrast to RESS, the pressure was permanently conserved above the critical pressure before and after depressurization. Therefore, the expansion process was gentle, which led to obtaining small and uniform particles. In the NP production process, the most adequate parameters were 360[Formula: see text]atm premier pressure, 120[Formula: see text]atm subsequent pressure, 25[Formula: see text]min equilibrium time, 30[Formula: see text]min sedimentation time, and [Formula: see text]C temperature. The average size of precipitated NPs was 41[Formula: see text]nm according to the results of field emission scanning electron microscopy analysis. The liquid chromatography-mass spectrometry evaluation demonstrated the presence of chebulinic and chebulagic acids in the extracted sample.

In Vitro Evaluation of Antioxidant, Anti-Inflammatory, Antimicrobial and Wound Healing Potential of Thymus Sipyleus Boiss. Subsp. Rosulans (Borbas) Jalas

Thymus sipyleus Boiss. subsp. rosulans (Borbas) Jalas (TS) is a commonly used plant in the treatment of various complaints, including skin wounds in Turkish folk medicine. Despite the widespread traditional use of TS, there is not any scientific report confirming the effectiveness of this plant on the healing process. This research aimed to investigate the effects of different extracts obtained from TS on biological events during wound healing, on a cellular basis. In this context, proliferative activities of the extracts, as well as the effects on wound closure and hydroxyproline synthesis, were determined. In addition to wound healing properties, the antioxidant, antibacterial and anti-inflammatory activities of the extracts were evaluated. Decoction (D) and infusion (I) extracts contained the highest amount of phenolic content and showed the most potent activity against DPPH radical. All extracts exhibited complete protection against the damage induced by hydrogen peroxide (H2O2) by increasing cell viability compared to only H2O2-treated groups, both in co-treatment and pre-treatment protocols. None of the extracts exhibited cytotoxic activity, and most of the extracts from the TS stimulated fibroblast proliferation and migration. All TS extracts exert anti-inflammatory activity by suppressing the overproduction of tumor necrosis factor-alpha (TNF-α) and nitric oxide (NO). The most pronounced activity on hydroxyproline synthesis was observed in D extract. In summary, it was observed that TS extracts can promote the healing process by enhancing fibroblast migration, proliferation and collagen synthesis as well as suppressing pro-inflammatory cytokines. The obtained data in this work support the traditional use of TS as a valuable plant-based compound for the treatment of wounds.

Effect of Pentacyclic Triterpenoids-Rich Callus Extract of Chaenomeles japonica (Thunb.) Lindl. ex Spach on Viability, Morphology, and Proliferation of Normal Human Skin Fibroblasts

The effect of the well-characterized callus extract of Chaenomeles japonica on viability, morphology, and proliferation of normal human skin fibroblasts was investigated. The phytochemical analysis was performed using the ultra-high performance liquid chromatography method. The total phenolic, phenolic acid, and flavonoid contents were determined spectrophotometrically. The antioxidant activity was investigated using the DPPH (1,1-Diphenyl-1-picrylhydrazyl Radical Scavenging), FRAP (Ferric Reducing Antioxidant Power), and CUPRAC (CUPric Reducing Antioxidant Capacity) assays. The callus growth index during passages was high as well as the content of pentacyclic triterpenoids. The microscopic observations of the fibroblast viability, morphology and the evaluation of the proliferation ratio (xCELLigence system) proved that the influence of callus extract on the fibroblasts was dose-dependent. The evaluated level of fibroblasts proliferation rate after 72 h of incubation with callus extract at concentration 12.5 µg L⁻¹ was the highest compared to all the analyzed ligands. Moreover, callus extract administrated for 72 h caused a significant increase in the proliferation rate in comparison with the control group (5.7 ± 0.1 vs. 4.4 ± 0.9; p < 0.01). The preliminary studies carried out may suggest that the callus extract rich in triterpenoids may be a potential source of cosmetic ingredients with a beneficial effect on human skin.

Terminalia chebula Retz. – an important medicinal plant

Ayurveda, whispered to be the ancient practice of healthcare existed and contributes a holistic approach to health, healing and longevity. Terminalia chebula Retz. is a popular plant and widely spread all over southern Asia. T. chebula is a native plant of India and its dried fruit is extensively used in various types of home remedies. Dried fruit of T. chebula contains high quantities phenolic compounds that consist of ellagic acid, gallic acid and chebulic acid. The fruit extract of T. chebula is known to display different biological properties like anticancer, anti-inflammatory, antioxidant, anti-protozoal, antimicrobial, hepato and renal protective activities, and in the management of metabolic syndrome. The phenolic active compounds might play vital role in the influence of biological activity. Fruit extract of T. chebula is widely employed as an important ingredient in various ayurvedic preparations like ‘Triphala’. This formulation is beneficial as detoxifying agent of the colon, purgative in chronic constipation, aids in digestion and as a body rejuvenator. The fruit has great medicinal significance and conventionally applied for the management of various illness conditions, such as sore throat, high cough, asthma, ulcers, gout, heart burn, vomiting, diarrhea, dysentery, bleeding piles and bladder diseases. It is also utilized as mild laxative, antispasmodic and stomachic. Because of these enormous medicinal properties, T. chebula is commonly termed as ‘King of Medicine’ in Tibet and can be called as a ‘wonder herb’. In the present review, recent advances in medicinal properties of T. chebula are discussed.

Scar management in burn injuries using drug delivery and molecular signaling: Current treatments and future directions

In recent decades, there have been tremendous improvements in burn care that have allowed patients to survive severe burn injuries that were once fatal. However, a major limitation of burn care currently is the development of hypertrophic scars in approximately 70% of patients. This significantly decreases the quality of life for patients due to the physical and psychosocial symptoms associated with scarring. Current approaches to manage scarring include surgical techniques and non-surgical methods such as laser therapy, steroid injections, and compression therapy. These treatments are limited in their effectiveness and regularly fail to manage symptoms. As a result, the development of novel treatments that aim to improve outcomes and quality of life is imperative. Drug delivery that targets the molecular cascades of wound healing to attenuate or prevent hypertrophic scarring is a promising approach that has therapeutic potential. In this review, we discuss current treatments for scar management after burn injury, and how drug delivery targeting molecular signaling can lead to new therapeutic strategies.

Optimization of Phenolic Compounds Extraction from Flax Shives and Their Effect on Human Fibroblasts

The goal of this study was to evaluate the most effective technique for extraction of phenolics present in flax shives and to assess their effect on human fibroblasts. Flax shives are by-products of fibre separation, but they were found to be a rich source of phenolic compounds and thus might have application potential. It was found that the optimal procedure for extraction of phenolics was hydrolysis enhanced by the ultrasound with NaOH for 24 h at 65°C and subsequent extraction with ethyl acetate. The influence of the flax shives extract on fibroblast growth and viability was assessed using the MTT and SRB tests. Moreover, the influence of flax shives extract on the extracellular matrix remodelling process was verified. The 20% increase of the viability was observed upon flax shives extract treatment and the decrease of mRNA collagen genes, an increase of matrix metalloproteinase gene expression, and reduction in levels of interleukin 6, interleukin 10, and suppressor of cytokinin signaling 1 mRNA were observed. Alterations in MCP-1 mRNA levels were dependent on flax shives extract concentration. Thus, we suggested the possible application of flax shives extract in the wound healing process.

The Role of Phytochemicals in the Inflammatory Phase of Wound Healing

Historically, plant-based products have been the basis of medicine since before the advent of modern Western medicine. Wound dressings made of honey, curcumin and other phytochemical-rich compounds have been traditionally used. Recently, the mechanisms behind many of these traditional therapies have come to light. In this review, we show that in the context of wound healing, there is a global theme of anti-inflammatory and antioxidant phytochemicals in traditional medicine. Although promising, we discuss the limitations of using some of these phytochemicals in order to warrant more research, ideally in randomized clinical trial settings.

Terminalia Chebula provides protection against dual modes of necroptotic and apoptotic cell death upon death receptor ligation

Death receptor (DR) ligation elicits two different modes of cell death (necroptosis and apoptosis) depending on the cellular context. By screening a plant extract library from cells undergoing necroptosis or apoptosis, we identified a water extract of Terminalia chebula (WETC) as a novel and potent dual inhibitor of DR-mediated cell death. Investigation of the underlying mechanisms of its anti-necroptotic and anti-apoptotic action revealed that WETC or its constituents (e.g., gallic acid) protected against tumor necrosis factor-induced necroptosis via the suppression of TNF-induced ROS without affecting the upstream signaling events. Surprisingly, WETC also provided protection against DR-mediated apoptosis by inhibition of the caspase cascade. Furthermore, it activated the autophagy pathway via suppression of mTOR. Of the WETC constituents, punicalagin and geraniin appeared to possess the most potent anti-apoptotic and autophagy activation effect. Importantly, blockage of autophagy with pharmacological inhibitors or genetic silencing of Atg5 selectively abolished the anti-apoptotic function of WETC. These results suggest that WETC protects against dual modes of cell death upon DR ligation. Therefore, WETC might serve as a potential treatment for diseases characterized by aberrantly sensitized apoptotic or non-apoptotic signaling cascades.

3D Printing of Scaffold for Cells Delivery: Advances in Skin Tissue Engineering

Injury or damage to tissue and organs is a major health problem, resulting in about half of the world’s annual healthcare expenditure every year. Advances in the fields of stem cells (SCs) and biomaterials processing have provided a tremendous leap for researchers to manipulate the dynamics between these two, and obtain a skin substitute that can completely heal the wounded areas. Although wound healing needs a coordinated interplay between cells, extracellular proteins and growth factors, the most important players in this process are the endogenous SCs, which activate the repair cascade by recruiting cells from different sites. Extra cellular matrix (ECM) proteins are activated by these SCs, which in turn aid in cellular migrations and finally secretion of growth factors that can seal and heal the wounds. The interaction between ECM proteins and SCs helps the skin to sustain the rigors of everyday activity, and in an attempt to attain this level of functionality in artificial three-dimensional (3D) constructs, tissue engineered biomaterials are fabricated using more advanced techniques such as bioprinting and laser assisted printing of the organs. This review provides a concise summary of the most recent advances that have been made in the area of polymer bio-fabrication using 3D bio printing used for encapsulating stem cells for skin regeneration. The focus of this review is to describe, in detail, the role of 3D architecture and arrangement of cells within this system that can heal wounds and aid in skin regeneration.

Activities of Tannins – from in Vitro Studies to Clinical Trials

Tannins are considered as valuable plant secondary metabolites providing many benefits for human health. In this review information was gathered about bioactivity in vitro and in vivo, as well as about conducted clinical trials. The literature research was based on ScienceDirect, Scopus, and Cochrane databases and presents a wide range of tested activities of tannins. The described clinical trials verify laboratory tests and show the effective health benefits taken from supplementation with tannins.

Bactericidal Activity and Mechanism of Photoirradiated Polyphenols against Gram-Positive and -Negative Bacteria

The bactericidal effect of various types of photoirradiated polyphenols against Gram-positive and -negative bacteria was evaluated in relation to the mode of action. Gram-positive bacteria (Enterococcus faecalis, Staphylococcus aureus, and Streptococcus mutans) and Gram-negative bacteria (Aggregatibacter actinomycetemcomitans, Escherichia coli, and Pseudomonas aeruginosa) suspended in a 1 mg/mL polyphenol aqueous solution (caffeic acid, gallic acid, chlorogenic acid, epigallocatechin, epigallocatechin gallate, and proanthocyanidin) were exposed to LED light (wavelength, 400 nm; irradiance, 260 mW/cm(2)) for 5 or 10 min. Caffeic acid and chlorogenic acid exerted the highest bactericidal activity followed by gallic acid and proanthocyanidin against both Gram-positive and -negative bacteria. It was also demonstrated that the disinfection treatment induced oxidative damage of bacterial DNA, which suggests that polyphenols are incorporated into bacterial cells. The present study suggests that blue light irradiation of polyphenols could be a novel disinfection treatment.

Ointment of Brassica oleracea var. capitata Matures the Extracellular Matrix in Skin Wounds of Wistar Rats

Wound healing is a complex process that aims to restore damaged tissue. Phytotherapeutics, such as cabbage, Brassica oleracea var. capitata (Brassicaceae), and sunflower, Helianthus annuus L. (Asteraceae) oil, are used as wound healers. Five circular wounds, each 12 mm in diameter, were made in the dorsolateral region of each rat. The animals were divided into four groups: balsam (B. oleracea); ointment (B. oleracea); sunflower oil (Helianthus annuus); control (saline solution 0.9%). These products were applied daily for 20 days and every four days the tissues of different wounds were removed. The wound contraction area, total collagen, types I and III collagen, glycosaminoglycans, and tissue cellularity were analyzed. In the groups that received ointment and balsam there was reduction in the wound area on days 4, 8, 12, and 20. Throughout the trial period, the balsam and ointment groups showed a higher amount of total collagen, type I collagen, and glycosaminoglycan compared to the others groups. The rats in the groups treated with B. oleracea var. capitata showed a higher number of cells on days 8, 16, and 20. B. oleracea was effective in stimulating the maturation of collagen and increasing the cellularity, as also in improving the mechanical resistance of the newly formed tissue.

Acceleration of proliferative response of mouse fibroblasts by short-time pretreatment with polyphenols

Under the hypothesis that photo-irradiated proanthocyanidin could accelerate wound healing through reactive oxygen species (ROS) formation, we examined the effect of proanthocyanidin on 3T3-L1 mouse fibroblasts with or without photo-irradiation. As a result, irrespective of presence or absence of photo-irradiation, only 1 min exposure of the cells to proanthocyanidin resulted in accelerated proliferation of the cells in a concentration-dependent manner. Similarly to proanthocyanidin, 1 min pretreatment with catechin, caffeic acid, and chlorogenic acid accelerated the proliferative response, but gallic acid, epicatechin gallate, epigallocatechin, and epigallocatechin gallate failed. If incorporated active ingredient such as proanthocyanidin for such a short time as 1 min accelerates the proliferation response, a bioassay was conducted by utilizing antioxidant potential of proanthocyanidin. That is, intracellular oxidation of 2',7'-dichlorodihydrofluorescin induced by H2O2 was significantly inhibited when the cells were pretreated with proanthocyanidin for 1 min, suggesting that incorporated proanthocyanidin into the cells exerted antioxidant effect. This was also supported by a liquid chromatography/mass spectrometry analysis in which incorporation of proanthocyanidin components such as catechin monomers and dimers into the cells within 1 min was confirmed. These results suggest that active polyphenolic compounds such as proanthocyanidin, catechin, caffeic acid, and chlorogenic acid incorporated into the cells in such a short time as 1 min could accelerate the proliferative response of the cells.

Effects of the novel compound DK223 ([1E,2E-1,2-Bis(6-methoxy-2H-chromen-3-yl)methylene]hydrazine) on migration and proliferation of human keratinocytes and primary dermal fibroblasts

Wound healing plays an important role in protecting the human body from external infection. Cell migration and proliferation of keratinocytes and dermal fibroblasts are essential for proper wound healing. Recently, several studies have demonstrated that secondary compounds produced in plants could affect skin cells migration and proliferation. In this study, we identified a novel compound DK223 ([1E,2E-1,2-bis(6-methoxy-2H-chromen-3-yl)methylene]hydrazine) that concomitantly induced human keratinocyte migration and dermal fibroblast proliferation. We evaluated the regulation of epithelial and mesenchymal protein markers, such as E-cadherin and Vimentin, in human keratinocytes, as well as extracellular matrix (ECM) secretion and metalloproteinase families in dermal fibroblasts. DK223 upregulated keratinocyte migration and significantly increased the epithelial marker E-cadherin in a time-dependent manner. We also found that reactive oxygen species (ROS) increased significantly in keratinocytes after 2 h of DK223 exposure, returning to normal levels after 24 h, which indicated that DK223 had an early shock effect on ROS production. DK223 also stimulated fibroblast proliferation, and induced significant secretion of ECM proteins, such as collagen I, III, and fibronectin. In dermal fibroblasts, DK223 treatment induced TGF-β1, which is involved in a signaling pathway that mediates proliferation. In conclusion, DK223 simultaneously induced both keratinocyte migration via ROS production and fibroblast proliferation via TGF-β1 induction.