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Liu J, He Q, Guo G, Zhai C. Analysis of risk factors related to chronic non-healing wound infection and the construction of a clinical prediction model. Exp Dermatol 2024; 33:e15102. [PMID: 38973268 DOI: 10.1111/exd.15102] [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: 01/22/2024] [Revised: 04/28/2024] [Accepted: 05/07/2024] [Indexed: 07/09/2024]
Abstract
This study is aimed to analyse the risk factors associated with chronic non-healing wound infections, establish a clinical prediction model, and validate its performance. Clinical data were retrospectively collected from 260 patients with chronic non-healing wounds treated in the plastic surgery ward of Shanxi Provincial People's Hospital between January 2022 and December 2023 who met the inclusion criteria. Risk factors were analysed, and a clinical prediction model was constructed using both single and multifactor logistic regression analyses to determine the factors associated with chronic non-healing wound infections. The model's discrimination and calibration were assessed via the concordance index (C-index), receiver operating characteristic (ROC) curve and calibration curve. Multivariate logistic regression analysis identified several independent risk factors for chronic non-healing wound infection: long-term smoking (odds ratio [OR]: 4.122, 95% CI: 3.412-5.312, p < 0.05), history of diabetes (OR: 3.213, 95% CI: 2.867-4.521, p < 0.05), elevated C-reactive protein (OR: 2.981, 95% CI: 2.312-3.579, p < 0.05), elevated procalcitonin (OR: 2.253, 95% CI: 1.893-3.412, p < 0.05) and reduced albumin (OR: 1.892, 95% CI: 1.322-3.112, p < 0.05). The clinical prediction model's C-index was 0.762, with the corrected C-index from internal validation using the bootstrap method being 0.747. The ROC curve indicated an area under the curve (AUC) of 0.762 (95% CI: 0.702-0.822). Both the AUC and C-indexes ranged between 0.7 and 0.9, suggesting moderate-to-good predictive accuracy. The calibration chart demonstrated a good fit between the model's calibration curve and the ideal curve. Long-term smoking, diabetes, elevated C-reactive protein, elevated procalcitonin and reduced albumin are confirmed as independent risk factors for bacterial infection in patients with chronic non-healing wounds. The clinical prediction model based on these factors shows robust performance and substantial predictive value.
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Affiliation(s)
- Jing Liu
- Department of the Comprehensive Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi Province, China
| | - Qiang He
- The Colorectal and Anal Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi Province, China
| | - Gaijuan Guo
- Fenyang City People's Hospital, Fenyang, Shanxi Province, China
| | - Chunbao Zhai
- The Colorectal and Anal Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi Province, China
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2
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Mihai MM, Bălăceanu-Gurău B, Ion A, Holban AM, Gurău CD, Popescu MN, Beiu C, Popa LG, Popa MI, Dragomirescu CC, Preda M, Muntean AA, Macovei IS, Lazăr V. Host-Microbiome Crosstalk in Chronic Wound Healing. Int J Mol Sci 2024; 25:4629. [PMID: 38731848 PMCID: PMC11083077 DOI: 10.3390/ijms25094629] [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: 03/26/2024] [Revised: 04/14/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
The pathogenesis of chronic wounds (CW) involves a multifaceted interplay of biochemical, immunological, hematological, and microbiological interactions. Biofilm development is a significant virulence trait which enhances microbial survival and pathogenicity and has various implications on the development and management of CW. Biofilms induce a prolonged suboptimal inflammation in the wound microenvironment, associated with delayed healing. The composition of wound fluid (WF) adds more complexity to the subject, with proven pro-inflammatory properties and an intricate crosstalk among cytokines, chemokines, microRNAs, proteases, growth factors, and ECM components. One approach to achieve information on the mechanisms of disease progression and therapeutic response is the use of multiple high-throughput 'OMIC' modalities (genomic, proteomic, lipidomic, metabolomic assays), facilitating the discovery of potential biomarkers for wound healing, which may represent a breakthrough in this field and a major help in addressing delayed wound healing. In this review article, we aim to summarize the current progress achieved in host-microbiome crosstalk in the spectrum of CW healing and highlight future innovative strategies to boost the host immune response against infections, focusing on the interaction between pathogens and their hosts (for instance, by harnessing microorganisms like probiotics), which may serve as the prospective advancement of vaccines and treatments against infections.
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Affiliation(s)
- Mara Mădălina Mihai
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.M.M.); (C.B.); (L.G.P.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
- Research Institute of the University of Bucharest, Department of Botany-Microbiology, Faculty of Biology, University of Bucharest, 050663 Bucharest, Romania; (A.M.H.); (V.L.)
| | | | - Ana Ion
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Alina Maria Holban
- Research Institute of the University of Bucharest, Department of Botany-Microbiology, Faculty of Biology, University of Bucharest, 050663 Bucharest, Romania; (A.M.H.); (V.L.)
| | - Cristian-Dorin Gurău
- Orthopedics and Traumatology Clinic, Clinical Emergency Hospital, 014451 Bucharest, Romania;
| | - Marius Nicolae Popescu
- Department of Physical and Rehabilitation Medicine, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Clinic of Physical and Rehabilitation Medicine, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Cristina Beiu
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.M.M.); (C.B.); (L.G.P.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Liliana Gabriela Popa
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.M.M.); (C.B.); (L.G.P.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Mircea Ioan Popa
- Department of Microbiology, “Cantacuzino” Institute, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.I.P.); (C.C.D.); (A.-A.M.)
- Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania; (M.P.); (I.S.M.)
| | - Cerasella Cristiana Dragomirescu
- Department of Microbiology, “Cantacuzino” Institute, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.I.P.); (C.C.D.); (A.-A.M.)
- Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania; (M.P.); (I.S.M.)
| | - Mădălina Preda
- Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania; (M.P.); (I.S.M.)
- Department of Microbiology, Parasitology and Virology, Faculty of Midwives and Nursing, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alexandru-Andrei Muntean
- Department of Microbiology, “Cantacuzino” Institute, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.I.P.); (C.C.D.); (A.-A.M.)
- Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania; (M.P.); (I.S.M.)
| | - Ioana Sabina Macovei
- Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania; (M.P.); (I.S.M.)
| | - Veronica Lazăr
- Research Institute of the University of Bucharest, Department of Botany-Microbiology, Faculty of Biology, University of Bucharest, 050663 Bucharest, Romania; (A.M.H.); (V.L.)
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3
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Iungin O, Shydlovska O, Moshynets O, Vasylenko V, Sidorenko M, Mickevičius S, Potters G. Metal-based nanoparticles: an alternative treatment for biofilm infection in hard-to-heal wounds. J Wound Care 2024; 33:xcix-cx. [PMID: 38588056 DOI: 10.12968/jowc.2024.33.sup4a.xcix] [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: 04/10/2024]
Abstract
Metal-based nanoparticles (MNPs) are promoted as effective compounds in the treatment of bacterial infections and as possible alternatives to antibiotics. These MNPs are known to affect a broad spectrum of microorganisms using a multitude of strategies, including the induction of reactive oxygen species and interaction with the inner structures of the bacterial cells. The aim of this review was to summarise the latest studies about the effect of metal-based nanoparticles on pathogenic bacterial biofilm formed in wounds, using the examples of Gram-positive bacterium Staphylococcus aureus and Gram-negative bacterium Pseudomonas aeruginosa, as well as provide an overview of possible clinical applications.
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Affiliation(s)
- Olga Iungin
- 1 Kyiv National University of Technologies and Design (KNUTD), Kyiv, Ukraine
- 2 Institute of Molecular Biology and Genetics of the National Academy of Sciences of Ukraine, Kyiv, Ukraine
| | - Olga Shydlovska
- 1 Kyiv National University of Technologies and Design (KNUTD), Kyiv, Ukraine
| | - Olena Moshynets
- 2 Institute of Molecular Biology and Genetics of the National Academy of Sciences of Ukraine, Kyiv, Ukraine
| | - Volodymyr Vasylenko
- 3 Vytautas Magnus University, Faculty of Natural Science, Akademija, Lithuania
| | - Marina Sidorenko
- 3 Vytautas Magnus University, Faculty of Natural Science, Akademija, Lithuania
| | - Saulius Mickevičius
- 3 Vytautas Magnus University, Faculty of Natural Science, Akademija, Lithuania
| | - Geert Potters
- 4 Antwerp Maritime Academy, Antwerp, Belgium
- 5 University of Antwerp, Antwerp, Belgium
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Huang D, Du J, Luo F, He G, Zou M, Wang Y, Lin Z, Wu D, Weng Z. Injectable Hydrogels with Integrated Ph Probes and Ultrasound-Responsive Microcapsules as Smart Wound Dressings for Visual Monitoring and On-Demand Treatment of Chronic Wounds. Adv Healthc Mater 2024; 13:e2303379. [PMID: 38211342 DOI: 10.1002/adhm.202303379] [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: 10/05/2023] [Revised: 01/07/2024] [Indexed: 01/13/2024]
Abstract
Hydrogel dressings capable of infection monitoring and precise treatment administration show promise for advanced wound care. Existing methods involve embedd ingorganic dyes or flexible electronics into preformed hydrogels, which raise safety issues and adaptability challenges. In this study, an injectable hydrogel based smart wound dressing is developed by integrating food-derived anthocyanidin as a visual pH probe for infection monitoring and poly(L-lactic acid) microcapsules as ultrasound-responsive delivery systems for antibiotics into a poly(ethylene glycol) hydrogel. This straightforwardly prepared hydrogel dressing maintains its favorable properties for wound repair, including porous morphology and excellent biocompatibility. In vitro experiments demonstrated that the hydrogel enabled visual assessment of pH within the range of 5 ∼ 9.Meanwhile, the release of antibiotics could be triggered and controlled by ultrasound. In vivo evaluations using infected wounds and diabetic wounds revealed that the wound dressing effectively detected wound infection by monitoring pH levels and achieved antibacterial effects through ultrasound-triggered drug release. This led to significantly enhanced wound healing, as validated by histological analysis and the measurement of inflammatory cytokine levels. This injectable hydrogel-based smart wound dressing holds great potential for use in clinical settings to inform timely and precise clinical intervention and in community to improve wound care management.
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Affiliation(s)
- Da Huang
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, 350108, China
- Ministry of Education Key Laboratory for Analytical Science of Food Safety and Biology, Fujian Provincial Key Laboratory of Analysis and Detection for Food Safety, College of Chemistry, Fuzhou University, Fuzhou, Fujian, 350108, China
| | - Jiahao Du
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, 350108, China
| | - Fang Luo
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, 350108, China
- Ministry of Education Key Laboratory for Analytical Science of Food Safety and Biology, Fujian Provincial Key Laboratory of Analysis and Detection for Food Safety, College of Chemistry, Fuzhou University, Fuzhou, Fujian, 350108, China
| | - Gang He
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Minglang Zou
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, 350108, China
| | - Yongming Wang
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, 350108, China
| | - Zhenyu Lin
- Ministry of Education Key Laboratory for Analytical Science of Food Safety and Biology, Fujian Provincial Key Laboratory of Analysis and Detection for Food Safety, College of Chemistry, Fuzhou University, Fuzhou, Fujian, 350108, China
| | - Decheng Wu
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Zuquan Weng
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, 350108, China
- Department of Plastic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, China
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5
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Chen Z, Shan J, Niu Q, Chen H, Zhang W, Cao D, Wang X. pH-responsive double-enzyme active metal-organic framework for promoting the healing of infected wounds. J Colloid Interface Sci 2024; 657:250-262. [PMID: 38041970 DOI: 10.1016/j.jcis.2023.11.143] [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: 08/31/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/04/2023]
Abstract
The abuse of antibiotics accelerates the spread and evolution of drug-resistant bacteria, which seriously threatens human health. Hydroxyl radicals (•OH) are generated by peroxidase in the presence of H2O2, which is strongly oxidizing and can effectively kill bacteria. However, high production costs and poor stability limit the clinical use of natural enzymes. "Nanozyme" is a general term for nanomaterials with catalytic activity similar to that of biological enzymes. Compared to biological enzymes, nanozymes have the advantages of low cost, facile preparation, and easy storage, making them a good choice for the development of antibacterial agents. Here, a nickel-based metal-organic framework (Ni-MOF) with dual enzymatic activity that switches depending on the pH environment was studied. In a slightly acidic environment, Ni-MOF can react with hydrogen peroxide to produce hydroxyl radicals that kill bacteria; in a neutral environment, Ni-MOF instead removes excessive reactive oxygen species (ROS) and promotes the transformation of macrophages into M2 macrophages. Compared to most nanozymes, Ni-MOF has unique electrical conductivity and better biosafety. The results of animal experiments show that Ni-MOF can not only treat infected wounds but also promote the healing of acute wounds and exhibits great clinical application potential.
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Affiliation(s)
- Zenghong Chen
- Department of Plastic and Reconstructive Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China
| | - Jie Shan
- Department of Burn, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, PR China
| | - Qiang Niu
- School of Biomedical Engineering, Research and Engineering Center of Biomedical Materials, Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei 230032, PR China
| | - Hongrang Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Wei Zhang
- School of Biomedical Engineering, Research and Engineering Center of Biomedical Materials, Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei 230032, PR China; Institute of Clinical Pharmacology, Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-Inflammatory and Immune Medicine, Anhui Medical University, Hefei 230022, PR China.
| | - Dongsheng Cao
- Department of Plastic and Reconstructive Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China.
| | - Xianwen Wang
- School of Biomedical Engineering, Research and Engineering Center of Biomedical Materials, Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei 230032, PR China; College and Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei 230032, PR China.
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6
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Juszczuk-Kubiak E. Molecular Aspects of the Functioning of Pathogenic Bacteria Biofilm Based on Quorum Sensing (QS) Signal-Response System and Innovative Non-Antibiotic Strategies for Their Elimination. Int J Mol Sci 2024; 25:2655. [PMID: 38473900 DOI: 10.3390/ijms25052655] [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: 12/19/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
One of the key mechanisms enabling bacterial cells to create biofilms and regulate crucial life functions in a global and highly synchronized way is a bacterial communication system called quorum sensing (QS). QS is a bacterial cell-to-cell communication process that depends on the bacterial population density and is mediated by small signalling molecules called autoinducers (AIs). In bacteria, QS controls the biofilm formation through the global regulation of gene expression involved in the extracellular polymeric matrix (EPS) synthesis, virulence factor production, stress tolerance and metabolic adaptation. Forming biofilm is one of the crucial mechanisms of bacterial antimicrobial resistance (AMR). A common feature of human pathogens is the ability to form biofilm, which poses a serious medical issue due to their high susceptibility to traditional antibiotics. Because QS is associated with virulence and biofilm formation, there is a belief that inhibition of QS activity called quorum quenching (QQ) may provide alternative therapeutic methods for treating microbial infections. This review summarises recent progress in biofilm research, focusing on the mechanisms by which biofilms, especially those formed by pathogenic bacteria, become resistant to antibiotic treatment. Subsequently, a potential alternative approach to QS inhibition highlighting innovative non-antibiotic strategies to control AMR and biofilm formation of pathogenic bacteria has been discussed.
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Affiliation(s)
- Edyta Juszczuk-Kubiak
- Laboratory of Biotechnology and Molecular Engineering, Department of Microbiology, Prof. Wacław Dąbrowski Institute of Agricultural and Food Biotechnology-State Research Institute, Rakowiecka 36 Street, 02-532 Warsaw, Poland
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Dehbashi S, Tahmasebi H, Alikhani MY, Vidal JE, Seifalian A, Arabestani MR. The healing effect of Pseudomonas Quinolone Signal (PQS) with co-infection of Staphylococcus aureus and Pseudomonas aeruginosa: A preclinical animal co-infection model. J Infect Public Health 2024; 17:329-338. [PMID: 38194764 DOI: 10.1016/j.jiph.2023.12.016] [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: 08/01/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Because of the rise in antibiotic resistance and the control of pathogenicity, polymicrobial bacterial biofilms exacerbate wound infections. Since bacterial quorum sensing (QS) signals can dysregulate biofilm development, they are interesting therapeutic treatments. In this study, Pseudomonas Quinolone Signal (PQS) was used to treat an animal model of a wound that had both Staphylococcus aureus and Pseudomonas aeruginosa co-infection. METHODS S. aureus and P. aeruginosa mono- and co-infection models were developed in vitro on the L-929 cell line and in an animal model of wound infection. Moreover, PQS was extracted and purified using liquid chromatography. Then, the mono- and co-infection models were treated by PQS in vitro and in vivo. RT-PCR analysis was used to look into changes in biofilm, QS, tissue regeneration, and apoptosis genes after the treatment. RESULTS PQS significantly disrupted established biofilm up to 90% in both in vitro and in vivo models. Moreover, a 93% reduction in the viability of S. aureus and P. aeruginosa was detected during the 10 days of treatment in comparison to control groups. In addition, the biofilm-encoding and QS-regulating genes were down-regulated to 75% in both microorganisms. Also, fewer epithelial cells died when treated with PQS compared to control groups in both mono- and co-infection groups. CONCLUSION According to this study, PQS may facilitate wound healing by stimulating the immune system and reducing apoptosis. It seems to be a potential medication to use in conjunction with antibiotics to treat infections that are difficult to treat.
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Affiliation(s)
- Sanaz Dehbashi
- Department of Laboratory Sciences, Varastegan Institute of Medical Sciences, Mashhad, Iran
| | - Hamed Tahmasebi
- School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Yousef Alikhani
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jorge E Vidal
- Department of Cell and Molecular Biology, Center for Immunology and Microbial Research, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA
| | - Alexander Seifalian
- Nanotechnology & Regenerative Medicine Commercialization Centre (NanoRegMed Ltd, Nanoloom Ltd, & Liberum Health Ltd), London BioScience Innovation Centre, London, United Kingdom
| | - Mohammad Reza Arabestani
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran; Infectious Disease Research center, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
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Haba D, Qin Q, Takizawa C, Tomida S, Minematsu T, Sanada H, Nakagami G. Local low-frequency vibration accelerates healing of full-thickness wounds in a hyperglycemic rat model. J Diabetes Investig 2023; 14:1356-1367. [PMID: 37688317 PMCID: PMC10688122 DOI: 10.1111/jdi.14072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/06/2023] [Accepted: 08/07/2023] [Indexed: 09/10/2023] Open
Abstract
AIMS/INTRODUCTION Local low-frequency vibration (LLFV) promotes vasodilation and blood flow, enhancing wound healing in diabetic foot ulcers with angiopathy. However, vibration-induced vasodilation does not occur, owing to chronic hyperglycemia and inflammation. We hypothesized that LLFV improves glycometabolism and inflammation, leading to vasodilation and angiogenesis in diabetic wounds. Therefore, this study investigated the effect of LLFV on wound healing in hyperglycemic rats, primarily focusing on glycometabolism, inflammation, vasodilation, and angiogenesis. MATERIALS AND METHODS Streptozotocin-induced hyperglycemic Sprague-Dawley rats were used in this study. We applied LLFV to experimentally-induced wounds at 50 Hz and 0, 600, 1,000 or 1,500 mVpp for 40 min/day from post-wounding days (PWD) 1-14. RESULTS The relative wound areas in the 600 and 1,000 mVpp groups on PWD 5-7 were significantly smaller than those at 0 mVpp. The expression of Glo-1 (1,500 mVpp) and Slc2A4 (1,000 and 1,500 mVpp) was upregulated on PWD 4 and 14, respectively. However, there was no difference in methylglyoxal expression levels in any group until PWD 14. At 1,000 mVpp, the expression of Tnfa on PWD 4, and that of Ptx3 and Ccl2 on PWD 14 was downregulated. Furthermore, the M1/M2 macrophage ratio was considerably decreased on both days. The expression of Nos3, Vegfa and vascular endothelial growth factor A was upregulated on PWD 4. In addition, vasodilation and angiogenesis were more obvious on PWD 14 with 1,000 mVpp. CONCLUSIONS The results suggest that LLFV promotes wound healing, improves glycometabolism and inflammation, and enhances vasodilation and angiogenesis in hyperglycemic wounds.
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Affiliation(s)
- Daijiro Haba
- Global Nursing Research Center, Graduate School of MedicineThe University of TokyoTokyoJapan
- Department of Gerontological Nursing/Wound Care Management, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Qi Qin
- Department of Gerontological Nursing/Wound Care Management, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Chihiro Takizawa
- Department of Gerontological Nursing/Wound Care Management, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Sanai Tomida
- Department of Gerontological Nursing/Wound Care Management, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Takeo Minematsu
- Global Nursing Research Center, Graduate School of MedicineThe University of TokyoTokyoJapan
- Department of Skincare Science, Graduate School of MedicineThe University of TokyoTokyoJapan
- Ishikawa Prefectural Nursing UniversityIshikawaJapan
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of MedicineThe University of TokyoTokyoJapan
- Department of Gerontological Nursing/Wound Care Management, Graduate School of MedicineThe University of TokyoTokyoJapan
- Ishikawa Prefectural Nursing UniversityIshikawaJapan
| | - Gojiro Nakagami
- Global Nursing Research Center, Graduate School of MedicineThe University of TokyoTokyoJapan
- Department of Gerontological Nursing/Wound Care Management, Graduate School of MedicineThe University of TokyoTokyoJapan
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9
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Haba D, Ohmiya T, Sekino M, Qin Q, Takizawa C, Tomida S, Minematsu T, Sanada H, Nakagami G. Efficacy of wearable vibration dressings on full-thickness wound healing in a hyperglycemic rat model. Wound Repair Regen 2023; 31:816-826. [PMID: 37950849 DOI: 10.1111/wrr.13129] [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: 04/28/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/13/2023]
Abstract
Local low-frequency vibration promotes blood flow and wound healing in hard-to-heal diabetic foot ulcers (DFUs). However, vibration treatment is challenging in patients with DFUs due to wound management difficulties and low adherence. Consequently, developing wearable self-care devices becomes imperative for effective wound healing. This study introduces a wearable vibration dressing and assesses its impact on wound healing in hyperglycemic rats. Low-frequency vibration at 52 Hz was applied to the wound for 40 min/day in awake rats. Relative wound areas on post-wounding days (PWDs) 4-7 were significantly smaller and the wound closure rate was significantly higher in the vibration group than in the control group (p < 0.05, respectively). The total haemoglobin at baseline and after vibration on post-wounding day 7 was significantly larger in the vibration group than in the control group (p < 0.05). On PWD 7, the thickness of the granulation tissue was significantly higher in the vibration group than in the control group (p < 0.05). Moreover, the number of blood vessels at the wound site and vascular endothelial growth factor A protein expression were significantly higher in the vibration group than in the control group (p < 0.05, respectively). The ratio of (CD68+ /iNOS+ )/(CD163+ ) macrophages in the vibration group was significantly lower than that in the control group (p < 0.05). These results indicate the potential of wearable vibration dressings as new self-care devices that can promote angiogenesis and blood flow, improve inflammation, and enhance wound healing in DFUs.
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Affiliation(s)
- Daijiro Haba
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takafumi Ohmiya
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Masaki Sekino
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Qi Qin
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chihiro Takizawa
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sanai Tomida
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Ishikawa Prefectural Nursing University, Ishikawa, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Ishikawa Prefectural Nursing University, Ishikawa, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Sánchez ML, Valdez H, Conde M, Viaña-Mendieta P, Boccaccini AR. Polymers and Bioactive Compounds with a Macrophage Modulation Effect for the Rational Design of Hydrogels for Skin Regeneration. Pharmaceutics 2023; 15:1655. [PMID: 37376103 DOI: 10.3390/pharmaceutics15061655] [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: 02/21/2023] [Revised: 05/08/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
The development of biomaterial platforms for dispensing reagents of interest such as antioxidants, growth factors or antibiotics based on functional hydrogels represents a biotechnological solution for many challenges that the biomedicine field is facing. In this context, in situ dosing of therapeutic components for dermatological injuries such as diabetic foot ulcers is a relatively novel strategy to improve the wound healing process. Hydrogels have shown more comfort for the treatment of wounds due to their smooth surface and moisture, as well as their structural affinity with tissues in comparison to hyperbaric oxygen therapy, ultrasound, and electromagnetic therapies, negative pressure wound therapy or skin grafts. Macrophages, one of the most important cells of the innate immune system, have been described as the key not only in relation to the host immune defense, but also in the progress of wound healing. Macrophage dysfunction in chronic wounds of diabetic patients leads to a perpetuating inflammatory environment and impairs tissue repair. Modulating the macrophage phenotype from pro-inflammatory (M1) to anti-inflammatory (M2) could be a strategy for helping to improve chronic wound healing. In this regard, a new paradigm is found in the development of advanced biomaterials capable of inducing in situ macrophage polarization to offer an approach to wound care. Such an approach opens a new direction for the development of multifunctional materials in regenerative medicine. This paper surveys emerging hydrogel materials and bioactive compounds being investigated to induce the immunomodulation of macrophages. We propose four potential functional biomaterials for wound healing applications based on novel biomaterial/bioactive compound combination that are expected to show synergistic beneficial outcomes for the local differentiation of macrophages (M1-M2) as a therapeutic strategy for chronic wound healing improvement.
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Affiliation(s)
- Mirna L Sánchez
- Laboratorio de Farmacología Molecular, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Bernal B1876, Argentina
- Institute of Biomaterials, Department of Materials Science and Engineering, University of Erlangen-Nuremberg, Cauerstrasse 6, 91058 Erlangen, Germany
| | - Hugo Valdez
- Laboratorio de Microbiología Celular e Inmunomecanismos, CINDEFI|Centro de Investigación y Desarrollo en Fermentaciones Industriales Facultad de Ciencias Exactas, La Plata B1900AJL, Argentina
| | - Micaela Conde
- Laboratorio de Farmacología Molecular, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Bernal B1876, Argentina
| | - Pamela Viaña-Mendieta
- Tecnologico de Monterrey, Instituto para la Investigación en Obesidad, Monterrey 64849, Mexico
| | - Aldo R Boccaccini
- Institute of Biomaterials, Department of Materials Science and Engineering, University of Erlangen-Nuremberg, Cauerstrasse 6, 91058 Erlangen, Germany
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11
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Rippon M, Rogers AA, Westgate S, Ousey K. Effectiveness of a polyhexamethylene biguanide-containing wound cleansing solution using experimental biofilm models. J Wound Care 2023; 32:359-367. [PMID: 37300862 DOI: 10.12968/jowc.2023.32.6.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Antiseptics are widely used in wound management to prevent or treat wound infections, and have been shown to have antibiofilm efficacy. The objective of this study was to assess the effectiveness of a polyhexamethylene biguanide (PHMB)-containing wound cleansing and irrigation solution on model biofilm of pathogens known to cause wound infections compared with a number of other antimicrobial wound cleansing and irrigation solutions. METHOD Staphylococcus aureus and Pseudomonas aeruginosa single-species biofilms were cultured using microtitre plate and Centers for Disease Control and Prevention (CDC) biofilm reactor methods. Following a 24-hour incubation period, the biofilms were rinsed to remove planktonic microorganisms and then challenged with wound cleansing and irrigation solutions. Following incubation of the biofilms with a variety of concentrations of the test solutions (50%, 75% or 100%) for 20, 30, 40, 50 or 60 minutes, remaining viable organisms from the treated biofilms were quantified. RESULTS The six antimicrobial wound cleansing and irrigation solutions used were all effective in eradicating Staphylococcus aureus biofilm bacteria in both test models. However, the results were more variable for the more tolerant Pseudomonas aeruginosa biofilm. Only one of the six solutions (sea salt and oxychlorite/NaOCl-containing solution) was able to eradicate Pseudomonas aeruginosa biofilm using the microtitre plate assay. Of the six solutions, three (a solution containing PHMB and poloxamer 188 surfactant, a solution containing hypochlorous acid (HOCl) and a solution containing NaOCl/HOCl) showed increasing levels of eradication of Pseudomonas aeruginosa biofilm microorganisms with increasing concentration and exposure time. Using the CDC biofilm reactor model, all six cleansing and irrigation solutions, except for the solution containing HOCl, were able to eradicate Pseudomonas aeruginosa biofilms such that no viable microorganisms were recovered. CONCLUSION This study demonstrated that a PHMB-containing wound cleansing and irrigation solution was as effective as other antimicrobial wound irrigation solutions for antibiofilm efficacy. Together with the low toxicity, good safety profile and absence of any reported acquisition of bacterial resistance to PHMB, the antibiofilm effectiveness data support the alignment of this cleansing and irrigation solution with antimicrobial stewardship (AMS) strategies.
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Affiliation(s)
- Mark Rippon
- Visiting Clinical Research Associate, Huddersfield University, Huddersfield, UK
- Medical Marketing Consultant, Daneriver Consultancy Ltd, Holmes Chapel, Cheshire, UK
| | - Alan A Rogers
- Independent Wound Care Consultant, Flintshire, North Wales, UK
| | | | - Karen Ousey
- Professor of Skin Integrity, Director for the Institute of Skin Integrity and Infection Prevention, University of Huddersfield Department of Nursing and Midwifery, Huddersfield, UK
- Adjunct Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Australia
- Visiting Professor, RCSI, Dublin, Ireland
- Chair IWII
- President Elect ISTAP
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12
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Fernández-Guarino M, Bacci S, Pérez González LA, Bermejo-Martínez M, Cecilia-Matilla A, Hernández-Bule ML. The Role of Physical Therapies in Wound Healing and Assisted Scarring. Int J Mol Sci 2023; 24:7487. [PMID: 37108650 PMCID: PMC10144139 DOI: 10.3390/ijms24087487] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Wound healing (WH) is a complex multistep process in which a failure could lead to a chronic wound (CW). CW is a major health problem and includes leg venous ulcers, diabetic foot ulcers, and pressure ulcers. CW is difficult to treat and affects vulnerable and pluripathological patients. On the other hand, excessive scarring leads to keloids and hypertrophic scars causing disfiguration and sometimes itchiness and pain. Treatment of WH includes the cleaning and careful handling of injured tissue, early treatment and prevention of infection, and promotion of healing. Treatment of underlying conditions and the use of special dressings promote healing. The patient at risk and risk areas should avoid injury as much as possible. This review aims to summarize the role of physical therapies as complementary treatments in WH and scarring. The article proposes a translational view, opening the opportunity to develop these therapies in an optimal way in clinical management, as many of them are emerging. The role of laser, photobiomodulation, photodynamic therapy, electrical stimulation, ultrasound therapy, and others are highlighted in a practical and comprehensive approach.
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Affiliation(s)
- Montserrat Fernández-Guarino
- Dermatology Service, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Stefano Bacci
- Research Unit of Histology and Embryology, Department of Biology, University of Florence, 50121 Firenze, Italy
| | - Luis Alfonso Pérez González
- Dermatology Service, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Mariano Bermejo-Martínez
- Specialist Nursing in Wound Healing, Angiology and Vascular Service, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Almudena Cecilia-Matilla
- Diabetic Foot Unit, Angiology and Vascular Service, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Maria Luisa Hernández-Bule
- Bioelectromagnetic Lab, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, 28034 Madrid, Spain
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13
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Zhang WQ, Tang W, Hu SQ, Fu XL, Wu H, Shen WQ, Chen HL. Effect of matrix metalloproteinases on the healing of diabetic foot ulcer: A systematic review. J Tissue Viability 2023; 32:51-58. [PMID: 36513539 DOI: 10.1016/j.jtv.2022.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/24/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aims to discuss the expression of matrix metalloproteinase in wound healing of diabetic foot ulcers and further summarize the strategies of targeted matrix metalloproteinase and its inhibitors in the treatment of diabetic foot ulcers. METHODS Following PRISMA-SCR guidelines, databases (PubMed, Home-PMC-NCBI, CINAHL, Web of Science) were systematically searched from inception to 19 June 2022. Newcastle-Ottawa Scale (NOS) was used to evaluate the bias risk of the included studies. RESULTS Eight studies are finally eligible for our systematic review. The combined data analysis of 8 studies showed that there were no significant difference in age(p = 0.110), duration of diabetes(p = 0.197), glycosylated hemoglobin content(p = 0.489), size(p = 0.133) and depth(p>0.05) of initial ulcer between the ulcer wound healing group and the non-healing group. MMP-1, 2, 8, 9, and TIMP-1, 2 affected the healing of DFUs. In the DFUs healing group, the concentrations of MMP (MMP-1, 2, 8, 9) decreased, and the concentration of TIMP-1 increased. CONCLUSION Our study showed that high levels of MMP-1, 2, 9 delayed the healing of diabetic foot ulcers, and high expression of MMP-8 in tissues improved wound healing. This study also summarized the effective intervention strategies for the treatment of diabetic foot ulcers.
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Affiliation(s)
| | - Wen Tang
- School of Medicine, Nantong University, Nantong, China
| | - Shi-Qi Hu
- School of Medicine, Nantong University, Nantong, China
| | - Xue-Lei Fu
- School of Medicine, Nantong University, Nantong, China
| | - Hua Wu
- School of Medicine, Nantong University, Nantong, China
| | - Wang-Qin Shen
- School of Medicine, Nantong University, Nantong, China.
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, China.
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14
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Murphy CA, Bowler PG, Chowdhury MF. 'Granulitis': defining a common, biofilm-induced, hyperinflammatory wound pathology. J Wound Care 2023; 32:22-28. [PMID: 36630113 DOI: 10.12968/jowc.2023.32.1.22] [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: 01/12/2023]
Abstract
The hard-to-heal (chronic) wound condition, now believed to be inextricably linked to the presence of microbial biofilm, has posed challenges in translating scientific understanding to clinical practice in recent decades. During this time, multiple descriptive terms of the wound pathology have been described, including critical colonisation, biofilm infection and inflammatory stasis. However, the absence of naming this disease state as a specifically identified condition that is tangible to treat has led to some confusion and delay in possible therapeutic approaches. When there is clinical uncertainty of wound status, antibiotics are too often inappropriately administered as a precaution. We therefore propose that introducing the term 'granulitis' (inflamed, unhealthy granulation tissue) could be used to identify the biofilm-induced, persistent inflammatory wound condition. This will help to raise clinician and public awareness of the condition, guide appropriate and prompt local wound hygiene, and encourage allocation of adequate resources to improve wound healing outcomes globally.
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Affiliation(s)
| | | | - M Fahad Chowdhury
- The Ottawa Hospital, Ottawa, ON, Canada.,Department of Medicine, Division of Infectious Diseases, University of Ottawa, Ottawa, ON, Canada
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15
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Novel Curcumin-Encapsulated α-Tocopherol Nanoemulsion System and Its Potential Application for Wound Healing in Diabetic Animals. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7669255. [PMID: 36158895 PMCID: PMC9499807 DOI: 10.1155/2022/7669255] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 11/17/2022]
Abstract
Objective This project was aimed at formulating a novel nanoemulsion system and evaluating it for open incision wound healing in diabetic animals. Methods The nanoemulsions were characterized for droplet size and surface charge, drug content, antioxidant and antimicrobial profiling, and wound healing potential in diabetic animals. The skin samples excised were also analyzed for histology, mechanical strength, and vibrational and thermal analysis. Results The optimized nanoemulsion (CR-NE-II) exhibited droplet size of26.76 ± 0.9 nm with negative surface charge (−10.86 ± 1.06 mV), was homogenously dispersed with drug content of68.05 ± 1.2%, released almost82.95 ± 2.2%of the drug within first 2 h of experiment with synergistic antioxidant (95 ± 2.1%) and synergistic antimicrobial activity against selected bacterial strains in comparison to blank nanoemulsion, and promoted significantly fast percent reepithelization (96.47%). The histological, vibrational, thermal, and strength analysis of selected skin samples depicted a uniform and even distribution of collagen fibers which translated into significant increase in strength of skin samples in comparison to the control group. Conclusions The optimized nanoemulsion system significantly downregulated the oxidative stress, enhanced collagen deposition, and precluded bacterial contamination of wound, thus accelerating the skin tissue regeneration process.
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16
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Wound-Healing Promotion and Anti-Inflammatory Properties of Carvacrol Prodrugs/Hyaluronic Acid Formulations. Pharmaceutics 2022; 14:pharmaceutics14071468. [PMID: 35890363 PMCID: PMC9323613 DOI: 10.3390/pharmaceutics14071468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 12/04/2022] Open
Abstract
Background. Wound healing (WH) is a complex process involving several stages, such as hemostasis, inflammation, re-epithelialization, and remodeling. Many factors can impair WH, and different pharmacological approaches were studied to date, but the increase in antibiotic resistance, invasiveness, treatment duration, and high cost, have often hampered the resolution of the wound. In this study, we investigated the possible application of water-soluble carvacrol prodrugs (WSCPs) and hyaluronic acid (HA) and their formulations (WSCPs/HA) to improve WH and regulate the inflammatory response. Materials and methods. Firstly, the cytotoxicity of 0.1, 1 and 10 µg/mL of HA, WSCPs and WSCPs/HA formulations were evaluated on HaCaT cells and THP-1 cell lines. The ability of WSCPs/HA formulations to modulate wound repair was evaluated in an in vitro model of WH, using HaCaT cells at 6, 18, and 24 h. The expression of WH mediators, after wound closure was determined by qRT-PCR. Following, we polarized THP-1 cells in M1/M2-like macrophages and tested the anti-inflammatory properties of WSCPs/HA formulations. After, we tested the in vitro WH model for the effects of conditioned medium (CM) from M1/M2-like cells cultured in the presence of WSCPs/HA. Results. Results showed that WSCPs/HA formulations were able to significantly raise the wound closure rate, compared to the single constituents, promoting a complete wound closure after 18 h for WSCP1/HA (10 µg/mL) and after 24 h for WSCP2/HA (10 µg/mL), modulating the MMPs, TGFβ, and COX-2 gene expression. The effects of CM derived from M1/M2 polarized cells cultured in the presence of WSCPs/HA determined WH regulation, with a better ability of the WSCP2/HA formulation to modulate the time-dependent expression of reparative and inflammatory mediators. Conclusion. Our data underline the possible application of WSCPs/HA formulations as bioactive agents for the regulation of the wound repair process by the modulation of inflammatory and remodeling phases, affecting the activity of immune cells.
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17
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Rajabloo Z, Farahpour MR, Saffarian P, Jafarirad S. Biofabrication of ZnO/Malachite nanocomposite and its coating with chitosan to heal infectious wounds. Sci Rep 2022; 12:11592. [PMID: 35803975 PMCID: PMC9270442 DOI: 10.1038/s41598-022-15768-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
Recently, nanocomposites produced from clays and metals coated with chitosan have shown wound healing activity. This study aimed to synthesize the zinc oxide/malachite nanocomposite (ZnO/Mlt-NC) and its coating form with chitosan (ZnO/Mlt/Chsn-NC). Physicochemical characterization of the produced nanocomposites was investigated. Biomedical effects of nanocomposites, such as in vivo and in vitro antibacterial activity, antioxidant properties, cytotoxicity, and modulation in the gene expressions of interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-10 (IL-10), and transforming growth factor-β (TGF-β) and histopathological parameters, were also investigated. Expression intensities of basic fibroblast growth factor (bFGF) and tumor necrosis factor alpha (TNF-α) were also investigated by immunofluorescence staining. To investigate biomedical effects under in vivo conditions, infected wounds were induced and inoculated with Staphylococcus aureus (ATCC 25923), and Pseudomonas aeruginosa (ATCC 27853). The results indicated spherical ZnO nanoparticles on the surface of malachite and strong antibacterial activity and antioxidant properties. The ointments produced from the nanocomposites also exhibited wound healing activity. The administration of the ointments prepared from ZnO/Mlt, and ZnO/Mlt/Chsn NCs decreased the expressions of IL-1β, IL-6, and TNF-α, while it increased the expressions of IL-10, TGF-β and bFGF. In sum, the nanocomposites produced from ZnO, malachite, and chitosan had better biological activity than ZnO/Malachite nanocomposites. We suggest applying ZnO/Mlt/Chsn nanocomposites in the structure of ointments to treat infected wounds after future clinical studies.
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Affiliation(s)
- Zahra Rajabloo
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Reza Farahpour
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Urmia Branch, Islamic Azad University, Urmia, Iran.
| | - Parvaneh Saffarian
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Saeed Jafarirad
- Department of Organic and Biochemistry, Faculty of Chemistry, University of Tabriz, Tabriz, Iran.,Research Institute of Bioscience and Biotechnology, University of Tabriz, Tabriz, Iran
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18
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Gobin M, Proust R, Lack S, Duciel L, Des Courtils C, Pauthe E, Gand A, Seyer D. A Combination of the Natural Molecules Gallic Acid and Carvacrol Eradicates P. aeruginosa and S. aureus Mature Biofilms. Int J Mol Sci 2022; 23:ijms23137118. [PMID: 35806123 PMCID: PMC9266711 DOI: 10.3390/ijms23137118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 01/18/2023] Open
Abstract
Wound infection, especially the development of bacterial biofilms, delays wound healing and is a major public health concern. Bacteria in biofilms are more tolerant to antimicrobial agents, and new treatments to eradicate mature biofilms are needed. Combining antimicrobial molecules with different mechanisms of action is an attractive strategy to tackle the heterogeneous nature of microbial communities in biofilms. This study focused on three molecules of natural origin: gallic acid (G), carvacrol (K) and curcumin (Q). Their abilities, individually or in combination, to eradicate biofilms were quantified on mono- and dual-species mature biofilms of Pseudomonas aeruginosa and Staphylococcus aureus, the strains most commonly found in infected wounds. G presented biofilm eradicating activity on P. aeruginosa, whereas K had biofilm eradicating activity on S. aureus and P. aeruginosa. Q had no potent biofilm eradicating activity. The combination of G and K increased the effects previously observed on P. aeruginosa biofilm and led to complete eradication of S. aureus biofilm. This combination was also efficient in eradicating a dual-species biofilm of S. aureus and P. aeruginosa. This work demonstrates that K and G used in combination have a strong and synergistic eradicating activity on both mono- and dual-species mature biofilms of S. aureus and P. aeruginosa and may therefore represent an efficient alternative for the treatment of biofilms in wounds.
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Affiliation(s)
- Maxime Gobin
- ERRMECe Laboratory, 1 rue Descartes, CY Cergy Paris University, 95031 Neuville sur Oise, France; (M.G.); (E.P.); (A.G.)
| | - Richard Proust
- Les Laboratoires BROTHIER, 41 Rue de Neuilly, 92735 Nanterre, France; (R.P.); (S.L.); (L.D.); (C.D.C.)
| | - Stéphane Lack
- Les Laboratoires BROTHIER, 41 Rue de Neuilly, 92735 Nanterre, France; (R.P.); (S.L.); (L.D.); (C.D.C.)
| | - Laura Duciel
- Les Laboratoires BROTHIER, 41 Rue de Neuilly, 92735 Nanterre, France; (R.P.); (S.L.); (L.D.); (C.D.C.)
| | - Céline Des Courtils
- Les Laboratoires BROTHIER, 41 Rue de Neuilly, 92735 Nanterre, France; (R.P.); (S.L.); (L.D.); (C.D.C.)
| | - Emmanuel Pauthe
- ERRMECe Laboratory, 1 rue Descartes, CY Cergy Paris University, 95031 Neuville sur Oise, France; (M.G.); (E.P.); (A.G.)
| | - Adeline Gand
- ERRMECe Laboratory, 1 rue Descartes, CY Cergy Paris University, 95031 Neuville sur Oise, France; (M.G.); (E.P.); (A.G.)
| | - Damien Seyer
- ERRMECe Laboratory, 1 rue Descartes, CY Cergy Paris University, 95031 Neuville sur Oise, France; (M.G.); (E.P.); (A.G.)
- Correspondence:
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19
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Mirhaj M, Labbaf S, Tavakoli M, Seifalian A. An Overview on the Recent Advances in the Treatment of Infected Wounds: Antibacterial Wound Dressings. Macromol Biosci 2022; 22:e2200014. [PMID: 35421269 DOI: 10.1002/mabi.202200014] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/20/2022] [Indexed: 11/11/2022]
Abstract
A wound can be surgical, cuts from an operation or due to accident and trauma. The infected wound, as a result of bacteria growth within the damaged skin, interrupts the natural wound healing process and significantly impacts the quality of life. Wound dressing is an important segment of the skincare industry with its economic burden estimated at $ 20.4 billion (in 2021) in the global market. The results of recent clinical trials suggest that the use of modern dressings can be the easiest, most accessible, and most cost-effective way to treat chronic wounds and, hence, holds significant promise. With the sheer number of dressings in the market, the selection of correct dressing is confusing for clinicians and healthcare workers. The aim of this research was to review widely used types of antibacterial wound dressings, as well as emerging products, for their efficiency and mode of action. In this review, we focus on introducing antibiotics and antibacterial nanoparticles as two important and clinically widely used categories of antibacterial agents. The perspectives and challenges for paving the way for future research in this field are also discussed. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marjan Mirhaj
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Sheyda Labbaf
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Mohamadreza Tavakoli
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Amelia Seifalian
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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20
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Hawas S, Verderosa AD, Totsika M. Combination Therapies for Biofilm Inhibition and Eradication: A Comparative Review of Laboratory and Preclinical Studies. Front Cell Infect Microbiol 2022; 12:850030. [PMID: 35281447 PMCID: PMC8915430 DOI: 10.3389/fcimb.2022.850030] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/04/2022] [Indexed: 12/26/2022] Open
Abstract
Microbial biofilms are becoming increasingly difficult to treat in the medical setting due to their intrinsic resistance to antibiotics. To combat this, several biofilm dispersal agents are currently being developed as treatments for biofilm infections. Combining biofilm dispersal agents with antibiotics is emerging as a promising strategy to simultaneously disperse and eradicate biofilms or, in some cases, even inhibit biofilm formation. Here we review studies that have investigated the anti-biofilm activity of some well-studied biofilm dispersal agents (e.g., quorum sensing inhibitors, nitric oxide/nitroxides, antimicrobial peptides/amino acids) in combination with antibiotics from various classes. This review aims to directly compare the efficacy of different combination strategies against microbial biofilms and highlight synergistic treatments that warrant further investigation. By comparing across studies that use different measures of efficacy, we can conclude that treating biofilms in vitro and, in some limited cases in vivo, with a combination of an anti-biofilm agent and an antibiotic, appears overall more effective than treating with either compound alone. The review identifies the most promising combination therapies currently under development as biofilm inhibition and eradication therapies.
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Affiliation(s)
- Sophia Hawas
- Centre for Immunology and Infection Control, Queensland University of Technology, Brisbane, QLD, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Anthony D. Verderosa
- Centre for Immunology and Infection Control, Queensland University of Technology, Brisbane, QLD, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Makrina Totsika
- Centre for Immunology and Infection Control, Queensland University of Technology, Brisbane, QLD, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- *Correspondence: Makrina Totsika,
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21
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Cheong JZA, Liu A, Rust CJ, Tran CL, Hassan SE, Kalan LR, Gibson ALF. Robbing Peter to Pay Paul: Chlorhexidine gluconate demonstrates short-term efficacy and long-term cytotoxicity. Wound Repair Regen 2022; 30:573-584. [PMID: 36638156 PMCID: PMC9542784 DOI: 10.1111/wrr.13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 01/27/2023]
Abstract
Wound cleansing agents are routine in wound care and preoperative preparation. Antiseptic activity intends to prevent contaminating microbes from establishing an infection while also raising concerns of cytotoxicity and delayed wound healing. We evaluated the cytotoxicity of five clinically used wound cleaning agents (saline, povidone iodine, Dove® and Dial® soaps, and chlorhexidine gluconate [CHG]) using both an ex vivo and in vivo human skin xenograft mouse model, in contrast to classical in vitro models that lack the structural and compositional heterogeneity of human skin. We further established an ex vivo wound contamination model inoculated with ~100 cells of Pseudomonas aeruginosa or Staphylococcus aureus to evaluate antimicrobial efficacy. Scanning electron microscopy and confocal microscopy were used to evaluate phenotypic and spatial characteristics of bacterial cells in wound tissue. CHG significantly reduced metabolic activity of the skin explants, while all treatments except saline affected local cellular viability. CHG cytotoxicity persisted and progressed over 14 days, impairing wound healing in vivo. Within the contamination model, CHG treatment resulted in a significant reduction of P. aeruginosa wound surface counts at 24 h post-treatment. However, this effect was transient and serial application of CHG had no effect on both P. aeruginosa or S. aureus microbial growth. Microscopy revealed that viable cells of P. aeruginosa reside deep within wound tissue post-CHG application, likely serving as a reservoir to re-populate the tissue to a high bioburden. We reveal concerning cytotoxicity and limited antimicrobial activity of CHG in human skin using clinically relevant models, with the ability to resolve spatial localization and temporal dynamics of tissue viability and microbial growth.
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Affiliation(s)
- J. Z. Alex Cheong
- Department of Medical Microbiology and ImmunologyUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA,Microbiology Doctoral Training ProgramUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Aiping Liu
- Department of SurgeryUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Clayton J. Rust
- Department of SurgeryUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Collin L. Tran
- Department of SurgeryUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Sameeha E. Hassan
- Department of SurgeryUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Lindsay R. Kalan
- Department of Medical Microbiology and ImmunologyUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA,Department of Medicine, Division of Infectious DiseaseUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Angela L. F. Gibson
- Department of SurgeryUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA
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22
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Raziyeva K, Kim Y, Zharkinbekov Z, Kassymbek K, Jimi S, Saparov A. Immunology of Acute and Chronic Wound Healing. Biomolecules 2021; 11:700. [PMID: 34066746 PMCID: PMC8150999 DOI: 10.3390/biom11050700] [Citation(s) in RCA: 280] [Impact Index Per Article: 93.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/14/2022] Open
Abstract
Skin wounds greatly affect the global healthcare system, creating a substantial burden on the economy and society. Moreover, the situation is exacerbated by low healing rates, which in fact are overestimated in reports. Cutaneous wounds are generally classified into acute and chronic. The immune response plays an important role during acute wound healing. The activation of immune cells and factors initiate the inflammatory process, facilitate wound cleansing and promote subsequent tissue healing. However, dysregulation of the immune system during the wound healing process leads to persistent inflammation and delayed healing, which ultimately result in chronic wounds. The microenvironment of a chronic wound is characterized by high quantities of pro-inflammatory macrophages, overexpression of inflammatory mediators such as TNF-α and IL-1β, increased activity of matrix metalloproteinases and abundance of reactive oxygen species. Moreover, chronic wounds are frequently complicated by bacterial biofilms, which perpetuate the inflammatory phase. Continuous inflammation and microbial biofilms make it very difficult for the chronic wounds to heal. In this review, we discuss the role of innate and adaptive immunity in the pathogenesis of acute and chronic wounds. Furthermore, we review the latest immunomodulatory therapeutic strategies, including modifying macrophage phenotype, regulating miRNA expression and targeting pro- and anti-inflammatory factors to improve wound healing.
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Affiliation(s)
- Kamila Raziyeva
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (K.R.); (Y.K.); (Z.Z.); (K.K.)
| | - Yevgeniy Kim
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (K.R.); (Y.K.); (Z.Z.); (K.K.)
| | - Zharylkasyn Zharkinbekov
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (K.R.); (Y.K.); (Z.Z.); (K.K.)
| | - Kuat Kassymbek
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (K.R.); (Y.K.); (Z.Z.); (K.K.)
| | - Shiro Jimi
- Central Lab for Pathology and Morphology, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan;
| | - Arman Saparov
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (K.R.); (Y.K.); (Z.Z.); (K.K.)
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23
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Research progress in nanozyme-based composite materials for fighting against bacteria and biofilms. Colloids Surf B Biointerfaces 2021; 198:111465. [DOI: 10.1016/j.colsurfb.2020.111465] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 12/23/2022]
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