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Voorde WT, Wind S, Abdisalaam I, Mancini A, Linders F, Jansen MAA, Kolk TNVD, Burggraaf J, Rissmann R. A SUCTION BLISTER MODEL TO CHARACTERIZE EPIDERMAL WOUND HEALING AND EVALUATE THE EFFICACY OF THE TOPICAL WOUND HEALING AGENT INM-755 IN HEALTHY VOLUNTEERS. Eur J Pharm Sci 2024:106867. [PMID: 39084539 DOI: 10.1016/j.ejps.2024.106867] [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: 05/13/2024] [Revised: 07/15/2024] [Accepted: 07/27/2024] [Indexed: 08/02/2024]
Abstract
Non-healing wounds represent a substantial medical burden with few effective treatments available. To address this challenge, we developed a novel epidermal wound healing model using suction blisters in healthy volunteers. This model allowed for the comprehensive assessment of wound healing dynamics and the evaluation of INM-755, a topical cream containing cannabinol, as a potential therapeutic agent. Two clinical studies were conducted: an observational study and an interventional study. In both studies, healthy volunteers underwent a suction blister procedure on their lower back, creating open epidermal wounds. Wound healing parameters were assessed using advanced imaging systems. Skin barrier function and perfusion were evaluated through trans epidermal water loss (TEWL) and dynamic optical coherence tomography (D-OCT), respectively. The observational study demonstrated the successful and reproducible Induction of blisters and the removal of epidermal sheet, enabling quantifiable measurements of wound healing parameters over time. Re-epithelialization was observed, revealing recovery of skin barrier function and perfusion. In the interventional study, differences of treatments over time were quantified using the above-described techniques. Despite differences from disease-specific blistering, our developed model provides a valuable platform for studying wound healing mechanisms and assessing novel therapeutic interventions. The sensitivity to treatment effects demonstrated in our study underscores the potential utility of this model in early-phase clinical drug development programs targeting wound healing disorders.
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Affiliation(s)
- Wouter Ten Voorde
- Centre for Human Drug Research, Leiden, the Netherlands; Leiden University Medical Centre, Leiden, the Netherlands
| | - Selinde Wind
- Centre for Human Drug Research, Leiden, the Netherlands; Leiden University Medical Centre, Leiden, the Netherlands
| | - Ismahaan Abdisalaam
- Centre for Human Drug Research, Leiden, the Netherlands; Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Feeke Linders
- Centre for Human Drug Research, Leiden, the Netherlands
| | | | | | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, the Netherlands; Leiden University Medical Centre, Leiden, the Netherlands
| | - Robert Rissmann
- Centre for Human Drug Research, Leiden, the Netherlands; Leiden University Medical Centre, Leiden, the Netherlands; Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands.
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2
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Wallblom K, Lundgren S, Saleh K, Schmidtchen A, Puthia M. Image-based non-invasive assessment of suction blister wounds for clinical safety and efficacy. Wound Repair Regen 2024; 32:343-359. [PMID: 38511666 DOI: 10.1111/wrr.13172] [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: 08/30/2023] [Revised: 02/07/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
Recognising the need for objective imaging-based technologies to assess wound healing in clinical studies, the suction blister wound model offers an easily accessible wound model that creates reproducible epidermal wounds that heal without scarring. This study provides a comprehensive methodology for implementing and evaluating photography-based imaging techniques utilising the suction blister wound model. Our method encompasses a protocol for capturing consistent, high-quality photographs and procedures for quantifying these images via a visual wound healing score and a computer-assisted colour analysis of wound exudation and wound redness. We employed this methodology on 16 suction blister wounds used as controls in a clinical phase-1 trial. Our method enabled us to discern and quantify subtle differences between individual wounds concerning healing progress, erythema and wound exudation. The wound healing score exhibited a high inter-rater agreement. There was a robust correlation between the spectrophotometer-measured erythema index and photography-based wound redness, as well as between dressing protein content and photography-based dressing yellowness. In conclusion, this study equips researchers conducting clinical wound studies with reproducible methods that may support future wound research and aid in the development of new treatments.
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Affiliation(s)
- Karl Wallblom
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Dermatology, Skane University Hospital, Lund, Sweden
| | - Sigrid Lundgren
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Dermatology, Skane University Hospital, Lund, Sweden
| | - Karim Saleh
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Dermatology, Skane University Hospital, Lund, Sweden
| | - Artur Schmidtchen
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Dermatology, Skane University Hospital, Lund, Sweden
| | - Manoj Puthia
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Lund, Sweden
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3
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Amin R, Rancan F, Hillmann K, Blume‐Peytavi U, Vogt A, Kottner J. Effects of a leave-on product on the strength of the dermoepidermal junction: An exploratory, intraindividual, randomized controlled trial in older adults with dry skin. Health Sci Rep 2024; 7:e1985. [PMID: 38505682 PMCID: PMC10949320 DOI: 10.1002/hsr2.1985] [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: 11/24/2023] [Revised: 02/08/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024] Open
Abstract
Background and Aims Skin aging is associated with dry skin and a decrease of the strength of the dermoepidermal adhesion, which increases the risk for lacerations (skin tears). Application of leave-on products improves dry skin and seems to reduce skin tear incidence. The aim of this study was to measure the effects of a humectant containing leave-on product on the strength of the dermoepidermal junction in older adult participants with dry skin. Methods A randomized controlled trial using a split body design was conducted. One forearm was randomly selected and treated with a lipophilic leave-on product containing 5% urea for 8 weeks. The other forearm was the control. The parameters stratum corneum hydration (SCH), transepidermal water loss, pH, roughness, epidermal thickness and skin stiffness were measured at the baseline, Weeks 4 and 8. At Week 8, suction blisters were created and time to blistering was measured. Blister roofs and interstitial fluid were analyzed for Interleukin-1α, 6 and 8. Results Twelve participants were included. After 8 weeks treatment, SCH was higher (median difference 11.6 AU), and the overall dry skin score (median difference -1) and median roughness (Rz difference -12.2 µm) were lower compared to the control arms. The median group difference for Interleukin-1α was -452 fg/µg total protein (TP) in the blister roofs and -2.2 fg/µg TP in the blister fluids. The median time to blister formation was 7.7 min higher compared to the control arms. Conclusion The regular application of humectant containing leave-on products improves dry skin and seems to lower inflammation and contribute to the strengthening of the dermoepidermal adhesion. This partly explains how the use of topical leave-on products helps to prevent skin tears.
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Affiliation(s)
- Ruhul Amin
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- BCSIR Laboratories DhakaBangladesh Council of Scientific and Industrial ResearchDhakaBangladesh
| | - Fiorenza Rancan
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Kathrin Hillmann
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Ulrike Blume‐Peytavi
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Annika Vogt
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Jan Kottner
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1BerlinGermany
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Lundgren S, Wallblom K, Fisher J, Erdmann S, Schmidtchen A, Saleh K. Study protocol for a phase 1, randomised, double-blind, placebo-controlled study to investigate the safety, tolerability and pharmacokinetics of ascending topical doses of TCP-25 applied to epidermal suction blister wounds in healthy male and female volunteers. BMJ Open 2023; 13:e064866. [PMID: 36813496 PMCID: PMC9950920 DOI: 10.1136/bmjopen-2022-064866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION TCP-25 gel is intended for use in treatment of wound infection and inflammation. Current local therapies for wounds have limited efficacy to prevent infections and there are no wound treatments available today that target the excessive inflammation that often hampers wound healing in both acute and chronic wounds. There is therefore a high medical need for new therapeutic alternatives. METHODS AND ANALYSIS A randomised, double-blinded, first-in-human study was designed to evaluate the safety, tolerability and potential systemic exposure of three increasing doses of the TCP-25 gel applied topically on suction blister wounds in healthy adults. The dose-escalation will be divided into three sequential dose groups with eight subjects in each group (24 patients in total). Within each dose group, the subjects will receive four wounds, with two wounds on each thigh. Each subject will receive TCP-25 on one wound per thigh and placebo on one wound per thigh in a randomised double-blinded manner, with a reverse reciprocal position on each respective thigh, to a total of five doses over 8 days. An internal safety review committee will monitor emerging safety and plasma concentration data over the course of the study and must give a favourable recommendation prior to initiating the next dose group, which will receive placebo gel or a higher concentration of TCP-25 in exactly the same manner described above. ETHICS AND DISSEMINATION The study will be performed in accordance with ethical principles consistent with the Declaration of Helsinki, ICH/GCPE6 (R2), European Union Clinical Trials Directive and applicable local regulatory requirements.This study is approved by the Swedish Medical Products Agency and the Swedish ethics committee under the registration number 2022-00527-01. The results of this study will be disseminated via publication to a peer-reviewed journal at the discretion of the Sponsor. TRIAL REGISTRATION NUMBER NCT05378997.
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Affiliation(s)
- Sigrid Lundgren
- Section for Dermatology and Venereology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Dermatology, Skåne University Hospital Lund, Lund, Sweden
| | - Karl Wallblom
- Section for Dermatology and Venereology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Dermatology, Skåne University Hospital Lund, Lund, Sweden
| | - Jane Fisher
- Section for Dermatology and Venereology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Susanne Erdmann
- Department of Dermatology, Skåne University Hospital Lund, Lund, Sweden
| | - Artur Schmidtchen
- Section for Dermatology and Venereology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Dermatology, Skåne University Hospital Lund, Lund, Sweden
- Copenhagen Wound Healing Center, Bispebjerg Hospital, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denamark
| | - Karim Saleh
- Section for Dermatology and Venereology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Dermatology, Skåne University Hospital Lund, Lund, Sweden
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5
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Ahmad N. In Vitro and In Vivo Characterization Methods for Evaluation of Modern Wound Dressings. Pharmaceutics 2022; 15:pharmaceutics15010042. [PMID: 36678671 PMCID: PMC9864730 DOI: 10.3390/pharmaceutics15010042] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/10/2022] [Accepted: 12/17/2022] [Indexed: 12/25/2022] Open
Abstract
Chronic wound management represents a major challenge in the healthcare sector owing to its delayed wound-healing process progression and huge financial burden. In this regard, wound dressings provide an appropriate platform for facilitating wound healing for several decades. However, adherent traditional wound dressings do not provide effective wound healing for highly exudating chronic wounds and need the development of newer and innovative wound dressings to facilitate accelerated wound healing. In addition, these dressings need frequent changing, resulting in more pain and discomfort. In order to overcome these issues, a wide range of affordable and innovative modern wound dressings have been developed and explored recently to accelerate and improve the wound healing process. However, a comprehensive understanding of various in vitro and in vivo characterization methods being utilized for the evaluation of different modern wound dressings is lacking. In this context, an overview of modern dressings and their complete in vitro and in vivo characterization methods for wound healing assessment is provided in this review. Herein, various emerging modern wound dressings with advantages and challenges have also been reviewed. Furthermore, different in vitro wound healing assays and in vivo wound models being utilized for the evaluation of wound healing progression and wound healing rate using wound dressings are discussed in detail. Finally, a summary of modern wound dressings with challenges and the future outlook is highlighted.
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Affiliation(s)
- Naveed Ahmad
- Department of Pharmaceutics, College of Pharmacy, Jouf University, Sakaka 72388, Aljouf, Saudi Arabia
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6
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Ågren MS, Litman T, Eriksen JO, Schjerling P, Bzorek M, Gjerdrum LMR. Gene Expression Linked to Reepithelialization of Human Skin Wounds. Int J Mol Sci 2022; 23:ijms232415746. [PMID: 36555389 PMCID: PMC9779194 DOI: 10.3390/ijms232415746] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Our understanding of the regulatory processes of reepithelialization during wound healing is incomplete. In an attempt to map the genes involved in epidermal regeneration and differentiation, we measured gene expression in formalin-fixed, paraffin-embedded standardized epidermal wounds induced by the suction-blister technique with associated nonwounded skin using NanoString technology. The transcripts of 139 selected genes involved in clotting, immune response to tissue injury, signaling pathways, cell adhesion and proliferation, extracellular matrix remodeling, zinc transport and keratinocyte differentiation were evaluated. We identified 22 upregulated differentially expressed genes (DEGs) in descending order of fold change (MMP1, MMP3, IL6, CXCL8, SERPINE1, IL1B, PTGS2, HBEGF, CXCL5, CXCL2, TIMP1, CYR61, CXCL1, MMP12, MMP9, HGF, CTGF, ITGB3, MT2A, FGF7, COL4A1 and PLAUR). The expression of the most upregulated gene, MMP1, correlated strongly with MMP3 followed by IL6 and IL1B. rhIL-1β, but not rhIL-6, exposure of cultured normal human epidermal keratinocytes and normal human dermal fibroblasts increased both MMP1 mRNA and MMP-1 protein levels, as well as TIMP1 mRNA levels. The increased TIMP1 in wounds was validated by immunohistochemistry. The six downregulated DEGs (COL7A1, MMP28, SLC39A2, FLG1, KRT10 and FLG2) were associated with epidermal maturation. KLK8 showed the strongest correlation with MKI67 mRNA levels and is a potential biomarker for keratinocyte proliferation. The observed gene expression changes correlate well with the current knowledge of physiological reepithelialization. Thus, the gene expression panel described in this paper could be used in patients with impaired healing to identify possible therapeutic targets.
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Affiliation(s)
- Magnus S. Ågren
- Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, 2400 Copenhagen, Denmark
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, 2400 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Correspondence:
| | - Thomas Litman
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jens Ole Eriksen
- Department of Pathology, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Peter Schjerling
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg-Frederiksberg, 2400 Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Michael Bzorek
- Department of Pathology, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Lise Mette Rahbek Gjerdrum
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Pathology, Zealand University Hospital, 4000 Roskilde, Denmark
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7
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Yu JR, Varrey P, Liang BJ, Huang HC, Fisher JP. Liposomal SDF-1 Alpha Delivery in Nanocomposite Hydrogels Promotes Macrophage Phenotype Changes and Skin Tissue Regeneration. ACS Biomater Sci Eng 2021; 7:5230-5241. [PMID: 34699182 DOI: 10.1021/acsbiomaterials.1c01140] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Skin regeneration in chronic wounds is often delayed due to persistent inflammation induced by underlying conditions such as diabetes. This effect is mediated, in part, by macrophages present in the wound, which can be stimulated to adopt either pro- or anti-inflammatory phenotypes depending on the status of the local microenvironment. In this work, the prohealing chemokine stromal cell-derived factor-1 alpha (SDF-1α) is controllably released from a hydrogel-based biomaterial to promote skin tissue regeneration and wound closure. This innovative nanocomposite hydrogel system releases liposomal stromal cell-derived factor-1 alpha (lipoSDF) as a new treatment approach for dorsal full-thickness skin wounds in wild-type and diabetic mice. Using this strategy, the recruitment and polarization of macrophages primarily of the anti-inflammatory phenotype were observed, along with a decreased amount of open wound surface area in diabetic mice after 28 days. This was accompanied by histological observations of increased epidermal stratification and dermal angiogenesis. These findings represent an important step of investigation distinctive in its field for developing immunomodulatory biomaterials that are able to influence macrophage phenotype and promote healing as hydrogel-based wound dressings.
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Affiliation(s)
- Justine R Yu
- Fischell Department of Bioengineering, University of Maryland, College Park, 3121 A. James Clark Hall, 8278 Paint Branch Drive, College Park, Maryland 20742, United States.,NIH/NBIB Center for Engineering Complex Tissues, University of Maryland, College Park, 3121 A. James Clark Hall, 8278 Paint Branch Drive, College Park, Maryland 20742, United States.,University of Maryland School of Medicine, Baltimore, Maryland 21201, United States
| | - Pranav Varrey
- Fischell Department of Bioengineering, University of Maryland, College Park, 3121 A. James Clark Hall, 8278 Paint Branch Drive, College Park, Maryland 20742, United States
| | - Barry J Liang
- Fischell Department of Bioengineering, University of Maryland, College Park, 3121 A. James Clark Hall, 8278 Paint Branch Drive, College Park, Maryland 20742, United States.,NIH/NCI, Laboratory of Cell Biology, Center for Cancer Research, Bethesda, Maryland 20892, United States
| | - Huang-Chiao Huang
- Fischell Department of Bioengineering, University of Maryland, College Park, 3121 A. James Clark Hall, 8278 Paint Branch Drive, College Park, Maryland 20742, United States.,Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland 21201, United States
| | - John P Fisher
- Fischell Department of Bioengineering, University of Maryland, College Park, 3121 A. James Clark Hall, 8278 Paint Branch Drive, College Park, Maryland 20742, United States.,NIH/NBIB Center for Engineering Complex Tissues, University of Maryland, College Park, 3121 A. James Clark Hall, 8278 Paint Branch Drive, College Park, Maryland 20742, United States
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8
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El Genedy-Kalyoncu M, Richter C, Surber C, Blume-Peytavi U, Kottner J. The effect of a basic skin care product on the structural strength of the dermo-epidermal junction: An exploratory, randomised, controlled split-body trial. Int Wound J 2021; 19:426-435. [PMID: 34121334 PMCID: PMC8762572 DOI: 10.1111/iwj.13643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/17/2022] Open
Abstract
Skin ageing is associated with various structural alterations including a decreased strength of the dermo‐epidermal adhesion increasing the risk for shear type injuries (skin tears). Topical applications of basic skin care products seem to reduce skin tear incidence. The suction blister method leads to the artificial and controlled separation of dermis and epidermis. Therefore, time to blister formation may be used as outcome measuring the strength of dermo‐epidermal adhesion. We conducted an exploratory, randomised, controlled trial with a split‐body design on forearms in healthy female subjects (n = 12; mean age 70.3 [SD 2.1] years). Forearms assigned to the intervention were treated twice daily with petrolatum for 8 weeks. Suction blisters were induced on forearms after 4 and 8 weeks and time to blister formation was measured. Stratum corneum and epidermal hydration were measured and epidermal thickness was assessed via optical coherence tomography. Time to blistering was longer and stratum corneum as well as epidermal hydration was consistently higher in intervention skin areas. We conclude that topical application of basic skin care products may improve mechanical adhesion of the dermo‐epidermal junction and that the parameter “time to blistering” is a suitable outcome to measure dermo‐epidermal adhesion strength in clinical research.
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Affiliation(s)
- Monira El Genedy-Kalyoncu
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Richter
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Surber
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Ulrike Blume-Peytavi
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Kottner
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Charité Center for Health and Human Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
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9
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Lim Y, Lee H, Woodby B, Valacchi G. Ozonated Oils and Cutaneous Wound Healing. Curr Pharm Des 2020; 25:2264-2278. [PMID: 31267858 DOI: 10.2174/1381612825666190702100504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022]
Abstract
Wound tissue repair is a complex and dynamic process of restoring cellular structures and tissue layers. Improvement in this process is necessary to effectively treat several pathologies characterized by a chronic delayed wound closure, such as in diabetes, and the investigation of new approaches aimed to ameliorate the wound healing process is under continuous evolution. Recently, the usage of vegetable matrices in the form of ozonated oils has been proposed, and several researchers have shown positive effects on wound healing, due to the bactericidal, antiviral, and antifungal properties of these ozonated oils. In the present review, we intend to summarize the actual state of the art of the topical usage of ozonated oil in cutaneous wounds with special emphasis to the importance of the ozonated degree of the oil.
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Affiliation(s)
- Yunsook Lim
- Department of Food and Nutrition, Kyung Hee University, Seoul 02447, Korea
| | - Heaji Lee
- Department of Food and Nutrition, Kyung Hee University, Seoul 02447, Korea
| | - Brittany Woodby
- Plant for Human Health Institute, Kannapolis Research Center, North Carolina State University, 28081, NC, United States
| | - Giuseppe Valacchi
- Department of Food and Nutrition, Kyung Hee University, Seoul 02447, Korea.,Plant for Human Health Institute, Kannapolis Research Center, North Carolina State University, 28081, NC, United States.,Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara 44121, Italy
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10
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Rakita A, Nikolić N, Mildner M, Matiasek J, Elbe-Bürger A. Re-epithelialization and immune cell behaviour in an ex vivo human skin model. Sci Rep 2020; 10:1. [PMID: 31913322 PMCID: PMC6959339 DOI: 10.1038/s41598-019-56847-4] [Citation(s) in RCA: 5158] [Impact Index Per Article: 1289.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/10/2019] [Indexed: 02/06/2023] Open
Abstract
A large body of literature is available on wound healing in humans. Nonetheless, a standardized ex vivo wound model without disruption of the dermal compartment has not been put forward with compelling justification. Here, we present a novel wound model based on application of negative pressure and its effects for epidermal regeneration and immune cell behaviour. Importantly, the basement membrane remained intact after blister roof removal and keratinocytes were absent in the wounded area. Upon six days of culture, the wound was covered with one to three-cell thick K14+Ki67+ keratinocyte layers, indicating that proliferation and migration were involved in wound closure. After eight to twelve days, a multi-layered epidermis was formed expressing epidermal differentiation markers (K10, filaggrin, DSG-1, CDSN). Investigations about immune cell-specific manners revealed more T cells in the blister roof epidermis compared to normal epidermis. We identified several cell populations in blister roof epidermis and suction blister fluid that are absent in normal epidermis which correlated with their decrease in the dermis, indicating a dermal efflux upon negative pressure. Together, our model recapitulates the main features of epithelial wound regeneration, and can be applied for testing wound healing therapies and investigating underlying mechanisms.
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Affiliation(s)
- Ana Rakita
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Nenad Nikolić
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Michael Mildner
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Johannes Matiasek
- Department of Plastic, Aesthetic and Reconstructive Surgery, St. Josef Hospital, Vienna, Austria
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11
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Akdeniz M, Gabriel S, Lichterfeld-Kottner A, Blume-Peytavi U, Kottner J. Transepidermal water loss in healthy adults: a systematic review and meta-analysis update. Br J Dermatol 2018; 179:1049-1055. [DOI: 10.1111/bjd.17025] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2018] [Indexed: 12/12/2022]
Affiliation(s)
- M. Akdeniz
- Charité-Universitätsmedizin Berlin; Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany
| | - S. Gabriel
- Charité-Universitätsmedizin Berlin; Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany
| | - A. Lichterfeld-Kottner
- Charité-Universitätsmedizin Berlin; Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany
| | - U. Blume-Peytavi
- Charité-Universitätsmedizin Berlin; Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany
| | - J. Kottner
- Charité-Universitätsmedizin Berlin; Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany
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12
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Larsen HF, Ahlström MG, Gjerdrum LMR, Mogensen M, Ghathian K, Calum H, Sørensen AL, Forman JL, Vandeven M, Holerca MN, Du-Thumm L, Jorgensen LN, Ågren MS. Noninvasive measurement of reepithelialization and microvascularity of suction-blister wounds with benchmarking to histology. Wound Repair Regen 2018; 25:984-993. [DOI: 10.1111/wrr.12605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 11/13/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Heidi F. Larsen
- Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Malin G. Ahlström
- Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | | | - Mette Mogensen
- Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Khaled Ghathian
- Department of Clinical Microbiology, Hvidovre Hospital; University of Copenhagen; Copenhagen Denmark
| | - Henrik Calum
- Department of Clinical Microbiology, Hvidovre Hospital; University of Copenhagen; Copenhagen Denmark
| | - Anne L. Sørensen
- Section of Biostatistics, Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Julie L. Forman
- Section of Biostatistics, Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | | | | | | | - Lars N. Jorgensen
- Digestive Disease Center, Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Magnus S. Ågren
- Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
- Digestive Disease Center, Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
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13
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Zou Y, Maibach HI. Dermal-epidermal separation methods: research implications. Arch Dermatol Res 2017; 310:1-9. [PMID: 28936624 DOI: 10.1007/s00403-017-1774-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 08/01/2017] [Accepted: 08/25/2017] [Indexed: 12/01/2022]
Abstract
Dermal-epidermal separation is an important basic investigation technique for pharmacology, toxicology and biology. To choose the optimal method for a given research need, we reviewed studies on epidermal separation. PubMed, Embase, and Web of Science were utilized. Different separation systems have been compared, including chemical, enzyme, heat and mechanical separation; each has advantages and disadvantages. Heat is simple but causes thermal damage. Chemical reagents are effective but disturb cellular electrolyte equilibrium. Enzymes provide complete separation, but destroy important components. Mechanical division does not alter physical and/or chemical integrity, but necessitates a relatively large sample and may cause cross-contamination of layers. Thus, the appropriate method should be chosen for a given research question, and no single method appears superior for all purposes.
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Affiliation(s)
- Ying Zou
- Skin and Cosmetic Research Department, Shanghai Skin Disease Hospital, 1278 Baode Road, Shanghai, 200443, People's Republic of China
- Department of Dermatology, School of Medicine, University of California San Francisco, San Francisco, 94143-0989, USA
| | - Howard I Maibach
- Department of Dermatology, School of Medicine, University of California San Francisco, San Francisco, 94143-0989, USA.
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14
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Ahlström M, Gjerdrum L, Larsen H, Fuchs C, Sørensen A, Forman J, Ågren M, Mogensen M. Suction blister lesions and epithelialization monitored by optical coherence tomography. Skin Res Technol 2017; 24:65-72. [DOI: 10.1111/srt.12391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2017] [Indexed: 12/17/2022]
Affiliation(s)
- M.G. Ahlström
- Department of Dermatology and Copenhagen Wound Healing Center; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - L.M.R. Gjerdrum
- Department of Pathology; Zealand University Hospital; Roskilde Denmark
| | - H.F. Larsen
- Department of Dermatology and Copenhagen Wound Healing Center; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - C. Fuchs
- Department of Dermatology and Copenhagen Wound Healing Center; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - A.L. Sørensen
- Section of Biostatistics; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - J.L. Forman
- Section of Biostatistics; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - M.S. Ågren
- Department of Dermatology and Copenhagen Wound Healing Center; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
- Digestive Disease Center; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - M. Mogensen
- Department of Dermatology and Copenhagen Wound Healing Center; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
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15
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Schmitt L, Amann PM, Marquardt Y, Heise R, Czaja K, Gerber PA, Steiner T, Hölzle F, Baron JM. Molecular effects of fractional ablative erbium:YAG laser treatment with multiple stacked pulses on standardized human three-dimensional organotypic skin models. Lasers Med Sci 2017; 32:805-814. [PMID: 28299490 DOI: 10.1007/s10103-017-2175-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 02/20/2017] [Indexed: 11/25/2022]
Abstract
The molecular changes in gene expression following ablative laser treatment of skin lesions, such as atrophic scars and UV-damaged skin, are not completely understood. A standardized in vitro model of human skin, to study the effects of laser treatment on human skin, has been recently developed. Therefore, the aim of the investigation was to examine morphological and molecular changes caused by fractional ablative erbium:YAG laser treatment on an in vitro full-thickness 3D standardized organotypic model of human skin. A fractional ablative erbium:YAG laser was used to irradiate organotypic human 3D models. Laser treatments were performed at four different settings using a variety of stacked pulses with similar cumulative total energy fluence (60 J/cm2). Specimens were harvested at specified time points and real-time PCR (qRT-PCR) and microarray studies were performed. Frozen sections were examined histologically. Three days after erbium:YAG laser treatment, a significantly increased mRNA expression of matrix metalloproteinases and their inhibitors (MMP1, MMP2, MMP3, TIMP1, and TIMP2), chemokines (CXCL1, CXCL2, CXCL5, and CXCL6), and cytokines such as IL6, IL8, and IL24 could be detected. qRT-PCR studies confirmed the enhanced mRNA expression of IL6, IL8, IL24, CXCLs, and MMPs. In contrast, the mRNA expression of epidermal differentiation markers, such as keratin-associated protein 4, filaggrin, filaggrin 2, and loricrin, and antimicrobial peptides (S100A7A, S100A9, and S100A12) as well as CASP14, DSG2, IL18, and IL36β was reduced. Four different settings with similar cumulative doses have been tested (N10%, C10%, E10%, and W25%). These laser treatments resulted in different morphological changes and effects on gene regulations. Longer pulse durations (1000 μs) especially had the strongest impact on gene expression and resulted in an upregulation of genes, such as collagen-1A2, collagen-5A2, and collagen-6A2, as well as FGF2. Histologically, all treatment settings resulted in a complete regeneration of the epidermis 3 days after irradiation. Fractional ablative erbium:YAG laser treatment with a pulse stacking technique resulted in histological alterations and shifts in the expression of various genes related to epidermal differentiation, inflammation, and dermal remodeling depending on the treatment setting applied. A standardized in vitro 3D model of human skin proved to be a useful tool for exploring the effects of various laser settings both on skin morphology and gene expression during wound healing. It provides novel data on the gene expression and microscopic architecture of the exposed skin. This may enhance our understanding of laser treatment at a molecular level.
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Affiliation(s)
- Laurenz Schmitt
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - P M Amann
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Y Marquardt
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - R Heise
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - K Czaja
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - P A Gerber
- Department of Dermatology and Allergology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - T Steiner
- Department of Oral and Maxillofacial Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Interdisciplinary Center for Laser Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - F Hölzle
- Department of Oral and Maxillofacial Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Interdisciplinary Center for Laser Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Jens Malte Baron
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
- Interdisciplinary Center for Laser Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.
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16
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Wilhelm KP, Wilhelm D, Bielfeldt S. Models of wound healing: an emphasis on clinical studies. Skin Res Technol 2016; 23:3-12. [PMID: 27503009 DOI: 10.1111/srt.12317] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The healing of wounds has always provided challenges for the medical community whether chronic or acute. Understanding the processes which enable wounds to heal is primarily carried out by the use of models, in vitro, animal and human. It is generally accepted that the use of human models offers the best opportunity to understand the factors that influence wound healing as well as to evaluate efficacy of treatments applied to wounds. OBJECTIVES The objective of this article is to provide an overview of the different methodologies that are currently used to experimentally induce wounds of various depths in human volunteers and examines the information that may be gained from them. METHODS There is a number of human volunteer healing models available varying in their invasiveness to reflect the different possible depth levels of wounds. RESULTS Currently available wound healing models include sequential tape stripping, suction blister, abrasion, laser, dermatome, and biopsy techniques. The various techniques can be utilized to induce wounds of variable depth, from removing solely the stratum corneum barrier, the epidermis to even split-thickness or full thickness wounds. CONCLUSION Depending on the study objective, a number of models exist to study wound healing in humans. These models provide efficient and reliable results to evaluate treatment modalities.
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Affiliation(s)
- K-P Wilhelm
- proDERM Institute for Applied Dermatological Research, Schenefeld/Hamburg, Germany.,Lübeck University, Lübeck, Germany
| | - D Wilhelm
- proDERM Institute for Applied Dermatological Research, Schenefeld/Hamburg, Germany
| | - S Bielfeldt
- proDERM Institute for Applied Dermatological Research, Schenefeld/Hamburg, Germany
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17
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Schweiger D, Schoelermann AM, Filbry A, Hamann T, Moser C, Rippke F. Highly efficient and compatible shampoo for use after hair transplant. Clin Cosmet Investig Dermatol 2015; 8:355-60. [PMID: 26229498 PMCID: PMC4517519 DOI: 10.2147/ccid.s86015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Sensitive or hyperreactive skin is a common condition defined by prickling, burning, pain, and pruritus. Although this skin problem was initially described on the face, the scalp is often affected. A sensitive scalp can react with irritation to harsh surfactants or other additives which are often present in shampoos. For this reason, we developed a new rinse-off hypertolerant shampoo specifically designed for the hypersensitive and problematic scalp. Methods The shampoo formulation is based on an extremely mild surfactant system and contains bisabolol, an anti-irritant and anti-inflammatory ingredient of chamomile. The shampoo is free of additives such as perfumes, silicones, colorants, parabens, paraffins, and betaine. Since skin can remain in a hyperreactive state after wounding, the status after hair transplantation was chosen as a model system to test the shampoo. Scalp condition and compatibility of each volunteer were analyzed by a plastic surgeon directly after hair transplant and after stitch removal. The plastic surgeons also rated whether they would recommend the further use of the test shampoo. Additionally, volunteers completed a self-assessment questionnaire. Results Following hair transplantation, regular use of the shampoo resulted in a significant reduction in the extent of scabbing and erythema. This was confirmed by dermatological scalp examinations performed by the plastic surgeon as well as in volunteers’ self-assessments. The plastic surgeon highly recommended the further use of the test shampoo after hair transplant to all study participants. Conclusion Application of the test shampoo demonstrated excellent skin compatibility and product efficacy after hair transplant. The test shampoo significantly reduced the extent of scabs and erythema. Therefore, the shampoo is ideally suited for use after hair transplantation and for the treatment of sensitive scalp. The excellent skin compatibility is because of the mild surfactant system, the calming ingredient bisabolol, and the absence of potentially irritating ingredients.
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Affiliation(s)
| | | | | | - Tina Hamann
- Research and Development, Beiersdorf AG, Hamburg, Germany
| | - Claudia Moser
- Moser Medical, Clinics for Aesthetic Plastic Surgery, Vienna, Austria
| | - Frank Rippke
- Research and Development, Beiersdorf AG, Hamburg, Germany
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18
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Marquardt Y, Amann PM, Heise R, Czaja K, Steiner T, Merk HF, Skazik‐Voogt C, Baron JM. Characterization of a novel standardized human three‐dimensional skin wound healing model using non‐sequential fractional ultrapulsed CO
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laser treatments. Lasers Surg Med 2015; 47:257-65. [DOI: 10.1002/lsm.22341] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Yvonne Marquardt
- Department of Dermatology and AllergologyRWTH Aachen UniversityAachenGermany
| | - Philipp M. Amann
- Department of Dermatology and AllergologyRWTH Aachen UniversityAachenGermany
| | - Ruth Heise
- Department of Dermatology and AllergologyRWTH Aachen UniversityAachenGermany
| | - Katharina Czaja
- Department of Dermatology and AllergologyRWTH Aachen UniversityAachenGermany
| | - Timm Steiner
- Department of Oral and Maxillofacial SurgeryMedical FacultyRWTH Aachen UniversityAachenGermany
| | - Hans F. Merk
- Department of Dermatology and AllergologyRWTH Aachen UniversityAachenGermany
| | | | - Jens M. Baron
- Department of Dermatology and AllergologyRWTH Aachen UniversityAachenGermany
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19
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Hatje LK, Richter C, Blume-Peytavi U, Kottner J. Blistering time as a parameter for the strength of dermoepidermal adhesion: a systematic review and meta-analysis. Br J Dermatol 2014; 172:323-30. [PMID: 25065915 DOI: 10.1111/bjd.13298] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2014] [Indexed: 01/02/2023]
Abstract
Skin ageing is associated with a flattening of the dermoepidermal junction and a less effective anchoring system, predisposing to bulla formation, trauma and shear-type injuries. An artificial and controlled technique for standardized dermoepidermal separation is the suction blister method, whereby the strength of dermoepidermal adhesion is characterized by blistering time. To identify and quantify influencing factors on blistering time in healthy humans. A search in the Medline and Embase databases (1946 to June 2014) and in reference lists was conducted. In total, results of 146 suction blister experiments in 3418 individuals reported in 59 publications were analysed. The median blister diameter was 6 mm (IQR 5-6) and the median suction pressure was -210 mmHg (IQR -200 to -300), resulting in a median blistering time of 75 min (IQR 48-120). In the multivariate model, skin temperature and age were the strongest predictors for suction blistering time (P < 0·001, R(2) adjusted = 0·707). This strong association between temperature and suction blistering indicates that the dermoepidermal junction loses its strength with increasing skin temperature. This finding supports the practice of skin and tissue cooling to prevent injuries. The increased vulnerability of the skin seems to exist irrespectively of applied mechanical loads. We conclude that blistering time is an important and clinically relevant (outcome) parameter measuring the structural and mechanical integrity of deeper cutaneous layers.
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Affiliation(s)
- L K Hatje
- Charité-Universitätsmedizin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, 10117, Berlin, Germany
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Sonnad SS, Goldsack JC, Mohr P, Tunis S. Methodological recommendations for comparative research on the treatment of chronic wounds. J Wound Care 2013; 22:470-80. [PMID: 24005781 DOI: 10.12968/jowc.2013.22.9.470] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To provide specific recommendations to product developers and clinical researchers on the design of comparative effectiveness studies for the treatment of chronic wounds, specifically those pertaining to arterial and venous-disease related ulcers, diabetic foot ulcers, pressure ulcers and burn wounds. METHOD The recommendations were developed based on a process defined by the Center for Medical Technology Policy (CMTP). After selecting the subject area, semi-structured phone interviews were conducted by one of the authors (SSS) with representatives of payers, manufacturers, clinicians, clinician/researchers and patient advocates. Next, a broad range of stakeholders participated in a meeting convened by CMTP to determine their needs. A technical working group comprising key stakeholders then participated in clarifying recommendations developed by CMTP staff and adding important considerations for their implementation. The resulting draft document was finalised based on public and solicited comment from individual manufacturers; a consortium of product developers and manufacturers; and an alliance of physicians, providers, manufacturers and patient organisations. This article is a summary of the full effectiveness guidance document. RESULTS To address the needs of patients, clinicians, guideline developers, payers and other post-regulatory decision makers, this work makes ten recommendations to guide comparative effectiveness research for chronic wound care. These recommendations fall into four categories: study design, population, comparators and outcomes. CONCLUSION This paper suggests that using the recommendations outlined to conduct comparative effectiveness research on treatments for chronic wound therapies would facilitate trials that provide patients, clinicians, and payers with the information they need to make optimal treatment decisions. These recommendations focus on design changes that would have the largest impact in improving the usability of the results by decision makers and provide specific guidance on the design of prospective studies intended to inform decision making by patients, clinicians and payers. DECLARATION OF INTEREST There were no external sources of funding for these recommendations. The Value Institute and the Center for Medical Technology Policy (CMTP) are both private, non-profit organisations. The authors have no financial, commercial or social conflicts of interest to declare with respect to the article or its content.
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Affiliation(s)
- S S Sonnad
- The Value Institute, Christiana Care Health System, Newark, Delaware, USA
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