Wound healing: a new approach to the topical wound care

Antimicrobial hybrid coatings: A review on applications of nano ZnO based materials for biomedical applications

The extreme survivability of infectious microorganisms on various surfaces prompts for the risk of disease transmissions, posing a perilous concern for global health. Thus, the treatment of these pathogenic microorganisms using the nanomaterials functionalized with antimicrobial coatings reaps relevant scope in the ongoing trend of research. Driven by their admirable biocompatibility, cost-effectiveness, and minimal toxicity, ZnO nanoparticles (ZnO-NPs) based antimicrobial hybrid coatings have emerged as a robust material to prevent the growth of infectious microorganisms on various surfaces, which in turn boosted their applications in the area of biomedical sciences. In this context, the current review focuses on the synthesis of ZnO-NPs based hybrid coatings using different polymers and inorganic materials for effective utilization in biomedical domains including dentistry, orthopedics, implantable medical devices and wound healing. The synergistic effect of ZnO-NPs hybrids with remarkable antibacterial, antifungal and antiviral property has been discussed. Finally, we highlight the future potential of ZnO-NPs based antimicrobial hybrid coatings for potential clinical translation.

Amelioration of full-thickness cutaneous wound healing using stem cell exosome and zinc oxide nanoparticles in rats

Background

Wound healing is a complex procedure that requires the coordination of several factors, so this study aimed to assess the zinc oxide nanoparticles' regenerated effect and stem cell exosomes on full-thickness wounds in rats.

Methods

Seventy-two Wistar male rats were subjected to a full-thickness skin defect (20 mm2) on the dorsal surface of each rat between two shoulder joints. The rats were randomized into four groups (18/group) according to wound treatments. The wounds were irrigated with normal saline (Control group), or the wound's edges were subcutaneously injected daily with 0.3 ml of exosome (Exo-group), or 1 ml of zinc oxide nanoparticles (ZnO2-NPs group), or 0.3 ml of exosome in combined with 1 ml of zinc oxide nanoparticles (Exo/ZnO2-NPs group). On the 7th, 14th, and 21st days post-wounding, the weight of the rats, the wound healing breaking strength, the wound size, and the contraction percent were evaluated. Six rats in each group were euthanized at each time point for histopathological, immunohistochemical examination of collagen, the levels of alpha-smooth muscle actin (α-SMA), and epidermal growth factor receptor (EGFR). additionally, the gene expression analysis of the relative renal nuclear factor erythroid 2-related factor2 (Nrf2 mRNA), Transforming growth factor beta-1 (TGFβ1), fibroblast growth factor-7 (FGF7), Transforming growth factor beta-1 (TGFβ1), Lysyl oxidase (LOX), and Vascular endothelial growth factor (VEGF) were applied.

Results

The Exo-group exhibited a significant decrease in wound size and a significant increase in wound contraction compared with other groups. Histopathologically evaluation during the three intervals revealed that the Exo-group had the highest collagen deposition area with a significant reduction of the granulation tissue. Moreover, upregulated gene expression profiles of the growth factors genes at all time points post-wounding.

Discussion

The exosomes-treated group revealed superior wound healing and contraction, with minimal inflammatory signs, higher angiogenesis, and myofibroblasts, and associated with higher growth factor expression genes compared to the other groups.

Conclusions

Exosome-based therapy demonstrates potential as a treatment method to promote and accelerate wound healing by modulating angiogenesis, re-epithelialization, collagen deposition, and gene expression profiles.

Potential of nanoemulsions for accelerated wound healing: innovative strategies

Wounds represent various significant health concerns for patients and also contribute major costs to healthcare systems. Wound healing comprises of overlapped and various coordinated steps such as homeostasis, inflammation, proliferation, and remodeling. In response to the failure of many strategies in delivering intended results including wound closure, fluid loss control, and exhibiting properties such as durability, targeted delivery, accelerated action, along with histocompatibility, numerous nanotechnological advances have been introduced. To understand the magnitude of wound therapy, this systematic and updated review discussing the effectiveness of nanoemulsions has been undertaken. This review portrays mechanisms associated with wound healing, factors for delayed wound healing, and various technologies utilized to treat wounds effectively. While many strategies are available, nanoemulsions have attracted the tremendous attention of scientists globally for the research in wound therapy due to their long-term thermodynamic stability and bioavailability. Nanoemulsions not only aid in tissue repair, but are also considered as an excellent delivery system for various synthetic and natural actives. Nanotechnology provides several pivotal benefits in wound healing, including improved skin permeation, controlled release, and stimulation of fibroblast cell proliferation. The significant role of nanoemulsions in improved wound healing along with their preparation techniques has also been highlighted with special emphasis on mechanistic insights. This article illustrates recent research advancements for the utilization of nanoemulsions in wound treatment. An adequate literature search has been conducted using the keywords 'Nanoemulsions in wound healing', 'Wound therapy and nanoemulsions', 'Herbal actives in wound therapy', 'Natural oils and wounds treatment' etc., from PubMed, Science Direct, and Google Scholar databases. Referred and original publications in the English language accessed till April 2022 has been included, whereas nonEnglish language papers, unpublished data, and nonoriginal papers were excluded from the study.

Jellyfishes—Significant Marine Resources with Potential in the Wound-Healing Process: A Review

The wound-healing process is a significant area of interest in the medical field, and it is influenced by both external and patient-specific factors. The aim of this review paper is to highlight the proven wound-healing potential of the biocompounds found in jellyfish (such as polysaccharide compounds, collagen, collagen peptides and amino acids). There are aspects of the wound-healing process that can benefit from polysaccharides (JSPs) and collagen-based materials, as these materials have been shown to limit exposure to bacteria and promote tissue regeneration. A second demonstrated benefit of jellyfish-derived biocompounds is their immunostimulatory effects on growth factors such as (TNF-α), (IFN-γ) and (TGF), which are involved in wound healing. A third benefit of collagens and polysaccharides (JSP) is their antioxidant action. Aspects related to chronic wound care are specifically addressed, and within this general theme, molecular pathways related to tissue regeneration are explored in depth. Only distinct varieties of jellyfish that are specifically enriched in the biocompounds involved in these pathways and live in European marine habitats are presented. The advantages of jellyfish collagens over mammalian collagens are highlighted by the fact that jellyfish collagens are not considered transmitters of diseases (spongiform encephalopathy) or various allergic reactions. Jellyfish collagen extracts stimulate an immune response in vivo without inducing allergic complications. More studies are needed to explore more varieties of jellyfish that can be exploited for their biocomponents, which may be useful in wound healing.

The gain in keratinized gingiva using apically positioned flap during implant placement with and without ridge augmentation: A comparative prospective study

OBJECTIVES

To evaluate whether ridge augmentation (RA) affects the gain in keratinized gingiva (KG) in implant surgery using a full-thickness apically positioned flap (fAPF).

MATERIAL AND METHODS

We conducted a prospective study from April 2017 to April 2019 recording patient- and implant-related factors. The subjects underwent fAPF during implant placement and were divided two groups: Group A, one-stage surgical protocol without RA; Group B, two-stage surgical protocol with RA. The initial width of KG and the width of KG at 1 week, 3 weeks, 3 months, and 6 months after surgery and baseline were measured using a paper ruler. Multivariable generalized estimating equation (GEE) models were estimated to evaluate RA effects on the gain in KG, the shrinkage amount of KG, and shrinkage ratio of KG after fAPF.

RESULTS

Seventy-nine participants with 203 implants were included. The baseline values of KG were 1.68 mm in Group A and 0.82 mm in Group B (p < 0.001). The results of the multivariable GEE demonstrated that the gain in KG, the shrinkage amount of KG, and the shrinkage ratio of KG showed no significant difference in groups (p > 0.05). The gain in KG was 1.92 ± 1.67 mm in Group A, 1.48 ± 1.36 mm in Group B. The total shrinkage amount and the shrinkage ratio of KG were 1.87 mm and 42.43%, respectively.

CONCLUSIONS

A fAPF is a reliable technique that enables significant increase in KG regardless of RA in implant surgery.

Knockout of E2F1 enhances the polarization of M2 phenotype macrophages to accelerate the wound healing process

Wound healing is a complex process, which is classically divided into inflammation, proliferation, and remodeling phases. Macrophages play a key role in wound healing, however, whether E2F1 mediates the M1/M2 polarization during the wound healing process is not known. Skin wounds were surgically induced in E2F1^-/- mice and their WT littermates. At day 2 and day 7 post-surgery, the wounded skin tissues including 2 to 3 mm normal skin were obtained. The wounded skin tissues were used for the analyses of immunofluorescence staining (CD68, iNOS, CD206), western blotting (CD68, iNOS, CD206, PPAR-γ) and Co-immunoprecipitation (E2F1-PPAR-γ interactions). E2F1^-/- mice exhibited faster wound healing process. At day 2, the M2 macrophages were remarkably increased in the E2F1^-/- mice. Surprisingly, in the border zone of the wound, E2F1^-/- mice had also more M2 macrophages and fewer M1 macrophages at day 7 post-surgery, suggesting a certain degree of polarization amongst the M1 and M2 phenotypes. Co-IP revealed that E2F1 indeed interacted with PPAR-γ, meanwhile western blotting and RT-PCR showed higher expression of PPAR-γ in the E2F1^-/- mice as compared to that in the WT mice. Therefore, the findings suggest that wound healing process could be accelerated with enhanced M2 polarization through increased PPAR-γ expression in E2F1 knockout mice.

Exosomal miR-135a derived from human amnion mesenchymal stem cells promotes cutaneous wound healing in rats and fibroblast migration by directly inhibiting LATS2 expression

Background

Wound healing is a complex pathophysiological process that involves a variety of cells and cytokines. In this study, we found that local injection of human amnion mesenchymal stem cells into wounds in rats could promote wound healing. Therefore, we hypothesized that the exosomes of human amnion mesenchymal stem cells contain substances that regulate the migration of epidermal cells. It has been reported that miR-135a is involved in cell migration and transformation. However, there have been no reports of its function in skin wound healing.

Methods

To test this hypothesis, we injected exosomes overexpressing miR-135a directly into the wound margin. In addition, we tested the migration of BJ cells with overexpression or knockdown of miR-135a in vitro. Additionally, Western blot analysis was used to detect the expression of fibroblast migration-associated proteins after treatment with miR-135a overexpression or knockdown.

Results

MiR-135a significantly promoted wound healing compared to the control treatment. Western blot analysis showed a significant downregulation of LATS2 after overexpression of miR-135a. In addition, knockdown of miR-135a effectively attenuated the promoting effect of exosomes on cell migration.

Conclusions

Our results indicated that miR-135a promotes wound healing, which may be mediated by downregulating LATS2 levels to increase cell migration. This study provides a rationale for the therapeutic effect on wound healing of miR-135a in exosomes derived from human amnion mesenchymal stem cells.

Variation in Expression of Inflammation-Related Signaling Molecules with Profibrotic and Antifibrotic Effects in Cutaneous and Oral Mucosa Scars

Wound healing is a complex biologic process evolving in three phases: inflammation, proliferation, and tissue remodeling controlled by numerous growth factors and cytokines. Oral mucosa wounds heal with significantly less important scars with less numerous macrophages and mast cells and more numerous myofibroblasts than cutaneous counterparts. We analyzed 32 cutaneous and 32 oral mucosa scars for TGFbeta1, TGFbeta2, TGFbeta3, TNFalpha, PDGF BB and FGF1 expression in mesenchymal cells, endothelial cells, macrophages, and multinucleated giant cells. We identified differences in the expression of profibrotic and antifibrotic factors in oral mucosa and skin scars; TGFbeta2 was positive in cutaneous multinucleated giant cells, TNFalpha was positive in cutaneous macrophages, and both were negative in oral mucosa while TGFbeta3 was positive in oral macrophages and mostly negative in cutaneous ones. PDGF BB and FGF1 were positive in oral endothelial cells and oral macrophages and negative in macrophages with opposite positivity pattern in cutaneous scars. Based on these findings, macrophage seems to be the key player in modulating pro- and antifibrotic processes in wound regeneration.

Wound Healing Problems in the Mouth

Wound healing is a primary survival mechanism that is largely taken for granted. The literature includes relatively little information about disturbed wound healing, and there is no acceptable classification describing wound healing process in the oral region. Wound healing comprises a sequence of complex biological processes. All tissues follow an essentially identical pattern to complete the healing process with minimal scar formation. The oral cavity is a remarkable environment in which wound healing occurs in warm oral fluid containing millions of microorganisms. The present review provides a basic overview of the wound healing process and with a discussion of the local and general factors that play roles in achieving efficient would healing. Results of oral cavity wound healing can vary from a clinically healed wound without scar formation and with histologically normal connective tissue under epithelial cells to extreme forms of trismus caused by fibrosis. Many local and general factors affect oral wound healing, and an improved understanding of these factors will help to address issues that lead to poor oral wound healing.

Principles of Wound Management and Wound Healing in Exotic Pets

The care of wounds in exotic animal species can be a challenging endeavor. Special considerations must be made in regard to the animal's temperament and behavior, unique anatomy and small size, and tendency toward secondary stress-related health problems. It is important to assess the entire patient with adequate systemic evaluation and consideration of proper nutrition and husbandry, which could ultimately affect wound healing. This article summarizes the general phases of wound healing, factors that affect healing, and principles of wound management. Emphasis is placed on novel methods of treating wounds and species differences in wound management and healing.

Randomised controlled trial evaluating the efficacy of wrap therapy for wound healing acceleration in patients with NPUAP stage II and III pressure ulcer

Objectives To evaluate if 'wrap therapy' using food wraps, which is widely used in Japanese clinical sites, is not inferior when compared to guideline adhesion treatments. Design Multicentre, prospective, randomised, open, blinded endpoint clinical trial. Setting 15 hospitals in Japan. Patients 66 older patients with new National Pressure Ulcer Advisory Panel stage II or III pressure ulcers. Interventions Of these 66 patients, 31 were divided into the conventional treatment guidelines group and 35 into the wrap therapy group. Main outcome measures The primary end point was the period until the pressure ulcers were cured. The secondary end point was a comparison of the speed of change in the Pressure Ulcer Scale for Healing score. Results 64 of the 66 patients were analysed. The estimated mean period until healing was 57.5 days (95% CI 45.2 to 69.8) in the control group as opposed to 59.8 days (95% CI 49.7 to 69.9) in the wrap therapy group. By the extent of pressure ulcer infiltration, the mean period until healing was 16.0 days (95% CI 8.1 to 23.9) in the control group as opposed to 18.8 days (95% CI 10.3 to 27.2) in the wrap therapy group with National Pressure Ulcer Advisory Panel stage II ulcers, and 71.8 days (95% CI 61.4 to 82.3) as opposed to 63.2 days (95% CI 53.0 to 73.4), respectively, with stage III ulcers. There is no statistical significance in difference in Pressure Ulcer Scale for Healing scores. Conclusions It might be possible to consider wrap therapy as an alternative choice in primary care settings as a simple and inexpensive dressing care. Clinical Trial registration UMIN Clinical Trials Registry UMIN000002658. Summary protocol is available on https://upload.umin.ac.jp/cgi-bin/ctr/ctr.cgi?function=brows&action=brows&type=detail&recptno=R000003235&admin=0&language=J.