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Petrenko O, Badziukh S, Korsa V, Kolosovych I, Tykhomyrov A. Topical Application of Autologous Plasma-Derived Plasminogen Accelerates Healing of Chronic Foot Ulcers in Type 2 Diabetes Patients. INT J LOW EXTR WOUND 2024:15347346241256025. [PMID: 38758187 DOI: 10.1177/15347346241256025] [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: 05/18/2024]
Abstract
Plasminogen (Pg) is currently considered a master regulator of wound healing, but the molecular mechanisms of its efficacy in improving impaired closure of chronic skin ulcers in type 2 diabetes patients remain unclear. Here, we investigated wound healing effects of autologous plasma-derived Pg in diabetes patients with chronic foot ulcers and evaluated Pg-induced changes in levels of key protein markers related to wound repair. Type 2 diabetes patients with chronic wounds of lower extremities were included in the study and received topical applications of Pg in a dose of 1.0 mg/mL every 2 days during 20 days, in addition to the standard wound management treatment. Patients treated only according to conventional protocol served as a control. Wound closure rates were monitored by digital planimetry of wound areas. Plasminogen supplementary treatment significantly accelerated relative wound closure as compared with diabetes patients from the control group (24 ± 4 days vs 120 ± 17 days, respectively, P < .01). As shown by Western blot, Pg application reduced expression of protein regulators of hypoxia events, angiogenesis, and autophagy such as hypoxia-inducible factor-1α (by 6.3-folds, P < .01), angiostatins (by 2.5-folds, P < .05), and autophagy marker LC3-II/LC3-I (by 8.6-folds, P < .05), while increasing vascular endothelial growth factor level by 1.9-folds (P < .05). Gelatin zymography showed that Pg-supplemented therapy decreased activity of matrix metalloproteinase-9 (MMP-9) by 3.5-folds at the end of treatment period (P < .01). We report here for the first time that topically applied plasma-derived Pg has a pronounced beneficial effect in promoting foot ulcer healing in patients with type 2 diabetes through preventing hypoxia-induced signaling, reducing autophagy flux, diminishing excessive MMP activity, and enhancing angiogenesis.
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Affiliation(s)
- Oleg Petrenko
- Department of Surgery, Bogomolets National Medical University, Kyiv, Ukraine
| | - Sergiy Badziukh
- Department of Surgery, Bogomolets National Medical University, Kyiv, Ukraine
| | - Victoria Korsa
- Department of Enzyme Chemistry & Biochemistry, Palladin Institute of Biochemistry of NAS of Ukraine, Kyiv, Ukraine
| | - Ihor Kolosovych
- Department of Surgery, Bogomolets National Medical University, Kyiv, Ukraine
| | - Artem Tykhomyrov
- Department of Enzyme Chemistry & Biochemistry, Palladin Institute of Biochemistry of NAS of Ukraine, Kyiv, Ukraine
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Memarpour S, Raoufinia R, Saburi E, Razavi MS, Attaran M, Fakoor F, Rahimi HR. The future of diabetic wound healing: unveiling the potential of mesenchymal stem cell and exosomes therapy. AMERICAN JOURNAL OF STEM CELLS 2024; 13:87-100. [PMID: 38765803 PMCID: PMC11101987 DOI: 10.62347/ovbk9820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/18/2024] [Indexed: 05/22/2024]
Abstract
Diabetes mellitus (DM) is a significant public health problem and is one of the most challenging medical conditions worldwide. It is the severe complications that make this disease more intricate. A diabetic wound is one of these complications. Patients with diabetes are at higher risk of developing diabetic foot ulcers (DFU). Due to the ineffectiveness of Conventional treatments, growth in limb amputation, morbidity, and mortality have been recognized, which indicates the need for additional treatment. Mesenchymal stem cells (MSCs) can significantly improve wound healing. However, there are some risks related to stem cell therapy. Exosome therapy is a new treatment option for diabetic wounds that has shown promising results. However, an even more advanced form called cell-free therapy using exosomes has emerged. This upgraded version of stem cell therapy offers improved efficacy and eliminates the risk of cancer progression. Exosome therapy promotes wound healing from multiple angles, unlike traditional methods that primarily rely on the body's self-healing ability and only provide wound protection. Therefore, exosome therapy has the potential to replace conventional treatments effectively. However, further research is necessary to distinguish the optimal type of stem cells for therapy, ensure their safety, establish appropriate dosing, and identify the best management trail. The present study focused on the current literature on diabetic wound ulcers, their treatment, and mesenchymal stem cell and exosome therapy potential in DFU.
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Affiliation(s)
- Sara Memarpour
- Medical Genetics Research Center, Mashhad University of Medical SciencesMashhad, Iran
| | - Ramin Raoufinia
- Medical Genetics Research Center, Mashhad University of Medical SciencesMashhad, Iran
- Department of Basic Medical Sciences, Neyshabur University of Medical SciencesNeyshabur, Iran
| | - Ehsan Saburi
- Medical Genetics Research Center, Mashhad University of Medical SciencesMashhad, Iran
| | - Masoud Sharifian Razavi
- Department of Internal Medicine, Ghaem Hospital, Mashhad University of Medical SciencesMashhad, Iran
| | - Matin Attaran
- Department of Obstetrics and Gynecology, Mashhad University of Medical SciencesMashhad, Iran
| | - Farhad Fakoor
- Department of Paramedical Sciences, Iran University of Medical SciencesTehran, Iran
| | - Hamid Reza Rahimi
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical SciencesMashhad, Iran
- Department of Medical Genetics and Molecular Medicine, School of Medicine, Mashhad University of Medical SciencesMashhad, Iran
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Armstrong DG, Orgill DP, Galiano RD, Glat PM, Kaufman JP, Carter MJ, DiDomenico LA, Zelen CM. A purified reconstituted bilayer matrix shows improved outcomes in treatment of non-healing diabetic foot ulcers when compared to the standard of care: Final results and analysis of a prospective, randomized, controlled, multi-centre clinical trial. Int Wound J 2024; 21:e14882. [PMID: 38606794 PMCID: PMC11010253 DOI: 10.1111/iwj.14882] [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: 03/03/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024] Open
Abstract
As the incidence of diabetic foot ulcers (DFU) increases, better treatments that improve healing should reduce complications of these ulcers including infections and amputations. We conducted a randomized controlled trial comparing outcomes between a novel purified reconstituted bilayer membrane (PRBM) to the standard of care (SOC) in the treatment of non-healing DFUs. This study included 105 patients who were randomized to either of two treatment groups (n = 54 PRBM; n = 51 SOC) in the intent to treat (ITT) group and 80 who completed the study per protocol (PP) (n = 47 PRBM; n = 33 SOC). The primary endpoint was the percentage of wounds closed after 12 weeks. Secondary outcomes included percent area reduction, time to healing, quality of life, and cost to closure. The DFUs that had been treated with PRBM healed at a higher rate than those treated with SOC (ITT: 83% vs. 45%, p = 0.00004, PP: 92% vs. 67%, p = 0.005). Wounds treated with PRBM also healed significantly faster than those treated with SOC with a mean of 42 versus 62 days for SOC (p = 0.00074) and achieved a mean wound area reduction within 12 weeks of 94% versus 51% for SOC (p = 0.0023). There were no adverse events or serious adverse events that were related to either the PRBM or the SOC. In comparison to the SOC, DFUs healed faster when treated with PRBM. Thus, the use of this PRBM is an effective option for the treatment of chronic DFUs.
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Affiliation(s)
- David G. Armstrong
- Division of Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Dennis P. Orgill
- Division of Plastic SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
| | - Robert D. Galiano
- Division of Plastic Surgery, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Paul M. Glat
- Surgery and PediatricsDrexel University College of Medicine, St. Christopher's Hospital for ChildrenPhiladelphiaPennsylvaniaUSA
| | - Jarrod P. Kaufman
- Department of Surgery, Temple University School of Medicine and McGowan Institute for Regenerative MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
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Costa D, Scalise E, Ielapi N, Bracale UM, Andreucci M, Serra R. Metalloproteinases as Biomarkers and Sociomarkers in Human Health and Disease. Biomolecules 2024; 14:96. [PMID: 38254696 PMCID: PMC10813678 DOI: 10.3390/biom14010096] [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: 12/11/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Metalloproteinases (MPs) are zinc-dependent enzymes with proteolytic activity and a variety of functions in the pathophysiology of human diseases. The main objectives of this review are to analyze a specific family of MPs, the matrix metalloproteinases (MMPs), in the most common chronic and complex diseases that affect patients' social lives and to better understand the nature of the associations between MMPs and the psychosocial environment. In accordance with the PRISMA extension for a scoping review, an examination was carried out. A collection of 24 studies was analyzed, focusing on the molecular mechanisms of MMP and their connection to the manifestation of social aspects in human disease. The complexity of the relationship between MMP and social problems is presented via an interdisciplinary approach based on complexity paradigm as a new approach for conceptualizing knowledge in health research. Finally, two implications emerge from the study: first, the psychosocial states of individuals have a profound impact on their overall health and disease conditions, which implies the importance of adopting a holistic perspective on human well-being, encompassing both physical and psychosocial aspects. Second, the use of MPs as biomarkers may provide physicians with valuable tools for a better understanding of disease when used in conjunction with "sociomarkers" to develop mathematical predictive models.
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Affiliation(s)
- Davide Costa
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (D.C.); (E.S.)
- Interuniversity Center of Phlebolymphology (CIFL), Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Enrica Scalise
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (D.C.); (E.S.)
- Interuniversity Center of Phlebolymphology (CIFL), Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, “Sapienza” University of Rome, 00185 Rome, Italy;
| | | | - Michele Andreucci
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (D.C.); (E.S.)
- Interuniversity Center of Phlebolymphology (CIFL), Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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Ferroni L, D'Amora U, Gardin C, Leo S, Dalla Paola L, Tremoli E, Giuliani A, Calzà L, Ronca A, Ambrosio L, Zavan B. Stem cell-derived small extracellular vesicles embedded into methacrylated hyaluronic acid wound dressings accelerate wound repair in a pressure model of diabetic ulcer. J Nanobiotechnology 2023; 21:469. [PMID: 38062461 PMCID: PMC10702007 DOI: 10.1186/s12951-023-02202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Over the past years, the development of innovative smart wound dressings is revolutionizing wound care management and research. Specifically, in the treatment of diabetic foot wounds, three-dimensional (3D) bioprinted patches may enable personalized medicine therapies. In the present work, a methacrylated hyaluronic acid (MeHA) bioink is employed to manufacture 3D printed patches to deliver small extracellular vesicles (sEVs) obtained from human mesenchymal stem cells (MSC-sEVs). The production of sEVs is maximized culturing MSCs in bioreactor. A series of in vitro analyses are carried out to demonstrate the influence of MSC-sEVs on functions of dermal fibroblasts and endothelial cells, which are the primary functional cells in skin repair process. Results demonstrate that both cell populations are able to internalize MSC-sEVs and that the exposure to sEVs stimulates proliferation and migration. In vivo experiments in a well-established diabetic mouse model of pressure ulcer confirm the regenerative properties of MSC-sEVs. The MeHA patch enhances the effectiveness of sEVs by enabling controlled release of MSC-sEVs over 7 days, which improve wound epithelialization, angiogenesis and innervation. The overall findings highlight that MSC-sEVs loading in 3D printed biomaterials represents a powerful technique, which can improve the translational potential of parental stem cell in terms of regulatory and economic impact.
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Affiliation(s)
- Letizia Ferroni
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, 48033, Italy.
| | - Ugo D'Amora
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, 80125, Italy
| | - Chiara Gardin
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, 48033, Italy
| | - Sara Leo
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, 48033, Italy
| | - Luca Dalla Paola
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, 48033, Italy
| | - Elena Tremoli
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, 48033, Italy
| | - Alessandro Giuliani
- Department of Veterinary Medical Science (DIMEVET), University of Bologna, Ozzano Emilia, 40064, Italy
| | - Laura Calzà
- Department of Pharmacy and Biotechnology and CIRI-SDV, University of Bologna, Bologna, 40126, Italy
| | - Alfredo Ronca
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, 80125, Italy
| | - Luigi Ambrosio
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, 80125, Italy
| | - Barbara Zavan
- Translational Medicine Department, University of Ferrara, Ferrara, 44121, Italy.
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Harmon KA, Kammer M, Avery JT, Kimmerling KA, Mowry KC. Retention of Key Characteristics of Unprocessed Chorion Tissue Resulting in a Robust Scaffold to Support Wound Healing. Int J Mol Sci 2023; 24:15786. [PMID: 37958770 PMCID: PMC10649069 DOI: 10.3390/ijms242115786] [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: 09/21/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Placental membranes have been widely studied and used clinically for wound care applications, but there is limited published information on the benefits of using the chorion membrane. The chorion membrane represents a promising source of placental-derived tissue to support wound healing, with its native composition of extracellular matrix (ECM) proteins and key regulatory proteins. This study examined the impact of hypothermic storage on the structure of chorion membrane, ECM content, and response to degradation in vitro. Hypothermically stored chorion membrane (HSCM) was further characterized for its proteomic content, and for its functionality as a scaffold for cell attachment and proliferation in vitro. HSCM retained the native ECM structure, composition, and integrity of native unprocessed chorion membrane and showed no differences in response to degradation in an in vitro wound model. HSCM retained key regulatory proteins previously shown to be present in placental membranes and promoted the attachment and proliferation of fibroblasts in vitro. These data support the fact that hypothermic storage does not significantly impact the structure and characteristics of the chorion membrane compared to unprocessed tissue or its functionality as a scaffold to support tissue growth.
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Luo L, An Y, Geng K, Wan S, Zhang F, Tan X, Jiang Z, Xu Y. High glucose-induced endothelial STING activation inhibits diabetic wound healing through impairment of angiogenesis. Biochem Biophys Res Commun 2023; 668:82-89. [PMID: 37245293 DOI: 10.1016/j.bbrc.2023.05.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023]
Abstract
Chronic hyperglycemia-induced impairment of angiogenesis is important in diabetic foot ulcer (DFU). Additionally, the stimulator of interferon gene (STING), which is a key protein in innate immunity, mediates palmitic acid-induced lipotoxicity in metabolic diseases through oxidative stress-induced STING activation. However, the role of STING in DFU is unknown. In this study, we established a DFU mouse model with streptozotocin (STZ) injection and found that the expression of STING was significantly increased in the vascular endothelial cells of wound tissues from diabetic patients and in the STZ-induced diabetic mouse model. We further established high glucose (HG)-induced endothelial dysfunction with rat vascular endothelial cells and found that the expression of STING was also increased by high-glucose treatment. Moreover, the STING inhibitor, C176, promoted diabetic wound healing, whereas the STING activator, DMXAA, inhibited diabetic wound healing. Consistently, STING inhibition reversed the HG-induced reduction of CD31 and vascular endothelial growth factor (VEGF), inhibited apoptosis, and promoted migration of endothelial cells. Notably, DMXAA treatment alone was sufficient to induce endothelial cell dysfunction as a high-glucose treatment. Mechanistically, STING mediated HG-induced vascular endothelial cell dysfunction by activating the interferon regulatory factor 3/nuclear factor kappa B pathway. In conclusion, our study reveals an endothelial STING activation-mediated molecular mechanism in the pathogenesis of DFU and identifies STING as a novel potential therapeutic target for DFU.
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Affiliation(s)
- Lifang Luo
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China; Metabolic Vascular Disease Key Laboratory of Sichuan Province, Sichuan, 646000, China; Sichuan Clinical Research Center for Nephropathy, Sichuan, 646000, China
| | - Ying An
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China; Metabolic Vascular Disease Key Laboratory of Sichuan Province, Sichuan, 646000, China; Sichuan Clinical Research Center for Nephropathy, Sichuan, 646000, China
| | - Kang Geng
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Sichuan, 646000, China; Sichuan Clinical Research Center for Nephropathy, Sichuan, 646000, China
| | - Shengrong Wan
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Sichuan, 646000, China; Sichuan Clinical Research Center for Nephropathy, Sichuan, 646000, China
| | - Fanjie Zhang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China; Metabolic Vascular Disease Key Laboratory of Sichuan Province, Sichuan, 646000, China; Sichuan Clinical Research Center for Nephropathy, Sichuan, 646000, China
| | - Xiaozhen Tan
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China; Metabolic Vascular Disease Key Laboratory of Sichuan Province, Sichuan, 646000, China; Sichuan Clinical Research Center for Nephropathy, Sichuan, 646000, China
| | - Zongzhe Jiang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China; Metabolic Vascular Disease Key Laboratory of Sichuan Province, Sichuan, 646000, China; Sichuan Clinical Research Center for Nephropathy, Sichuan, 646000, China; Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China.
| | - Yong Xu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China; Metabolic Vascular Disease Key Laboratory of Sichuan Province, Sichuan, 646000, China; Sichuan Clinical Research Center for Nephropathy, Sichuan, 646000, China.
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Chen X, Song QL, Wang JY, Ji R, Li ZH, Cao ML, Mu XF, Guo DY, Zhang Y, Yang J. Profilin1 regulates trophoblast invasion and macrophage differentiation. THE AMERICAN JOURNAL OF PATHOLOGY 2023:S0002-9440(23)00165-7. [PMID: 37164274 DOI: 10.1016/j.ajpath.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/08/2023] [Accepted: 04/18/2023] [Indexed: 05/12/2023]
Abstract
Unexplained recurrent spontaneous abortion (URSA) has been associated with the dysfunction of trophoblasts and decidual macrophages. Current evidence suggests that profilin1 (PFN1) plays an important role in many biological processes. However, little is currently known on whether PFN1 is related to URSA. The location of PFN1 was detected by immunohistochemistry. The level of PFN1 were detected by qRT-PCR, western blot and immunohistochemistry. The proliferation of trophoblasts was detected by CCK8 and EdU assays. Apoptosis of trophoblasts was detected by TUNEL assays. The migration and invasion ability of trophoblasts were assessed by the wound-healing test and transwell test. Macrophages were cultured in trophoblast conditioned medium and the polarization of macrophages was detected. PFN1 expression was observed in in cytotrophoblasts, syncytiotrophoblasts, and extravillous trophoblasts and decreased in the villous tissue of URSA patients. The migration and invasion ability and cell viability of trophoblastic cell lines that underwent PFN1 knockdown significantly decreased, and apoptosis increased. Opposite findings were observed following the overexpression of PFN1 in trophoblastic cells. In addition, PFN1 could regulate trophoblast function through PI3K/AKT signal transduction rather than MAPK signaling pathways. In addition, this study also found that knockdown of PFN1 in trophoblast promotes TNF-α secretion to induce macrophage polarization to M1 phenotype, mediated by the NF- κ B signaling pathway.
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Affiliation(s)
- Xin Chen
- Reproductive Medical Center, Renmin Hospital of Wuhan University and Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei, China
| | - Qian Lin Song
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jia Yu Wang
- Reproductive Medical Center, Renmin Hospital of Wuhan University and Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei, China
| | - Rui Ji
- Reproductive Medical Center, Renmin Hospital of Wuhan University and Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei, China
| | - Ze Hong Li
- Reproductive Medical Center, Renmin Hospital of Wuhan University and Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei, China
| | - Ming Liang Cao
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xue Feng Mu
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Duan Ying Guo
- Longgang District People's Hospital of Shenzhen, Shenzhen, China
| | - Yan Zhang
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Jing Yang
- Reproductive Medical Center, Renmin Hospital of Wuhan University and Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei, China.
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Awad SS, Stern JD, Milne CT, Dowling SG, Sotomayor R, Ayello EA, Feo Aguirre LJ, Khalaf BZ, Gould LJ, Desvigne MN, Chaffin AE. Surgical Reconstruction of Stage 3 and 4 Pressure Injuries: A Literature Review and Proposed Algorithm from an Interprofessional Working Group. Adv Skin Wound Care 2023; 36:249-258. [PMID: 37079788 PMCID: PMC10144322 DOI: 10.1097/01.asw.0000922708.95424.88] [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: 12/06/2022] [Accepted: 02/07/2022] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Stage 3 and 4 pressure injuries (PIs) present an enormous societal burden with no clearly defined interventions for surgical reconstruction. The authors sought to assess, via literature review and a reflection/evaluation of their own clinical practice experience (where applicable), the current limitations to the surgical intervention of stage 3 or 4 PIs and propose an algorithm for surgical reconstruction. METHODS An interprofessional working group convened to review and assess the scientific literature and propose an algorithm for clinical practice. Data compiled from the literature and a comparison of institutional management were used to develop an algorithm for the surgical reconstruction of stage 3 and 4 PIs with adjunctive use of negative-pressure wound therapy and bioscaffolds. RESULTS Surgical reconstruction of PI has relatively high complication rates. The use of negative-pressure wound therapy as adjunctive therapy is beneficial and widespread, leading to reduced dressing change frequency. The evidence for the use of bioscaffolds both in standard wound care and as an adjunct to surgical reconstruction of PI is limited. The proposed algorithm aims to reduce complications typically seen with this patient cohort and improve patient outcomes from surgical intervention. CONCLUSIONS The working group has proposed a surgical algorithm for stage 3 and 4 PI reconstruction. The algorithm will be validated and refined through additional clinical research.
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Affiliation(s)
- Samir S Awad
- Samir S. Awad, MD, MPH, FACS, is Professor of Surgery, Baylor College of Medicine and Chief of Surgery, Michael E. DeBakey VA Medical Center, Houston, Texas, USA. James D. Stern, MD, FACS, is Plastic Surgeon, Memorial Regional Hospital, Hollywood, Florida. Cathy T. Milne, APRN, MSN, ANP/ACNS-BC, CWOCN-AP, is Co-owner, Connecticut Clinical Nursing Associates, Bristol, Connecticut. Shane G. Dowling, MSPAS, PA-C, CWS, is Medical Science Liaison, Aroa Biosurgery Limited, Auckland, New Zealand. Ron Sotomayor, BA, RN, CWOCN, is a wound, ostomy, and continence nurse, Advent Health, Orlando, Florida. Elizabeth A. Ayello, PhD, MS, RN, ETN, CWON, FAAN, is Editor-in-Chief, Advances in Skin & Wound Care and President, Ayello, Harris and Associates Incorporated, Copake, New York. Leandro J. Feo Aguirre, MD, FACS, is Colorectal Surgeon, Palm Beach Health Network, Del Ray Beach, Florida. Basil Z. Khalaf, MD, is Wound Care Physician, The MEDIKAL Group, Houston, Texas. Lisa J. Gould, MD, is Plastic Surgeon, South Shore Health, Weymouth, Massachusetts. Michael N. Desvigne, MD, FACS, CWS, is Plastic Surgeon, Desvigne Plastic Surgery and Abrazo Health, Scottsdale, Arizona. Abigail E. Chaffin, MD, FACS, CWSP, is Associate Professor of Surgery and Chief, Division of Plastic Surgery, Tulane University and Medical Director, MedCentris Wound Healing Institute, New Orleans, Louisiana
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