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Cooper BG, Catalina Bordeianu, Nazarian A, Snyder BD, Grinstaff MW. Active agents, biomaterials, and technologies to improve biolubrication and strengthen soft tissues. Biomaterials 2018; 181:210-226. [PMID: 30092370 PMCID: PMC6766080 DOI: 10.1016/j.biomaterials.2018.07.040] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 07/22/2018] [Accepted: 07/25/2018] [Indexed: 12/27/2022]
Abstract
Normal functioning of articulating tissues is required for many physiological processes occurring across length scales from the molecular to whole organism. Lubricating biopolymers are present natively on tissue surfaces at various sites of biological articulation, including eyelid, mouth, and synovial joints. The range of operating conditions at these disparate interfaces yields a variety of tribological mechanisms through which compressive and shear forces are dissipated to protect tissues from material wear and fatigue. This review focuses on recent advances in active agents and biomaterials for therapeutic augmentation of friction, lubrication, and wear in disease and injured states. Various small-molecule, biological, and gene delivery therapies are described, as are tribosupplementation with naturally-occurring and synthetic biolubricants and polymer reinforcements. While reintroduction of a diseased tissue's native lubricant received significant attention in the past, recent discoveries and pre-clinical research are capitalizing on concurrent advances in the molecular sciences and bioengineering fields, with an understanding of the underlying tissue structure and physiology, to afford a desired, and potentially patient-specific, tissue mechanical response for restoration of normal function. Small and large molecule drugs targeting recently elucidated pathways as well as synthetic and hybrid natural/synthetic biomaterials for restoring a desired tissue mechanical response are being investigated for treatment of, for example, keratoconjunctivitis sicca, xeroderma, and osteoarthritis.
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Affiliation(s)
- Benjamin G Cooper
- Department of Chemistry, Boston University, Boston, MA, United States; Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
| | - Catalina Bordeianu
- Department of Chemistry, Boston University, Boston, MA, United States; Department of Biomedical Engineering, Boston University, Boston, MA, United States.
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
| | - Brian D Snyder
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Biomedical Engineering, Boston University, Boston, MA, United States; Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, United States.
| | - Mark W Grinstaff
- Department of Chemistry, Boston University, Boston, MA, United States; Department of Biomedical Engineering, Boston University, Boston, MA, United States; Department of Medicine, Boston University, Boston, MA, United States.
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Reid B, Zhao M. The Electrical Response to Injury: Molecular Mechanisms and Wound Healing. Adv Wound Care (New Rochelle) 2014; 3:184-201. [PMID: 24761358 DOI: 10.1089/wound.2013.0442] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 06/21/2013] [Indexed: 01/06/2023] Open
Abstract
Significance: Natural, endogenous electric fields (EFs) and currents arise spontaneously after wounding of many tissues, especially epithelia, and are necessary for normal healing. This wound electrical activity is a long-lasting and regulated response. Enhancing or inhibiting this electrical activity increases or decreases wound healing, respectively. Cells that are responsible for wound closure such as corneal epithelial cells or skin keratinocytes migrate directionally in EFs of physiological magnitude. However, the mechanisms of how the wound electrical response is initiated and regulated remain unclear. Recent Advances: Wound EFs and currents appear to arise by ion channel up-regulation and redistribution, which are perhaps triggered by an intracellular calcium wave or cell depolarization. We discuss the possibility of stimulation of wound healing via pharmacological enhancement of the wound electric signal by stimulation of ion pumping. Critical Issues: Chronic wounds are a major problem in the elderly and diabetic patient. Any strategy to stimulate wound healing in these patients is desirable. Applying electrical stimulation directly is problematic, but pharmacological enhancement of the wound signal may be a promising strategy. Future Directions: Understanding the molecular regulation of wound electric signals may reveal some fundamental mechanisms in wound healing. Manipulating fluxes of ions and electric currents at wounds might offer new approaches to achieve better wound healing and to heal chronic wounds.
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Affiliation(s)
- Brian Reid
- Departments of Dermatology and Ophthalmology, School of Medicine, University of California, Davis, California
| | - Min Zhao
- Departments of Dermatology and Ophthalmology, School of Medicine, University of California, Davis, California
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McGaughey H, Dhamija S, Oliver L, Porter-Armstrong A, McDonough S. Pulsed electromagnetic energy in management of chronic wounds: a systematic review. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328809x435231] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Vollenweider D, Ebneter I, Mayer D, Hafner J, Steurer J, Puhan MA. Dealing with heterogeneous populations in randomized wound trials: challenges and potential solutions. Wound Repair Regen 2012; 20:466-72. [PMID: 22672225 DOI: 10.1111/j.1524-475x.2012.00806.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 02/27/2012] [Indexed: 12/19/2022]
Abstract
Chronic wounds have a great variety of etiologies and manifestations that influence wound healing. Such heterogeneity potentially threatens the validity and clinical usefulness of trials if not considered appropriately. In 82 randomized wound trials retrieved from 10 Cochrane reviews, we assessed if and how authors considered wound and other prognostically important characteristics in the conduct and analysis of wound trials. We assessed whether these characteristics were discussed, reflected in the eligibility criteria, used for prestratification or for adjustments to ensure comparability of treatment groups, and whether subgroup analyses were conducted to identify heterogeneity of treatment effects. Nine percent of all trials explicitly discussed characteristics that influence wound healing in the introduction and 43% in the Discussion section. Ninety percent of trials had at least one prognostically important characteristic as eligibility criterion. Only 11% of trials used prestratification, and 6% adjusted the results for imbalances between treatment groups. Twenty-seven percent performed subgroup analyses with prognostically important characteristics defining subgroups. Chronic wound trials use simple randomization, but rarely adapt the study design and analysis to take the heterogeneity of patients into consideration. Collaborative multicenter trials would overcome many of the limitations and provide statistical power to detect important treatment effects both overall and in subgroups.
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Affiliation(s)
- Daniela Vollenweider
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland 21287, USA
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Kahle B, Hermanns HJ, Gallenkemper G. Evidence-based treatment of chronic leg ulcers. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:231-7. [PMID: 21547162 PMCID: PMC3087120 DOI: 10.3238/arztebl.2011.0231] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 11/30/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic leg ulcers are defined as those that show no tendency to heal after 3 months of appropriate treatment or are still not fully healed at 12 months. In this article, we present an approach to the challenging problem of chronic leg ulcers that is based on the principles of evidence-based medicine, i.e., the explicit use of the best available scientific evidence as a guide to treatment. METHODS Selective review of the relevant literature, including current guidelines and meta-analyses, concerning diagnostic and therapeutic strategies for chronic leg ulcers. RESULTS The main types of causally directed treatment are: vein surgery to eliminate pathological reflux, interventions to improve the circulation in arterial occlusive disease, and treatment of underlying diseases, such as diabetes mellitus. CONCLUSION Physicians providing modern evidence-based management of chronic leg ulcers should make use of their own clinical experience in combination with the best current scientific evidence. It seems clear that the many available treatment options should be evaluated critically in an interdisciplinary setting. In particular, causally directed treatment must be provided in addition to symptomatic, stage-based local wound treatment.
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Affiliation(s)
- Birgit Kahle
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Dermatologie, Allergologie und Venerologie, 23538 Lübeck, Germany
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Heinlin J, Schreml S, Babilas P, Landthaler M, Karrer S. [Cutaneous wound healing. Therapeutic interventions]. Hautarzt 2010; 61:611-26; quiz 627. [PMID: 20556349 DOI: 10.1007/s00105-010-1978-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In modern medicine chronic wounds are an interdisciplinary major therapeutic and financial issue. Essential for therapy is both the causal treatment of the underlying disease and the symptomatic treatment depending on the phase of wound healing. The physiological process of cutaneous wound healing is divided into three overlapping phases: inflammation, proliferation and tissue remodelling. The choice of a suitable therapy depends on the extent of the wound, the localization, exudation and bacterial infestation. In recent years a number of novel findings were made about this complex biological process and the insights gained have resulted in new therapeutic concepts. In the following article we give an overview about possible therapeutic options and present the various modern wound dressings.
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Affiliation(s)
- J Heinlin
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
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Guo A, Song B, Reid B, Gu Y, Forrester JV, Jahoda CA, Zhao M. Effects of physiological electric fields on migration of human dermal fibroblasts. J Invest Dermatol 2010; 130:2320-7. [PMID: 20410911 PMCID: PMC2952177 DOI: 10.1038/jid.2010.96] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Endogenous electric currents generated instantly at skin wounds direct migration of epithelial cells and are likely to be important in wound healing. Migration of fibroblasts is critical in wound healing. It remains unclear how wound electric fields guide migration of dermal fibroblasts. We report here that mouse skin wounds generated endogenous electric currents for many hours. Human dermal fibroblasts of both primary and cell-line cultures migrated directionally but slowly toward the anode in an electric field of 50-100 mV mm(-1). This is different from keratinocytes, which migrate quickly to the cathode. It took more than 1 hour for dermal fibroblasts to manifest detectable directional migration. Larger field strength (400 mV mm(-1)) was required to induce directional migration within 1 hour after onset of the field. Phosphatidylinositol-3-OH kinase (PI3 kinase) mediates cathode-directed migration of keratinocytes. We tested the role of PI3 kinase in anode-directed migration of fibroblasts. An applied electric field activated PI3 kinase/Akt in dermal fibroblasts. Dermal fibroblasts from p110gamma (a PI3 kinase catalytic subunit) null mice showed significantly decreased directional migration. These results suggest that physiological electric fields may regulate motility of dermal fibroblasts and keratinocytes differently, albeit using similar PI3 kinase-dependent mechanisms.
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Affiliation(s)
- Aihua Guo
- School of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Department of Biological and Biomedical Science, Durham University, Durham, England, UK
| | - Bing Song
- School of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Department of Dermatology, School of Medicine, University of California, Davis, Davis, California, USA
| | - Brian Reid
- School of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Department of Dermatology, School of Medicine, University of California, Davis, Davis, California, USA
| | - Yu Gu
- School of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Department of Dermatology, School of Medicine, University of California, Davis, Davis, California, USA
| | - John V. Forrester
- School of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Colin A.B. Jahoda
- Department of Biological and Biomedical Science, Durham University, Durham, England, UK
| | - Min Zhao
- School of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Department of Dermatology, School of Medicine, University of California, Davis, Davis, California, USA
- Department of Ophthalmology, School of Medicine, University of California, Davis, Davis, California, USA
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