Effects of the blended fibroin/aloe gel film on wound healing in streptozotocin-induced diabetic rats

In Vitro Wound Healing Potential of a Fibroin Film Incorporating a Cannabidiol/2-Hydroxypropyl-β-cyclodextrin Complex

This study aimed to develop a film dressing prepared by incorporating a complex of cannabidiol and 2-hydroxypropyl-β-cyclodextrin (CBD/HP-β-CD) into a fibroin-based film and to investigate its wound healing capabilities. The fibroin from silkworm cocoons exhibited a total protein content of 96.34 ± 0.14% w/w and a molecular weight range of 25 to 245 kDa. Fourier-transform infrared spectroscopy (FTIR) revealed the presence of characteristic amide peaks (I, II, and III) in the isolated fibroin. The CBD/HP-β-CD complex, prepared with a molar ratio of 1:2 (CBD to HP-β-CD), had 81.5 ± 1.2% w/w CBD content, as determined by high-performance liquid chromatography (HPLC). X-ray diffraction (XRD) and FTIR analyses demonstrated successful encapsulation of CBD's hydrophobic aromatic rings by HP-β-CD. Blending the fibroin solution with the CBD/HP-β-CD complex produced a transparent, slightly yellowish film. Mechanical testing revealed a tensile strength of 48.67 ± 2.57 MPa and a % elongation at a break of 1.71 ± 0.21%. XRD and FTIR analyses showed distinctive crystalline and chemical structures of the film. In subsequent in vitro experiments with normal human dermal fibroblasts, the film demonstrated potential for wound healing. An increase in cell division (G2/M phase) was observed compared to the fibroin film without the CBD/HP-β-CD complex. Additionally, fibroblasts treated with the film exhibited enhanced cell migration in a scratch assay and increased expression of vascular endothelial growth factor protein compared to the control group. Overall, these findings underscore the film's potential for enhancing wound healing outcomes.

Extremophilic Solutions: The Role of Deinoxanthin in Counteracting UV-Induced Skin Harm

This research delved into the protective capacities of deinoxanthin, a carotenoid present in Deinococcus radiodurans, against UVA- and UVB-mediated skin damage using human fibroblast foreskin cells (HFF-1). Using the MTT assay, HFF-1 cells treated with 10 µM DNX displayed 20% and 31.7% higher viability than the positive (Vitamin C-treated) and negative (DNX-untreated) control groups, respectively, upon 100 mJ/cm2 UVB exposure. At 24 J/cm2 UVA, 20 µM DNX-treated cells showed 80.6% viability, exceeding the positive and negative control groups by 28.6% and 33.6%, respectively. Flow cytometry analysis revealed that cells treated with DNX and exposed to 24 J/cm2 UVA exhibited a 69.32% reduction in apoptotic processes compared to untreated cells. Similarly, when exposed to 100 mJ/cm2 UVB, DNX-treated cells demonstrated a 72.35% decrease in apoptotic processes relative to their untreated counterparts. DNX also displayed dose-dependent inhibition on tyrosinase activity. The study emphasized DNX's antioxidative capacity, evident in its modulation of superoxide dismutase activity and measurements of Malondialdehyde and intracellular reactive oxygen species levels. DNX-treated cells exhibited higher hydroxyproline levels, suggesting healthier collagen production. Additionally, the wound-healing assay method confirmed an accelerated healing rate in DNX-treated cells. Conclusively, DNX offers significant protection against UV-induced skin damage, emphasizing its potential for skincare and therapeutics.

Natural Polymer-Based Thin Film Strategies for Skin Regeneration in Lieu of Regenerative Dentistry

Wound healing (WH) is a complex and dynamic process that comprises of a series of molecular and cellular events that occur after tissue injury. The injuries of the maxillofacial and oral region caused by trauma or surgery result in undesirable WH such as delayed wound closure and formation of scar tissue. Skin tissue engineering (TE)/regeneration is an emerging approach toward faster, superior, and more effective resolution of clinically significant wounds effectively. A multitude of TE principles approaches are being put to action for the fabrication of hydrogels, electrospun sheets, 3D scaffolds, and thin films that can be used as wound dressings materials, sutures, or skin substitutes. Thin films are advantageous over other materials owing to their flexibility, ability to provide a barrier against external contamination, easy gaseous exchange, and easy monitoring of wounds. This review focuses on wound-dressing films and their significance and discusses various fabrication techniques. In addition, we explore various natural biopolymers that can be used for fabrication of skin TE materials. Impact Statement In this review article, critical evaluations of natural polymers used in skin regeneration were discussed. Further, the fabrication technology of the 2D and 3D material in wound healing were discussed.

Application of Silk-Fibroin-Based Hydrogels in Tissue Engineering

Silk fibroin (SF) is an excellent protein-based biomaterial produced by the degumming and purification of silk from cocoons of the Bombyx mori through alkali or enzymatic treatments. SF exhibits excellent biological properties, such as mechanical properties, biocompatibility, biodegradability, bioabsorbability, low immunogenicity, and tunability, making it a versatile material widely applied in biological fields, particularly in tissue engineering. In tissue engineering, SF is often fabricated into hydrogel form, with the advantages of added materials. SF hydrogels have mostly been studied for their use in tissue regeneration by enhancing cell activity at the tissue defect site or counteracting tissue-damage-related factors. This review focuses on SF hydrogels, firstly summarizing the fabrication and properties of SF and SF hydrogels and then detailing the regenerative effects of SF hydrogels as scaffolds in cartilage, bone, skin, cornea, teeth, and eardrum in recent years.

Development of Biocellulose Sheet Incorporating Aloe vera Gel Extract for Diabetic Wound Healing

In this study, a biocellulose (BC) sheet containing Aloe vera gel extract (AE) was developed for application in healing chronic wounds, such as diabetic wounds. The BC sheet was produced by Acetobacter xylinum and then lyophilized to obtain dried sheets. A. vera gel was extracted by precipitation in 35% ammonium sulfate, lyophilized, dried, and incorporated into the BC sheet. The protein content of the AE was 12.32 ± 3.4% w/w, with a molecular weight of ∼20 kDa. The release of TNF-α from lipopolysaccharide-induced RAW264.7 cells was reduced by treatment with AE in a dose-dependent manner. The physicochemical and biological properties of the developed sheet were investigated. Morphological examination of the BC/AE sheet using scanning electron microscopy revealed the 3D construction of nanofibrils, which showed high porosity. The BC/AE sheet exhibited water absorption at 74%, and the release of proteins in the AE reached 97.23% at 4 h. The BC sheet incorporated with proteins in the AE at 283.78 ± 7.7 μg/cm² can promote the wound healing in streptozotocin-induced diabetic rats. The recovering skin in diabetic wounds treated with the BC/AE sheet exhibited a normal cell arrangement without fibrosis, as revealed by histological staining. The research findings indicate that the BC/AE sheet has potential for applications in wound dressings.

Therapeutic Efficacy of Polymeric Biomaterials in Treating Diabetic Wounds-An Upcoming Wound Healing Technology

Diabetic wounds are one of the serious, non-healing, chronic health issues faced by individuals suffering from diabetic mellitus. The distinct phases of wound healing are either prolonged or obstructed, resulting in the improper healing of diabetic wounds. These injuries require persistent wound care and appropriate treatment to prevent deleterious effects such as lower limb amputation. Although there are several treatment strategies, diabetic wounds continue to be a major threat for healthcare professionals and patients. The different types of diabetic wound dressings that are currently used differ in their properties of absorbing wound exudates and may also cause maceration to surrounding tissues. Current research is focused on developing novel wound dressings incorporated with biological agents that aid in a faster rate of wound closure. An ideal wound dressing material must absorb wound exudates, aid in the appropriate exchange of gas, and protect from microbial infections. It must support the synthesis of biochemical mediators such as cytokines, and growth factors that are crucial for faster healing of wounds. This review highlights the recent advances in polymeric biomaterial-based wound dressings, novel therapeutic regimes, and their efficacy in treating diabetic wounds. The role of polymeric wound dressings loaded with bioactive compounds, and their in vitro and in vivo performance in diabetic wound treatment are also reviewed.

Beneficial Effects of a Blended Fibroin/Aloe Gel Extract Film on the Biomolecular Mechanism(s) via the MAPK/ERK Pathway Relating to Diabetic Wound Healing

In diabetic patients, the process of wound healing is usually delayed or impaired. A diabetic environment could be associated with dermal fibroblast dysfunction, reduced angiogenesis, the release of excessive proinflammatory cytokines, and senescence features. Alternative therapeutic treatments using natural products are highly demanded for their high potential of bioactive activity in skin repair. Two natural extracts were combined to develop fibroin/aloe gel wound dressing. Our previous studies revealed that the prepared film enhances the healing rate of diabetic foot ulcers (DFUs). Moreover, we aimed to explore its biological effects and underlying biomolecular mechanisms on normal dermal, diabetic dermal, and diabetic wound fibroblasts. Cell culture experiments showed that the γ-irradiated blended fibroin/aloe gel extract film promotes skin wound healing by enhancing cell proliferation and migration, vascular epidermal growth factor (VEGF) secretion, and cell senescence prevention. Its action was mainly linked to the activation of the mitogen-activated protein kinases/extracellular signal-regulated kinase (MAPK/ERK) signaling pathway known to regulate various cellular activities, including proliferation. Therefore, the findings of this study confirm and support our previous data. The blended fibroin/aloe gel extract film displays a biological behavior with favorable properties for delayed wound healing and can be considered as a promising therapeutic approach in the treatment of diabetic nonhealing ulcers.

Regenerated silk fibroin loaded with natural additives: a sustainable approach towards health care

According to World Health Organization (WHO), on average, 0.5 Kg of hazardous waste is generated per bed every day in high-income countries. The adverse effects imposed by synthetic materials and chemicals on the environment and humankind have urged researchers to explore greener technologies and materials. Amidst of all the natural fibers, silk fibroin (SF), by virtue of its superior toughness (6 × 10⁴∼16 × 10⁴ J/kg), tensile strength (47.2-67.7 MPa), tunable biodegradability, excellent Young's modulus (1.9-3.9 GPa), presence of functional groups, ease of processing, and biocompatibility has garnered an enormous amount of scientific interests. The use of silk fibroin conjoint with purely natural materials can be an excellent solution for the adverse effects of chemical-based treatment techniques. Considering this noteworthiness, vigorous research is going on in silk-based biomaterials, and it is opening up new vistas of opportunities. This review enswathes the structural aspects of silk fibroin along with its potency to form composites with other natural materials, such as curcumin, keratin, alginate, hydroxyapatite, hyaluronic acid, and cellulose, that can replace the conventionally used synthetic materials, providing a sustainable pathway to biomedical engineering. It was observed that a large amount of polar functional moieties present on the silk fibroin surface enables them to compatibilize easily with the natural additives. The conjunction of silk with natural additives initiates synergistic interactions that mitigate the limitations offered by individual units as well as enhance the applicability of materials. Further the current status and challenges in the commercialization of silk-based biomedical devices are discussed.

Effects of Hair Follicle Stem Cells Coupled With Polycaprolactone Scaffold on Cutaneous Wound Healing in Diabetic Male Rats

INTRODUCTION

Chronic wounds are debilitating complications of diabetes mellitus. The present study was conducted to investigate the effect of the hair follicle stem cells (HFSCs) by polycaprolactone scaffold on the healing of incisional cutaneous wounds on streptozotocin-induced diabetic male rats.

METHODS

The wound model was obtained by a biopsy punch of the skin of the animals' back. The animals were randomly divided into five groups as follows: (1) Sham (nondiabetic, not treated), (2) Control (diabetic, not treated), (3) Scaffold (diabetic, treated with polycaprolactone nanofiber scaffold), (4) HFSCs (diabetic, treated with HFSCs), and (5) Scaffold + HFSCs (diabetic, treated with combination of Scaffold and HFSCs). The wounds were photographed in the course of the treatment and their healing rate was assessed. The samples were collected from the wound sites 7, 14, and 28 d after their development. Angiogenesis was surveyed by examining messenger RNA expression and the protein synthesis levels of vascular endothelial growth factor receptor 2 (VEGFR2) and platelet/endothelial cell adhesion molecule-1/cluster of differentiation 31. The histological changes were investigated using hematoxylin and eosin and Masson's trichrome staining. Furthermore, the wound breaking strength was measured on the 28th day by tensiometry.

RESULTS

The application of the VEGFR2 as a substrate promotes the expression of CD31 in HFSCs and Scaffold + HFSCs groups compared to controls (P < 0.0001). HFSCs and scaffold also rescue the diabetes-induced dysfunction as assessed based on the parameters, such as viability, proliferation, colony formation, cellular adhesion, and chemotactic migration. HFSCs augment the levels of VEGFR2 and promote the restoration of the wound healing in diabetic groups. Furthermore, the maximum biomechanical stress significantly increased in the experimental diabetic groups (Scaffold: 1.38 ± 0.09, HFSCs: 2.13 ± 0.8, Scaffold + HFSCs: 2.38 ± 0.11) compared to the diabetes control group (1.16 ± 0.12). Using of HFSCs and scaffold on diabetic wounds leads to an accelerated wound closure, notably.

CONCLUSIONS

Thus, the current data showed that HFSCs and scaffold form excellent biomaterial in the treatment of diabetic wounds.

Silk Fibroin Hydrogels Incorporated with the Antioxidant Extract of Stryphnodendron adstringens Bark

Barbatimão (Stryphnodendron adstringens) is a Brazilian medicinal plant known for its pharmacological properties, including healing activity related to its phenolic composition, which is chiefly given by tannins. In order to preserve its stability and bioactivity, barbatimão extracts can be incorporated into (bio-)polymeric matrixes, of which silk fibroin stands out due to its versatility and tunable properties. This work aimed to obtain barbatimão bark extract rich in phenolic compounds and evaluate its incorporation in fibroin hydrogels. From the extraction process, it was observed that the PG (propylene glycol) extract presented a higher global yield (X₀) and phenolic compounds (TPC) than the ET (ethanol) extract. Furthermore, the antioxidant activity (ORAC and FRAP) was similar between both extracts. Regarding the hydrogels, morphological, chemical, thermal, and mechanical characterizations were performed to understand the influence of the barbatimão extract and the solvent on the fibroin hydrogel properties. As a result, the hydrogels containing the barbatimão PG extract (BT/PG hydrogels) showed the better physical-chemical and structural performance. Therefore, these hydrogels should be further investigated regarding their potential in medical and pharmaceutical applications, especially in wound healing.

Mesoporous silica-coated silver nanoparticles as ciprofloxacin/siRNA carriers for accelerated infected wound healing

The colonization of bacterial pathogens is a major concern in wound infection and becoming a public health issue. Herein, a core–shell structured Ag@MSN (silver core embedded with mesoporous silica, AM)-based nanoplatform was elaborately fabricated to co-load ciprofloxacin (CFL) and tumor necrosis factor-α (TNF-α) small interfering RNA (siTNF-α) (AMPC@siTNF-α) for treating the bacterial-infected wound. The growth of bacterial pathogens was mostly inhibited by released silver ions (Ag⁺) and CFL from AMPC@siTNF-α. Meanwhile, the loaded siTNF-α was internalized by macrophage cells, which silenced the expression of TNF-α (a pro-inflammatory cytokine) in macrophage cells and accelerated the wound healing process by reducing inflammation response. In the in vivo wound model, the Escherichia coli (E. coli)-infected wound in mice almost completely disappeared after treatment with AMPC@siTNF-α, and no suppuration symptom was observed during the course of the treatment. Importantly, this nanoplatform had negligible side effects both in vitro and in vivo. Taken together, this study strongly demonstrates the promising potential of AMPC@siTNF-α as a synergistic therapeutic agent for clinical wound infections.

Aloe vera incorporated starch-64S bioactive glass-quail egg shell scaffold for promotion of bone regeneration

Simultaneous promotion of osteoconductive and osteoinductive characteristics through combining bioactive glasses with natural polymers is still a challenge in bone tissue engineering. Starch, 64S bioactive glass (BG), aloe vera (AV) and quail eggshell powder (QE) were utilized to achieve biodegradable, bioactive, biocompatible and mechanically potent multifunctional scaffolds, using freeze-drying mechanism. Cell viability for starch-BG-AV-QE scaffolds at 3 and 7 day intervals was reported to be over 95 %. Acridine orange staining was employed to study live/dead cells cultured on the scaffolds. The high sufficiency of starch-BG-AV-QE scaffolds in osteogenic differentiation and extracellular matrix mineralization was confirmed through alkaline phosphatase activity and alizarin red staining assessments after 7 and 14 days of cell culture. High compressive strength, managed biodegradability and expression of osteocalcin and osteopontin as late markers of osteogenic differentiation were also reached in the range of 30-75 % for starch-BG-AV-QE scaffolds. Hence, starch-BG-AV-QE scaffolds with ideal physico-mechanical and biological characteristics can be considered as promising candidates for promotion of bone regeneration.

Silk-based phyto-hydrogel formulation expedites key events of wound healing in full-thickness skin defect model

Immense socio-economic burden of chronic wound demands effective, low-cost strategies for wound care. Herein, we have developed a chemical crosslinker-free phyto-hydrogel by encapsulating phytochemicals of Aloe vera mucilage extract (AVM) in the self-assembled polymeric chains of two different silk fibroin (SF) proteins (from Bombyx mori and Antheraea assamensis). Additionally, polyvinylpyrrolidone (PVP) has been used as a stabilizer that also contributed to the mucoadhesive property of the composite (SAP; made of SF, AVM, and PVP) hydrogel. The physicochemical properties of the hydrogel were evaluated and compared with SF hydrogel containing only SF proteins without any additives. The biocompatibility assessment of the hydrogel under in vitro conditions has shown improved cellular proliferative and migratory responses, suggesting faster tissue repairability of the hydrogel. A detailed in vivo comparative study with a commercially available DuoDERM® gel revealed that SAP hydrogel not only promoted wound closure but also showed better deposition and remodeling of the extracellular matrix. Moreover, the hydrogel also demonstrated its ability to downregulate pro-inflammatory markers (IL-1β, TNF-α) and upregulation of anti-inflammatory markers (IL-10, TGF-β) at the early stage of healing. Therefore, the bioactive proteins-carbohydrates composite efficiently accelerates skin regeneration and possesses great translational potential to offer a low-cost alternative wound care therapeutic.

Aloe vera and Streptozotocin-Induced Diabetes Mellitus

Diabetes mellitus is defined as prolonged hyperglycemia, which can harm the eyes, kidneys, and cardiovascular and neurological systems. Herbal agents and their derived supplements have been used for treatment of diabetes mellitus as a part of integrated complementary medicine for centuries. Numerous studies have considered Aloe vera (L.) Burm.f, Xanthorrhoeaceae, as an alternative medicine due to its abundant bioactive chemicals, such as alkaloids, anthraquinones, and enthrones, with therapeutical properties including antioxidant, anti-inflammatory, neuro-protective, and anti-diabetic effects. Aloe vera has received considerable attention in traditional medicine for the treatment of several diseases including diabetes mellitus. Numerous studies have investigated the effects of herbal agents on diabetes mellitus using a streptozotocin-induced diabetic model. Thereby, this article reviews the effects of Aloe vera prescription on streptozotocin-induced diabetes mellitus to provide a clear insight into the role of this medicinal plant in several biological functions, such as antioxidant, wound healing, anti-inflammatory, anti-hyperglycemic, and anti-hyperlipidemic in diabetic models.

Polymer-Based Wound Dressing Materials Loaded with Bioactive Agents: Potential Materials for the Treatment of Diabetic Wounds

Diabetic wounds are severe injuries that are common in patients that suffer from diabetes. Most of the presently employed wound dressing scaffolds are inappropriate for treating diabetic wounds. Improper treatment of diabetic wounds usually results in amputations. The shortcomings that are related to the currently used wound dressings include poor antimicrobial properties, inability to provide moisture, weak mechanical features, poor biodegradability, and biocompatibility, etc. To overcome the poor mechanical properties, polymer-based wound dressings have been designed from the combination of biopolymers (natural polymers) (e.g., chitosan, alginate, cellulose, chitin, gelatin, etc.) and synthetic polymers (e.g., poly (vinyl alcohol), poly (lactic-co-glycolic acid), polylactide, poly-glycolic acid, polyurethanes, etc.) to produce effective hybrid scaffolds for wound management. The loading of bioactive agents or drugs into polymer-based wound dressings can result in improved therapeutic outcomes such as good antibacterial or antioxidant activity when used in the treatment of diabetic wounds. Based on the outstanding performance of polymer-based wound dressings on diabetic wounds in the pre-clinical experiments, the in vivo and in vitro therapeutic results of the wound dressing materials on the diabetic wound are hereby reviewed.

Evaluation of the safety and healing potential of a fibroin-aloe gel film for the treatment of diabetic foot ulcers

OBJECTIVE

This study aimed to develop a wound dressing prepared from the blending of silkworm fibroin and aloe gel extract for use in the treatment of diabetic foot ulcers (DFUs).

METHODS

Fibroin extracted from silkworm cocoons and aloe gel extract were dissolved in deionised water. pH levels were then adjusted with lactic acid solution. A simple casting technique was used to obtain the fibroin-aloe gel film. The surface morphology, hardness, flexibility and infrared spectrum of the sterilised film were tested. Swelling ratio was measured from changes in weight. The cytocompatibility of the film to human dermal fibroblast was determined using XTT assay. Hard-to-heal DFUs (grade I Wagner score) were treated with the film for four weeks. The application site was assessed for allergic reactions and/or sensitisation. Wound size was measured using standardised digital photography.

RESULTS

A total of five hard-to-heal DFUs were treated. The obtained film sterilised with ozonation showed a non-porous structure. The elongation at break and tensile strength of the wet film were 9.00±0.95% and 6.89±1.21N, respectively. Fourier-transform infrared spectroscopy data indicated the presence of amides I, II and III, of peptide linkage, which are the chemical characteristics of the fibroin. Functional groups relating to healing activity of the aloe gel extract were also found. The swelling ratio of the film immersed in water for 24 hours was 0.8±0.01. In three DFUs (40-50mm² in size), a wound area reduction of 0.4-0.8mm²/day was observed and were healed in 2-3 weeks. The remaining two SFUs (500mm² in size) showed a wound area reduction of 4mm²/day and were almost closed at four weeks. No allergic reaction or infection was observed in any of the wounds.

CONCLUSION

The obtained film showed a non-porous structure, and its strength and flexibility were adequate for storage and handling. The film tended to increase the proliferation of fibroblasts. The wound dressing showed potential for accelerating the healing rate of DFUs.

Clinical application of traditional Chinese medicine moisture exposed burn ointment in the treatment of facial soft tissue defect

OBJECTIVE

To introduce a new method of treating facial soft tissue defect by observing the clinical curative effects of traditional Chinese medicine moisture exposed burn ointment in treating facial soft tissue defect.

METHODS

A total of 85 patients with facial soft tissue defects were treated with traditional Chinese medicine moisture exposed burn ointment, and the clinical therapeutic effects were analyzed by observing the wound healing time, scar formation and changes of facial appearance and functions.

RESULTS

Of the 85 patients, the shortest wound healing time was 12 days and the longest was 72 days; the facial appearance and functions restored to be normal in 74 patients, with good skin elasticity and mild scar formation in the wound area; 11 patients were lost to the follow-up; two patients suffered from the longest wound healing time due to their skin defect of nasal tip and nasal columella and the cartilage defect of nasal wings, and V-shaped defects were left at the edge of the left nostrils after the wound healing, which may be attributed to the ineffectiveness of MEBT/MEBO on cartilage.

CONCLUSION

Traditional Chinese medicine moisture exposed burn ointment can realize more satisfying healing effects when applied in the treatment of facial soft tissue defects, including user-friendly operation, no special requirements for medical devices, obviously lower treatment cost, etc., and thus it is an easy-to-operate and effective way for such patients, especially for elderly patients, patients with poor body conditions and patients unbearable to undergo complicated operations.

Angelica dahurica and Rheum officinale Facilitated Diabetic Wound Healing by Elevating Vascular Endothelial Growth Factor

Traditional Chinese medicine (TCM) provides alternative treatment choices for diabetic wounds. The aim of this study was to evaluate the effects of Angelica dahurica and Rheum officinale (ARE) on diabetic wounds and its underlying action mechanism. A total of 36 healthy male Sprague-Dawley rats were randomly divided into three groups: diabetes mellitus (DM) rats treated with ARE (DM-ARE), DM rats treated with 0.9% saline (DM-NS), and non-DM rats treated with 0.9% saline (NDM-NS). DM was induced by intraperitoneal administration of 40 mg/kg of streptozotocin after a 2-week high-fat diet feeding. After excisional skin wounds and treatments, the remaining wound area (RWA) in each group was measured. The RWA in the DM-NS group (69.60% ± 2.35%) was greater than that in the DM-ARE (55.70% ± 1.85%) and NDM-NS groups (52.50% ± 2.77%) on day 6. Besides, the DM-ARE group showed higher vascular endothelial growth factor (VEGF), higher inducible nitric oxide synthase (iNOs), higher [Formula: see text]-smooth muscle actin ([Formula: see text]-SMA), and lower nuclear factor kappa-light-chain-enhancer of activated B cell (NF-[Formula: see text]B) expression in the wound skin tissue. These results showed that treatment with ARE shifted the recovery pattern of diabetic rats to the pattern of nondiabetic rats, indicating that ARE may improve wound healing in diabetic conditions.

Fabrication of Hybrid Nanofibers from Biopolymers and Poly (Vinyl Alcohol)/Poly (ε-Caprolactone) for Wound Dressing Applications

The management of chronic wounds is challenging. The factors that impede wound healing include malnutrition, diseases (such as diabetes, cancer), and bacterial infection. Most of the presently utilized wound dressing materials suffer from severe limitations, including poor antibacterial and mechanical properties. Wound dressings formulated from the combination of biopolymers and synthetic polymers (i.e., poly (vinyl alcohol) or poly (ε-caprolactone) display interesting properties, including good biocompatibility, improved biodegradation, good mechanical properties and antimicrobial effects, promote tissue regeneration, etc. Formulation of these wound dressings via electrospinning technique is cost-effective, useful for uniform and continuous nanofibers with controllable pore structure, high porosity, excellent swelling capacity, good gaseous exchange, excellent cellular adhesion, and show a good capability to provide moisture and warmth environment for the accelerated wound healing process. Based on the above-mentioned outstanding properties of nanofibers and the unique properties of hybrid wound dressings prepared from poly (vinyl alcohol) and poly (ε-caprolactone), this review reports the in vitro and in vivo outcomes of the reported hybrid nanofibers.

Aloe vera: A Medicinal Plant Used in Skin Wound Healing

Skin injury is a major problem threatening human physical and mental health, and how to promote wound healing has been the focus. Developing new wound dressings is an important strategy in skin regeneration. Aloe vera is a medicinal plant with a long history, complex constituents, and various pharmacological activities. Many studies have shown that A. vera plays an important role in promoting wound healing. Adding A. vera to wound dressing has become an ideal way. This review will describe the process of skin injury and wound healing and analyze the role of A. vera in wound healing. In addition, the types of wound dressing and the applications of A. vera in wound dressing will be discussed.

Macrophage polarization in wound healing: role of aloe vera/chitosan nanohydrogel

The balance between M1 and M2 macrophages plays an important role in wound healing. Interestingly, this immune response can be modulated by natural biomaterials such as chitosan nanohydrogel (Ch) and aloe vera (AV). Therefore, we aimed to improve wound recovery response by exploiting the potential healing properties of Ch and AV. Wounds were created in rats and were treated daily with either saline (control), AV, Ch, or different ratios of AV (volume):Ch (weight) (1:1), (2:1), and (3:1). M1 (iNOS, TNF-α) and M2 (CD163, TGF-β) responses were analyzed at days 3, 7, 14, 21, and 28. Wound healing increased within the third and seventh days in AV-Ch (3:1) (P < 0.001 and P < 0.002, respectively). In the treated groups, immunohistochemistry of iNOS expression decreased on the third day (P < 0.0001) while CD163 increased (P < 0.0001) on the 3rd, 7th, and 14th days. The gene expression of TGF-β decreased on the third day in AV group (P < 0.03) and on the 21st and 28th days in Ch-treated group (P < 0.00). TNF-α expression decreased in AV, Ch, and AV-Ch (3:1 v/w) on the 14th and 28th days (P < 0.00). TGF-β and TNF-α proteins decreased on the 28th day compared to the control and AV-Ch (3:1 v/w), respectively. AV-Ch (1 and 3:1 v/w) and Ch resulted in optimum wound repair by decreasing M1 after 3 days and increasing M2 after 14. Thus, Ch nanohydrogel, especially in combination with 1:1 and 1:3 ratio to AV, could be a proper candidate for modulating macrophages in response to wound healing.

Silk biomaterials in wound healing and skin regeneration therapeutics: From bench to bedside

Silk biomaterials are known for biomedical and tissue engineering applications including drug delivery and implantable devices owing to their biocompatible and a wide range of ideal physico-chemical properties. Herein, we present a critical overview of the progress of silk-based matrices in skin regeneration therapeutics with an emphasis on recent innovations and scientific findings. Beginning with a brief description of numerous varieties of silks, the review summarizes our current understanding of the biological properties of silk that help in the wound healing process. Various silk varieties such as silkworm silk fibroin, silk sericin, native spider silk and recombinant silk materials have been explored for cutaneous wound healing applications from the past few decades. With an aim to harness the regenerative properties of silk, numerous strategies have been applied to develop functional bioactive wound dressings and viable bio-artificial skin grafts in recent times. The review examines multiple inherent properties of silk that aid in the critical events of the healing process such as cell migration, cell proliferation, angiogenesis, and re-epithelialization. A detailed insight into the progress of silk-based cellular skin grafts is also provided that discusses various co-culture strategies and development of bilayer and tri-layer human skin equivalent under in vitro conditions. In addition, functionalized silk matrices loaded with bioactive molecules and antibacterial compounds are discussed, which have shown great potential in treating hard-to-heal wounds. Finally, clinical studies performed using silk-based translational products are reviewed that validate their regenerative properties and future applications in this area. STATEMENT OF SIGNIFICANCE: The review article discusses the recent advances in silk-based technologies for wound healing applications, covering various types of silk biomaterials and their properties suitable for wound repair and regeneration. The article demonstrates the progress of silk-based matrices with an update on the patented technologies and clinical advancements over the years. The rationale behind this review is to highlight numerous properties of silk biomaterials that aid in all the critical events of the wound healing process towards skin regeneration. Functionalization strategies to fabricate silk dressings containing bioactive molecules and antimicrobial compounds for drug delivery to the wound bed are discussed. In addition, a separate section describes the approaches taken to generate living human skin equivalent that have recently contributed in the field of skin tissue engineering.

Fabrication and Characterization of Silk Fibroin/Curcumin Sustained-Release Film

In the present work, a sustained-release film composed of silk fibroin (SF), curcumin (Cur), glutaraldehyde (GA), and glycerol (Gly) was prepared successfully for wound dressings. Features relevant to wound dressings of SF/Gly/GA/Cur film were assessed. Physical and chemical properties of the fabricated materials were also characterized. The results showed that the prepared SF/Gly/GA/Cur film demonstrated a good sustained-release performance, flexibility, and gas permeability. In addition, it was found that the prepared SF/Gly/GA/Cur film possessed the capability to effectively inhibit the growth of bacteria and prevent bacterial penetration with a suitable water vapor transmission rate. Furthermore, the prepared composite film was non-cytotoxic, which makes it an ideal material for wound dressings.

Biopolymer-based biomaterials for accelerated diabetic wound healing: A critical review

Non-healing, chronic wounds place a huge burden on healthcare systems as well as individual patients. These chronic wounds especially diabetic wounds will ultimately lead to compromised mobility, amputation of limbs and even death. Currently, wounds and limb ulcers associated with diabetes remain significant health issues; the associated healthcare cost ultimately leads to the increased clinical burden. The presence of diabetes interrupts a highly coordinated cascade of events in the wound closure process. Advances in the understanding of pathophysiological conditions associated with diabetic wounds lead to the development of drug delivery systems which can enhance wound healing by targeting various phases of the impaired processes. Wound environments typically contain degradative enzymes, along with an elevated pH and demonstrate a physiological cascade involved in the regeneration of tissue, which requires the application of an effective delivery system. This article aims to review the pathophysiological conditions associated with chronic and diabetic wounds. The delivery systems, involved in their treatment are described, highlighting potential biomaterials and polymers for establishing drug delivery systems, specifically for the treatment of diabetic wounds and the promotion of the associated mechanisms involved in advanced wound healing. Emerging approaches and engineered devices for effective wound care are reported. The discussion will give insight into the mechanisms relevant to all stages of wound healing.

Antiacne and antiblotch activities of a formulated combination of Aloe barbadensis leaf powder, Garcinia mangostana peel extract, and Camellia sinensis leaf extract

Objective: We compared the efficacy of an antiacne hydrogel formulated with a combination of Aloe barbadensis leaf extract, Garcinia mangostana peel extract, and Camellia sinensis leaf extract (AGC) at a ratio of 50:25:1 with a marketed 1% clindamycin gel (CG) formulation on antiacne and antiblotch activities. Methods: A single-center, parallel-arm, randomized controlled trial was performed from November 2017 to April 2018. Sixty subjects with mild-moderate acne severity according to the the American Academy of Dermatology were enrolled for the study. Outcome end points were total acne lesions (TALs) and acne-severity index (ASI) by counting the inflamed lesions and comedones and skin colors using erythema and melanin values. Results: For TALss, a decrease (P<0.0001) in the number of total inflamed lesions from baseline was evidenced in AGC group, but not in the CG group. Higher reduction in mean ASI in the AGC group was seen than in the CG group. However, there was no statistically significant difference regarding reduction in ASI between the AGC and CG groups. For erythema, a remarked reduction in skin redness from baseline was clearly seen at day 3 (P<0.05) in the AGC group. No significant decrease in erythema values from baseline was seen in the CG group. A significant decrease (P=0.037) in mean melanin value from baseline was seen in the AGC group after 14 days of twice-daily use, but not in the CG group. Both products were well tolerated, with no reports of severe adverse events. Conclusion: An anti-acne hydrogel containing a combination of mangosteen rinds, aloe vera gel, and green tea-leaf extracts was superior to 1% clindamycin gel in antiacne and antiblotch activities when measured by TALs and erythema and melanin values.

Molecular Concept of Diabetic Wound Healing: Effective Role of Herbal Remedies

The incidence of diabetes mellitus (DM) is on the rise, worldwide. One of the main complications in DM is delayed wound healing and it often requires amputation. Various drugs were used to treat DM but they presented with adverse effects. Often, patients failed to comply with such treatment. This opened the door for complementary and alternative medicine. In the present review, we explored the molecular concept of wound healing occurring in different stages with special emphasis to DM. We also highlighted the potential herbal products such as NF3 (Chinese 2-Herb Formula), Zicao, Jing Wan Hong ointment, Aleo vera, mixture of Adiantum capillus-veneris, Commiphora molmol, Aloe vera, and henna, Phenol-rich compound sweet gel, Jinchuang ointment, San-huang-sheng-fu (S) oil, Yi Bu A Jie extract, Astragali Radix (AR) and Rehmanniae Radix (RR), Yiqi Huayu, Tangzu yuyang ointment, Shengji Huayu recipe, Angelica sinensis, Lithospermun erythrorhison, Hippophae rhamnoides L., Curcuma longa and Momordica charantia that could be used effectively to treat DM wounds. Future clinical trials are needed for designing potential drugs which may be effective in treating DM wounds.

Effect of Silk Fibroin on Cell Viability in Electrospun Scaffolds of Polyethylene Oxide

In this study, a coating from electrospun silk fibroin was performed with the aim to modify the surface of breast implants. We evaluated the effect of fibroin on polymeric matrices of poly (ethylene oxide) (PEO) to enhance cell viability, adhesion, and proliferation of HaCaT human keratinocytes to enhance the healing process on breast prosthesis implantation. We electrospun six blends of fibroin and PEO at different concentrations. These scaffolds were characterized by scanning electron microscopy, contact angle measurements, ATR-FTIR spectroscopy, and X-ray diffraction. We obtained diverse network conformations at different combinations to examine the regulation of cell adhesion and proliferation by modifying the microstructure of the matrix to be applied as a potential scaffold for coating breast implants. The key contribution of this work is the solution it provides to enhance the healing process on prosthesis implantation considering that the use of these PEO⁻fibroin scaffolds reduced (p < 0.05) the amount of pyknotic nuclei. Therefore, viability of HaCaT human keratinocytes on PEO⁻fibroin matrices was significantly improved (p < 0.001). These findings provide a rational strategy to coat breast implants improving biocompatibility.

Mechanistic insight into diabetic wounds: Pathogenesis, molecular targets and treatment strategies to pace wound healing

Wound management in diabetic patient is of an extreme clinical and social concern. The delayed and impaired healing makes it more critical for research focus. The research on impaired healing process is proceeding hastily evident by new therapeutic approaches other than conventional such as single growth factor, dual growth factor, skin substitutes, cytokine stimulators, cytokine inhibitors, matrix metalloproteinase inhibitors, gene and stem cell therapy, extracellular matrix and angiogenesis stimulators. Although numerous studies are available that support delayed wound healing in diabetes but detailed mechanistic insight including factors involved and their role still needs to be revealed. This review mainly focuses on the molecular cascades of cytokines (with growth factors) and erstwhile factors responsible for delayed wound healing, molecular targets and recent advancements in complete healing and its cure. Present article briefed recent pioneering information on possible molecular targets and treatment strategies including clinical trials to clinicians and researchers working in similar area.

Accelerated Healing of Diabetic Wounds Treated with L-Glutamic acid Loaded Hydrogels Through Enhanced Collagen Deposition and Angiogenesis: An In Vivo Study

We have developed L-glutamic acid (LG) loaded chitosan (CS) hydrogels to treat diabetic wounds. Although literature reports wound healing effects of poly(glutamic acid)-based materials, there are no studies on the potential of L-glutamic acid in treating diabetic wounds. As LG is a direct precursor for proline synthesis, which is crucial for collagen synthesis, we have prepared CS + LG hydrogels to accelerate diabetic wound healing. Physiochemical properties of the CS + LG hydrogels showed good swelling, thermal stability, smooth surface morphology, and controlled biodegradation. The addition of LG to CS hydrogels did not alter their biocompatibility significantly. CS + LG hydrogel treatment showed rapid wound contraction compared to control and chitosan hydrogel. Period of epithelialization is significantly reduced in CS + LG hydrogel treated wounds (16 days) compared to CS hydrogel (20 days), and control (26 days). Collagen synthesis and crosslinking are also significantly improved in CS + LG hydrogel treated diabetic rats. Histopathology and immunohistochemistry results revealed that the CS + LG hydrogel dressing accelerated vascularization and macrophage recruitment to enhance diabetic wound healing. These results demonstrate that incorporation of LG can improve collagen deposition, and vascularization, and aid in faster tissue regeneration. Therefore, CS + LG hydrogels could be an effective wound dressing used to treat diabetic wounds.

Phase Behaviour and Miscibility Studies of Collagen/Silk Fibroin Macromolecular System in Dilute Solutions and Solid State

Miscibility is an important issue in biopolymer blends for analysis of the behavior of polymer pairs through the detection of phase separation and improvement of the mechanical and physical properties of the blend. This study presents the formulation of a stable and one-phase mixture of collagen and regenerated silk fibroin (RSF), with the highest miscibility ratio between these two macromolecules, through inducing electrostatic interactions, using salt ions. For this aim, a ternary phase diagram was experimentally built for the mixtures, based on observations of phase behavior of blend solutions with various ratios. The miscibility behavior of the blend solutions in the miscible zones of the phase diagram was confirmed quantitatively by viscosimetric measurements. Assessing the effects of biopolymer mixing ratio and salt ions, before and after dialysis of blend solutions, revealed the importance of ion-specific interactions in the formation of coacervate-based materials containing collagen and RSF blends that can be used in pharmaceutical, drug delivery, and biomedical applications. Moreover, the conformational change of silk fibroin from random coil to beta sheet, in solution and in the final solid films, was detected by circular dichroism (CD) and Fourier transform infrared spectroscopy (FTIR), respectively. Scanning electron microscopy (SEM) exhibited alterations of surface morphology for the biocomposite films with different ratios. Surface contact angle measurement illustrated different hydrophobic properties for the blended film surfaces. Differential scanning calorimetry (DSC) showed that the formation of the beta sheet structure of silk fibroin enhances the thermal stability of the final blend films. Therefore, the novel method presented in this study resulted in the formation of biocomposite films whose physico-chemical properties can be tuned by silk fibroin conformational changes by applying different component mixing ratios.

From Inflammation to Current and Alternative Therapies Involved in Wound Healing

Wound healing is a complex event that develops in three overlapping phases: inflammatory, proliferative, and remodeling. These phases are distinct in function and histological characteristics. However, they depend on the interaction of cytokines, growth factors, chemokines, and chemical mediators from cells to perform regulatory events. In this article, we will review the pathway in the skin healing cascade, relating the major chemical inflammatory mediators, cellular and molecular, as well as demonstrating the local and systemic factors that interfere in healing and disorders associated with tissue repair deficiency. Finally, we will discuss the current therapeutic interventions in the wounds treatment, and the alternative therapies used as promising results in the development of new products with healing potential.

Electrospun Polycaprolactone/Aloe Vera_Chitosan Nanofibrous Asymmetric Membranes Aimed for Wound Healing Applications

Today, none of the wound dressings available on the market is fully capable of reproducing all the features of native skin. Herein, an asymmetric electrospun membrane was produced to mimic both layers of skin. It comprises a top dense layer (manufactured with polycaprolactone) that was designed to provide mechanical support to the wound and a bottom porous layer (composed of chitosan and Aloe Vera) aimed to improve the bactericidal activity of the membrane and ultimately the healing process. The results obtained revealed that the produced asymmetric membranes displayed a porosity, wettability, as well as mechanical properties similar to those presented by the native skin. Fibroblast cells were able to adhere, spread, and proliferate on the surface of the membranes and the intrinsic structure of the two layers of the membrane is capable of avoiding the invasion of microorganisms while conferring bioactive properties. Such data reveals the potential of these asymmetric membranes, in the near future, to be applied as wound dressings.

Recent advances in biomaterials for the treatment of diabetic foot ulcers

Diabetes mellitus is one of the most challenging epidemics facing the world today, with over 300 million patients affected worldwide.

Ethanol extract of Terminalia chebula fruit protects against UVB-induced skin damage

CONTEXT

The fruit of Terminalia chebula Retz. (Combretaceae) has been used for several therapeutic purposes in Thai folk medicines. Currently, the ethanol extracts containing antioxidant compounds have shown the ability to promote collagen synthesis.

OBJECTIVE

This purpose of this work was to study the effects of the ethanol extract from T. chebula fruit on the inhibition of cutaneous photodamage.

MATERIALS AND METHODS

The viability of human skin fibroblasts after incubation with T. chebula at concentration 0.5-50 μg/mL for 24, 48 and 72 h was assessed by using sodium 3'-[(phenyl-amino)-carbonyl]-3,4,tetrazolium-bis(4-methoxy-6-notro)benzene-sulphonic acid hydrate (XTT). The levels of type I procollagen and matrix metalloproteinases (MMP)-1 and MMP-13 produced by UVB-irradiated fibroblasts were determined by ELISA. Skin thickness and collagen content caused by long-term UVB irradiation in male ICR mice were determined from haematoxylin and eosin stained tissue sections and spectrophotometric measurement of hydroxyproline.

RESULTS

The extract (0.5-50 μg/mL) had no effect on cell viability or morphology of the human fibroblasts. In vitro studies showed that the T. chebula extract reduced the UVB-induced MMP-1 and MMP-13 expression, whereas an increased production of type I procollagen was observed. In a UVB-irradiated animal model, male ICR mice with hair shaved were chronically exposed to UVB which lead to epidermal thickness and loss of hydroxyproline. However, these effects were fully prevented by the topical application of the T. chebula ethanol extract.

DISCUSSION AND CONCLUSION

These data suggested that the T. chebula ethanol fruit extract is an efficacious pharmaceutical protectant of skin against photodamage.

Biomacromolecule immobilization: grafting of fish-scale collagen peptides onto aminolyzed P(3HB-co-4HB) scaffolds as a potential wound dressing

Polyhydroxyalkanoate (PHA) is a microbial polymer that has been at the forefront of many attempts at tissue engineering. However, the surface of poly(3-hydroxybutyrate-co-4-hydroxybutyrate) (P(3HB-co-4HB)) is hydrophobic with few recognition sites for cell attachment. Various concentrations of fish-scale collagen peptides (FSCPs) were incorporated into P(3HB-co-4HB) copolymer by aminolysis. Later, FSCPs were introduced onto the aminolyzed P(3HB-co-4HB) scaffolds. Introduction of the FSCP groups was verified using Fourier transform infrared spectroscopy and the ninhydrin method. The effect of the incorporation of FSCPs on hydrophilicity was investigated using the water contact angle. As the concentration of FSCPs increased, the water contact angle decreased. In vitro study demonstrated that P(3HB-co-4HB)/FSCP scaffolds provided better cell attachment and growth of L929 mouse fibroblast cells and better cell proliferation. In vivo study showed that P(3HB-co-4HB)/1.5 wt% FSCPs had a significant effect on wound contractions, with the highest percentage of wound closure (61%) in 7 d.

Nature-Derived Aloe Vera Gel Blended Silk Fibroin Film Scaffolds for Cornea Endothelial Cell Regeneration and Transplantation

The goal of this study was to fabricate an appropriate replacement for cadaveric corneas to overcome a shortage of cadaveric corneas for transplantation. In this study, we fabricated transparent ultrathin film scaffolds with nature-derived aloe vera (AV) gel and silk fibroin (SF) for corneal endothelial cells (CECs). The scaffolds were subjected to analysis of transparency and contact angle using field emission scanning electron microscopy (FESEM) and Fourier transform infrared spectroscopy to determine their physical and chemical properties. FESEM images revealed that the critical morphology of CECs was formed on the AV gel in the blend with SF rather than in the scaffold with SF alone. The cell proliferation, phenotype, and specific gene marker expressions for CECs were determined by MTT assays, immunofluorescence, and reverse transcription polymerase chain reactions. Incorporation of a small amount of AV gel increased the cell viability and maintained its functions well. The scaffolds were easily handled for transplantation into rabbit eyes with small incisions and examined by their transparency after transplantation and histological staining. The scaffolds attached to the surface of the corneal stroma and integrated with surrounding corneal tissue without a significant inflammatory reaction. These results indicate that AV blended SF film scaffolds might be a suitable substitute for alternative corneal grafts for transplantation.