Phytochemicals and Naturally Derived Substances for Wound Healing

Topical Cream Derived From Hylocereus polyrhizus (Red Dragon Fruit) Extract Accelerates Wound Healing Through Increased Hydroxyproline and Fibroblast Growth Factor 2 Levels: A Pilot Study

The red dragon fruit (Hylocereus polyrhizus) extract (RDFE) is frequently used for a variety of therapeutic purposes (e.g., boosting the immune system, promoting a healthy gastrointestinal system, improving wound healing). We investigated the effects of a topical cream containing 7.5% RDFE on hydroxyproline and fibroblast growth factor 2 (FGF-2) levels and wound healing. On Day 0, we divided a total of 36 albino male Wistar rats into two equal groups. Using an 8-mm punch biopsy, we created a circular excision to fascial depth on the back of each rat. On Day 1, we treated the control group (n = 18) with 20 mg of base cream and the RDFE group (n = 18) with 20 mg of 7.5% RDFE cream. We measured hydroxyproline and FGF-2 levels in the wound tissue using an ELISA method on Days 3, 7, and 14. We found that on Day 3, hydroxyproline levels were significantly lower in the treatment group than in the control group (p = .031). We also found a significant correlation between FGF-2 levels in the treatment group and wound diameter (p = .02). On the basis of the results of this study, we concluded that using a topical cream containing 7.5% RDFE has the potential to accelerate wound healing by increasing levels of hydroxyproline and FGF-2 in the wound.

The wound healing effect of botanicals and pure natural substances used in in vivo models

Repairing the wound is a multistep process that includes the spatial and temporal synchronization of a different range of cell types to increase the speed of wound contraction, the proliferation of epithelial cells, and collagen formation. The need for proper management of acute wounds to be cured and not turned into chronic wounds is a significant clinical challenge. The traditional practice of medicinal plants in many regions of the world has been used in wound healing since ancient times. Recent scientific research introduced evidence of the efficacy of medicinal plants, their phyto-components, and the mechanisms underlying their wound-repairing activity. This review aims to briefly highlight the wound-curing effect of different plant extracts and purely natural substances in excision, incision, and burn experimental animal models with or without infection of mice, rats (diabetic and nondiabetic), and rabbits in the last 5 years. The in vivo studies represented reliable evidence of how powerful natural products are in healing wounds properly. They have good scavenging activity against Reactive oxygen species (ROS) and anti-inflammatory and antimicrobial effects that help in the process of wound healing. It is evident that incorporating bioactive natural products into wound dressings of bio- or synthetic polymers in nanofiber, hydrogel, film, scaffold, and sponge forms showed promising results in different phases of the wound-curing process of haemostasis, inflammation, growth, re-epithelialization, and remodelling.

Evidence for Natural Products as Alternative Wound-Healing Therapies

Chronic, non-healing wounds represent a significant area of unmet medical need and are a growing problem for healthcare systems around the world. They affect the quality of life for patients and are an economic burden, being difficult and time consuming to treat. They are an escalating problem across the developed world due to the increasing incidence of diabetes and the higher prevalence of ageing populations. Effective treatment options are currently lacking, and in some cases chronic wounds can persist for years. Some traditional medicines are believed to contain bioactive small molecules that induce the healing of chronic wounds by reducing excessive inflammation, thereby allowing re-epithelisation to occur. Furthermore, many small molecules found in plants are known to have antibacterial properties and, although they lack the therapeutic selectivity of antibiotics, they are certainly capable of acting as topical antiseptics when applied to infected wounds. As these molecules act through mechanisms of action distinct from those of clinically used antibiotics, they are often active against antibiotic resistant bacteria. Although there are numerous studies highlighting the effects of naturally occurring small molecules in wound-healing assays in vitro, only evidence from well conducted clinical trials can allow these molecules or the remedies that contain them to progress to the clinic. With this in mind, we review wound-healing natural remedies that have entered clinical trials over a twenty-year period to the present. We examine the bioactive small molecules likely to be in involved and, where possible, their mechanisms of action.

Himatanthus bracteatus-Composed In Situ Polymerizable Hydrogel for Wound Healing

The Himatanthus genus presents anti-inflammatory, antioxidant activities, suggesting potential wound-healing properties. This study aimed to develop and analyze the wound-healing properties of a photopolymerizable gelatin-based hydrogel (GelMA) containing an ethanolic extract of Himatanthus bracteatus in a murine model. The extract was obtained under high pressure conditions, incorporated (2%) into the GelMA (GelMA-HB), and physically characterized. The anti-inflammatory activity of the extract was assessed using a carrageenan-induced pleurisy model and the GelMA-HB scarring properties in a wound-healing assay. The extract reduced IL-1β and TNF-α levels (48.5 ± 6.7 and 64.1 ± 4.9 pg/mL) compared to the vehicle (94.4 ± 2.3 pg/mL and 106.3 ± 5.7 pg/mL; p < 0.001). GelMA-HB depicted significantly lower swelling and increased resistance to mechanical compression compared to GelMA (p < 0.05). GelMA-HB accelerated wound closure over the time course of the experiment (p < 0.05) and promoted a significantly greater peak of myofibroblast differentiation (36.1 ± 6.6 cells) and microvascular density (23.1 ± 0.7 microvessels) on day 7 in comparison to GelMA (31.9 ± 5.3 cells and 20.2 ± 0.6 microvessels) and the control (25.8 ± 4.6 cells and 17.5 ± 0.5 microvessels) (p < 0.05). In conclusion, GelMA-HB improved wound healing in rodents, probably by modulating the inflammatory response and myofibroblastic and microvascular differentiation.

The Discovery and Development of Natural-Based Biomaterials with Demonstrated Wound Healing Properties: A Reliable Approach in Clinical Trials

Current research across the globe still focuses strongly on naturally derived biomaterials in various fields, particularly wound care. There is a need for more effective therapies that will address the physiological deficiencies underlying chronic wound treatment. The use of moist bioactive scaffolds has significantly increased healing rates compared to local and traditional treatments. However, failure to heal or prolonging the wound healing process results in increased financial and social stress imposed on health institutions, caregivers, patients, and their families. The urgent need to identify practical, safe, and cost-effective wound healing scaffolding from natural-based biomaterials that can be introduced into clinical practice is unequivocal. Naturally derived products have long been used in wound healing; however, clinical trial evaluations of these therapies are still in their infancy. Additionally, further well-designed clinical trials are necessary to confirm the efficacy and safety of natural-based biomaterials in treating wounds. Thus, the focus of this review is to describe the current insight, the latest discoveries in selected natural-based wound healing implant products, the possible action mechanisms, and an approach to clinical studies. We explore several tested products undergoing clinical trials as a novel approach to counteract the debilitating effects of impaired wound healing.

Polysaccharide extract of Caesalpinia ferrea (Mart) pods attenuates inflammation and enhances the proliferative phase of rat cutaneous wounds

Pods of Caesalpinia ferrea, popularly used to treat inflammatory processes, were collected to obtain the polysaccharide-rich extract, presenting anti-inflammatory and antinociceptive effects in acute inflammation models. This study aimed to evaluate the anti-inflammatory, antinociceptive and healing activities of the polysaccharide-rich extract from Caesalpinia ferrea pods (PEp-Cf) in the rat model of cutaneous excisional wound. PEp-Cf (0.025-0.1%) or 0.9% NaCl was topically applied in the wounds at dorsal thoracic region (2×/day) during 21 days for measurement of clinical signs (hyperemia, inflammatory exudate, edema, nociception), wound size, histopathological/histomorphometric, oxidative/inflammatory markers and systemic toxicity. PEp-Cf at 0.1% reduced wound area and increased ulcer contraction [days 2 and 10 (21-78%)]. PEp-Cf reduced clinical signs [days 2 and 5 (2.2-2.8×)] and modulated the healing inflammatory phase via stimulation of epithelialization (days 10 and 14), and inhibition of polymorphonuclears [days 2 and 5 (71-74%)], protein leakage [days 2 and 5 (28-41%)], nitrate [days 2 and 5 (2.2-6×)] and malondialdehyde [days 2 and 5 (46-49%)]. PEp-Cf increased the number of blood vessels [days 5 and 7 (3.1-9.6×)], fibroblasts [days 5 and 7 (2.1-6.4×)] and collagen [days 5 to 14 (1.5-1.8×)]. In conclusion, the topical application of PEp-Cf at 0.1% accelerates the healing process of rat cutaneous wounds via modulation of the inflammatory and proliferative phases, being devoid of systemic alterations.

Challenges in Healing Wound: Role of Complementary and Alternative Medicine

Although the word wound sounds like a simple injury to tissue, individual's health status and other inherent factors may make it very complicated. Hence, wound healing has gained major attention in the healthcare. The biology wound healing is precise and highly programmed, through phases of hemostasis, inflammation, proliferation and remodeling. Current options for wound healing which includes, use of anti-microbial agents, healing promoters along with application of herbal and natural products. However, there is no efficient evidence-based therapy available for specific chronic wounds that can result in definitive clinical outcomes. Under co-morbid conditions, chronic would poses numerous challenges. Use of Complementary and Alternative Medicines (CAMs) in health care sector is increasing and its applications in wound management remains like to "separate the diamonds from ore." Attempts have been made to understand the wound at the molecular level, mainly through the analysis of signature genes and the influence of several synthetic and natural molecules on these. We have outlined a review of challenges in chronic wound healing and the role of CAMs in chronic wound management. The main focus is on the applications and limitations of currently available treatment options for a non-healing wound and the best possible alternates to consider. This information generates broader knowledge on challenges in chronic wound healing, which can be further addressed using multidisciplinary approach and combination therapies.

Fabrication and Characterization of Nanocomposite Hydrogel Based on Alginate/Nano-Hydroxyapatite Loaded with Linum usitatissimum Extract as a Bone Tissue Engineering Scaffold

In the current paper, we fabricated, characterized, and applied nanocomposite hydrogel based on alginate (Alg) and nano-hydroxyapatite (nHA) loaded with phenolic purified extracts from the aerial part of Linum usitatissimum (LOH) as the bone tissue engineering scaffold. nHA was synthesized based on the wet chemical technique/precipitation reaction and incorporated into Alg hydrogel as the filler via physical cross-linking. The characterizations (SEM, DLS, and Zeta potential) revealed that the synthesized nHA possess a plate-like shape with nanometric dimensions. The fabricated nanocomposite has a porous architecture with interconnected pores. The average pore size was in the range of 100–200 µm and the porosity range of 80–90%. The LOH release measurement showed that about 90% of the loaded drug was released within 12 h followed by a sustained release over 48 h. The in vitro assessments showed that the nanocomposite possesses significant antioxidant activity promoting bone regeneration. The hemolysis induction measurement showed that the nanocomposites were hemocompatible with negligible hemolysis induction. The cell viability/proliferation confirmed the biocompatibility of the nanocomposites, which induced proliferative effects in a dose-dependent manner. This study revealed the fabricated nanocomposites are bioactive and osteoactive applicable for bone tissue engineering applications.

Wound Healing Effect of Gintonin Involves Lysophosphatidic Acid Receptor/Vascular Endothelial Growth Factor Signaling Pathway in Keratinocytes

Gintonin, a novel compound of ginseng, is a ligand of the lysophosphatidic acid (LPA) receptor. The in vitro and in vivo skin wound healing effects of gintonin remain unknown. Therefore, the objective of this study was to investigate the effects of gintonin on wound healing-linked responses, especially migration and proliferation, in skin keratinocytes HaCaT. In this study, 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide assay, Boyden chamber migration assay, scratch wound healing assay, and Western blot assay were performed. A tail wound mouse model was used for the in vivo test. Gintonin increased proliferation, migration, and scratch closure in HaCaT cells. It also increased the release of vascular endothelial growth factor (VEGF) in HaCaT cells. However, these increases, induced by gintonin, were markedly blocked by treatment with Ki16425, an LPA inhibitor, PD98059, an ERK inhibitor, 1,2-Bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid tetrakis (acetoxymethyl ester), a calcium chelator, and U73122, a PLC inhibitor. The VEGF receptor inhibitor axitinib also attenuated gintonin-enhanced HaCaT cell proliferation. Gintonin increased the phosphorylation of AKT and ERK1/2 in HaCaT cells. In addition, gintonin improved tail wound healing in mice. These results indicate that gintonin may promote wound healing through LPA receptor activation and/or VEGF release-mediated downstream signaling pathways. Thus, gintonin could be a beneficial substance to facilitate skin wound healing.

Codiaeum variegatum (L.) Rumph. ex A. Juss. (Euphorbiaceae): An overview of its botanical diversity, traditional uses, phytochemistry, pharmacological effects and perspectives towards developing its plant-based products

ETHNOPHARMACOLOGICAL RELEVANCE

Codiaeum variegatum also called miracle shrub, is a plant species constituted of more than 300 cultivars which are mostly used as indoor plants for decoration. However, some of these varieties are used by indigenous populations for the treatment of diarrhoea, stomach ache, external wounds, intestinal worms and ulcers.

AIM OF THE STUDY

This study describes an overview of the botanical diversity, medicinal uses, phytochemical composition of C. variegatum. Then it critically discusses its pharmacological activities versus toxic potential and new perspectives are suggested for the development of its plant-based products.

MATERIALS AND METHODS

A bibliographic assessment of publications on C. variegatum indexed in Google Scholar, PubMed, Science Direct, Scopus, Springer Link, and Web of Science online databases was conducted from 1970 to 2020, and 89 relevant articles related to the botanical diversity (17), traditional uses (22), phytochemical analysis (11), pharmacological activity (31) and toxicity profile (18) of C. variegatum were selected for this review.

RESULTS

Most commonly, it was found that aqueous leaf extracts or decoctions of C. variegatum are used in traditional medicine to treat amoebic dysentery and stomach ache while a bath with root decoction or sap is applied in small quantities on skin related infections. A total of 14 identified and 24 non-identified varieties of C. variegatum were reported for pharmacological activity, and prominent research topics include the anti-amoebic, antimicrobial, antiviral and cytotoxic activities. Alkaloids (3), terpenoids (5) and phenolics (15) were the major compounds identified, and a new antiviral cyanoglucoside was isolated from the sap of C. variegatum. Toxic substances (5-deoxyingenol and phorbol esters) were found in some varieties used as ornamental plants, but the Mollucanum variety used in traditional medicine was found to be safe.

CONCLUSION

The present review revealed that the native variety of C. variegatum (cv. Mollucanum) can be used to treat amoebic dysentery. Alkaloids, terpenoids and phenolic compounds have been characterized in this plant species while other classes of phytochemicals are not yet investigated. The development of new cultivars recommends an in-depth toxicological study before any use. No clinical trial has been reported to date, and further studies are needed to evaluate other claimed medicinal uses. Due to its efficacy and safety, the Mollucanum variety is most likely suitable for the development of a medicine against amoebiasis, which will surely lay the foundation for clinical studies.

Effect of snail mucus on angiogenesis during wound healing

Background: Angiogenesis is the process through which new blood vessels are formed from existing ones. This process plays an important role in supplying the oxygen and nutrients needed for cellular metabolism and eliminating cell debris during wound healing. Snail mucus can bind to several factors that stimulate angiogenesis, including vascular endothelial growth factor, platelet-derived growth factor, and fibroblast growth factor. The aim of this study is to observe changes in angiogenesis during the healing of wounds topically applied with snail mucus. Methods: Punch biopsy was performed on the back of male Wistar rats to obtain four wounds, and different concentrations of snail mucus were applied to each of these wounds. The animals were sacrificed on days 2, 4, and 7 to observe the extent of angiogenesis during wound healing by microscopy. Results: Two-way ANOVA showed differences in number of blood vessels formed (p = 0.00) and day of observation (p = 0.00) between groups. Post hoc Tukey's HSD test showed that 24% snail mucus treatment does not significantly affect wound healing (p = 0.488); by contrast, treatment with 48% and 96% snail mucus demonstrated significant effects on angiogenesis (p = 0.01). Spearman's test showed interactive effects between snail mucus concentration and day of observation on the extent of angiogenesis (p = 0.001, R = 0.946). Conclusion: Topical application of snail mucus gel can increase angiogenesis during wound healing in Wistar rat skin.

Investigation of Healing Effects of Cinnamic Acid in a Full-Thickness Wound Model in Rabbit

Background: Wounds represent a major global problem for health care systems, clinicians, patients, and their families. Cinnamic Acid (CA) is a naturally occurring phenolic compound that possesses anti-inflammatory, antimicrobial, and antioxidant properties. Objectives: This study aimed to investigate the effects of CA on skin wound-healing in the animal model. Methods: Full-thickness wounds were created on the back of white New Zealand rabbits of both sexes. Animals were divided into six groups (six animals and 12 wounds in each group). Negative control received no treatment, while positive control was treated with phenytoin cream, vehicle group with eucerin, and test groups with 0.1, 1, and 10% CA ointments. The healing activity of CA was evaluated by determining the wound closure rate and hydroxyproline content of wound tissue samples. In addition, the histopathological study of tissue samples of different groups was performed using hematoxylin and eosin staining. Results: The rate of wound closure and hydroxyproline levels of tissue samples in animals treated with CA 0.1% were significantly (P < 0.05) higher than those of no-treatment and vehicle-treated groups. Histological study revealed the increased number of fibroblasts and hair follicles, increased reepithelialization rate, and enhanced neovascularization in CA 0.1%-treated group when compared to no-treatment and vehicle groups. Conclusions: Cinnamic acid at low concentrations (< 1%) is potent for skin wound-healing and could be used as a safe and effective topical healing agent. Further studies are needed to confirm our findings.

Pharmacodynamic appraisal of wound-healing herbs of Sushruta Samhita

Background

In Sushruta Samhita, various medicinal plants as single and compound formulations having Vrana-Shodhana (wound cleansing) and Vrana-Ropana (wound healing) potential are enumerated. There are no published data available on these wound-healing medicinal plants of Sushruta Samhita. The effectivee management of wound is necessary in the immunocompromised and chronic wounds patients as they take more time to heal.

Aim

To review and systematically analyze wound-healing medicinal plants and their modus-operandi on the basis of pharmacodynamics attributes, i.e., Rasa (taste), Veerya (potency), and Vipaka (biotransformation) in the various stages of healing.

Materials and methods

Review of Sushruta Samhita was done to gather wound-healing medicinal plants; pharmacodynamics attributes were gatherd from various Nighantus to understand their role in wound healing. The contemporary information about wound-healing mechanism was gathered from PubMed to interpitate the rational use of plants in the various stages of wound healing.

Results

The study suggests that 43 medicinal plants have Vrana-Shodhana activity, 48 have Vrana-Ropana and 62 have both Vrana-Shodhana and Vrana-Ropana potential. Medicinal plants with Vrana-Shodhana category are having predominance of Katu (pungent), Tikta (bitter) and Kashaya (astriengent) Rasa. Plants under Vrana-Ropana are having Madhura, Kashaya Rasa (sweet taste), Madhura Vipaka (sweet biotransform) and Sheeta Veerya (cold potency).

Conclusion

Plants having Tikta, Kashaya Rasa, Katu Vipaka, and Sheeta Veerya may be useful in the inflammatory stage, plants having Madhura, Kashaya Rasa and Sheeta Veerya may be useful in the prolifiratory stage and plants having Madhura Rasa, Sheeta Veerya, and Madhura Vipaka may be useful in the remodeling stage. The present review will help to give the directions to the researchers for the development of effective wound-healing medicines for wounds.

Development and Optimization of Naringenin-Loaded Chitosan-Coated Nanoemulsion for Topical Therapy in Wound Healing

The potential role of naringenin (NAR), a natural flavonoid, in the treatment of chronic wound has prompted the present research to deliver the drug in nanoemulsion (NE) form, where synergistic role of chitosan was achieved through development of chitosan-coated NAR NE (CNNE). The NE consisted of Capryol 90, Tween 20 and Transcutol P, which was fabricated by low-energy emulsification method to encapsulate NAR within the oil core. The optimization of the formulated NEs was performed using Box-Behnken statistical design to obtain crucial variable parameters that influence globule size, size distribution and surface charge. Finally, the optimized formulation was coated with different concentrations of chitosan and subsequently characterized in vitro. The size of the CNNE was found to be increased when the drug-loaded formulation was coated with chitosan. Controlled release characteristics depicted 67-81% release of NAR from the CNNE, compared to 89% from the NE formulation. Cytotoxicity study of the formulation was performed in vitro using fibroblast cell line (NIH-3T3), where no inhibition in proliferation of the cells was observed with CNNE. Finally, the wound healing potential of the CNNE was evaluated in an abrasion-created wound model in experimental animals where the animals were treated and compared histologically at 0 and 14 days. Significant improvement in construction of the abrasion wound was observed when the animals were treated with formulated CNNE, whereas stimulation of skin regeneration was depicted in the histological examination. Therefore, it could be summarized that the chitosan coating of the developed NAR NE is a potential platform to accelerate healing of wounds.

Topical Applications of Thiosulfinate-Enriched Allium sativum Extract Accelerates Acute Cutaneous Wound Healing in Murine Model

OBJECTIVE

To determine whether topical applications of thiosulfinate-enriched Allium sativum extract (TASE) can accelerate acute cutaneous wound healing (WH) in a murine model.

METHODS

Keratinocyte viability and in vitro wound closure were assessed in keratinocyte cultures. Effects of topical TASE (0.5 μg/mL of allicin in 97% ethanol) on acute cutaneous WH were determined in a murine model of acute cutaneous wound. Twelve mice were alternately assigned to the vehicle- and TASE-treated groups (n=6 per group). Expression levels of mRNA for keratinocyte differentiation marker-related proteins (filaggrin, loricrin and involucrin) and lipid synthetic enzymes (elongation of very long chain fatty acids protein 4 (ELOVL4), fatty acid synthase (FA2H), 3-hydroxy- 3-methyl-glutaryl-coenzyme A reductase (HMGCoA), and serine palmitoyltransferase (SPT)) were assessed using real-time quantitative polymerase chain reaction on day 3 and 8 after wounding, while transepidermal water loss (TEWL) rates were measured in wounded areas.

RESULTS

TASE accelerated WH both in vivo (40% vs. 22% reduction in wound area, P<0.01) and in vitro (90% vs. 65% reduction in wound area, P<0.01). Moreover, topical applications of TASE upregulated the expression levels of epidermal mRNA for ELOVL4, HMGCoA, SPT, filaggrin, loricrin and involucrin (P<0.05 vs. vehicle-treated controls) on day 3 after wounding. Likewise, TASE significantly lowered TEWL rates in comparison with vehicle alone on day 8 (33.06±2.09 g/(m²·h) vs. 24.60±2.04 g/(m²·h), P<0.01).

CONCLUSIONS

Topical applications of TASE stimulated keratinocyte proliferation and formation of epidermal permeability barrier function, leading to acceleration of acute cutaneous WH. Topical products containing TASE could be used to manage acute cutaneous WH.

Hypermongone C Accelerates Wound Healing through the Modulation of Inflammatory Factors and Promotion of Fibroblast Migration

The physiology of wound healing is dependent on the crosstalk between inflammatory mediators and cellular components of skin regeneration including fibroblasts and endothelial cells. Therefore, strategies to promote healing must regulate this crosstalk to achieve maximum efficacy. In light of the remarkable potential of natural compounds to target multiple signaling mechanisms, this study aims to demonstrate the potential of hypermongone C, a polycyclic polyprenylated acylphloroglucinol (PPAP), to accelerate wound closure by concurrently enhancing fibroblast proliferation and migration, promoting angiogenesis, and suppressing pro-inflammatory cytokines. This compound belongs to a family of plants (Hypericum) that traditionally have been used to treat injuries. Nevertheless, the exact biological evidence to support the claims is still missing. The results were obtained using a traditional model of cell scratch assay and endothelial cell tube formation, combined with the analysis of protein and gene expression by macrophages. In summary, the data suggest that hypermongone C is a multi-targeting therapeutic natural compound for the promotion of tissue repair and the regulation of inflammation.

Wound Healing Activity of Plants from the Convolvulaceae Family

Significance: Compounds derived from plants are gaining importance for the treatment of several diseases. Many plants from the Convolvulaceae family contain compounds that have demonstrated wound healing and antidiabetic activity. Such compounds can be effectively used as a part of treatments to promote wound healing in diabetics and used in combination with antimicrobial therapy to reduce the likelihood of drug resistance and allergic reactions. Novel strategies for developing herbal formulations such as nanoparticles and adhesive patches can improve the delivery of plant-based therapeutic agents. Recent Advances: Studies have confirmed the antidiabetic and wound healing activities of Merremia tridentata, Argyreia speciosa, and Ipomoea batatas, whereas Evolvulus alsinoides, Evolvulus nummularius, Argyreia cuneata, and Ipomoea carnea have wound healing activity. Critical Issues: Drug resistance is a major problem associated with antimicrobial therapy and can affect wound healing processes. Phytoconstituents can facilitate healing processes and reduce reliance on antibiotics. Future Directions: Plants from the Convolvulaceae family have had frequent traditional uses, and all plants selected for this study have antimicrobial, antidiabetic, and wound healing properties. Detailed phytochemical studies of these plants can help develop novel wound healing therapies.

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.

Evaluation of the Effects of Local Application of Thyme Honey in Open Cutaneous Wound Healing

BACKGROUND

Clinicians have been searching for ways to obtain "super normal" wound healing. Honey is a traditional remedy for the treatment of infected wounds. We aimed to evaluate the wound contraction and antibacterial properties of locally produced Thyme honey on managing full-thickness wounds in vivo.

METHODS

This experimental study was conducted in 2015, in Department of Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran on 54 adult male Wistar rats weighing 200-250 gr, and ages of 3-4 months. A square 1.5*1.5 wound was made on the back of the neck. The rats were divided into control and two experimental groups. Additionally, the control and experimental groups were separated into three subgroups corresponding to 4, 7, and 14 d of study. The control group did not receive any treatment. For histological studies, samples were taken from the wound and adjacent skin. This tissue was examined using histological staining (H&E). Wound surface and wound healing were evaluated. Data were analyzed by using one-way ANOVA with post hoc Tukey test and (P<0.05) was significant.

RESULTS

The macroscopic and microscopic evaluations showed that the percentage of wound healing on different days in the control and experimental groups were significant (P< 0.05).

CONCLUSION

Using honey twice a day on open wounds will accelerate the healing process.

Smart Dressings Based on Nanostructured Fibers Containing Natural Origin Antimicrobial, Anti-Inflammatory, and Regenerative Compounds

A fast and effective wound healing process would substantially decrease medical costs, wound care supplies, and hospitalization significantly improving the patients' quality of life. The search for effective therapeutic approaches seems to be imperative in order to avoid the aggravation of chronic wounds. In spite of all the efforts that have been made during the recent years towards the development of artificial wound dressings, none of the currently available options combine all the requirements necessary for quick and optimal cutaneous regeneration. Therefore, technological advances in the area of temporary and permanent smart dressings for wound care are required. The development of nanoscience and nanotechnology can improve the materials and designs used in topical wound care in order to efficiently release antimicrobial, anti-inflammatory and regenerative compounds speeding up the endogenous healing process. Nanostructured dressings can overcome the limitations of the current coverings and, separately, natural origin components can also overcome the drawbacks of current antibiotics and antiseptics (mainly cytotoxicity, antibiotic resistance, and allergies). The combination of natural origin components with demonstrated antibiotic, regenerative, or anti-inflammatory properties together with nanostructured materials is a promising approach to fulfil all the requirements needed for the next generation of bioactive wound dressings. Microbially compromised wounds have been treated with different essential oils, honey, cationic peptides, aloe vera, plant extracts, and other natural origin occurring antimicrobial, anti-inflammatory, and regenerative components but the available evidence is limited and insufficient to be able to draw reliable conclusions and to extrapolate those findings to the clinical practice. The evidence and some promising preliminary results indicate that future comparative studies are justified but instead of talking about the beneficial or inert effects of those natural origin occurring materials, the scientific community leads towards the identification of the main active components involved and their mechanism of action during the corresponding healing, antimicrobial, or regenerative processes and in carrying out systematic and comparative controlled tests. Once those natural origin components have been identified and their efficacy validated through solid clinical trials, their combination within nanostructured dressings can open up new avenues in the fabrication of bioactive dressings with outstanding characteristics for wound care. The motivation of this work is to analyze the state of the art in the use of different essential oils, honey, cationic peptides, aloe vera, plant extracts, and other natural origin occurring materials as antimicrobial, anti-inflammatory and regenerative components with the aim of clarifying their potential clinical use in bioactive dressings. We conclude that, for those natural occurring materials, more clinical trials are needed to reach a sufficient level of evidence as therapeutic agents for wound healing management.