Skin Wound Healing: An Update on the Current Knowledge and Concepts

A systematic review of liposomal nanofibrous scaffolds as a drug delivery system: a decade of progress in controlled release and therapeutic efficacy

Drug-loaded liposomes incorporated in nanofibrous scaffolds is a promising approach as a multi-unit nanoscale system, which combines the merits of both liposomes and nanofibers (NFs), eliminating the drawback of liposomes' poor stability on the one hand and offering a higher potential of controlled drug release and enhanced therapeutic efficacy on the other hand. The current systematic review, which underwent a rigorous search process in PubMed, Web of Science, Scopus, Embase, and Central (Cochrane) employing (Liposome AND nanofib* AND electrosp*) as search keywords, aims to present the recent studies on using this synergic system for different therapeutic applications. The search was restricted to original, peer-reviewed studies published in English between 2014 and 2024. Of the 309 identified records, only 29 studies met the inclusion criteria. According to the literature, three different methods were identified to fabricate those nanofibrous liposomal scaffolds. The results consistently demonstrated the superiority of this dual system for numerous therapeutic applications in improving the therapy efficacy, enhancing both liposomes and drug stability, and releasing the encapsulated drug in a proper sustained release without significant initial burst release. Merging drug-loaded liposomes with NFs as liposomal nanofibrous scaffolds are a safe and efficient approach to deliver drug molecules and other substances for various pharmaceutical applications, particularly for wound dressing, tissue engineering, cancer therapy, and drug administration via the buccal and sublingual routes. However, further research is warranted to explore the potential of this system in other therapeutic applications.

Cationic porphyrin-based covalent organic frameworks for enhanced phototherapy and targeted chemotherapy of bacterial infections

Bacterial infections significantly impede wound healing and threaten global public health. Porphyrin covalent organic frameworks (COFs) have shown promise as phototherapy antibacterial materials. However, the inherent π-π stacking interactions between the monomers also lead to aggregation and quenching of photosensitizers, thereby reducing the production of singlet oxygen (1O2) and compromising their antibacterial efficacy. Herein, we designed and prepared a novel cationic porphyrin-based COFs nanoplatform (TAPP-VIO), utilizing photosensitive TAPP and cationic VIO as structural units. This multifunctional nanoplatform is specifically tailored for targeted phototherapy and chemotherapy against bacterial infections. Upon irradiation, TAPP unit in TAPP-VIO generates heat and 1O2, which effectively disrupt bacterial structure and cause cell death. The incorporation of VIO unit introduces electrostatic repulsion between layers, mitigating π-π stacking effects and enhancing 1O2 production. Additionally, the positive charge imparted by the VIO unit enables TAPP-VIO to bind efficiently to negatively charged bacterial surfaces, immobilizing the bacteria and reducing their motility, thereby improving the overall efficacy of phototherapy. Under identical experimental conditions and concentrations, TAPP-VIO exhibits a 1O2 generation capacity that is 179 % higher than that of nonionic porphyrin COF. Moreover, the temperature increase induced by TAPP-VIO is 85 % of that observed with nonionic porphyrin COF (TAPP-MMA-Da), which is conducive to enhancing the phototherapeutic effects while minimizing heat-induced damage to healthy tissues. In summary, our study presents a straightforward approach to developing non-antibiotic antibacterial nanoagents, and the as-prepared TAPP-VIO is a promising candidate drug suitable for clinical trials in the future.

Targeting m6A demethylase FTO to heal diabetic wounds with ROS-scavenging nanocolloidal hydrogels

Chronic diabetic wounds are a prevalent and severe complication of diabetes, contributing to higher rates of limb amputations and mortality. N6-methyladenosine (m6A) is a common RNA modification that has been shown to regulate tissue repair and regeneration. However, whether targeting m6A could effectively improve chronic diabetic wound healing remains largely unknown. Here, we found a significant reduction in mRNA m6A methylation levels within human diabetic foot ulcers, and the expression level of fat mass and obesity-associated protein (FTO) was significantly increased. We identified that m6A modifies the RNA of matrix Metalloproteinase 9 (MMP9), a key factor in diabetic wound healing, to regulate its expression. Importantly, we developed a ROS-scavenging nanocolloidal hydrogel loaded with an FTO inhibitor to increase the m6A level of MMP9 RNA in wounds. The hydrogel can effectively accelerate wound healing and skin appendage regeneration in streptozotocin-induced type I diabetic rats at day 14 (approximately 98 % compared to 76.98 % in the control group) and type II diabetic db/db mice at day 20 (approximately 93 % compared to 60 % in the control group). Overall, our findings indicate that targeting m6A with ROS-scavenging hydrogel loaded with FTO inhibitor may be an effective therapeutic strategy for diabetic wound healing.

Programmed wound healing in aged skin may be enhanced by mesenchymal cell loaded gene-activated scaffolds

Aging can prolong the wound healing and is associated with decline in stem cells, delays in cellular migration, and lower vascularization. Tissue engineering has largely evolved to incorporate advanced three-dimensional wound dressings, scaffolds, and hydrogels that may be seeded with mesenchymal stromal cells (MSCs) to foster an environment conducive to regeneration and enhance the healing process. The effectiveness of stem cell-seeded scaffolds can be improved by incorporating activating agents such as nucleic acids resulting in gene-activated scaffolds (GAS), thereby facilitating targeted wound healing in aged patients. In this study, we assess the in vivo wound healing potential of a promising MSC seeded gene-activated collagen scaffold, containing the anti-fibrotic agent β-klotho and pro-angiogenic stromal derived factor (SDF-1α) in aged male Sprague Dawley rats (20-24 month old). A MSC cell loaded split skin model compared MSC only with the clinical standard dressing +Jelonet, MSCs +gene-free collagen scaffold, and MSCs +SDF-1α/β-klotho dual gene-activated collagen scaffold up to 21 days. Our results showed wound healing in all groups except in MSC +Jelonet which showed scab formation with exudate. MSC only group healed primarily via fibrotic contraction. In contrast, the scaffold groups showed host tissue integration and a redistribution of extracellular matrix proteins, less contraction, and complete re-epithelized wounds at day 21. The dual GAS displayed programmed wound healing with the greatest neo-vascularization CD31 expression. In conclusion, wound healing in aged rats can be effectively modulated when MSCs are loaded on biocompatible collagen scaffolds, particularly when these scaffolds are loaded with anti-fibrotic and pro-angiogenic factors. This approach enhances blood vessel formation while reducing fibrosis, suggesting a promising potential for programmed wound healing strategies in aged chronic wounds.

Efficacy of topical moxifloxacin on therapeutic laparoscopy-induced wound healing: a double-blind, randomized clinical trial

BACKGROUND

Wound healing is crucial for maintaining healthy skin and preventing complications. Topical administration is a preferred method for delivering therapeutic medicines at the surgery site, as it is simple, affordable, and does not result in systemic harm or antibiotic resistance. Moxifloxacin (MXF), a broad-spectrum antibiotic with anti-inflammatory effects, seems to be effective against bacteria and accelerates wound healing. This study aims to determine the therapeutic effect of topical MXF on wound healing after therapeutic laparoscopy.

METHODS

This double-blind clinical trial involved 80 patients with therapeutic laparoscopy-induced wounds, randomly assigned to either 0.5% MXF cream or placebo, 24 h after surgery. The primary outcome was wound healing assessment using the REEDA index. Patients were followed by 1, 3, and 5 days of inclusion.

RESULTS

Of the 80 study participants included, 50 were women (62.5%), with the mean (SD) age of the participants being 49.5 (19.8) years in the MXF group and 45.8 (17.8) years in the control group. The severity of redness, oedema, and discharge in the MXF group was significantly lower on the first, third, and fifth days of treatment. The case group showed a significant decrease in ecchymosis from the third day of treatment compared to the control group, and no significant difference was observed in wound approximation rate. Hence, topical MXF therapy yielded a significant decrease in REEDA index MXF (P-Value < 0.0001). No treatment-related serious adverse events occurred in the MXF group vs. the comparator group.

CONCLUSIONS

The results of the current clinical trial demonstrated that the use of topical MXF could be a potential option to expedite therapeutic laparoscopy-induced wound healing by reducing redness, oedema, ecchymosis, and discharge with a satisfactory safety profile.

TRIAL REGISTRATION

IRCT20181208041882N5, 25/10/2021 ( https://en.irct.ir/trial/46768 ).

Laminaria japonica polysaccharide nano‑silver film with synergistic antibiosis for wound healing

Facing the clinical challenge of uncontrolled bleeding and infection after trauma, it is urgent to obtain a new type of dressing with antibacterial and wound healing promoting activities and good biological safety. Polysaccharide was extracted from Laminaria japonica Aresch by water extraction and alcohol precipitation, and LA-1 was obtained after separation and purification by DEAE-52 cellulose column. LA-1 had →2,6)-β-Manp-(1→) as the main chain and →4)-OAC-β-Galp-(1→, →3)-α-Fucp(1→, →4)-β-ManpA-(1→ and →4). Then, A kind of (PSx%AN) membrane with hemostatic and antibacterial functions was prepared by solution casting with LA-1 as green reducing agent and stabilizer. The (PSx%AN) film was formed by the cross-linking reaction of LA-1, AgNO3, polyvinyl alcohol and starch (3:1), in which the starch interacted with the polyhydroxy structure of polyvinyl alcohol to form hydrogen bonds, which endowed the film with good mechanical strength and biocompatibility. In order to comprehensively evaluate the performance of (PSx%AN) membrane, the oxidation resistance, antibacterial activity and cytotoxicity were tested, and animal experiments were also carried out. The results of the anti-oxidation and anti-bacterial experiments showed that the (PSx%AN) film not only exhibited good anti-oxidation performance, but also demonstrated a strong inhibitory effect on S. aureus and E. coli, with the maximum inhibition zone diameters of 16.8 ± 0.3 mm and 11.0 ± 0.2 mm respectively. The full-thickness skin defect experiment demonstrated that the (PS1%AN) membrane exhibited superior results compared to other groups on the 11th day. Specifically, it effectively increased the hydroxyproline concentration to 4.69 ± 0.19 μg/mL and the total protein content to 551.09 ± 7.19 μg/mL. Additionally, it reduced inflammatory responses, shortened wound healing time in mice, and promoted tissue repair. These findings provide a novel perspective for the (PSx%AN) membrane as a potential hemostatic and anti-infective wound dressing.

Injectable polypeptide/chitosan hydrogel with loaded stem cells and rapid gelation promoting angiogenesis for diabetic wound healing

Diabetic wounds face challenges like infection, prolonged inflammation, and poor vascularization. To address these, we developed an injectable hydrogel for diabetic wound dressing by grafting palmitoyl tetrapeptide-7 (Pal-7) onto chitosan (CS) to form CS/Pal-7 (CP7). Glutaraldehyde (GA) was used to enhance crosslinking between CS, creating the CP7 hydrogel. The hydrogel showed rapid gelation, good mechanical properties, biocompatibility, and strong antibacterial effects. Additionally, stem cells derived from human deciduous teeth (SHED) were loaded into the CP7 hydrogel to form SHED@CP7. This complex promoted human umbilical vein endothelial cell (HUVEC) migration and tube formation, aiding angiogenesis, and induced macrophage polarization toward the M2 phenotype, exerting anti-inflammatory effects. In streptozotocin-induced diabetic mouse wounds, SHED@CP7 significantly improved wound healing with over 95 % wound closure, increased collagen deposition, and reduced tumor necrosis factor-α (TNF-α) expression by approximately 75 % and Interleukin-6 (IL-6) expression by around 81 %. It also increased Interleukin-10 (IL-10) expression by approximately 58 %, modulating the inflammatory microenvironment for regeneration. Moreover, SHED@CP7 enhanced angiogenesis, as shown by a 69 % increase in endothelial cell marker CD31 staining, supporting faster wound healing. These results highlight the potential of SHED@CP7 as an effective treatment for diabetic wounds.

The Causal Effect of Iron Traits on Risk of Hypertrophic Scarring: A Two-Sample Mendelian Randomization Study

BACKGROUND

The involvement of iron deficiency anemia (IDA) and abnormal iron metabolism in multiple fibrotic diseases is known, but their precise relationship with hypertrophic scarring (HTS) remains uncertain.

AIM

This study aimed to explore whether there are causal associations between iron traits-such as IDA, transferrin (TF), transferrin saturation (TFS), ferritin (FERR), and IRON levels-and the risk of HTS using a two-sample Mendelian randomization (MR) approach.

METHODS

Relevant consortia provided genome-wide association study (GWAS) data for iron traits, while the FinnGen study supplied GWAS data for HTS. Stringent criteria for instrumental variable (IV) selection were applied, and MR analyses were performed using the inverse-variance weighted (IVW) method as the primary analysis, along with MR-Egger, weighted median, and weighted mode methods. Sensitivity analyses, including the MR-Egger intercept, Cochran's Q test, leave-one-out analysis, and MR-PRESSO, were utilized to assess horizontal pleiotropy, heterogeneity, and outlier effects.

RESULTS

The MR analyses did not indicate significant causal links between IDA, TF, FERR, or IRON levels and the risk of HTS. While the IVW method proposed a potential protective effect of elevated TFS levels (OR = 0.69, 95% CI: 0.51-0.93, p = 0.0155) on HTS risk, the results varied across different MR methods. Sensitivity analyses found no significant pleiotropy or heterogeneity.

CONCLUSION

The two-sample MR study did not find compelling evidence for causal associations between most iron traits and HTS risk. However, the IVW method pointed to a potential protective effect of elevated TFS levels on HTS risk. Further investigation is necessary to explore the role of iron metabolism in scarring.

Quercetin as a therapeutic agent for skin problems: a systematic review and meta-analysis on antioxidant effects, oxidative stress, inflammation, wound healing, hyperpigmentation, aging, and skin cancer

Quercetin is abundant in plants and has notable pharmacological properties for skin health. This review aims to comprehensively evaluate the effects of quercetin on skin-related issues, adhering to the PRISMA guidelines and analyzing studies from ScienceDirect, Web of Science, Scopus, and PubMed. Of the 1,398 studies identified, 65 studies met the criteria for meta-analysis. The meta-analysis indicated that quercetin had powerful antioxidant properties, protecting against oxidative stress by significantly lowering levels of MDA (Z-score, 2.51), ROS (Z-score, 3.81), and LPO (Z-score, 4.46), and enhancing enzymes of GSH (Z-score, 5.46), CAT (Z-score, 5.20), and SOD (Z-score, 4.37). Quercetin acted as an anti-inflammatory by significantly suppressing protein regulators such as NF-κβ, AP-1, and MAPKs (ERK and JNK), cytokines of TNFα, IL-6, IL-1β, IL-8, and MCP-1, and enzymes of COX-2, iNOS, and MPO, while upregulating the cytokine IL-10. Additionally, quercetin significantly suppressed IL-4 (Z-score, 3.16) and IFNγ (Z-score, 3.76) cytokines involved in chronic inflammation of atopic dermatitis. Quercetin also supported wound healing by significantly decreasing inflammatory cells (Z-score, 5.60) and enhancing fibroblast distribution (Z-score, 5.98), epithelialization (Z-score, 8.57), collagen production (Z-score, 4.20), and angiogenesis factors of MVD (Z-score, 5.66) and VEGF (Z-score, 3.86). Furthermore, quercetin significantly inhibited tyrosinase activity (Z-score, 1.95), resulting in a significantly reduced melanin content (Z-score, 2.56). A significant reduction in DNA damage (Z-score, 3.27), melanoma cell viability (Z-score, 2.97), and tumor formation was also observed to ensure the promising activity of quercetin for skin issues. This review highlights quercetin's potential as a multifaceted agent in skin care and treatment.

Reactive Oxygen Species and Antioxidants in Wound Healing: Mechanisms and Therapeutic Potential

Wound healing is a complex biological process encompassing haemostasis, inflammation, proliferation and matrix remodelling. Reactive oxygen species (ROS) play a pivotal role in regulating key events such as antimicrobial defence, platelet activation and angiogenesis. However, excessive ROS levels can induce oxidative stress (OS), disrupting the healing cascade and contributing to chronic wounds, inflammation and impaired tissue repair. Systemic conditions like diabetes, obesity, smoking and ageing further exacerbate OS, highlighting its clinical significance in wound management. Antioxidants (AOx), both endogenous and exogenous, have demonstrated therapeutic potential in mitigating OS, promoting wound closure and enhancing cellular recovery. Compounds like Vitamin E, curcumin, ferulic acid and resveratrol improve AOx enzyme activity, reduce oxidative damage and accelerate wound healing in multiple studies. Emerging evidence supports targeting oxidative pathways as a viable strategy to improve outcomes in chronic and systemic OS-related conditions. This review explores the dual role of ROS in wound healing, the impact of OS in systemic diseases, and the therapeutic potential of AOx in fostering optimal healing outcomes, advocating for robust clinical trials to establish standardised interventions.

Calycosin-7-glucoside-Loaded Hydrogel Promotes Wound Healing in Gestational Diabetes Mellitus

The prevalence of gestational diabetes mellitus (GDM) is currently on the rise globally, which heightens the risk of adverse pregnancy outcomes and subsequently increases the likelihood of cesarean delivery. GDM can induce hyperglycemic conditions in cesarean wounds, leading to delayed wound healing and complications such as itching, pain, and scarring. These complications significantly impact the quality of life and mental health of mothers. Furthermore, there is a lack of effective clinical prevention strategies. Consequently, the need to improve wound healing after cesarean sections in women with GDM is a pressing concern that warrants our attention. To maximize the therapeutic impact and extend the bioavailability of calycosin-7-glucoside (CG), it was integrated into a hybridized hydrogel (GOHA) as a drug carrier to create the GOHACG hydrogel. Bases on our tests, the GOHACG hydrogel demonstrated a strong capacity for water absorption, appropriate pore size, and good biocompatibility to adjust to the in situ surroundings of the wound. GOHACG also promoted epidermal regeneration, collagen deposition, angiogenesis, and the conversion of macrophages from the M1 to M2 phenotype. Indicating a reduction in the inflammatory response, accelerated wound repair, and minimized skin scarring in a postcesarean delivery model involving gestational diabetic mellitus mice. In brief, the GOHACG possesses significant properties that enhance wound healing in GDM model, suggesting its potential effects in treating wound healing of GDM.

Medical gas plasma modifies Nrf2 signaling in diabetic wound healing

INTRODUCTION

Diabetes mellitus is a chronic disease that can disrupt physiologic wound healing. Medical gas plasma technology produces therapeutic reactive species that support wound healing.

OBJECTIVE

Previous studies have shown that increasing the transcriptional activity of the redox regulator nuclear factor erythroid 2-related factor 2 (Nrf2) in diabetic models can improve insulin sensitivity, reduce blood glucose levels, and ameliorate diabetic complications. However, the therapeutic potential and mechanisms of action of gas plasma have not been addressed in this context.

METHODS

Full-thickness dermal ear wounds were created in a preclinical mouse model of type II diabetes and compared with a native wild-type strain of C57BL/6 mice. First, the formation of reactive species in the plasma gas phase was determined by optical emission spectroscopy. Second, qPCR, protein expression, and inflammation analysis by cytokine secretion were performed to confirm the transcriptional results. Finally, qPCR and cytokine profiling were conducted to measure the effects of gas plasma in patient wound samples.

RESULTS

Repeated in vivo treatment with medical gas plasma supported wound healing, e.g., re-epithelialization, in both sexes. Gas plasma-stimulated changes in Nrf2 signaling associated with downstream targets were supported by the evidence of impaired wound healing in Nrf2 knockout mice. In addition, gas plasma treatment significantly affected inflammation by modulating local and systemic cytokine levels. In vivo, treatment of human diabetic wounds underscored the involvement of Nrf2 signaling in protecting against oxidative stress, as assessed by qPCR. The cytokine signature of human diabetic wounds outlined different response patterns among patients after a single exposure, while inflammatory mediators were consistently reduced after repeated plasma treatment.

CONCLUSIONS

The present finding of accelerated wound healing by the Nrf2 activator underlines the high potential of medical gas plasma therapy in non-diabetic and diabetic wound healing.

Biomaterial-based chitosan nanohydrogel films: combination of Bistorta officinalis and Ca-doped carbon dots for improved blood clotting

BACKGROUND

Bleeding and traumatic injuries are still a major issue necessitating the development of advanced hemostatic materials that are economical, biocompatible, and effective. Chitosan's (CS) haemostatic and biocompatible properties make it a promising wound-healing material, however, effective cross-linking is essential for appropriate physiochemical properties. In this study, calcium-doped carbon dots (CDs) produced from coriander leaves were used as cross-linking agents to improve the functional performance and structural integrity of nanohydrogel films. Furthermore, extract of the medicinal plant Bistorta officinalis (BEX), a traditional medicinal plant with strong hemostatic and antibacterial qualities, was incorporated into the hydrogel matrix.

RESULTS

Analysis and characterization of the synthesized CDs thoroughly confirmed that they have monodispersed spherical shape, negative zeta potential, and active functional groups which effectively cross-linked the chitosan matrix and increased the mechanical strength and stability of the film. Cytotoxicity and antibacterial results of the final films showed the desired cytocompatibility against Human skin fibroblast (HFF-1 cells) with over 80% viability at the highest concentration and effective antibacterial activity against gram-positive and gram-negative bacteria (further improved by cross-linking with CDs and incorporating BEX), respectively. The incorporation of BEX and CDs in hydrogel films significantly enhanced the film's blood-clotting ability with negligible hemolysis due to blood clotting index and hemolysis tests.

CONCLUSIONS

The findings of this study highlight the potential of biomaterial-based nano hydrogel film, composed of CS cross-linked with CDs and containing BEX, as a promising wound dressing with outstanding biocompatibility, minimal cytotoxicity, enhanced hemostatic efficacy, and strong antibacterial properties.

Skin and Wound Healing: Conventional Dosage versus Nanobased Emulsions Forms

The skin plays a crucial role in the body's homeostasis through its thermoregulation functions, metabolic activity, and, mainly, its barrier function. Once this system has its homeostasis disturbed, through the promotion of tissue discontinuity, an injury happens and a restoration process starts. Different products can be used to promote, accelerate, or stimulate the healing process, such as hydrogels, emulsions, and ointments (main conventional formulations). Despite the historical use and wide market and consumer acceptance, new systems emerged for wound management with the main challenge to overcome conventional form limitations, in which nanosystems are found, mainly nanobased emulsion forms (nano- and microemulsions, NE and ME). Here, we discuss the skin function and wound healing process, highlighting the cellular and molecular processes, the different wound classifications, and factors that affect physiological healing. We also investigated the recent patents (2012-2023) filed at the United States Patent and Trademark Office, where we found few patents for conventional forms (hydrogels = 5; emulsions = 4; ointments = 6) but a larger number of patents for nanobased emulsions filed in this time (NE = 638; ME = 4,072). Furthermore, we address the use of nanobased emulsions (NE and ME) and their particularities, differences, and application in wound treatment. This work also discusses the challenges, bottlenecks, and regulatory framework for nanosystems, industrial, academic, and government interest in nanotechnology, and future perspectives about this key factor for the nanosystems market and consumer acceptance.

Red-light LED therapy promotes wound regeneration by upregulating COL1A1, COL2A1, VEGF and reducing IL-1β for anti-inflammation

This study examines the effects of 630 nm red-light laser therapy on wound healing, with a focus on VEGF-mediated angiogenesis and collagen production. The effectiveness of red-light therapy is influenced by critical parameters, including treatment duration and distance, which often lack standardization across protocols. To address this, we conducted cell viability and scratch wound assays using NIH/3T3 cells in-vitro to identify optimal treatment conditions. Treatment durations of 10 s, 30 s, 60 s, and 5 min, along with distances of 3 cm and 5 cm, were evaluated. Following parameter optimization, the wound-healing efficacy of red-light therapy was assessed in-vivo using nude mice. Standardized 4 mm wounds were created using a biopsy punch, and healing was evaluated at 7 and 21-days post-intervention. Histological analysis was performed, and gene and protein expression levels of COL1A1, COL2A1, VEGF, and IL-1β, which are implicated in wound healing, were assessed via RT-PCR, western blotting, and immunohistochemistry. Results demonstrated that red-light laser therapy significantly upregulated collagen and VEGF expression while reducing IL-1β levels at the three-week time point (p < 0.05). Notably, these effects were comparable to hydrogel treatment, which served as a positive control to assess the efficacy of light-emitting diode (LED)-based therapy. These findings indicate that red-light therapy effectively promotes wound healing by enhancing collagen synthesis and VEGF-mediated angiogenesis within the wound bed.

Review on application of silk fibroin hydrogels in the management of wound healing

Wounds are regarded as disruptions in the integrity of human skin tissues, and the process of wound healing is often characterized as protracted and complex, primarily due to the potential infection or inflammation caused by microorganisms. The quest for innovative solutions that accelerate wound healing while prioritizing patient safety and comfort has emerged as a focal point. Within this pursuit, silkworm silk fibroin-a natural polymer extracted from silk cocoons-exhibits a distinctive combination of properties including biocompatibility, biodegradability, superior mechanical strength, water absorption, and low immunogenicity, which align closely with the demands of contemporary wound care. Its remarkable biocompatibility facilitates seamless integration with host tissues, thereby minimizing the risk of rejection or adverse reactions. Furthermore, its intrinsic degradability permits controlled release of therapeutic agents, promoting an optimal microenvironment conducive to healing. This review investigates the multifaceted potential of silk fibroin specifically as a wound dressing material and examines the intricate nuances associated with its application in hydrogels for wound healing, aiming to furnish a thorough overview for both researchers and clinicians. By scrutinizing underlying mechanisms, current applications, and prospective directions, we aspire to cultivate new insights and inspire innovative strategies within this rapidly evolving field.

Emerging roles of hyaluronic acid hydrogels in cancer treatment and wound healing: A review

Hyaluronic acid (HA)-derived hydrogels demonstrate a significant development in the biomedical uses, especially in cancer treatment and wound repair. Cancer continues to be one of the leading causes of death worldwide, with current therapies frequently impeded by lack of specificity, side effects, and the emergence of resistance. HA hydrogels, characterized by their distinctive three-dimensional structure, hydrophilic nature, and biocompatibility, develop an advanced platform for precise drug delivery, improving therapeutic results while minimizing systemic toxicity. These hydrogels facilitate the controlled release of drugs, genes, and various therapeutic substances, enhancing the effectiveness of chemotherapy, radiotherapy, and immunotherapy. Additionally, they can be designed to react to stimuli such as pH, light, and magnetic fields, enhancing their therapeutic capabilities. In the process of wound healing, the hydrophilic and porous characteristics of HA hydrogels establish a moist environment encouraging cell growth and contributes to the tissue recovery. By imitating the extracellular matrix, they promote tissue regeneration, improve angiogenesis, and influence immune reactions. This review examines the various functions of HA-based hydrogels in cancer treatment and wound healing, highlighting their advancement, applications, and ability to change existing therapeutic methods in these important health sectors.

Self-assembled nanoparticles of hybrid elastin-like and Oncostatin M polymers for improved wound healing

Oncostatin M (OSM) is a pleiotropic cytokine that can significantly enhance wound healing. Here, we report on the use of nanoparticles (NPs) formulated from a genetically engineered A200_hOSM protein polymer, which combines an elastin-like recombinamer (A200) with human OSM (hOSM) in the same molecule, aiming at enhancing wound healing processes. A200_hOSM NPs were obtained by self-assembly and evaluated for their bioactivity in human keratinocytes and fibroblasts. The NPs demonstrated superior efficacy in promoting cell proliferation in a dose-dependent manner, exhibiting nearly threefold greater proliferation at 48 and 72 h, compared to cells treated with commercial hOSM. Moreover, the NPs stimulated cell migration and collagen production through activation of JAK/STAT3 signaling. They also promoted the production of IL-6 and IL-8, pro-inflammatory cytokines with a critical role for wound healing. Promotion of keratinocyte proliferation and differentiation were further validated in non-commercial 3D skin equivalents. The A200_hOSM NPs revealed potential in accelerating wound healing, evidenced by reduced wound size and a thicker epidermal layer. This system represents a significant advancement in the field of bioinspired biomaterials by improving cytokine bioavailability, allowing for localized therapy and offering a cost-effective strategy for employing hOSM in wound healing management.

Soft Materials and Devices Enabling Sensorimotor Functions in Soft Robots

Sensorimotor functions, the seamless integration of sensing, decision-making, and actuation, are fundamental for robots to interact with their environments. Inspired by biological systems, the incorporation of soft materials and devices into robotics holds significant promise for enhancing these functions. However, current robotics systems often lack the autonomy and intelligence observed in nature due to limited sensorimotor integration, particularly in flexible sensing and actuation. As the field progresses toward soft, flexible, and stretchable materials, developing such materials and devices becomes increasingly critical for advanced robotics. Despite rapid advancements individually in soft materials and flexible devices, their combined applications to enable sensorimotor capabilities in robots are emerging. This review addresses this emerging field by providing a comprehensive overview of soft materials and devices that enable sensorimotor functions in robots. We delve into the latest development in soft sensing technologies, actuation mechanism, structural designs, and fabrication techniques. Additionally, we explore strategies for sensorimotor control, the integration of artificial intelligence (AI), and practical application across various domains such as healthcare, augmented and virtual reality, and exploration. By drawing parallels with biological systems, this review aims to guide future research and development in soft robots, ultimately enhancing the autonomy and adaptability of robots in unstructured environments.

Microenvironment of diabetic foot ulcers: Implications for healing and therapeutic strategies

Diabetic foot ulcers (DFUs) are a common yet serious complication in individuals with diabetes, often presenting as chronic, nonhealing wounds that significantly impair quality of life. The healing process of DFUs is largely influenced by the local microenvironment, which encompasses factors such as hypoxia, inflammation, and the involvement of various cell types. Poor blood circulation in the affected area results in hypoxia, compromising cellular function and restricting nutrient supply, thereby delaying wound healing. In addition, chronic inflammation disrupts immune system balance, with excessive pro-inflammatory cytokines not only failing to facilitate tissue repair but also exacerbating tissue damage. Moreover, key cell types, including fibroblasts, keratinocytes, and macrophages, play crucial roles at different stages of the healing process, contributing to collagen production and skin regeneration. A comprehensive understanding of the complex dynamics within the DFU microenvironment is essential for developing more precise therapeutic approaches, such as advanced drug delivery systems and bioactive materials, aimed at promoting wound healing and reducing the risk of recurrence.

Perioperative Drug Management of Systemic Therapies in Breast Cancer: A Literature Review and Treatment Recommendations

Breast cancer accounts for about 30% of all new female cancers each year, and its incidence is increasing 0.6% per year. An enhanced understanding of the molecular mechanisms of carcinogenesis has led to the development of constantly evolving strategies for local and systemic therapies. Perioperative chemotherapy, immunotherapy, and endocrine therapy play pivotal roles in the overall treatment plan. Guidelines on the appropriate use of these drugs in patients undergoing extirpative breast surgery and/or breast reconstruction are lacking. Clear indications for the management of systemic therapies relative to the timing of surgery is crucial to ensure consistent treatment outcomes and to minimize complications. Our purpose is to propose evidence-based recommendations to optimize the perioperative management of systemic therapies in patients undergoing breast cancer surgery and breast reconstructive surgery. In this review, we outline the basic tenets of breast cancer therapies, provide an overview on wound-healing principles, delineate relevant pharmacodynamic concepts, summarize literature and pharmacologic data from various preclinical studies and clinical trials, and propose treatment recommendations. Synopsis: This review proposes evidence-based recommendations regarding systemic therapies management for outcome optimization in the perioperative period in breast cancer patients.

Microneedle drug delivery system based on hyaluronic acid for improving therapeutic efficiency of hypertrophic scars

Hypertrophic scar (HS) is a disease with excessive skin fibrosis and collagen disorder, which is generally caused by abnormal wound repair process after burn and trauma. Although intralesional injection of 5-fluorouracil (5-Fu) has been used in clinical treatment of HS, the patients' compliance of injection treatment is poor. In this study, a double-layer dissolution microneedle (MN) containing asiaticoside (AS) and 5-Fu was designed for the treatment of HS. Biological macromolecules materials affected the formability, drug release, and hardness of MNs. Therefore, several types of biomacromolecules, including hyaluronic acid (HA), chitosan, and sodium alginate, which could be used to prepare MNs, underwent prescription optimization experiments and the optimized MN prescriptions were obtained. In vitro characterization showed that the MN was sufficient to deliver drugs through the skin. Animal in vivo experiments showed that AS and 5-Fu can synergistically treat HS, significantly reduce the abnormal proliferation of fibroblasts and collagen fiber deposition, and down-regulated collagen I (Col I) and transforming growth factor-β1 (TGF-β1) expression. In conclusion, the micro-needle designed in this study has great prospects in the treatment of HS.

The Efficacy and Safety of Botulinum Toxin Type A in Prevention of Hypertrophic Scars After Epicanthoplasty: A Split-Face Double-Blinded Randomized Controlled Trial

BACKGROUND

Timely intervention can improve the aesthetic outcome of surgical scars, and botulinum toxin type A (BTXA) has demonstrated its potential as an effective treatment. However, conclusive scientific evidence is needed to definitively confirm the specific efficacy of BTXA following epicanthoplasty.

METHODS

A total of 21 patients who underwent epicanthoplasty were enrolled. Either BTXA or normal saline was randomly injected into the left or right epicanthus immediately after epicanthoplasty. The efficacy of scar prevention was assessed at a 1-month and 6-month follow-up visit using various assessment scales, and scar widths were also measured. The safety assessment included evaluating the complications and adverse effects after injections.

RESULTS

Totally, 20 patients completed the entire follow-up period. At 6-month follow-up, significant improvements were noted (P<0.05) in the treatment group compared to the control group across all evaluated metrics: the Modified Stony Brook Scar Evaluation Scale (total scores: 6.73±1.26 vs 5.75±1.60), Observer Scar Assessment Scale (total scores: 6.35±5.93 vs 8.55±5.65), Patient Scar Assessment Scale (color scores: 1.10±1.17 vs 1.85±1.69), Visual Analog Scale (total scores: 8.48±1.24 vs 7.94±1.37), and the average scar widths (0.37±0.18mm vs 0.68±0.42mm). No adverse effects were observed.

CONCLUSIONS

BTXA can effectively prevent scar hyperplasia after epicanthoplasty, especially in improving scar pigmentation, width, and softness.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Layer-By-Layer Functionalized Gauze With Designed α-Sheet Peptides Inhibits E. coli and S. aureus Biofilm Formation

Microbial biofilms on wounds lead to longer hospital stays, mechanical debridement, and higher mortality. Amyloid fibrils stabilize the bacterial biofilm's extracellular matrix (ECM) and represent a potential anti-biofilm target. As previously reported, de novo α-sheet peptides inhibit amyloid fibrillization and reduce biofilm formation in several bacterial species. Alginate (ALG) and chitosan (CH) are widely used in wound dressings due to their adhesive and antimicrobial activity. Here, we describe a layer-by-layer (LbL) functionalized gauze with alternating layers of ALG and CH loaded with α-sheet peptides for controlled release and biofilm inhibition at a wound site. Material analysis indicated successful LbL polyelectrolyte deposition and peptide incorporation. The LbL gauze facilitated controlled peptide release for 72 h with an initial burst delivery and demonstrated good biocompatibility with no toxicity towards human fibroblasts. The LbL gauze was assessed against Escherichia coli biofilms and reduced colony forming units (CFUs) of adherent bacteria by 81% and 96% as compared to the plain gauze for non-antibiotic and antibiotic (+gentamicin) conditions, respectively. A similar reduction in biofilm formation and increase in antibiotic susceptibility was observed for tests with Staphylococcus aureus and vancomycin. Thus, LbL gauze with incorporated α-sheet peptides demonstrated anti-biofilm properties for both gram-negative and gram-positive bacteria and presents an alternative wound dressing for the prevention of biofilm-associated infections.

Development of Polymeric Nanoparticles Loaded with Phlomis crinita Extract: A Promising Approach for Enhanced Wound Healing

The use of nanoparticles improves the stability, solubility, and skin permeability of natural compounds in skincare products. Based on these advantages, this study aimed to incorporate the Phlomis crinita extract into polymeric nanoparticles to improve its topical skin delivery for wound healing purposes. The study involved the preparation of nanoparticles of PLGA and PLGA-PEG (PCE-PLGA-NPs and PCE-PLGA-PEG-NPs) using the solvent displacement method, physicochemical and biopharmaceutical characterization, tolerance studies by the HET-CAM assay and evaluation of skin integrity parameters, and in vitro efficacy via a scratch wound healing experiment. The prepared nanoparticles were nanometer-sized with spherical form and demonstrated an encapsulation efficiency greater than 90%. The major component (luteolin) was released following a kinetic model of hyperbola for PCE-PLGA-PEG-NPs and one-phase exponential association for PCE-PLGA-NPs. Moreover, the important permeability of luteolin skin was observed, especially for PCE-PLGA-PEG-NPs. Both formulations exhibited no irritation and no damaging effects on skin integrity, suggesting their safety. Finally, the results of the scratch wound healing experiment using 3T3-L1 cells revealed significant cell migration and proliferation, with an improved efficacy for PCE-PLGA-PEG-NPs compared to the free extract, demonstrating the potential of this formulation in the treatment of wound healing.

Therapeutic potential of phloridzin carbomer gel for skin inflammatory healing in atopic dermatitis

Phloridzin (PL), a natural compound derived from apples, exhibits diverse pharmacological properties including anti-inflammatory, anti-tumor, antioxidant, and anti-aging effects. The present study aimed to evaluate the impact of Phloridzin Carbomer Gel (PL-CG) on skin inflammatory healing in a mouse model of atopic dermatitis (AD). In vitro experiments initially determined the non-toxic concentration range of PL in cells, established a cellular inflammation model by stimulating cells with histamine to ascertain the optimal therapeutic concentration of PL, and subsequently detected decreased mRNA expression levels of relevant inflammatory cytokines, interleukins, through RT-qPCR experiments following PL treatment. For in vivo experiments, an AD mouse model was constructed. Histopathological analysis, along with assessments of epidermal thickness, reduction in scratch counts on the back of mice, and healing rates of inflammatory areas, indicated that PL-CG facilitates epidermal tissue regeneration and wound repair, thereby accelerating skin inflammatory healing. Additionally, PL-CG was subjected to microstructural observation using scanning electron microscopy (SEM), and experiments were conducted to determine its optimal pH value, stability, viscosity, and the influence of different concentrations of carbomer gel on drug release. The study demonstrated that PL-CG possesses anti-inflammatory and antipruritic properties, as well as the ability to promote skin inflammatory healing. Compared to traditional corticosteroids, PL-CG exhibits a higher safety profile and fewer side effects, suggesting broad prospects for its clinical application in the treatment of atopic dermatitis.

New Perspectives of Hydrogels in Chronic Wound Management

Chronic wounds pose a substantial healthcare concern due to their prevalence and cost burden. This paper presents a detailed overview of chronic wounds and emphasizes the critical need for novel therapeutic solutions. The pathophysiology of wound healing is discussed, including the healing stages and the factors contributing to chronicity. The focus is on diverse types of chronic wounds, such as diabetic foot necrosis, pressure ulcers, and venous leg ulcers, highlighting their etiology, consequences, and the therapeutic issues they provide. Further, modern wound care solutions, particularly hydrogels, are highlighted for tackling the challenges of chronic wound management. Hydrogels are characterized as multipurpose materials that possess vital characteristics like the capacity to retain moisture, biocompatibility, and the incorporation of active drugs. Hydrogels' effectiveness in therapeutic applications is demonstrated by how they support healing, including preserving ideal moisture levels, promoting cellular migration, and possessing antibacterial properties. Thus, this paper presents hydrogel technology's latest developments, emphasizing drug-loaded and stimuli-responsive types and underscoring how these advanced formulations greatly improve therapy outcomes by enabling dynamic and focused reactions to the wound environment. Future directions for hydrogel research promote the development of customized hydrogel treatments and the incorporation of digital health tools to improve the treatment of chronic wounds.

Plant-Derived B-CGT Hydrogel Accelerates Diabetic Wound Healing Through Multitarget Modulation of Inflammation, Angiogenesis, and Tissue Remodeling

Diabetic wound healing presents significant challenges due to impaired angiogenesis, chronic inflammation, and cellular dysfunction. Building on previous research, this study further explores the potential of a plant-derived glucosyloxybenzyl 2-isobutylmalates (B-CGT) hydrogel in promoting diabetic wound healing. Network pharmacology and molecular docking analyses suggest that B-CGT may regulate key mechanisms, such as apoptosis, inflammation, and matrix remodeling, through core targets including SIRT1, CASP8, and MMP8. In vivo studies further demonstrated that B-CGT hydrogel significantly accelerated wound closure in diabetic mice, enhanced angiogenesis, promoted collagen deposition, and achieved immune balance by modulating macrophage polarization, thereby shifting the inflammatory environment toward a repair state. Moreover, B-CGT hydrogel significantly improved the wound microenvironment by upregulating VEGF expression and exerting antioxidant effects. By combining theoretical predictions with experimental validation, this study elucidates the multi-target synergistic regulatory mechanisms of B-CGT hydrogel. These findings provide new research directions for addressing immune imbalance and angiogenesis defects in diabetic wound healing and lay a scientific foundation for the optimization and application of chronic wound treatment strategies.

Advancements in 3D skin bioprinting: processes, bioinks, applications and sensor integration

This comprehensive review explores the multifaceted landscape of skin bioprinting, revolutionizing dermatological research. The applications of skin bioprinting utilizing techniques like extrusion-, droplet-, laser- and light-based methods, with specialized bioinks for skin biofabrication have been critically reviewed along with the intricate aspects of bioprinting hair follicles, sweat glands, and achieving skin pigmentation. Challenges remain with the need for vascularization, safety concerns, and the integration of automated processes for effective clinical translation. The review further investigates the incorporation of biosensor technologies, emphasizing their role in monitoring and enhancing the wound healing process. While highlighting the remarkable progress in the field, critical limitations and concerns are critically examined to provide a balanced perspective. This synthesis aims to guide scientists, engineers, and healthcare providers, fostering a deeper understanding of the current state, challenges, and future directions in skin bioprinting for transformative applications in tissue engineering and regenerative medicine.

Evaluation of the antibacterial properties of four bioactive biomaterials for chronic wound management

AIM

Chronic wound infections present a prevalent medical issue and a multifaceted problem that significantly impacts healthcare systems worldwide. Biofilms formed by pathogenic bacteria are fundamental virulence factors implicated in the complexity and persistence of bacterial-associated wound infections, leading to prolonged recovery times and increased risk of infection. This study aims to investigate the antibacterial effectiveness of commonly employed bioactive wound healing compositions with a particular emphasis on their effectiveness against common bacterial pathogens encountered in chronic wounds - Staphylococcus epidermidis, Escherichia coli, and Pseudomonas aeruginosa to identify optimal wound product composition for managing chronic wound infections.

METHODS

This study tested the antibacterial and antibiofilm effectiveness of four bioactive wound healing materials by performing in vitro antibacterial assays and measuring ion release profiles.

RESULTS

The anti-biofilm effectiveness differed extensively among the biomaterials tested and slightly among the bacterial species. Particularly, copper and zinc-doped borate bioactive glass wound healing compositions inhibited the three clinically relevant bacteria in both planktonic and biofilm forms, which were found to be ascribed to the copper and zinc gradual release.

CONCLUSION

The findings suggest that copper and zinc-doped bioactive glasses hold great promise for improving chronic wound management by providing strong antibacterial action and promoting faster healing.

MSC-EVs and UCB-EVs promote skin wound healing and spatial transcriptome analysis

Extracellular vesicles (EVs) are important paracrine mediators derived from various cells and biological fluids, including plasma, that are capable of inducing regenerative effects by transferring bioactive molecules such as microRNAs (miRNAs). This study investigated the effect of mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) isolated from umbilical cord blood and human umbilical cord plasma-derived extracellular vesicles (UCB-EVs) on wound healing and scar formation reduction. Spatial transcriptomics (ST) was used to study the effects of MSC-EVs and UCB-EVs on the heterogeneity of major cell types and wound healing pathways in mouse skin tissue. MSC-EVs and UCB-EVs were isolated using ultracentrifugation and identified using transmission electron microscopy, nanoparticle tracking analysis, and western blot. The effects of MSC-EVs and UCB-EVs on human dermal fibroblast-adult cell (HDF-a) migration and proliferation were evaluated using cell scratch assays, cell migration assays, and cell proliferation assays. In vivo, MSC-EVs and UCB-EVs were injected around full-cut wounds to evaluate their efficacy of wound healing by measuring wound closure rates and scar width and performing histological analysis. ST was performed on skin tissue samples from mice in each group after wound healing to analyze the heterogeneity of major cell types compared with the control group and investigate potential mechanisms affecting wound healing and scar formation. In vitro experiments demonstrated that MSC-EVs and UCB-EVs promoted the proliferation and migration of HDF-a cells. Local injection of MSC-EVs and UCB-EVs into the periphery of a mouse skin wound accelerated re-epithelialization, promoted wound healing, and reduced scar width. ST analysis of skin tissue from each group after wound healing revealed that MSC-EVs and UCB-EVs reduced the relative expression of marker genes in myofibroblasts, regulated wound healing, and decreased scar formation by reducing the expression of the TGF-β signaling pathway and increasing the expression of the Wnt signaling pathway. The results suggest that MSC-EVs and UCB-EVs play a significant role in the activity of cord blood plasma-derived mesenchymal stem cells and cord blood plasma. They can be considered promising new agents for promoting skin wound healing.

Unveiling the therapeutic journey of snail mucus in diabetic wound care

A diabetic wound (DW) is an alteration in the highly orchestrated physiological sequence of wound healing especially, the inflammatory phase. These alterations result in the generation of oxidative stress and inflammation at the injury site. This further leads to the impairment in the angiogenesis, extracellular matrix, collagen deposition, and re-epithelialization. Additionally, in DW there is the presence of microbial load which makes the wound worse and impedes the wound healing cycle. There are several treatment strategies which have been employed by the researchers to mitigate the aforementioned challenges. However, they failed to address the multifactorial pathogenic nature of the disease. Looking at the severity of the disease researchers have explored snail mucus and its components such as achacin, allantoin, elastin, collagen, and glycosaminoglycan due to its multiple therapeutic potentials; however, glycosaminoglycan (GAGs) is very important among all because they accelerate the wound-healing process by promoting reepithelialization, vascularization, granulation, and angiogenesis at the site of injury. Despite its varied applications, the field of snail mucus in wound healing is still underexplored. The present review aims to highlight the role of snail mucus in diabetic wound healing, the advantages of snail mucus over conventional treatments, the therapeutic potential of snail mucus, and the application of snail mucus in DW. Additionally, clinical trials, patents, structural variations, and advancements in snail mucus characterization have been covered in the article.

Recent advances in the role of neuroregulation in skin wound healing

Neuroregulation during skin wound healing involves complex interactions between the nervous system and intricate tissue repair processes. The skin, the largest organ, depends on a complex system of nerves to manage responses to injury. Recent research has emphasized the crucial role of neuroregulation in maximizing wound healing outcomes. Recently, researchers have also explained the interactive contact between the peripheral nervous system and skin cells during the different phases of wound healing. Neurotransmitters and neuropeptides, once observed as simple signalling molecules, have since been recognized as effective regulators of inflammation, angiogenesis, and cell proliferation. The significance of skin innervation and neuromodulators is underscored by the delayed wound healing observed in patients with diabetes and the regenerative capabilities of foetal skin. Foetal skin regeneration is influenced by the neuroregulatory environment, immature immune system, abundant growth factors, and increased pluripotency of cells. Foetal skin cells exhibit greater flexibility and specialized cell types, and the extracellular matrix composition promotes regeneration. The extracellular matrix composition of foetal skin promotes regeneration, making it more capable than adult skin because neuroregulatory signals affect skin regeneration. The understanding of these systems can facilitate the development of therapeutic strategies to alter the nerve supply to the skin to enhance the process of wound healing. Neuroregulation is being explored as a potential therapeutic strategy for enhancing skin wound repair. Bioelectronic strategies and neuromodulation techniques can manipulate neural signalling, optimize the neuroimmune axis, and modulate inflammation. This review describes the function of skin innervation in wound healing, emphasizing the importance of neuropeptides released by sensory and autonomic nerve fibres. This article discusses significant discoveries related to neuroregulation and its impact on skin wound healing.

Investigation of the Effect of Camellia Sinensis Essence Cream on Skin Burns

Background/Objective: Burn injuries are among the most common causes of trauma globally, affecting millions annually. Current treatments often rely on topical agents, but alternatives to synthetic formulations are increasingly sought due to safety and efficacy concerns. This study aimed to evaluate the therapeutic effects of a cream containing Camellia sinensis (white tea) extract on third-degree burn-induced skin lesions in a rat model. Methods: Thirty-two male Sprague-Dawley rats were randomized into four groups: control, Burn only, Burn + Camellia sinensis extract, and Burn + Camellia sinensis cream. Skin biopsies were evaluated using histopathological, immunohistochemical, and biochemical methods. Malondialdehyde (MDA) and glutathione (GSH) levels were measured to assess oxidative stress, while histological damage and immunoreactivity for collagen I, collagen III, NF-kβ/p65, TNF-alfa, 8-OhDG, and caspase-3 were analyzed. Results: The Camellia sinensis cream significantly reduced MDA levels and increased GSH levels compared to the burn-only group (p < 0.001). Histological analysis revealed enhanced epidermal regeneration and reduced dermal damage. The immunohistochemical findings demonstrated reduced NF-kβ/p65, TNF-alfa, 8-OhDG, caspase-3, collagen I, and collagen III immunopositivity in the cream-treated group (p < 0.001). Conclusions: Camellia sinensis cream demonstrated significant protective and reparative effects on burn-induced skin damage, suggesting its potential as a natural, effective, and safe alternative for burn management.

Martignago CC, Assis L, Vieira Botelho Delpupo F, Assis M, S. J. Sousa K, Souza e Silva LC, Líbero LO, de Oliveira F, Renno ACM. Casting Skin Dressing Containing Extractions of the Organic Part of Marine Sponges for Wound Healing

Skin wounds are extremely frequent injuries related to many etiologies. They are a burden on healthcare systems worldwide. Skin dressings are the most popular therapy, and collagen is the most commonly used biomaterial, although new sources of collagen have been studied, especially spongin-like from marine sponges (SPG), as a promising source due to a similar composition to vertebrates and the ability to function as a cell-matrix adhesion framework. Despite evidence showing the positive effects of SPG for tissue healing, the effects of skin dressings manufactured are still limited. In this context, this study aimed at investigating the effects of collagen skin dressings in an experimental model of skin wounds in rats. For this purpose, SEM, FTIR, cell viability, morphological and morphometric aspects, collagen deposition, and immunostaining of TGF-β and FGF were evaluated. The results demonstrated micro- and macropores on the rough surface, peak characteristics of collagen, and no cytotoxicity for the skin dressing. Also, the control group (CG) after 5 and 10 days exhibited an intense inflammatory process and the presence of granulation tissue, while the treated group (TG) exhibited re-epithelialization after 10 days. The evaluation of granulation tissue and neoepithelial length had an intragroup statistical difference (p = 0.0216) and no intergroup difference. Birefringence demonstrated an organized mesh arranged in a network pattern, presenting type I and type III collagen fibers in all groups. Moreover, in the morphometric evaluation, there were no statistical differences in intergroups or time points for the different types of collagen evaluated. In conclusion, these findings may indicate that the dressing has not exacerbated the inflammatory process and may allow faster healing. However, further studies using a critical wound healing injury model should be used, associated with longer experimental periods of evaluation, to further investigate the effects of these promising therapeutic approaches throughout the skin repair process.

Lovastatin and Resveratrol Synergistically Improve Wound Healing and Inhibit Bacterial Growth

Wound healing is a complex physiological process, with scarring and infection caused by Staphylococcus aureus and Pseudomonas aeruginosa being the most common complications. The reutilization of known medications has received increased attention for their role in cell function as small molecules. Examples of these include lovastatin, a cholesterol-lowering agent, and resveratrol, which have multiple biological properties. Both molecules have been reported to improve wound healing and possess antibacterial properties, with conflicting results. The wound-healing capabilities of human mesenchymal stem cells were evaluated after exposure to lovastatin, resveratrol, and their combination through scratch test, migrations assay, and qPCR. Protein docking was performed to assess the lovastatin/resveratrol combination as potential wound-healing targets. AlamarBlue assay was used to determine cell viability. Additionally, the impact of lovastatin and resveratrol combination to inhibit the growth of S. aureus and P. aeruginosa was tested using broth microdilution test and checkerboard assay to determine synergism. The combination of lovastatin 0.1 μM and resveratrol 0.1 μM synergistically improved wound healing and demonstrated an additive effect against S. aureus and P. aeruginosa, presenting potential antibacterial applications.

Diagnostic Significance of Serum VEGF, bFGF, and Wound Tissue EGFR in Diabetic Chronic Refractory Wounds

BACKGROUND

Patients with diabetes mellitus (DM) face a higher risk of developing chronic refractory wounds. Vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and epidermal growth factor receptor (EGFR) plays an important role in diabetes-related complications. This study aims to analyze the correlation between the 3 indicators and diabetic chronic refractory wounds, in order to establish the diagnostic value of these 3 indicators and provide reference for the treatment.

MATERIAL AND METHODS

We selected 168 patients, with 84 in healing group and 84 in refractory group. The levels of serum VEGF, bFGF, and wound tissue EGFR were compared before treatment, and the correlation between the 3 indicators and the refractory wounds was analyzed. After the specific treatment in refractory group, the clinical efficacy and wound closure index was recorded, and the correlation between them and the 3 indicators were analyzed.

RESULTS

The 3 indicators were all protective factors for diabetic chronic refractory wounds (p < .05). The serum VEGF and bFGF had relatively low diagnostic value for diabetic chronic refractory wounds, while wound tissue EGFR demonstrated higher diagnostic value (p < .05). The 3 indicators had a positive correlation with both the clinical efficacy and the wound closure index (p < .05).

CONCLUSION

Higher levels of serum VEGF, bFGF, and wound tissue EGFR are conducive to reducing the incidence of diabetic chronic refractory wounds. The combined measurement of these indicators holds high diagnostic value for the disease. Moreover, the higher the expression levels of these 3 indicators, the more favorable the clinical outcomes.

Advanced dressings based on novel biological targets for diabetic wound healing: A review

The diabetic wound is one of the most common complications of diabetes in clinic. The existing diabetic wound dressings all have bottlenecks in decreasing inflammation, stopping peripheral neuropathy, relieving local ischemia and hypoxia in diabetic wounds. These challenges are intricately linked to the roles of various growth factors, as well as matrix metalloproteinases. Thus, a comprehensive understanding of growth factors-particularly their dynamic interactions with the extracellular matrix (ECM) and cellular components-is essential. Cells and proteins that influence the synthesis of growth factors and matrix metalloproteinases emerge as potential therapeutic targets for diabetic wound management. This review discusses the latest advancements in the pathophysiology of diabetic wound healing, highlights novel biological targets, and evaluates new wound dressing strategies designed for the treatment of diabetic wounds.

Ultrasonic Deposition of Cellulose Nanocrystals on Substrates for Enhanced Eradication Activity on Multidrug-Resistant Pathogens

Amidst the pervasive threat of bacterial afflictions, the imperative for advanced antibiofilm surfaces with robust antimicrobial efficacy looms large. This study unveils a sophisticated ultrasonic synthesis method for cellulose nanocrystals (CNCs, 10-20 nm in diameter and 300-900 nm in length) and their subsequent application as coatings on flexible substrates, namely cotton (CC-1) and membrane (CM-1). The cellulose nanocrystals showed excellent water repellency with a water contact angle as high as 148° on the membrane. Noteworthy attributes of CNC-coated substrates include augmented reactive oxygen species (ROS) generation, heightened surface hydrophobicity, and comprehensive suppression of both drug-sensitive (MDR E. coli and MRSA) and susceptible (E. coli and S. aureus) planktonic and biofilm bacterial proliferation. In contrast, the uncoated substrates display 100% bacterial growth for the above bacteria. Empirical data corroborate the pronounced biofilm mass reduction capabilities of CNC-coated substrates across all tested bacterial strains. Elucidation of underlying mechanisms implicates ROS generation and electrostatic repulsion between CNCs and bacterial membranes in the disruption of mature biofilms. Hydroxyl radicals, superoxide, and hydrogen peroxide possess formidable reactivity, capable of disrupting essential biomolecules such as DNA, proteins, and lipids. The engineered CNC-coated substrates platform evinces considerable promise in the realm of infectious disease management, offering a cogent blueprint for the development of novel antimicrobial matrices adept at combating bacterial infections with efficacy and precision.

Application of infrared thermography for predicting pressure injury healing: A prospective study

BACKGROUND

An accurate assessment of pressure injury healing is crucial for the timely implementation of nursing intervention. This study aimed to investigate the accuracy of infrared thermography-based wound temperature measurement in predicting wound outcomes.

METHODS

This prospective, 16 days observational study included 156 adults with pressure injury. The temperature of wound bed, periwound skin and normal skin was recorded by using infrared thermography every three days. After that, three relative temperatures of PI were analyzed. The aim was to assess the significance of wound temperature in predicting healing outcomes for pressure injuries.

RESULTS

Relative temperature between periwound skin and normal skin was positively correlated with pressure injury healing (r > 0.64). Particularly the first day of follow up, it was found to be closely related to pressure injury healing (r = 0.687). On the last day and median time (the eighth to ninth day) of follow up, the optimal cutoff values of the indicator were negative values (periwound skin temperature was lower than normal skin). COX proportional hazard regression model analysis showed that relative temperature between periwound skin and normal skin on the first day of follow-up was the most significant predictor of pressure injury healing, and the healing risk increased largest- 8.79 times (95%CI: 4.53, 17.05), when its temperature greater than 0.000 °C.

CONCLUSION

Relative temperature between periwound skin and normal skin monitoring by infrared thermography better than visual assessment which can objectively serve as an indicator for predicting the healing status of pressure injury.

3D-Bioprinted Skin Tissues for Improving Wound Healing: Current Status and Perspective

Advancements in tissue engineering enable the fabrication of complex and functional tissues or organs. In particular, bioprinting enables controlled and accurate deposition of cells, biomaterials, and growth factors to create complex 3D skin constructs specific to a particular individual. Despite these advancements, challenges such as vascularization, long-term stability, and regulatory considerations hinder the clinical translation of bioprinted skin constructs. This chapter focuses on such approaches using advanced biomaterials and bioprinting techniques to overcome the current barriers in wound-healing studies. Moreover, it addresses current obstacles in wound-healing studies, highlighting the need for continued research and innovation to overcome these barriers and facilitate the practical utilization of bioprinted skin constructs in clinical settings.

Unlocking the Healing Potential: A Comprehensive Review of Ecology and Biology of Medical-Grade Honey in Wound Management and Tissue Regeneration

Background and Aims

Honey has long been studied for its healing abilities in wound care. This narrative review examines its properties and their impact on wound healing, particularly its ability to accelerate wound closure and promote tissue regeneration. The review focuses on how honey's botanical origins affect its medical properties and wound-healing capabilities. Finally, clinical studies on honey's effectiveness in wound healing were reviewed compared to traditional treatments.

Methods

Relevant keywords were searched in databases, yielding 1250 documents. After excluding nonrelevant sources, 450 documents were refined, and 167 articles were selected based on thematic alignment and originality. Data extraction focused on study design, intervention details, and outcomes, with quality assessed using standardized criteria. The study adhered to CONSORT and SANRA guidelines to ensure methodological rigor and reporting transparency.

Results

Honey-based medical products have demonstrated significant antibacterial, anti-inflammatory, and tissue-regenerative properties, making them highly effective in improving wound healing outcomes, particularly in chronic and burn wounds. These products have also been shown to reduce infection rates and hospital stays. While some studies have reported positive outcomes in accelerating the healing process, others have found no significant difference compared to conventional treatments.

Conclusion

Medical-grade honey (MGH) holds potential for wound care due to its versatility, though variations in its composition present challenges. Further research is needed to optimize its clinical use. The effectiveness of MGH in wound healing remains debated, with mixed results from trials. Genetic modification of bees to enhance MGH's properties could make it more competitive against conventional treatments. Honey-based medications could reduce costs, improve energy efficiency, and have minimal side effects. Rigorous research is necessary to determine optimal use and fully unlock MGH's potential, which could revolutionize wound management globally.

Novel Strategies for Angiogenesis in Tissue Injury: Therapeutic Effects of iPSCs-Derived Exosomes

Regeneration after tissue injury is a dynamic and complex process, and angiogenesis is necessary for normal physiological activities and tissue repair. Induced pluripotent stem cells are a new approach in regenerative medicine, which provides good model for the study of difficult-to-obtain human tissues, patient-specific therapy, and tissue repair. As an innovative cell-free therapeutic strategy, the main advantages of the treatment of induced pluripotent stem cells (iPSCs)-derived exosomes are low in tumorigenicity and immunogenicity, which become an important pathway for tissue injury. This review focuses on the mechanism of the angiogenic effect of iPSCs-derived exosomes on wound repair in tissue injury and their potential therapeutic targets, with a view to providing a theoretical basis for the use of iPSCs-derived exosomes in clinical therapy.

Photobiomodulation studies on diabetic wound healing: An insight into the inflammatory pathway in diabetic wound healing

Diabetes mellitus remains a global challenge to public health as it results in non-healing chronic ulcers of the lower limb. These wounds are challenging to heal, and despite the different treatments available to improve healing, there is still a high rate of failure and relapse, often necessitating amputation. Chronic diabetic ulcers do not follow an orderly progression through the wound healing process and are associated with a persistent inflammatory state characterised by the accumulation of pro-inflammatory macrophages, cytokines and proteases. Photobiomodulation has been successfully utilised in diabetic wound healing and involves illuminating wounds at specific wavelengths using predominantly light-emitting diodes or lasers. Photobiomodulation induces wound healing through diminishing inflammation and oxidative stress, among others. Research into the application of photobiomodulation for wound healing is current and ongoing and has drawn the attention of many researchers in the healthcare sector. This review focuses on the inflammatory pathway in diabetic wound healing and the influence photobiomodulation has on this pathway using different wavelengths.

Topography-Mediated Induction of Epithelial Mesenchymal Transition via Alumina Textiles for Potential Wound Healing Applications

Substrate topography is vital in determining cell growth and fate of cellular behavior. Although current in vitro studies of the underlying cellular signaling pathways mostly rely on their induction by specific growth factors or chemicals, the influence of substrate topography on specific changes in cells has been explored less often. This study explores the impact of substrate topography, specifically the tricot knit microfibrous structure of alumina textiles, on cell behavior, focusing on fibroblasts and keratinocytes for potential wound healing applications. The textiles, studied for the first time as in vitro substrates, demonstrated support for keratinocyte adhesion, leading to alterations in cell morphology and the expression of E-cadherin and fibronectin. These topography-induced changes resembled the epithelial-to-mesenchymal transition (EMT), crucial for wound healing, and were specific to keratinocytes and absent in identically treated fibroblasts. Biochemically induced EMT in keratinocytes cultured on flat alumina substrates mirrored the changes seen with alumina textiles alone, suggesting the tricot knit microfibrous topography could serve as an in vitro model system to induce EMT-like mechanisms. These results enhance our understanding of how substrate topography influences EMT-related processes in wound healing, paving the way for further evaluation of microfibrous alumina textiles as innovative wound dressings.

Rosuvastatin accelerates the healing process of partial-thickness burn wounds in rats by reducing TNF-α levels

Introduction

Burn wound healing is a complex, dynamic process that involves a coordinated cascade of cellular responses and phases. Inflammation, proliferation and remodeling are the main phases of tissue repair, while tumor necrosis factor α (TNF-α) and procalcitonin (PCT) seem to be important mediators affecting the inflammatory state. Our aim was to assess the effect of rosuvastatin on tissue repair after partial thickness burn injury in healthy animals.

Material and methods

In this randomized prospective experimental study, 36 male rats were randomly divided into two groups: placebo-treated (PG) and topical rosuvastatin-treated (SG). Under anesthesia, a partial-thickness burn trauma was induced in the dorsal region of the rats using an iron seal. Tissue samples were collected for histopathological examination as well.

Results

Variables of TNF-α, procalcitonin and macroscopic assessment were normally distributed between the two groups on all studied days. The expression of TNF-α was found to be lower in burn injuries treated with topical rosuvastatin in comparison with placebo-treated animals on days 3, 6 and 9. PCT values in rosuvastatin-treated subgroups were statistically significantly lower than in placebo subgroups. Upon macroscopic examination, a significantly smaller burnt area in the statin-treated group was detected compared to the non-statin group on all days, except for day 3. Histopathological examination demonstrated higher levels of mean neutrophil infiltration in the placebo group (day 3). Finally, fibroblast proliferation, angiogenesis and re-epithelization levels were noted to be higher after the topical application of rosuvastatin.

Conclusions

Rosuvastatin accelerated wound healing and down-regulated TNF-α and PCT levels.

Compounds of Marine Origin with Possible Applications as Healing Agents

It is well established that marine organisms consist of a great variety of active compounds that appear exclusively in the marine environment while having the ability to be vastly reproduced, irrespective of the existing conditions. As a result, marine organisms can be used in many scientific fields, including the ones of pharmaceutics, nutrition, and cosmetic science. As for the latter, marine ingredients have been successfully included in cosmetic formulations for many decades, providing numerous benefits for the skin. In the present review, the contribution of marine compounds in wound healing is thoroughly discussed, focusing on their role both as active ingredients in suitable formulations, designed to contribute to different stages of skin regeneration and restoration and also, indirectly, as a tool for facilitating wound closure as part of a wound dressing. Additionally, the advantages of these marine ingredients are presented, as well as ways of incorporating them effectively in formulations, so as to enhance their performance. Numerous studies have been referenced, showcasing their efficacy in wound healing. Finally, important data in regard to their stability, limitations, and challenges to their use, safety issues, and the existing legislative framework are extensively reviewed.

Green synthesis of propolis mediated silver nanoparticles with antioxidant, antibacterial, anti-inflammatory properties and their burn wound healing efficacy in animal model

Developing an efficient and cost-effective wound-healing substance to treat wounds and regenerate skin is desperately needed in the current world. The present study evaluatedin vivowound healing andin vitroantioxidant, antibacterial, anti-inflammatory activities of propolis mediated silver nanoparticles. Extract of Bee propolis from northeast Punjab, Pakistan, has been prepared via maceration and subjected to chemical identification. The results revealed that it is rich in phenolic contents (88 ± 0.004 mg GAE ml-1, 34 ± 0.1875 mg QE ml-1) hence, employed as a reducer and capping agent to afford silver nanoparticles (AgNPs) by green approach. The prepared nanoparticles have been characterized by UV-visible (UV-vis), Fourier transform infrared spectroscopy (FTIR), Scanning electron microscopy (SEM), x-ray diffraction (XRD). The propolis mediated AgNPs possess cubic face center with spherical shape and measured 50-60 nm in size. Moreover, propolis mediated silver nanoparticles have been studied for various biological activities. The results showed excellent antioxidant (0.4696 μg ml-1), anti-inflammatory (0.3996 μg ml-1) and antibacterial activities againstStaphylococcus aureus(MIC 0.462 μg ml-1) andProteus mirabilis(MIC 0.659 μg ml-1) bacterium. An ointment was prepared by mixing AgNPs with polymeric gels for burn wound treatment in rabbits. We found rapid wound healing and higher collagen deposition in AgNPs treated wounds than in control group. Our data suggest that AgNPs from propolis ameliorate excision wounds, and hence, these AgNPs could be potential therapeutic agents for the treatment of burns.

Epidermal stem cell-derived exosomes improve wound healing by promoting the proliferation and migration of human skin fibroblasts

Background

Epidermal stem cells (ESCs) are primarily located in the basal layer of the epidermis and play a crucial role in wound healing. ESCs-derived exosomes (ESCs-Exo) are emerging as promising candidates for skin regeneration and wound healing. However, the underlying mechanisms remain unclear. This study aims to investigate the role and mechanisms of ESCs-Exo in promoting the proliferation, migration, and collagen synthesis of human skin fibroblasts (HSFBs).

Methods

This study generated, isolated, and characterized ESC-Exos. The effects of ESCs-Exo on the proliferation of human skin fibroblasts (HSFBs) were detected via Cell Counting Kit-8 (CCK8), 5-Ethynyl-2'-deoxyuridine (EdU), and Proliferating Cell Nuclear Antigen (PCNA) and Marker of Proliferation Ki-67 (MKI67) gene expression methods. The effect of ESCs-Exo on the migration of HSFBs was detected via a transwell assay and a scratch test. The concentrations of collagen secreted by the HSFBs and the mRNAs of the two kinds of collagen expressed by the HSFBs were analyzed. We also analyzed the phosphorylation of Protein Kinase N1 (PKN1) and the expression of cyclins via western blotting. Finally, the effect of ESCs-Exo on wound healing was verified by animal experiments, and the key genes and signaling pathways of ESCs-Exo were excavated by transcriptomic analysis.

Results

Western blotting revealed that the exosomes of ESCs highly expressed established markers such as Alix, CD63, and CD9. ESC-Exos significantly promoted HSFB proliferation and migration in a dose-dependent manner, as well as HSFB collagen synthesis, and effectively increased the ratio of collagen III/I. In addition, bioinformatics analysis showed that the expression of key gene C-X-C motif chemokine ligand 9 was lower in the ESCs-Exo group, which may promote wound healing by regulating PKN1-cyclin and tumor necrosis factor signaling pathways. Animal experiments demonstrated that ESCs-Exo could reduce inflammation and accelerate wound healing.

Conclusions

In this study, we found that ESCs-Exo may improve wound healing by promoting the proliferation and migration of HSFBs.

Niacin-Cholic Acid-Peptide Conjugate Act as a Potential Antibiotic Adjuvant to Mitigate Polymicrobial Infections Caused by Gram-Negative Pathogens

Polymicrobial wound infections caused by Gram-negative bacteria and associated inflammation are challenging to manage, as many antibiotics do not work against these infections. Utilizing adjuvants to repurpose the existing antibiotics for mitigating microbial infections presents an alternative therapeutic strategy. We designed and developed a niacin-cholic acid-peptide conjugate (1) to rejuvenate the therapeutic efficacy of macrolide antibiotics against Gram-negative pathogens. We conjugated niacin with anti-inflammatory properties at the carboxyl terminal of the cholic acid and dipeptide (glycine-valine) at the three hydroxyl terminals of cholic acid to obtain the amphiphile 1. Our findings demonstrated that amphiphile 1 serves as a microbial membrane disruptor that facilitates the entry of erythromycin (ERY) in bacterial cells. The combination of amphiphile 1 and ERY is bactericidal and can effectively eliminate monomicrobial and polymicrobial Gram-negative bacterial biofilms. We further demonstrated the antibacterial effectiveness of combining 1 and ERY against monomicrobial and polymicrobial wound infections. Together, these findings indicate that amphiphile 1 revitalizes the remedial efficacy of ERY against Gram-negative bacteria.