Recent advances in molecular mechanisms of skin wound healing and its treatments

Efficacy and safety of negative pressure wound therapy for the treatment of diabetic foot ulcers: A meta-analysis

BACKGROUND

Diabetic foot ulcers (DFUs) are a significant challenge in diabetic care, and the efficacy of negative pressure wound therapy (NPWT) in treating them remains a subject of continuous investigation.

AIM

To provide a comprehensive meta-analysis of the role of NPWT in the management of DFUs.

METHODS

A systematic review was performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching databases like PubMed, Embase, Web of Science, and the Cochrane Library. Randomized clinical trials (RCTs) were included to compare NPWT to other dressings for DFUs. Outcomes measured were wound healing time and rate, granulation tissue formation time, amputation rate, and adverse events. Study quality was evaluated using Cochrane's risk of bias tool. Analyses utilized χ², I², fixed or random-effects models via Stata v17.

RESULTS

Of the 1101 identified articles, 9 RCTs were selected for meta-analysis. Studies spanned from 2005 to 2020 and originated from countries including the United States, Chile, Pakistan, Italy, India, and Germany. Meta-analysis demonstrated a significant improvement in wound healing rate [risk ratio (RR) = 1.46, 95%CI: 1.22-1.76, P < 0.01] and a reduction in amputation rate (RR = 0.69, 95%CI: 0.50-0.96, P = 0.006) with NPWT. Furthermore, the time for granulation tissue formation was significantly reduced by an average of 19.54 days. However, the incidence of adverse events did not significantly differ between NPWT and control treatments.

CONCLUSION

NPWT significantly improves wound healing rates and reduces amputation rates in DFUs. It also hastens the formation of granulation tissue. However, the therapy does not significantly alter the risk of adverse events compared to alternate treatments.

Advanced healing potential of simple natural hydrogel loaded with sildenafil in combating infectious wounds

Infected wounds are common clinical injuries that often complicated by inflammation and oxidative stress due to bacterial invasion. These wounds typically suffer from impaired vascularization, which delays healing and increases the risk of complications such as sepsis and chronic wounds. Therefore, developing an effective treatment for infected wounds is highly necessary. Egg white can promote cell regeneration and repair, while chitosan is effective in resisting bacterial invasion. Sildenafil is believed to have the potential to promote angiogenesis. Based on these properties, we have prepared a new type of hydrogel using egg white and chitosan as the framework, loaded with sildenafil (CEHS). The hydrogel combines the benefits of its components, exhibiting good biocompatibility and promoting the proliferation and migration of NIH 3T3 (3T3) cells and human umbilical vein endothelial cells (HUVEC), as well as the angiogenesis in HUVEC. It also exhibits significant antioxidant, anti-inflammatory, and antibacterial properties against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus). Additionally, in a mouse model of infected wounds, the CEHS effectively promoted wound healing through its excellent antioxidant and anti-inflammatory properties, antibacterial activity, and pro-angiogenic effects. In summary, this simple-to-prepare, multifunctional natural hydrogel shows great promise for the treatment of infected wounds.

Effect of Hyaluronan in Collagen Biomaterials on Human Macrophages and Fibroblasts In Vitro

In adults, scars are formed after deep skin wound injuries like burns. However, the fetal microenvironment allows for scarless skin regeneration. One component that is abundantly present in the fetal extracellular matrix is hyaluronan (HA). To study whether biomaterials with HA improve wound healing, type I collagen scaffolds with and without HA were prepared and characterized. Their immune effect was tested using macrophages and their phenotypes were analyzed through cell surface markers and cytokine expression after 48 h. Since fibroblasts are the main cellular component in the dermis, adult, fetal and eschar-derived cells were cultured on scaffolds for 14 days and evaluated using histology, gene and protein expression analyses. Biochemical assays demonstrated that HA was successfully incorporated and evenly distributed throughout the scaffolds. Macrophages (M0) cultured on Col I+HA scaffolds exhibited a profile resembling the M2c-like phenotype (CD206high, CD163high and IL10high). HA did not significantly affect gene expression in adult and fetal fibroblasts, but significantly reduced scarring-related genes, such as transforming growth factor beta 1 (TGFB1) and type X collagen alpha 1 chain (COL10A1), in myofibroblast-like eschar cells. These findings highlight the potential of incorporating HA into collagen-based skin substitutes to improve the wound healing response.

A Matrix-Derived Bioactive Peptide Enhances Epidermal Thickness and Hair Follicle Neogenesis in Grafted Dermal-Epidermal Composites

Cutaneous wounds can be treated using skin substitutes, but they heal with scarring and absence of skin adnexal structures. We previously demonstrated hair follicle neogenesis in dermal-epidermal composites made of neonatal foreskin human keratinocytes and human dermal papilla cells grafted onto nude mice. A challenge to adapting this approach to graft large areas in humans is that dermal papilla cells lose trichogenicity when expanded in vitro. Herein, a peptide derived from a coiled-coil domain of multimerin-1, TSN6, was evaluated for its effects on graft characteristics and hair follicle formation. In a hair follicle reconstitution assay, TSN6 increased the number of hair fibres by 1.8-fold (p value < 0.05). Dermal-epidermal composites, constructed using late-passage human dermal papilla cells and incubated with TSN6 prior to grafting, retained 14 of 14 grafts for 10-12 weeks, whereas scrambled and vehicle groups kept only 9 of 12 and 13 of 16 grafts, respectively. Histological evaluation of skin grafts showed the presence of human hair follicles in 12 of 14 dermal-epidermal composites in the TSN6 group, 3 of 9 in the scrambled group and 6 of 13 in the vehicle group. The median number and interquartile range of hair follicles was 4.5 (1.8, 10.3) for the TSN6 group, 0 (0, 3.5) for the scrambled group and 0 (0, 3.3) for the vehicle group. TSN6 also increased epidermal thickness, showing a thickness of 127 ± 18 μm for the TSN6 group and 70 ± 28 μm and 94 ± 18 μm for the scrambled and vehicle groups, respectively. In summary, TSN6 increases epidermal thickness and promotes hair follicle neogenesis in a skin substitute.

Electroactive Electrospun Nanofibrous Scaffolds: Innovative Approaches for Improved Skin Wound Healing

The incidence and burden of skin wounds, especially chronic and complex wounds, have a profound impact on healthcare. Effective wound healing strategies require a multidisciplinary approach, and advances in materials science and bioengineering have paved the way for the development of novel wound healing dressing. In this context, electrospun nanofibers can mimic the architecture of the natural extracellular matrix and provide new opportunities for wound healing. Inspired by the bioelectric phenomena in the human body, electrospun nanofibrous scaffolds with electroactive characteristics are gaining widespread attention and gradually emerging. To this end, this review first summarizes the basic process of wound healing, the causes of chronic wounds, and the current status of clinical treatment, highlighting the urgency and importance of wound dressings. Then, the biological effects of electric fields, the preparation materials, and manufacturing techniques of electroactive electrospun nanofibrous (EEN) scaffolds are discussed. The latest progress of EEN scaffolds in enhancing skin wound healing is systematically reviewed, mainly including treatment and monitoring. Finally, the importance of EEN scaffold strategies to enhance wound healing is emphasized, and the challenges and prospects of EEN scaffolds are summarized.

Neutrophils in Tissue Injury and Repair: Molecular Mechanisms and Therapeutic Targets

Tissue repair represents a highly intricate and ordered dynamic process, critically reliant on the orchestration of immune cells. Among these, neutrophils, the most abundant leukocytes in the body, emerge as the initial immune responders at injury sites. Traditionally recognized for their antimicrobial functions in innate immunity, neutrophils now garner attention for their indispensable roles in tissue repair. This review delves into their novel functions during the early stages of tissue injury. We elucidate the mechanisms underlying neutrophil recruitment and activation following tissue damage and explore their contributions to vascular network formation. Furthermore, we investigate the pivotal role of neutrophils during the initial phase of repair across different tissue types. Of particular interest is the investigation into how the fate of neutrophils influences overall tissue healing outcomes. By shedding light on these emerging aspects of neutrophil function in tissue repair, this review aims to pave the way for novel strategies and approaches in future organ defect repair, regeneration studies, and advancements in tissue engineering. The insights provided here have the potential to significantly impact the field of tissue repair and regeneration.

Research progress on the role of fascia in skin wound healing

The skin, the human body's largest organ, is perpetually exposed to environmental factors, rendering it vulnerable to potential injuries. Fascia, a vital connective tissue that is extensively distributed throughout the body, fulfils multiple functions, including support, compartmentalization, and force transmission. The role of fascia in skin wound healing has recently attracted considerable attention. In addition to providing mechanical support, fascia significantly contributes to intercellular signalling and tissue repair, establishing itself as a crucial participant in wound healing. This review synthesises the latest advancements in fascia research and its implications for skin wound healing.

Medicinal plants and their derivatives for skin and hair: a Mediterranean perspective of women care

Since olden days, medicinal and aromatic plants have been consumed due to their well-known therapeutic, ornamental, culinary, and cosmetic properties. Plant-based cosmetics comprise a growing market offering brands of sustainable products with the ultimate goal of responding to the woman needs to boost their natural beauty, such as soothing, toning, moisturizing and protecting skin and hair. The increasing focus on body and beauty care, combined with a better understanding of the diverse biological effects of plants and their derivatives, has revitalized their significance in aesthetic, cosmetic, and dermatological contexts. Concurrently, the increasing prevalence of allergies and hypersensitivity reactions to synthetic additives commonly found in cosmetics and other skin products has spurred interest in seeking healthier and more efficacious natural alternatives. An intense investigation has been stated around the formulation of medicinal plants- and other plant-based cosmetic products for dermatological and aesthetic purposes. Similarly, a raising awareness by cosmetics' manufacturers and related industries have been progressively stated, culminating with the emergence of a line of plant-based cosmetics increasingly safe and with reliable quality features for multiple purposes. Although a high demand for natural-based products for cosmetic purposes has been stated, further studies are required to deepening knowledge on their beneficial properties, safety and quality features and to identify the main limitations and likelihood of side effects occurrence. In this review, an outlook of the current scenario regarding the use of medicinal and aromatic plants as cosmetic ingredients in the formulation of skin care and other dermatological products traditionally used by the Mediterranean woman for prevention and even cure of skin and hair diseases or for beautification is provided.

Polyvinyl Alcohol-Based Membranes: A Review of Research Progress on Design and Predictive Modeling of Properties for Targeted Application

This review provides a comprehensive evaluation of the current state of polyvinyl alcohol (PVA)-based membranes, emphasizing their significance in membrane technology for various applications. The analysis encompasses both experimental and theoretical research articles, with a focus on recent decades, aiming to elucidate the potential and limitations of different fabrication approaches, structure-property relationships, and their applicability in the real world. The review begins by examining the advanced polymeric materials and strategies employed in the design and processing of membranes with tailored properties. Fundamental principles of membrane processes are introduced, with a focus on general modeling approaches for describing the fluid transport through membranes. A key aspect of discussion is the distinction between the membrane performance and process performance. Additionally, an in-depth analysis of PVA membranes in various applications is presented, particularly in environmental fields (e.g., fuel cell, water treatment, air purification, and food packaging) and biomedical domains (e.g., drug delivery systems, wound healing, tissue engineering and regenerative medicine, hemodialysis and artificial organs, and ophthalmic and periodontal treatment). Special attention is given to the relationship between membranes' characteristics, such as material composition, structure, and processing parameters, and their overall performance, in terms of permeability, selectivity, and stability. Despite their promising properties, enhanced through innovative fabrication methods that expand their applicability, challenges remain in optimizing long-term stability, improving fouling resistance, and increasing process scalability. Therefore, further research is needed to develop novel modifications and composite structures that overcome these limitations and enhance the practical implementation of PVA-based membranes. By offering a systematic overview, this review aims to advance the understanding of PVA membrane fabrication, properties, and functionality, providing valuable insights for continued development and optimization in membrane technology.

MicroRNA Expression in Chronic Venous Leg Ulcers and Implications for Wound Healing: A Scoping Review

Purpose: Chronic venous leg ulcers (CVLUs) comprise the majority of lower-extremity wounds, yet their pathophysiology is not fully understood. While research has shown that microRNAs are an important component of wound inflammation, few have explored the role of microRNAs (miRNAs) in the healing of CVLUs. This scoping review examines miRNAs in CVLUs and the association with wound healing. Methods: In December 2023, we searched MEDLINE/PubMed, Embase, Scopus, and CINAHL for studies published in 2013-2023 examining miRNAs in CVLU healing. Results: Six studies met inclusion criteria. MicroRNAs were extracted from various specimens including serum, skin biopsy samples, and adipose tissue-derived mesenchymal cells from individuals with CVLUs. Overexpression of miR-221, miR-222, miR-92a, and miR-301a-3p hindered angiogenesis, while overexpression of miR-296, miR-126, miR-378, and miR-210 facilitated angiogenesis. Overexpression of miR-34a/c, miR-301a-3p, miR-450-5p, miR-424-5p, miR-516-5p, and miR-7704 increased local inflammatory responses and inhibited keratinocytes proliferation, impairing healing, while overexpression of miR-19a/b and miR-20 downregulated keratinocytes' inflammatory response, promoting healing. Downregulation of miR-205, miR-96-5p, and miR-218-5p enhanced cellular proliferation and promoted wound healing. Downregulation of miR-17-92 was linked with impaired healing. Discussion: MicroRNAs play a role in regulating angiogenesis, inflammatory responses, and cell migration in chronic-wound healing. However, studies of miRNAs in CVLUs are limited and lack a standardized approach to measurement and quantification. Further research is warranted to elucidate the mechanisms underlying microRNA involvement in CVLU healing to better understand the pathophysiology and for the future development of targeted therapies.

γ-Oryzanol: A nutrient-rich ingredient for promoting wound healing

γ-Oryzanol (Orz) is a powerful antioxidant found in rice bran and oil, known for its numerous health benefits. Nevertheless, its precise impact on skin wound healing remains largely unexplored. This research focuses on comprehensively examining the ability of Orz to promote tissue repair through laboratory-based and animal model experiments. The research further examines its antimicrobial activity and its role in promoting wound healing through anti-inflammatory effects. To evaluate the effect of Orz on tissue repair, scratch assays performed in vitro were used to analyze its impact on cellular migration. An in vivo experiment utilizing a rat skin wound excision model was carried out to investigate wound contraction rates and analyze histological modifications. The granulation tissue from a dead space wound model was examined to assess the levels of inflammatory mediators, free radicals, and antioxidant activity. The findings of the study demonstrated Orz improves cellular viability while facilitating the proliferation and migration of NIH-3T3 cells. It further promotes the generation of growth factors, such as fibroblast growth factor 21 and transforming growth factor-β. Moreover, Orz exhibited significant antimicrobial activity against various pathogens commonly found in wounds. An ointment with 10 % Orz showed significant effectiveness in promoting wound healing, as indicated by notable wound contraction observed on the 14th day after surgery. Histological analysis demonstrated that the application of 10 % Orz ointment resulted in remarkable tissue repair, heightened fibroblast proliferation, and improved formation of new blood vessels. The application of Orz ointment was also found to elevate interleukin-10 levels, reduce tumor necrosis factor-α levels and ED-1-immunopositive cells, and enhance antioxidant enzyme activity, thereby mitigating oxidative damage in healing tissues throughout the initial stages of tissue repair. These results indicate that Orz holds significant promise for application in the treatment of surface wounds.

Molecular Insights into the Interaction of Cathepsin D and Iron in Chronic Wound Healing: Exploring Therapeutic Potential and Mechanisms

Background: Chronic wounds, such as diabetic ulcers, often fail to progress through healing due to persistent inflammation, infections, and extracellular matrix (ECM) imbalances. Cathepsin D, an aspartate protease active in acidic environments, plays a pivotal role in wound healing by mediating inflammatory responses, ECM remodeling, and macrophage phenotype transitions. Its dysregulation, however, can impair healing, highlighting the need for targeted modulation of its activity. The aim of this study was to investigate the molecular interaction between Fe2+ and cathepsin D's catalytic core and ionic zipper under physiological and acidic conditions to identify strategies to enhance tissue repair and accelerate the healing of chronic wounds. Methods: The molecular structure of active cathepsin D was obtained from the Protein Data Bank (PDB) and analyzed using UCSF Chimera. Molecular interactions between cathepsin D and ferrous ions (Fe2+) were studied, focusing on key residues (D33 and D231) and ionic zipper residues (E5, E180, and D187). Results: Our results showed that the active form of cathepsin D, a 96 kDa dimer, consisted of heterodimers with distinct amino acid chains, where residues D33 and D231 formed the active site, and E5, E180, and D187 constituted the ionic zipper. A functional pocket containing the conserved residues D33 and D231, essential for proteolytic activity, was identified. At physiological pH (~7.5), D33 exhibited the most potent interactions with Fe2+, with interaction energies of -7 × 1017 J at oxygen atoms of the carboxylate group (OD1) and α-carbon (CA) atoms, whereas D231 showed slightly lower energies of -6 × 1017 J at γ-carbon atom (CG) and CA atoms. At acidic pH (~4), E5 was the primary interacting residue, with the shortest distance to Fe2+ (2.69 Å), and showed stable interactions across several atoms, emphasizing its role in metal binding. Conclusions: pH conditions strongly influence the interaction of cathepsin D with Fe2. At physiological pH, residues D33 and D231 demonstrate robust and energetically efficient binding with Fe2+. At the same time, under acidic conditions, E5 emerges as the primary residue involved, potentially affecting the ionic zipper of cathepsin D. These insights provide a molecular foundation for targeting specific residues to modulate cathepsin D activity, presenting promising opportunities for therapeutic strategies aimed at improving chronic wound healing.

Human Placenta MSC-Derived DNA Fragments Exert Therapeutic Effects in a Skin Wound Model via the A2A Receptor

PDRN, polydeoxyribonucleotide, which is used as a tissue-regeneration material, is present in human cells under physiological conditions and stimulates regeneration and metabolic activity. PDRN can be used as a biomaterial for several types of regeneration, including wound healing, to promote cell growth and growth-factor production. The aims of this study were to determine the effect of PDRN derived from human placenta-derived mesenchymal stem cells (hPD-MSCs) on cellular regeneration through A2A receptor signaling and to investigate its therapeutic effects in a mouse model of wound healing. Human PDRN (UNIPlax) was extracted from hPD-MSCs fragmented via a sonication system and evaluated for its effect on the migration of HaCaT cells in an in vitro system and in a wound-healing mouse model in vivo. Compared with the sham treatment, UNIPlax treatment significantly increased the migration of injured HaCaT cells (p < 0.05). Additionally, the tube formation of human umbilical vein endothelial cells (HUVECs) was greater than that of the sham group (p < 0.05), and the effects of this treatment were mediated through the A2A receptor. Furthermore, UNIPlax treatment led to a decrease in wound size; in addition, the area of granulation and the rate of collagen formation at the wound site were significantly greater than those in the sham group in the wound-healing mouse model (p < 0.001). We also confirmed that UNIPlax promoted tissue regeneration and the expression of VEGF through the A2A receptor. Taken together, these findings indicate that UNIPlax has potential for regeneration of damaged tissues, including during wound healing.

C24 Ceramide Lipid Nanoparticles for Skin Wound Healing

Background/Objectives: C24 ceramide plays a crucial role in skin regeneration and wound healing; however, its hydrophobic nature limits its application in therapeutic formulations. This study aims to enhance the bioavailability and efficacy of C24 ceramide by developing ceramide-based lipid nanoparticles (C24-LNP) and evaluate their impact on skin regeneration and wound healing. Methods: C24-LNP was synthesized and characterized for aqueous stability and bioavailability. In vitro experiments were conducted to assess its effects on keratinocyte proliferation and migration. Molecular biological analysis examined key signaling pathways, including AKT and ERK1/2 phosphorylation. Additionally, an in vivo mouse wound model was utilized to evaluate wound healing efficacy, with histological analysis performed to assess epidermal and dermal regeneration. Results: C24-LNP exhibited improved aqueous stability and bioavailability compared to free C24 ceramide. In vitro studies demonstrated that C24-LNP significantly promoted keratinocyte proliferation and migration. Molecular analysis revealed activation of the AKT and ERK1/2 signaling pathways, which are critical for cell growth and skin regeneration. In vivo wound healing experiments showed that C24-LNP accelerated wound closure compared to the control group. Histological analysis confirmed enhanced epidermal and dermal regeneration, leading to improved structural and functional skin repair. Conclusion: The lipid nanoparticle formulation of C24 ceramide effectively increases its bioavailability and enhances its therapeutic efficacy in skin regeneration and wound healing. C24-LNP presents a scalable and cost-effective alternative to traditional growth factor-based therapies, offering significant potential for clinical applications in wound care and dermatological treatments.

Mechanistic insights of diabetic wound: Healing process, associated pathways and microRNA-based delivery systems

Wounds that represent one of the most critical complications can occur in individuals suffering from diabetes mellitus, and results in the need for hospitalisation and, in severe cases, require amputation. This condition is primarily characterized by infections, persistent inflammation, and delayed healing processes, which exacerbate the overall health of the patients. As per the standard mechanism, signalling pathways such as PI3K/AKT, HIF-1, TGF-β, Notch, Wnt/β-Cat, NF-κB, JAK/STAT, TLR, and Nrf2 play major roles in inflammatory, proliferative and remodelling phases of wound healing. However, dysregulation of the above pathways has been seen during the healing of diabetic wounds. MicroRNAs (miRNAs) are small, non-coding RNAs that regulate the expression of various genes and signalling pathways which are associated with the process of wound healing. In the past few years, there has been a great deal of interest in the potential of miRNAs as biological agents in the management of a number of disorders. These miRNAs have been shown to modulate expression of genes involved in the healing process of wounds. There have been previous reviews pertaining to clinical trials examining miRNAs in several disorders, but only a few clinical studies have examined involvement of miRNAs in healing of wounds. Considering the therapeutic promise, there are several obstacles concerning their instabilities and inefficient delivery into the target cells. Therefore, this review is an attempt to discuss precise roles of signalling pathways and miRNAs in different phases of wound healing, and their aberrant regulation in diabetic wounds, particularly. It has also compiled a range of delivery mechanisms as well as an overview of the latest findings pertaining to miRNAs and associated delivery systems for improved healing of diabetic wounds.

Update on the Study of Angiogenesis in Surgical Wounds in Patients with Childhood Obesity

Background: Angiogenesis, the formation of new blood vessels from pre-existing ones, plays a pivotal role in wound healing, particularly in surgical contexts. Methods and results: However, this process can be significantly impaired in patients with childhood obesity, resulting in delayed healing and additional complications. The biological process of wound healing is complex, involving angiogenesis, cell proliferation, inflammation, and tissue remodeling. This review aims to explore recent advancements in research on angiogenesis in surgical wounds in patients with childhood obesity, with a focus on growth factors, inflammation, microcirculation, and innovative therapeutic strategies. Conclusions: It highlights therapeutic approaches such as the administration of growth factors and the application of biomaterials to enhance angiogenesis.

Application of novel strategies in chronic wound management with focusing on pressure ulcers: new perspective

Invading blood cells, extracellular tissue, and soluble mediators all play important roles in the wound-healing process. There is a substantial global burden of disease and mortality attributable to skin defects that do not heal. About 1% to 2% of the population in industrialized nations suffers from chronic wounds that don't heal, despite healthcare breakthroughs; this condition is very costly, costing about $25 billion each year in the US alone. Amputation, infection (affecting as many as 25% of chronic wounds), sepsis, and dermal replacements are all consequences of conventional therapeutic approaches like growth factor therapy and diabetic foot ulcers account for 85% of lower limb amputations. Despite these obstacles, scientists are constantly looking for new ways to speed healing and close wounds. The unique immunomodulatory capabilities and multipotency of mesenchymal stem cells (MSCs) have made them a potential therapeutic choice in tissue engineering and regenerative medicine. Animal models of wound healing have shown that MSCs can speed up the process by as much as 40% through enhancing angiogenesis, modulating inflammation, and promoting fibroblast migration. Clinical trials provide more evidence of their effectiveness; for instance, one RCT found that, after 12 weeks, patients treated with MSCs had a 72% smaller wound size than those in the control group. This review offers a thorough examination of MSCs by combining the latest research with preclinical evidence. Highlighting their potential to transform treatment paradigms, it delves into their biological properties, how they work during regeneration and healing, and therapeutic usefulness in controlling chronic wounds.

Facile Formulation of a Resveratrol-Mediated Multibond Network Hydrogel with Efficient Sustainable Antibacterial, Reactive Oxygen Species Scavenging, Pro-Angiogenesis, and Immunomodulation Activities for Accelerating Infected Wound Healing

The management of chronic infected wounds remains a significant clinical challenge, largely due to the deficiency of optimal wound dressings with adequate mechanical strength, appropriate adhesiveness, and efficient sustainable antibacterial, reactive oxygen species (ROS) scavenging, pro-angiogenesis, and immunomodulation properties. To address such a dilemma, we employed a simple and facile strategy to utilize resveratrol (RSV) as a functional component to mediate hydrogel gelation in this study. The structure of this obtained hydrogel was supported by a multibond network, which not only endowed the resultant product with superior mechanical strength and moderate adhesiveness but also effectively prolonged the bioavailability of RSV. This strategy successfully integrated the entire system with sustainable antibacterial, ROS scavenging, pro-angiogenesis, and immunomodulation properties. Subsequent in vivo evidence has verified that this material was capable to accelerate the healing of chronic infected wounds. The underlying mechanism can be explained that this hydrogel is capable of propelling macrophage polarization from the M1 to M2 phenotype through modulating the PI3K/AKT signaling pathway to activate the nuclear factor erythroid 2-related factor 2 (Nrf2) signaling as well as maintaining the mitochondrial membrane potential level in the normal state under excessive inflammatory and oxidative stimulus. In summary, this multifunctional hydrogel wound dressing provides a feasible way to promote the bioavailability of RSV, which is conducive for preparing a promising candidate for chronic infected wound healing. What is more important, it is also beneficial to reveal the correlative mechanisms to establish advanced therapeutic platform for targeting other complex infection microenvironment.

Wound healing potential of mouth gel containing isopimarane diterpene from Kaempferia galanga rhizomes for treatment of oral stomatitis

Background

Oral ulcers have an impact on 25% of the global population including patients who are suffering from chemotherapy and radiotherapy treatments. Kaempferia galanga L. has been traditionally used for treatment of mouth sores and tongue blisters. However, the wound healing study of isopimarane diterpenes isolated from K. galanga is still limited.

Objective

This study aims to evaluate the wound healing potential of 6β-acetoxysandaracopimaradiene-1α,9α-diol (KG6), a compound isolated from Kaempferia galanga, by examining its biological activities. Additionally, we investigate the physicochemical and biological properties of (KG6) in formulated mouth gels.

Methods

The KG6 mouth gels at 0.10%, 0.25% and 0.50% w/w were formulated using sodium carboxymethylcellulose as a gelling agent, and their physicochemical and biological stabilities were assessed through a heating-cooling acceleration test. The quantification of KG6 contents in KG6 mouth gels was determined using gas chromatography. Both KG6 and KG6 mouth gels were evaluated for their wound healing properties including cell proliferation, cell migration, and antioxidant activity (H2O2-induced oxidative stress) in human gingival fibroblast (HGF-1-ATCC CRL-2014) (HGF-1). In addition, the anti-inflammatory activity against nitric oxide (NO) production was investigated in macrophage cells (RAW 264.7).

Results

After KG6 mouth gels were incubated under heating-cooling acceleration condition, the physicochemical properties of the KG6 mouth gels remain stable across various parameters, including appearance, color, smell, texture, pH, viscosity, separation, and KG6 content. The biological studies indicated that the KG6 compound possessed good wound healing potential. The 0.50% KG6 mouth gel exhibited marked anti-inflammatory effect by inhibiting NO production with an IC50 of 557.7 µg/ml, comparable to that of Khaolaor mouth gel, a positive control. The 0.25% KG6 mouth gel increased HGF-1 cell proliferation to 101.7-103.5%, whereas all formulations of KG6 mouth gel enhanced HGF-1 cell migration to 94.7-98.9%, higher than Khaolaor mouth gel (73.5%). Moreover, 0.50% KG6 mouth gel also showed a good antioxidant effect under H2O2-induced oxidative stress.

Conclusion

This study substantiates the significant biological activities related to the wound healing property of 0.50% KG6 mouth gel for treatment of aphthous ulcers and oral stomatitis from chemotherapy and radiotherapy treatments.

Skin Function Improvement and Anti-Inflammatory Effects of Goat Meat Extract

Chronic skin conditions, such as atopic dermatitis, are characterized by a weakened skin barrier and persistent inflammation. Traditional treatments can frequently cause substantial side effects, emphasizing the need for safer alternatives. This study investigated the anti-inflammatory properties of goat meat extract and its effects on improving skin function. We conducted wound healing assays using HaCaT cells and analyzed the expression of key skin barrier-related genes. Additionally, the anti-inflammatory effects of goat meat extract were assessed in HaCaT cells stimulated with TNFα and IFNγ, as well as in LPS-treated RAW264.7 cells. Mechanistic studies focused on the activation of mitogen-activated protein kinase (MAPK) pathways. The results showed that goat meat extract significantly promoted wound closure in HaCaT cells and upregulated the expression of filaggrin, loricrin, and involucrin. The extract also reduced the production of pro-inflammatory cytokines and chemokines in both HaCaT and RAW264.7 cells. Furthermore, it inhibited the activation of the JNK, p38, and ERK pathways in TNFα/IFNγ-stimulated HaCaT cells. These findings suggest that goat meat extract improves skin barrier function and exhibits anti-inflammatory effects, indicating its potential as a therapeutic agent for chronic skin. Further research is required to investigate the in vivo effects of goat meat extract and validate its therapeutic potential.

Evaluating research waste and traits among randomized controlled trials of scars over the past 20 years: a cross-sectional study

PURPOSE

To analyze the changes in the characteristics of randomized controlled trials (RCTs) in the field of scarring over the last two decades, unveil the components of research waste (RW) within these RCTs, and identify targets for improvement.

METHODS

A search was conducted on ClinicalTrials.gov for RCTs registered from January 2000 to December 2023, using "scar" as the keyword. The search was carried out in January 2024.

RESULTS

391 RCTs were included in this analysis. The global registration of RCTs in scarring has exhibited a consistent increase annually, with the proportion in Asia gradually rising, while the shares in North America and Europe have demonstrated a declining trend. In the analysis of RW, 232 RCTs were included, of which 96 (41.4%) have been published. Among the published RCTs, 56 (58.3%) were evaluated to have sufficient reporting, while 47 RCTs (48.9%) were identified as having avoidable design flaws. Ultimately, 183 RCTs (78.9%) exhibited at least one form of RW. Multicenter design (OR: 3.324, 95%CI: 1.385-7.975, P = 0.018), non-pharmacological interventions (OR: 2.61, 95%CI: 1.253-5.435, P = 0.010), the absence of external funding (OR: 0.325, 95%CI: 0.144-0.732, P = 0.031), and participant numbers exceeding 50 (OR: 3.269, 95%CI: 1.573-6.794, P = 0.002) were identified as independent protective factors against waste.

CONCLUSIONS

This study delineates the changes in the characteristics of scar RCTs globally over the past two decades, uncovering a substantial burden of RW in scarring research. It provides an evidential reference for more rational planning of future scar-related RCTs and for minimizing RW.

A novel polyurethane-based silver foam dressing with superior antimicrobial action for management of infected chronic wounds

Wound healing is a complex and dynamic process supported by several cellular events. Around 13 million individuals globally suffer from chronic wounds yearly, for which dressings with excellent antimicrobial activity and cell viability (>70%, as per ISO 10993) are needed. Excessive use of silver can cause cytotoxicity and has been linked to increasing antimicrobial resistance. In this study, HDI Ag foam was synthesized using a safer hexamethylene diisocyanate-based prepolymer (HDI prepolymer) instead of commonly used diisocyanates like TDI and MDI and substantially lower Ag content than that incorporated in other Ag foams. In vitro characteristics of the HDI Ag foam were evaluated in comparison with leading clinically used foam-based dressings. All dressings underwent a detailed characterization in accordance with industrially accepted BS EN 13726 standards. The HDI Ag foam exhibited highest antimicrobial efficiency againstS. aureusandP. aeruginosa(static condition), with the lowest amount of Ag (0.2 wt%) on the wound contact surface. The extracts from HDI Ag foam showed superior cell viability (>70%), when tested on the L929 mouse fibroblast cell line. Measurements of moisture vapor transmission, fluid handling, physico-chemical and mechanical properties ensured that the HDI foam was clinically acceptable for chronic wound patients.

Hibiscus schizopetalus boosts wound healing via restoring redox balance and hindering inflammatory responses in rats: Insights on metabolome profiling and molecular docking

Hibiscus species (Malvaceae) possess a plethora of appealing pharmacological activities with an extended history of customary use in diverse medical conditions. The present study aimed at comparing the metabolomic analyses of three Hibiscus species native to Egypt, namely H. tiliaceus, H. schizopetalus extract (HSE), and H. rosa-sinensis, alongside identifying a promising natural wound healing candidate. Chemical profiling of the leaf extracts was achieved via UPLC-ESI/MS/MS-guided analysis that resulted in the tentative identification of a total of 48 secondary metabolites pertaining to phenolic acids, flavonoids, anthocyanins, fatty acids, and fatty amides. Remarkably, in vitro studies revealed that HSE exhibited the topmost wound healing activity. Subsequently, HSE was formulated into hydro- and nanogel (1% w/v) formulations for further assessing its efficacy in the wound excision model. HSE-nanogel demonstrated a significant in vivo wound contraction activity alongside improving histopathological abnormalities. Mechanistically, HSE-nanogel upregulated the wound antioxidant status through increasing the levels of reduced glutathione (GSH) and catalase activity. Moreover, HSE-nanogel suppressed the wound inflammatory responses by diminishing the expressions of NF-ĸB, TNF-α, and IL-6. Molecular docking studies were performed on HSE's major constituents using CDOCKER, which further supported the in vivo findings. Collectively, HSE nanogel exhibits notable aptitude as a wound-healing agent, warranting further clinical appraisal.

The Role of Nanoparticles in Accelerating Tissue Recovery and Inflammation Control in Physiotherapy Practices

Physiotherapy has significantly evolved since its inception in the late 19th century, expanding into various specializations such as sports, neurology, and wound care. Its primary goal is to restore or enhance bodily functions through therapeutic interventions, aiding in conditions ranging from injuries to chronic pain. Tissue recovery, which involves repair and regeneration, is a critical aspect of physiotherapy. This natural process is influenced by factors like inflammation and injury severity. Nanotechnology, a relatively recent advancement, has transformed medicine, including wound care, through innovations in drug delivery, diagnostics, and anti-inflammatory treatments. Nanoparticles, owing to their small size and enhanced bioavailability, play a crucial role in improving drug delivery, increasing the efficacy of treatments, and promoting faster recovery. In the context of tissue healing, nanoparticles aid in cell proliferation, inflammation control, and scar reduction, among other therapeutic benefits. They are increasingly used in physiotherapy applications, to support tissue regeneration and inflammation management. This review examines the role of nanoparticles in physiotherapy, with a focus on their application in wound healing, muscle recovery, and inflammation control. It discusses various in-vitro and in-vivo studies that have explored the therapeutic potential of nanoparticles in these domains, providing insights into their mechanisms of action and effectiveness in promoting tissue regeneration and managing inflammation in physiotherapy settings.

The Immobilization of an FGF2-Derived Peptide on Culture Plates Improves the Production and Therapeutic Potential of Extracellular Vesicles from Wharton's Jelly Mesenchymal Stem Cells

The skin is an essential organ that protects the body from external aggressions; therefore, damage from various wounds can significantly impair its function, and effective methods for regenerating and restoring its barrier function are crucial. This study aimed to mass-produce wound-healing exosomes using a fragment of the fibroblast growth factor 2 (FGF2)-derived peptide (FP2) to enhance cell proliferation and exosome production. Our experiments demonstrated increased cell proliferation when Wharton's jelly mesenchymal stem cells (WJ MSCs) were coated with FP2. Exosomes from FP2-coated WJ MSCs were analyzed using nanoparticle-tracking analysis, transmission electron microscopy, and Western blotting. Subsequently, fibroblasts were treated with these exosomes, and their viability and migration effects were compared. Anti-inflammatory effects were also evaluated by inducing pro-inflammatory factors in RAW264.7 cells. The treatment of fibroblasts with FP2-coated WJ MSC-derived exosomes (FP2-exo) increased the expression of FGF2, confirming their wound-healing effect in vivo. Overall, the results of this study highlight the significant impact of FP2 on the proliferation of WJ MSCs and the anti-inflammatory and wound-healing effects of exosomes, suggesting potential applications beyond wound healing.

Wound Closure Promotion by Leucine-Based Pseudo-Proteins: An In Vitro Study

Our research explores leucine-based pseudo-proteins (LPPs) for advanced wound dressings, focusing on their effects on wound healing in an in vitro model. We assessed three types of LPP films for their ability to enhance wound closure rates and modulate cytokine production. They all significantly improved wound closure compared to traditional methods, with the 8L6 and copolymer films showing the most pronounced effects. Notably, the latter exhibited an optimal cytokine profile: an initial burst of pro-inflammatory TNF-α, followed by a controlled release of IL-6 during the proliferative phase and a significant increase in anti-inflammatory IL-10 during remodeling. This balanced cytokine response suggests that the copolymer film not only accelerates wound closure but also supports a well-regulated healing process, potentially reducing fibrosis and abnormal scarring, underscoring the potential of copolymer LPPs as advanced wound dressing materials. Future research will aim to elucidate the specific signaling pathways activated by the copolymer LPP to better understand its mechanism of action. Overall, LPP films offer a promising approach to improving wound care and could lead to more effective treatments for complex wounds.