The Role of IL-6 in Skin Fibrosis and Cutaneous Wound Healing

Lipoic acid improves wound healing through its immunomodulatory and anti-inflammatory effects in a diabetic mouse model

Objectives

Diabetes mellitus is a chronic disease that has become more prevalent worldwide because of lifestyle changes. It leads to serious complications, including increased atherosclerosis, protein glycosylation, endothelial dysfunction, and vascular denervation. These complications impair neovascularization and wound healing, resulting in delayed recovery from injuries and an elevated risk of infections. The present study aimed to investigate the effect of lipoic acid (LA) on the key mediators involved in the wound healing process, specifically CD4 + CD25 + T cell subsets, CD4 + CD25 + Foxp3 + regulatory T (Treg) cells, T-helper-17 (Th17) cells that generate IL-17 A, glucocorticoid-induced tumor necrosis factor receptor (GITR) expressing cells, as well as cytokines such as IL-2, IL-1β, IL-6, and TNF-α and IFN-γ. These mediators play crucial roles in epidermal and dermal proliferation, hypertrophy, and cell migration.

Methods

We divided mice into 5 groups: the non-diabetic (normal control; NC), wounded non-diabetic mice (N + W), wounded diabetic mice (D + W), wounded diabetic mice treated with 50 mg/kg lipoic acid (D + W + L50) for 14 days, and wounded diabetic mice treated with 100 mg/kg lipoic acid (D + W + L100) for 14 days.

Results

Flow cytometric analysis indicated that lipoic acid-treated mice exhibited a significant decrease in the frequency of intracellular cytokines (IL-17 A, TNF-α and IFN-γ) in CD4 + T cells, as well as a reduction in the number of GITR-expressing cells. Conversely, a significant upregulation in the number CD4+, CD25+, FOXp3 + and CD4 + CD25 + Foxp3 + regulatory T (Treg) cells was observed in this group compared to both the normal + wounded (N + W) and diabetic + wounded (D + W) groups. Additionally, the mRNA Levels of inflammatory mediators (IL-2, IL-1β, IL-6, and TNF-α) were downregulated in lipoic acid-treated mice compared to other groups. T thereby he histological findings of diabetic skin wounds treated with lipoic acid showed well-healed surgical wounds.

Conclusions

These findings support the beneficial role of lipoic acid in fine-tuning the balance between anti-inflammatory and pro-inflammatory cytokines, influencing both their release and gene expression.

Construction of a methacrylated gelatine composite hydrogel based on tachyplesin II and its application in the repair of infected wounds

Tachyplesin II (TP) is a β-folded peptide isolated from horseshoe crabs. TP, with two disulfide bonds, effectively inhibits gram-negative and gram-positive bacteria, fungi and viruses. In this study, the antibacterial and antioxidant properties of synthetic TP were examined. Specifically, TP was incorporated into cross-linked methacrylated gelatine (GelMA) to construct a GelMA-TP hydrogel, which promoted infected wound healing. TP formed intermolecular hydrogen bonds with the GelMA network, endowing the GelMA-TP hydrogel with good antibacterial activity, stable rheological properties, high swelling capacity, self-healing behaviour, and good biocompatibility. We found that the anti-inflammatory and antioxidant activities of the GelMA-TP hydrogel significantly enhanced collagen production, thus accelerating healing in a rat-infected wound model. Overall, the GelMA-TP hydrogel demonstrates significant potential to stimulate the healing of infected wounds by reducing healing time and improving tissue repair outcomes. These findings highlight its translational promise as a clinically effective material for managing complex wounds, particularly in scenarios where conventional therapies are limited by persistent infections or excessive inflammation.

Hidradenitis Suppurativa Tunnels: Unveiling a Unique Disease Entity

Hidradenitis suppurativa tunnel structures lined with epithelium within the dermis are unique features of advanced disease stages that significantly impair patients' QOL. The presence of hidradenitis suppurativa tunnels is associated with a decreased likelihood of achieving a clinical response, even when receiving biological therapy. The cellular and molecular mechanisms underlying tunnel formation and pathology are only partially understood, which hampers the development of more effective targeted therapies. Tunnels create a unique microenvironment that drives a vicious cycle of hidradenitis suppurativa inflammation, with tunnel keratinocytes exhibiting an activated phenotype characterized by distinct gene expression signatures. In this review, we summarize the current literature and discuss aspects of the pathophysiology of tunnels, including the role of hair follicle epidermal stem cells in tunnel formation, potential role of fibroblast-mediated epithelial-mesenchymal transition, role of dermal papilla fibroblasts, and aberrant proinflammatory repair response contributing to the observed fibrosis and scarring. Finally, tunnel structures are characterized by unique microbial dysbiosis and an overabundance of Gram-negative anaerobes that are not targeted by current therapeutics. In addition to outlining the possible mechanisms of tunnel formation, we provide perspectives on the translation of current knowledge into more effective treatment approaches for patients with hidradenitis suppurativa tunnels.

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.

Hermetia illucens-derived chitosan as a promising sustainable biomaterial for wound healing applications: development of sponge-like scaffolds

Chitosan (CS), a biopolymer known for its wound-healing properties, has garnered significant interest in biomedical research. This study explores the potential of two Hermetia illucens-derived CS types-unbleached CS and bleached CS-as novel biomaterials for wound-healing applications, in comparison with commercial CS derived from the shells of Pandalus borealis (cold-water shrimp). CS was extracted from pupal exuviae, a byproduct of insect farming, which supports a circular economy by converting waste into valuable molecules for biomedical applications. Unbleached CS exhibited viscosity and viscoelastic properties comparable to those of commercial CS. The critical entanglement concentration (CEC) of unbleached CS (1.15 ± 0.05 % w/v) was similar to that of commercial CS (1.18 ± 0.09 % w/v). Moreover, both Hermetia illucens-derived CS types (unbleached and bleached) demonstrated a greater capability to enhance fibroblast viability (135 ± 7 % and 123 ± 6 %, respectively) compared to commercial CS (115 ± 7 %). Further investigation revealed that unbleached CS exhibited increased antioxidant activity, reversing >30 % of the loss of viability caused by H2O2 treatment, and demonstrated anti-inflammatory properties, decreasing IL-6 levels by 66 ± 2 %. Sponge-like scaffolds based on unbleached CS and commercial CS were prepared via freeze-drying. When comparing structural and functional properties of commercial and unbleached CS scaffolds, the unbleached CS scaffolds exhibited higher porosity (67.9 ± 2.7 %), smaller pore size (216 ± 35 nm), higher swelling ratio (25.4 ± 1.9), greater resistance to degradation, and enhanced fibroblast proliferation. These findings underscore the potential of insect-derived CS as a sustainable and bioactive material for wound healing. However, further research is required to fully understand its interactions and mechanisms in tissue repair.

In vitro and preclinical evaluation of the antifungal activity of 6-methoxy-1 H-indole-2-carboxylic acid produced by Bacillus toyonensis strain OQ071612 formulated as nanosponge hydrogel

BACKGROUND

In a previous study, 6-methoxy-1 H-indole-2-carboxylic acid (MICA) was isolated from the culture broth of Bacillus toyonensis strain OQ071612 soil isolate in our laboratory, and it demonstrated promising antifungal activities. The current study was designed to create a nanosponge (NS)-hydrogel (HG)-containing MICA followed by in vitro and preclinical evaluation for potential clinical use in the topical treatment of mycotic infections.

RESULTS

The enhanced NS formula was created using the Box Behnken Design (BBD), with independent process parameters including polyvinyl alcohol percentage (w/v%), homogenization time, speed and polymer: linker ratio. Dependent parameters were particle size (PS), polydispersity index (PDI), and entrapment efficiency percent (EE%). A hydrogel was formulated from the NS. In vitro drug release data indicated that the hydrogel best matched Higuchi's kinetic release model. The formulated NS-HG was stable and when compared to fluconazole, it exhibited increased antimycotic activity against C. albicans. An in vivo investigation revealed that MICA-NS-HG enhanced survival rates, wound gap repair, wound reduction, and inflammation inhibition. Masson's trichrome staining and histological analyses revealed increased collagen deposition and improved healing. Moreover, MICA hydrogel exhibited 1.5-fold greater permeability through rat skin compared to the control, 1% isoconazole.

CONCLUSION

The NS-HG formulation is a viable vehicle for better and more effective topical release of MICA. These findings represent a significant advancement in the formulation of MICA derived from naturally occurring soil bacteria.

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.

Self-assembled PAMAM-G4 dendrimer nanoparticles with Phloxine B as photosensitizer for antimicrobial photodynamic therapy

Antimicrobial resistance (AMR) represents a critical global health challenge, driving the need for innovative therapeutic strategies. This study introduces self-assembled nanoparticles based on fourth-generation polyamidoamine (PAMAM-G4) dendrimers and Phloxine B (PhB), forming G4-PhB nanoparticles as an advanced platform for antimicrobial photodynamic therapy (aPDT). The optimal dendrimer:dye molar ratio was determined through dynamic light scattering (DLS) titration experiments, yielding a 1:15 G4:PhB ratio. The resulting G4-PhB nanoparticles were spherical, with a hydrodynamic diameter of 260 ± 15 nm, a narrow polydispersity index (PDI) of 0.264 ± 0.085, and a positive zeta potential of 8.71 ± 2.88 mV, indicating monodispersity and colloidal stability. These features were corroborated by morphological analyses using TEM and AFM. Cytotoxicity assays conducted on murine fibroblasts (3 T3 cell line), using MTT, neutral red uptake, and crystal violet staining revealed that G4-PhB nanoparticles are intrinsically non-toxic, contrasting with the EDTA-PhB complex, which exhibited significant cytotoxic effects. Antibacterial activity was evaluated against Staphylococcus aureus (SA) and Pseudomonas aeruginosa (PA). While free PhB demonstrated bactericidal effects exclusively against SA, the G4-PhB nanoparticles exhibited enhanced activity against both bacterial strains, notably overcoming the limitations of free PhB against PA. These findings highlight the versatility and effectiveness of G4-PhB nanoparticles as a biocompatible and non-invasive system for localized aPDT, with potential applications in wound healing for immunocompromised patients. This work provides a robust foundation for future research into dendrimer-based photosensitizers as innovative solutions to pressing biomedical challenges.

Amelioration of Particulate Matter-Induced Oxidative Stress by a Bioactive Hizikia fusiformis Extract: A Functional Biomaterial for Cosmeceutical Applications

Air pollution-related skin damage has heightened the demand for natural protective agents. Hizikia fusiformis, a brown seaweed rich in fucoidan and bioactive fatty acids (α-linolenic acid, eicosatetraenoic acid, and palmitic acid), possesses antioxidant and anti-inflammatory properties. This study investigated the protective effects of H. fusiformis ethanol extract (HFE) against particulate matter (PM)-induced oxidative stress, inflammation, and apoptosis in human keratinocytes. Antioxidant activity was assessed using DPPH and hydroxyl radical scavenging assays, while PM-induced cytotoxicity, ROS generation, inflammatory markers, and apoptotic pathways were evaluated using the WST-8 assay, DCFH2-DA, qPCR, western blotting, and Hoechst staining. HFE significantly reduced ROS levels, enhanced antioxidant enzyme activity, and mitigated PM-induced cytotoxicity. These effects were mediated by fucoidan and fatty acids, which modulated inflammatory pathways (NF-κB and MAPK), stabilized membranes, and inhibited apoptosis (Bcl-2, Bax, and caspase-3). Collectively, these findings highlight HFE's potential as a natural anti-pollution skincare ingredient, supporting further in vivo studies and formulation development.

Wounds in the Unhoused Population

This study investigates the unique challenges of wound care among the unhoused population, focusing on assessment, treatment, and documentation strategies in low-resource settings. The research underscores the prevalence of trauma, chronic illnesses, and environmental exposures that complicate wound management. The paper illustrates the diverse and complex nature of wounds encountered in this population through detailed case studies, providing practical insights for health care providers. The findings highlight the necessity of resource management and innovative approaches to address the health care needs of this vulnerable group.

Comparative effects of various extracellular vesicle subpopulations derived from clonal mesenchymal stromal cells on cultured fibroblasts in wound healing-related process

INTRODUCTION

Non-healing wounds pose significant challenges and require effective therapeutic interventions. Extracellular vesicles (EVs) have emerged as promising cell-free therapeutic agents in tissue regeneration. However, the functional differences between different subpopulations of EVs in wound healing remain understudied. This study aimed to evaluate the effects of two distinct subpopulations of clonal mesenchymal stromal cells (cMSC)-derived EVs (cMSC-EVs), namely 20 K and 110K-cMSC-EVs, primarily on in vitro wound healing process, providing fast and cost-effective alternatives to animal models.

METHODS

In vitro assays were conducted to compare the effects of 20 K and 110K-cMSC-EVs, isolated through high-speed centrifugation and differential ultracentrifugation, respectively. For evaluation the main mechanisms of wound healing, including cell proliferation, cell migration, angiogenesis, and contraction. Human dermal fibroblasts (HDF) were considered as the main cells for analysis of these procedures. Moreover, gene expression analysis was performed to assess the impact of these EV subpopulations on the related process of wound healing on HDF.

RESULTS

The results demonstrated that both 20 K and 110K-cMSC-EVs exhibited beneficial effects on cell proliferation, cell migration, angiogenesis, and gel contraction. RT-qPCR revealed that both EV types downregulated interleukin 6 (IL6), induced proliferation by upregulating proliferating cell nuclear antigen (PCNA), and regulated remodeling by upregulating matrix metallopeptidase 1 (MMP1) and downregulating collagen type 1 (COL1).

DISCUSSION

This study highlights the effects of both 20 K and 110K-cMSC-EVs on the potency of HDFs in wound healing-related process. As the notable finding, 20K-cMSC-EVs offer a more feasible and cost-effective subpopulation for isolation and follow the GMP standard, recommended to utilize this fraction for therapeutic application.

Redefining CRP in tissue injury and repair: more than an acute pro-inflammatory mediator

Most early studies investigating the role of C-reactive protein (CRP) in tissue damage determined it supported pro-hemostatic and pro-inflammatory activities. However, these findings were not universal, as other data suggested CRP inhibited these same processes. A potential explanation for these disparate observations finally emerged with the recognition that CRP undergoes context-dependent conformational changes in vivo, and each of its three isoforms - pentameric CRP (pCRP), modified pentameric CRP (pCRP*), and monomeric CRP (mCRP) - have different effects. In this review, we consider this new paradigm and re-evaluate the role of CRP and its isoforms in the tissue repair process. Indeed, a growing body of evidence points toward the involvement of CRP not just in hemostasis and inflammation, but also in the resolution of inflammation and in tissue regeneration. Additionally, we briefly discuss the shortcomings of the currently available diagnostic tests for CRP and highlight the need for change in how CRP is currently utilized in clinical practice.

Effect of Leonurus japonicus alkaloids on endometrial inflammation and its mechanisms

ETHNOPHARMACOLOGICAL RELEVANCE

The aerial parts of Leonurus japonicus Houtt. (Chinese motherwort) are famous for their efficacy in treating obstetrical and gynecological diseases in traditional Chinese medicine (TCM). Alkaloids are the major bioactive components of motherwort and have gained extensive attention for alleviating several symptoms of obstetrical and gynecological diseases such as postpartum hemorrhage, postpartum rehabilitation, irregular menstruation, and dysmenorrhea. However, the effects of motherwort alkaloids on endometritis remain unclear.

AIM OF THE STUDY

The aim of this study was to investigate the effect of motherwort total alkaloids (MTAs) on endometritis and explore the molecular mechanisms using an integrating network analysis and in vitro experimental verification.

MATERIALS AND METHODS

Ultra-high performance liquid chromatography-tandem quadrupole-orbitrap high-resolution mass spectrometry (UPLC-Q-Orbitrap HRMS) was used to analyze and identify the components in the MTAs. The effects of MTAs were evaluated using bacteria-induced endometritis in rats. Network pharmacology was conducted to predict possible mechanism pathways of MTAs in endometritis. Finally, lipopolysaccharide-stimulated mouse mononuclear macrophage (RAW 264.7) cells and human endometrial epithelial cells were used to identify signaling pathways through which MTAs exert their effects.

RESULTS

Thirty-nine alkaloids were identified in MTAs using the UPLC-Q-Orbitrap HRMS analysis. Their corresponding putative targets were then predicted. The MTAs exerted pharmacological effects on endometritis through a multi-ingredient and multi-target pattern. Network pharmacology showed that the MTAs had 152 candidate targets in treating endometritis. According to the KEGG analysis, the MTAs were found to potentially affect the PI3K-AKT and NF-κB signaling pathways. The following experiments showed that the MTAs exhibited significant effects on endometritis in vivo, significantly reduced the overproduction of inflammatory mediators, and promoted endometrial cell repair via the PI3K/AKT/NF-κB signaling pathway.

CONCLUSIONS

Motherwort alkaloids can be used to treat endometrial inflammation by regulating the PI3K/AKT/NF-κB pathway. This study provides a scientific basis for the use of MTAs for treating endometritis.

Hyaluronic acid: Function and location in the urothelial barrier for bladder pain syndrome/interstitial cystitis, an in vitro study

Disruption of the glycosaminoglycan (GAG)-layer and urothelial barrier is an important aspect of the pathophysiology of bladder pain syndrome/ interstitial cystitis. Intravesical hyaluronic acid (HA) is often used in treatments for IC/BPS, however the role in the urothelial barrier is unknown. This study aims to clarify the location and functional contribution of HA in the urothelium, using an in vitro model. Immunohistochemistry was performed on human and porcine biopsies and on porcine cell cultures to evaluate the location of HA. Functional contribution was assessed through transepithelial electrical resistance measurements and the effects on gene expression in a differentiated primary porcine urothelial cell model. HA was found throughout in the urothelium and most abundant around the basal layer. Digestion of HA increased impermeability of the urothelium, contrasting with the effect of protamine sulfate (PS). After HA digestion, quantitative PCR analysis revealed upregulation of HA-synthesizing gene (HAS3) and the inflammatory marker (IL8). Treatment with HA and/or chondroitin sulfate therapy in undamaged cells upregulated genes related to GAG synthesis, barrier markers and inflammation. In PS-damaged cells, GAG therapy only upregulated genes associated with HA synthesis and inflammation, without affecting barrier recovery speed. These results emphasize the interaction of HA on urothelial cell inflammation and barrier repair physiology. HA seems to not directly restore the urothelial luminal GAG layer but influences barrier integrity through its interactions with urothelial cells.

Enhancing sickle cell leg ulcer healing with combined photodynamic and photobiomodulation therapies: A pilot experience

AIM

This study aimed to evaluate the safety and efficacy of combined photodynamic therapy (PDT) and photobiomodulation (PBM) in treating sickle cell leg ulcers (SCLUs), with a focus on pain reduction and enhanced healing.

MATERIALS AND METHODS

In this prospective, open-label, uncontrolled pilot study, ten SCD patients with 17 chronic leg ulcers received PDT and PBM treatments. Ulcer severity, pain levels, and microbiome changes were monitored, and clinical data were analyzed using appropriate statistical methods.

RESULTS

Among the treated ulcers, 64.7 % (11 out of 17) showed significant healing, with 9 ulcers achieving complete closure. The average reduction in ulcer size was significant, with a median healing time of 123 days. Pain levels decreased significantly in 82.3 % of treated ulcers (p < 0.001), and a 75.4 % reduction in bacterial load was observed, alongside increased microbiome diversity (p < 0.05). Elevated levels of IL-6 and PSGL-1 were associated with non-healing ulcers, indicating their potential as prognostic biomarkers.

CONCLUSION

The combined PDT and PBM therapy proved to be effective and safe for SCLUs, offering significant improvements in healing and pain reduction. These findings suggest that integrating PDT and PBM into standard care protocols could enhance the management of SCLUs.

Regenerative effect of lyophilized dental follicle mesenchymal stem cells and platelet-rich fibrin in skin wounds in geriatric and young rats

The aim of this study was to investigate the regenerative effect of lyophilized dental follicle mesenchymal stem cells (DF-MSCs) combined with rat platelet-rich fibrin (PRF) on geriatric skin wounds. Human DF-MSCs which were isolated from the wisdom teeth of healthy donors and PRF were mixed and incubated in a 37 °C incubator for 1-2 h containing 1 million cells in 150 mg PRF. The mixture was suspended in a freeze-drying solution and then lyophilized. Wounds were created on the back skin of Wistar albino rats using a 6 mm punch. Lyophilized DF-MSCs, PRF, or PRF + DF-MSCs were applied to the wounds of rats. On the 15th day, the wound area was histopathologically evaluated in rats. Blood samples from rats were analyzed for total antioxidant status (TAOS), and inflammatory cytokine levels using ELISA. In both young and geriatric rats treated with lyophilized PRF + DF-MSCs, wound area began to significantly decrease from the 10th day compared to the untreated group (p < 0.05). Histopathological examination revealed that in the lyophilized PRF + DF-MSCs treated groups, epithelial integrity and scarless healing significantly increased compared to the untreated groups (p < 0.05). There were no significant differences in TAOS, total oxidant status (TOS), tumor necrosis factor (TNF), interleukin-6 (IL6), and hydroxyproline levels in serum samples from young rats on the 15th day. In geriatric rats, hydroxyproline (HYPS) levels were increased in the DF-MSC and PRF + DF-MSC groups (p < 0.01), TNF was significantly elevated in PRF geriatric group and IL6 was increased in the PRF group compared to the control group (p = 0.01). Lyophilized PRF + DF-MSCs, which is a shelf-stable and ready-to-use product, hold promise, especially for traumatic wounds in geriatric individuals with longer healing times.

Chlorpheniramine maleate exerts an anti-keloid activity by regulation of IL-6/JAK1/STAT3 signaling pathway

Keloids are abnormal scars formed due to fibroblast dysfunction and excessively deposited extracellular matrix (ECM). Despite the unclear process leading to the occurrence of keloids, several studies have demonstrated that histamine and its H1 receptor can effectively regulate fibroblast functions, contributing to keloid formation. Chlorpheniramine maleate (CPM) as a first-generation H1 antihistamine has been widely applied in symptomatic treatment of allergic conditions but its effects on keloids are unknown. This study holds the objective of exploring its effect on keloids. Cell Counting Kit-8 (CCK-8), apoptosis, cell cycle and migration assays were conducted to determine the effects of CPM on human keloid fibroblasts (KFs), with its therapeutic effect evaluated by constructing a keloid model in nude mice. RNA sequencing analysis, ELISA, western blotting and immunohistochemistry assisted in examining the anti-keloid mechanism of CPM. It was observed that CPM inhibited the proliferation and migration of KFs, promoted apoptosis of KFs, and blocked the G0/G1 phase of KFs. Moreover, local intralesional injection of CPM into nude mice keloid model significantly reduced keloid scars. According to RNA sequencing analysis, the gene expression of IL-6 and JAK-STAT signaling pathway were both negatively related in CPM group versus the control group. According to the in vivo and vitro experiment results, the anti-keloid activity of CPM was attributed to its inhibitory effect on the IL-6/JAK1/STAT3 signal pathway. In summary, CPM holds great potential for localized treatment of keloids.

Exploring Isotretinoin's Unexpected Acceleration of wound Healing: A rat model study

BACKGROUND

There have been clinical observations indicating that wound healing could be affected in patients undergoing systemic isotretinoin treatment. However, the precise role of retinoids in wound healing is still unclear and controversial. It is generally assumed that systemic retinoids could be harmful to wound healing, but this requires further investigation.

METHODS

Sprague-Dawley rats were gavaged with 2 mg/Kg/day of Isotretinoin and divided into three groups: Control, Isotretinoin/1month and Isotretinoin/2month. Photographic documentation and histomorphometric investigation were performed. The mRNA expressions of IL-6, MCP-1, VEGF, ICAM1, L-Selectin, TGF-1β, IL-10, IL-1α, and IL-8 were examined by qRT-PCR.

RESULTS

There was no significant impact on the rate of wound closure in Isotretinoin/1month group. However, a two-month regimen accelerated the wound-healing process. RT-PCR results revealed increased expression of IL-6, IL-8, IL-1α, TGF-β1, IL-10 MCP-1, ICAM1, L-Selectin, and VEGF rats that were administered Isotretinoin. Histological observations showed an increased number of mast cells in the wound areas of rats treated with Isotretinoin.

CONCLUSION

Our research indicated that taking Isotretinoin did not slow down wound healing and may even help the growth phase. Additionally, we did not observe any keloid formation during our histopathological analysis, suggesting that it may not be necessary to postpone invasive surgical procedures for six months after Isotretinoin therapy.

Low-intensity pulsed ultrasound induces multifaced alterations in chromosome segregation, cytoskeletal filaments and cell junctions

Low-intensity pulsed ultrasound (LIPUS) is a widely used non-invasive approach with therapeutic purposes since it provides physical stimulation with minimal thermal effects. The skin epithelium is the first barrier of the human body that interfaces with LIPUS and is subjected to the highest intensity. Little is known about the impact of LIPUS on the skin surface. This work investigates the biological effects of one-hour exposure to 1 MHz LIPUS on human keratinocytes HaCaT and tumoral SK-MEL-28 skin cells. Specifically, we evaluated the cellular state immediately after LIPUS treatment by analyzing cytogenetic endpoints and the response of cytoskeleton and cell junction proteins. Herein we demonstrate that LIPUS induces genomic damage as shown by an increase of chromosome malsegregation and a consequent decrease of cellular proliferation. The mechanical stimulus produced by LIPUS is also transmitted to the cytoskeletal compartment, inducing the expression and re-organization of junction proteins (i.e., E-cadherin and Desmosomes) and intermediate filaments (i.e., F-actin and Cytokeratins) with impact on cell morphology and cell adhesion. These in vitro results highlight the different outcomes following the cytogenetic damage and the resilience response exerted by the cytoskeleton upon mechanical stress, laying the foundation for future in vivo investigations.

The Inflammatory Landscape of a Whole-Tissue Explant Model of Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a relatively common and highly morbid inflammatory skin disease. Due to the relatively limited understanding of HS's pathogenesis, there are currently insufficient treatment options available, and many patients' medical needs are not being met. This is partly due to the historical scarcity of ex vivo assays and animal models that accurately recapitulate the disease. Thus, we have developed a standardised whole-tissue explant model of HS to examine its pathogenic mechanisms and the efficacy of potential treatments within intact human tissue. We measured cytokine protein and RNA within whole tissue maintained in an agar-media solution, finding that IL-6 and IL-8 concentrations trended upwards in both HS explants and healthy controls, while IL-17A, IL-1β, and TNF-α exhibited increases in HS tissue alone. We also show that the explants were responsive to treatment with both dexamethasone and IL-2. Not only do our results show that this model effectively delivers treatments throughout the explants, but they also elucidate which cytokines are related to the explant process regardless of tissue state and which are related to HS tissue specifically, laying the groundwork for future implementations of this model.

Carboxymethyl Chitosan-Based Antioxidant Hydrogel Accelerates Diabetic Wound Healing

Diabetic wound healing is hampered due to oxidative stress, exacerbated inflammation, and impaired angiogenesis in the wounds. A pH-sensitive antioxidant hydrogel based on carboxymethyl chitosan (CMCS), oligoprocyanidins (OPC), and oxide dextran (Oxd) is prepared to accelerate diabetic wound healing. The hydrogel network is formed via imine and hydrogen bonding interactions in the presence of hydroxyl, amino, and aldehyde groups, and deferoxamine (DFO) is incorporated into the hydrogel. The hydrogel shows pH-triggered drug release, a good antioxidant, and anti-inflammatory properties, and can promote tube formation and cell migration in vitro. Moreover, the hydrogel can accelerate wound healing in streptozotocin (STZ)-induced diabetic mice by regulating the inflammation environment with up-regulation of anti-inflammatory factors (IL-4 and IL-10) and down-regulation of pro-inflammatory factors (TNF-α and IL-6), and promoting angiogenesis with up-regulation of HIF-1α, VEGF, and CD31. Thus, the pH-sensitive antioxidant hydrogel provides a promising therapeutic strategy for diabetic wound healing.

Chikungunya virus infection in the skin: histopathology and cutaneous immunological response

Alphavirus chikungunya virus (CHIKV) is an arbovirus, belonging to the Togaviridae family. The disease caused by CHIKV generally evolves with spontaneous resolution in a few weeks; however, progression to a chronic disease may occur. The most common symptoms are fever, myalgia, and arthralgia; however, skin manifestations may occur in 40 to 80% of infected individuals. Morbilliform and maculopapular erythematous eruptions, vesiculobullous lesions, generalized erythema, maculopapular eruption and skin peeling, hypermelanosis, painful oral lesions, and urticarial lesions have been reported. Usually, these manifestations disappear, but they can become sequelae. Since the skin is the first line of defense against CHIKV infection, in this study, we aimed to investigate the immunohistopathological aspects of the skin of infected individuals during the acute phase of the disease by performing histopathological and ultrastructural analysis, detection and quantification of the viral genome, detection of viral antigen and immune cells, and cytokines/chemokines' characterization. The main histopathological findings were perivascular and inflammatory infiltrates, blood capillary ectasia, and interstitial edema. The immunohistochemistry revealed CHIKV antigen in the epidermis, endothelial cells, fibroblasts, and macrophages in the reticular and papillary dermis; inflammatory cells infiltrate; arrector pili muscle; sweat and sebaceous glands; and hair follicle. Moreover, inflammatory infiltrates were composed of lymphocytes (CD4+ and CD8+) and macrophages (CD68+) in the dermis and perivascular infiltrate. TNF-α, IL-6, RANTES, and VEGFR2 were expressed in the epidermis, blood vessels, sweat glands, and migrating cells. Loss of contact among adjacent keratinocytes, epidermis presenting necrotic cells, and fibroblasts with dilated cisternae in the endoplasmic reticulum and mitochondria with few cristae was observed by transmission electron microscopy. Studies involving skin immunopathogenesis during CHIKV infection are still scarce; therefore, the findings presented here can contribute to a better understanding of the disease immunopathogenesis.

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.

Bacterial dysbiosis and decrease in SCFA correlate with intestinal inflammation following alcohol intoxication and burn injury

Background

Patients intoxicated at the time of burn experience increased rates of sepsis and death compared with that observed in similarly sized burns alone. We sought to characterise changes in the intestinal microbiome and short-chain fatty acids (SCFAs) following alcohol intoxication and burn injury and to determine whether these changes are associated with intestinal inflammation.

Methods

10-12-week-old C57BL/6 male and female mice were subjected to ethanol intoxication and a 12.5% total body surface area scald burn injury. The following day, mice were euthanised and faecal contents from the caecum and small intestine (SI) were harvested for 16S sequencing for microbial analysis and caecum contents underwent high-performance liquid chromatography mass spectroscopy to assess SCFAs.

Results

The intestinal microbiome of ethanol burn (EB) mice exhibited decreased alpha diversity and distinct beta diversity compared with sham vehicle (SV). EB faeces were marked by increased Proteobacteria and many pathobionts. EB caecum faeces exhibited a significant decrease in butyrate and a downward trend in acetate and total SCFAs. SCFA changes correlated with microbial changes particularly in the SI. Treatment of murine duodenal cell clone-K (MODE-K) cells with faecal slurries led to upregulation of interleukin-6 (IL-6) from EB faeces compared with SV faeces which correlated with levels of Enterobacteriaceae. However, supplementation of butyrate reduced faecal slurry-induced MODE-K cells IL-6 release.

Conclusion

Together, these findings suggest that alcohol and burn injury induce bacterial dysbiosis and a decrease in SCFAs, which together can promote intestinal inflammation and barrier disruption, predisposing to postinjury pathology.

A Snapshot of Cytokine Dynamics: A Fine Balance Between Health and Disease

Health and disease are intricately intertwined and often determined by the delicate balance of biological processes. Cytokines, a family of small signalling molecules, are pivotal in maintaining this balance, ensuring the body's immune system functions optimally. In a healthy condition, cytokines act as potent mediators of immune responses. They orchestrate the activities of immune cells, coordinating their proliferation, differentiation, and migration. This intricate role of cytokine signalling enables the body to effectively combat infections, repair damaged tissues, and regulate inflammation. However, the delicate equilibrium of cytokine production is susceptible to disruption. Excessive or abnormal cytokine levels can lead to a cascade of pathological conditions, including autoimmune diseases, chronic inflammation, infections, allergies, and even cancer. Interestingly, from the bunch of cytokines, few cytokines play an essential role in maintaining the balance between normal physiological status and diseases. In this review, we have appraised key cytokines' potential role and feedback loops in augmenting the imbalances in the body's biological functions, presenting a critical link between inflammation and disease pathology. Moreover, we have also highlighted the significance of cytokines and their molecular interplay, particularly in the recent viral pandemic COVID-19 disease. Hence, understandings regarding the interplay between viral infection and cytokine responses are essential and fascinating for developing effective therapeutic strategies.

A 10-year mono-center study on patients with burns ≥70% TBSA: prediction model construction and multicenter validation - retrospective cohort

BACKGROUND

Burn injuries with ≥70% total body surface area (TBSA) are especially acute and life-threatening, leading to severe complications and terrible prognosis, while a powerful model for the prediction of overall survival (OS) is lacking. The objective of this study is to identify prognostic factors for the OS of patients with burn injury ≥70% TBSA and construct and validate a feasible predictive model.

MATERIALS AND METHODS

Patients diagnosed with burns ≥70% TBSA admitted and treated between 2010 and 2020 in our hospital were included. A cohort of the patients from the Kunshan explosion were assigned as the validation set. The χ2 test and K-M survival analysis were conducted to identify potential predictors for OS. Then, multivariate Cox regression analysis was performed to identify the independent factors. Afterward, we constructed a nomogram to predict OS probability. Finally, the Kunshan cohort was applied as an external validation set.

RESULTS

Sex, the percentage of third-degree and fourth-degree burns as well as organ dysfunction were identified as significant independent factors. A nomogram only based on the factors of the individuals was built and evidenced to have promising predictive accuracy, accordance, and discrimination by both internal and external validation.

CONCLUSIONS

This study recognized significant influencing factors for the OS of patients with burns ≥70% TBSA. Furthermore, our nomogram proved to be an effective tool for doctors to quickly evaluate patients' outcomes and make appropriate clinical decisions at an early stage of treatment.

Zinc oxide and gum tragacanth based composite hydrogel heals partial thickness burn wound by attenuating pro-inflammatory genes and enhancing regenerating growth factors

In this study we have developed, characterized and examined the healing and regenerative potential of gum tragacanth based zinc oxide composite hydrogel (ZnO-GT). ZnO-GT composite is a pliable and soft formulation offering efficient, faster and improved burn wound healing/managements. In this procedure, we generated partial thickness burn wounds in murine model and then applied the wound with ZnO-GT formulation. ZnO-GT showed promising burn wound healing potential in vivo as only 0.48 % of burn residual area was observed in ZnO-GT treatment group compared to11.41 % in positive control group (silver sulfadiazine treatment) and 41.62 % in control group (saline treatment) at the end of 14th day. Two weeks of comparative histopathological study and analysis revealed dermal regeneration along with formation of skin appendages in hydrogel treated groups (p < 0.05). ZnO-GT accelerates inflammatory stage progression and reduces inflammatory responses of wound healing. Further it increases production of fibroblast growth factor and angiogenesis promoting factors such as NOX 4, VEGFR 2, HIF-1α and ANG1 which leads to the formation and differentiation of skin appendages as demonstrated by Western blotting studies. Altogether, ZnO-GT showed good biocompatibility along with substantial wound healing efficacy and regenerative property making it potent therapeutic agent for healing of burn skin wounds.

Sex-Stratified Bidirectional Mendelian Randomization Analysis of Eating Habits and Female Pelvic Peritoneal Adhesions

Background

Female pelvic peritoneal adhesions (FPPA) represent a significant global health burden. Dietary habits play a crucial role in health outcomes, yet their influence on FPPA remains unclear. This study aims to explore the bidirectional causal relationships between 72 eating habits and FPPA using sex-stratified Mendelian randomization (MR).

Methods

We employed a bidirectional MR approach, utilizing single nucleotide polymorphisms (SNPs) significantly associated with 72 different eating habits as instrumental variables. The causal relationships were assessed using five MR methods, including inverse variance weighting (IVW). After Bonferroni correction, eating habits with a p-value < 0.05 were considered to have a significant causal relationship with FPPA. For those habits with significant associations, reverse MR was conducted to assess potential reverse causality. Sensitivity analyses, including IVW, MR-Egger, and leave-one-out tests, were performed to ensure the robustness of the results.

Results

Before Bonferroni correction, five eating habits showed potential associations with FPPA, including non-oily fish intake (OR: 0.989, 95% CI: 0.982-0.995, p=0.000521), side salad intake: OR 1.003 (95% CI: 1.001-1.006), p=0.007779, poultry intake: OR 1.005 (95% CI: 1.001-1.009), p=0.018016, spirits intake: OR 1.010 (95% CI: 1.001-1.019), p=0.036152, hard cheese intake: OR 0.995 (95% CI: 0.991-1.000), p=0.043784. After correction, only non-oily fish intake remained significantly associated with a lower risk of FPPA. No reverse causal relationship was observed between non-oily fish intake and FPPA, and sensitivity analyses revealed no abnormalities, further confirming the robustness of the findings.

Discussion

Our study identifies non-oily fish intake as a protective dietary factor against FPPA, with no evidence of reverse causality. These findings highlight the importance of dietary interventions in managing FPPA risk and suggest potential avenues for future research and public health strategies.

Broadly Accessible 3D In Vitro Skin Model as a Comprehensive Platform for Antibacterial Therapy Screening

Skin infections are currently a worldwide emergency as antibiotic-resistant bacteria are spreading, leading to the ineffectiveness of most antibiotics and antibacterial strategies. Consequently, there is an urgency of developing and testing innovative antibacterial therapies. As traditional 2D cell culture and planktonic bacteria culture can be obsolete due to their incapability of resembling the complex infection environment, 3D in vitro skin models can be a powerful tool to test and validate therapies. In this article, a 3D in vitro epidermis-dermis skin model has been developed and biofabricated to be broadly available, reaching a balance between the simplicity and reproducibility of the model and its complexity in terms of wound, infection, and treatment response. The results are really promising, as the skin model developed a comprehensive physical barrier. To further investigate the skin model, controlled wounding, infection, and antibiotic treatments were performed. The results were remarkable: Not only was the unwounded epidermal barrier able to partially stop the bacterial proliferation, but the entire system reacted to both wound and infection in a complex and complete way. Extracellular matrix deposition and remodeling, inflammatory response, antimicrobial peptide production, and change in cellular behaviors, from epithelial to mesenchymal and from fibroblasts to myofibroblasts, were witnessed, with different extents depending on the bacterial strain. In addition, the inflammatory response to the antibiotic administration was opposite for the two bacterial infections, probably revealing the release of inflammatory endotoxins during Escherichia coli death. In conclusion, the presented 3D in vitro skin model has all the characteristics to be a future landmark as a platform for antibacterial strategy therapy testing.

Interleukin in Immune-Mediated Diseases: An Updated Review

The immune system comprises various regulators and effectors that elicit immune responses against various attacks on the body. The pathogenesis of autoimmune diseases is derived from the deregulated expression of cytokines, the major regulators of the immune system. Among cytokines, interleukins have a major influence on immune-mediated diseases. These interleukins initiate the immune response against healthy and normal cells of the body, resulting in immune-mediated disease. The major interleukins in this respect are IL-1, IL-3, IL-4, IL-6, IL-10 and IL-12 which cause immune responses such as excessive inflammation, loss of immune tolerance, altered T-cell differentiation, immune suppression dysfunction, and inflammatory cell recruitment. Systemic Lupus Erythematosus (SLE) is an autoimmune illness characterized by dysregulation of interleukins. These immune responses are the signs of diseases such as rheumatoid arthritis, inflammatory bowel disease, psoriasis, type I diabetes, and multiple sclerosis.

Eco-friendly Nanostructured Liquid Crystals Loaded with Clove Oil as a Sustainable Approach for Managing Infected Burn Wounds

Infections are a leading complication in patients with burns. Effective antimicrobial treatment with regenerative tissue healing is required. Utilizing components derived from plant origin such as natural oils as a sustainable and eco-friendly approach for managing disease is highly required nowadays. The aim of the current study is to assess the antibacterial and wound-healing activity of clove oil and its novel eco-friendly nanostructured liquid crystals (Eco-friendly-NLCs) formulation in treating infected burn wounds. A 23 full factorial design was used to optimize the Eco-friendly-NLCs. Clove oil and its novel nano-formulation were characterized and subjected to in vitro and in vivo assessments for their efficacy. Twenty rats were used experimentally. The optimum Eco-friendly-NLCs had 189.2 ± 1.9 nm, -22.8 ± 0.7 mV and 0.308 as values for particle size, zeta potential and polydispersity index. Transmission electron microscope images showed discrete spherical shape NLCs with no aggregations. The microbiological and pharmacological results revealed a superior efficacy regarding clove loaded Eco-friendly-NLCs in inhibiting bacterial growth (inhibition zone of 38 mm), significantly reducing inflammatory biomarker levels (p < 0.001), promoting angiogenesis and prompt wound healing. The Eco-friendly-NLCs loaded with clove oil could be considered as a promising formulation providing anti-inflammatory, anti-bacterial and wound healing effects.

Isolation, Expansion, and Characterization of Rat Hair Follicle Stem Cells and Their Secretome: Insights into Wound Healing Potential

Background: Stem cells are capable of self-renewal and differentiation into various specialized cells, making them a potential therapeutic option in regenerative medicine. This study establishes a comprehensive methodology for isolating, culturing, and characterizing rat hair follicle stem cells. Methods and Results: Hair follicles were harvested from Sprague-Dawley rats and subjected to two different isolation techniques. Immunohistochemical analysis and real-time PCR confirm the expression of specific surface markers and genes, validating the cells' identity. Growth kinetics, colony formation units (CFU), and tri-differentiation capacity were also assessed. Additionally, the cells' secretome was analyzed, regarding its content in biofactors with wound healing properties. Conclusions: These findings highlight the potential of these cells as a valuable cell source for skin regeneration applications. They contribute to advancing our understanding of stem cell applications in regenerative medicine and hold promise for therapeutic interventions in various clinical contexts, aligning with broader research on the diverse capabilities of hair follicle stem cells.

Wound management, healing, and early prosthetic rehabilitation: Part 2 - A scoping review of physical biomarkers

BACKGROUND

The timely provision of load-bearing prostheses significantly reduces healthcare costs and lowers post-amputation mortality risk. However, current methods for assessing residuum health remain subjective, underscoring the need for standardized, evidence-based approaches incorporating physical biomarkers to evaluate residual limb healing and determine readiness for prosthetic rehabilitation.

OBJECTIVES

This review aimed to identify predictive, diagnostic, and indicative physical biomarkers of healing of the tissues and structures found in the residual limbs of adults with amputation.

METHODOLOGY

A scoping review was conducted following Joanna Briggs Institute (JBI) and PRISMA-ScR guidance. Searches using "biomarkers", "wound healing", and "amputation" were performed on May 6, 2023, on Web of Science, Ovid MEDLINE, Ovid Embase, Scopus, Cochrane, PubMed, and CINAHL databases. Inclusion criteria were: 1) References to physical biomarkers and healing; 2) Residuum tissue healing; 3) Clear methodology with ethical approval; 4) Published from 2017 onwards. Articles were assessed for quality (QualSyst tool) and evidence level (JBI system), and categorized by study, wound, and model type. Physical biomarkers that were repeated not just within categories, but across more than one of the study categories were reported on.

FINDINGS

The search strategy identified 3,306 sources, 157 of which met the inclusion criteria. Histology was the most frequently repeated physical biomarker used in 64 sources, offering crucial diagnostic insights into cellular healing processes. Additional repeated indicative and predictive physical biomarkers, including ankle-brachial index, oxygenation measures, perfusion, and blood pulse and pressure measurements, were reported in 25, 19, 13, and 12 sources, respectively, providing valuable data on tissue oxygenation and vascular health.

CONCLUSION

Ultimately, adopting a multifaceted approach that integrates a diverse array of physical biomarkers (accounting for physiological factors and comorbidities known to influence healing) may substantially enhance our understanding of the healing process and inform the development of effective rehabilitation strategies for individuals undergoing amputation.

Deciphering the links: Fragmented polystyrene as a driver of skin inflammation

Nano- and microplastics (NMPs), ubiquitous in the environment, pose significant health risks. We report for the first time a comprehensive study using in-vitro, in-vivo, and ex-vivo models to investigate the penetration and inflammatory effects of fragmented polystyrene (fPS) on human skin, including the analysis of both penetration depth and fPS amounts that penetrate the skin. Human keratinocyte (HaCaT) and human dermal fibroblast (HDF) cells exposed to fPS exhibited notable internalization and cytotoxicity. In a 3D human skin model, fPS particles penetrated the dermal layer within one hour, with an average maximum penetration of 4.7 μg for particles smaller than 2 µm. Similarly, mouse dorsal skin and human abdominal skin models confirmed fPS penetration. RNA sequencing revealed substantial upregulation of inflammatory genes, including IL-1α, IL-1β, IL-18, IL-6, IL-8, ICAM-1, FOS, and JUN, following fPS exposure. These findings were validated at both the mRNA and protein levels, indicating a robust inflammatory response. Notably, the inflammatory response in both the 3D human skin and mouse models increased in a dose-dependent manner, underscoring the toxicological impact of fPS on skin health. This study provides crucial insights into the mechanisms through which NMPs affect human health and underscores the need for further research to develop effective mitigation strategies.

Myricetin ameliorates airway inflammation and remodeling in asthma by activating Sirt1 to regulate the JNK/Smad3 pathway

BACKGROUND

Myricetin has various biological activities and health benefits; however, its effects on airway remodeling in asthma have not been reported.

PURPOSE

We aimed to investigate the possibility that myricetin improves airway remodeling by activating Sirt1 and has potential as a new treatment for asthma.

METHODS

RAW 264.7 cells were stimulated with lipopolysaccharide and co-cultured with 3T6 cells in vitro to simulate the in vivo effects of inflammation on airway remodeling. Using an ovalbumin-induced chronic asthma mouse model, we compared changes in inflammatory factors and airway remodeling-related factors under treatment with myricetin and/or the Sirt1 inhibitor EX-527 using western blotting and quantitative PCR. Expression plasmids carrying Smad3 site mutations were transfected into 3T6 cells to identify the Sirt1 deacetylation site on Smad3 protein.

RESULTS

Myricetin significantly reduced the infiltration of airway inflammatory cells and the production of interleukin (IL)-6 and IL-5, and inhibited mucus secretion by goblet cells, collagen fiber proliferation, and the increase in inflammatory cells in bronchoalveolar lavage fluid from asthmatic mice. Results of in vitro experiments were consistent with those conducted in vivo. Exploring the mechanism of action of myricetin, we found that myricetin downregulated the levels of phosphorylated (p)-JNK, p-Smad3, and acetylated Smad3 proteins by activating Sirt1 both in vivo and in vitro. K341 was identified as the main deacetylation site of Smad3 by myricetin-activated Sirt1.

CONCLUSION

Myricetin ameliorates airway inflammation and remodeling in asthma by activating Sirt1 to regulate the JNK/Smad3 pathway.

Impact of inflammatory skin conditions on the biological profile of plasma rich in growth factor

Plasma rich in growth factors (PRGF) can be used over patients suffering from dermatoses due to its anti-inflammatory effect. However, this population group might present soluble autoimmune components and there is limited information about the effect of chronic skin inflammation on PRGF bioactive properties. With the aim of characterizing PRGF composition, PRGF from healthy (H) donors and patients with atopic dermatitis (AD), psoriasis (PS), or lichen sclerosus (LS) was obtained. In order to reduce the inflammatory component, leukocyte exclusion and heat-inactivation (Immunosafe) were tested. Haematological-serological parameters, platelet functionality, clot microstructure, protein content and bioactivity were determined. Mean values and 95 % confidence intervals (mean[95 % CI]) were computed for key haematological parameters, such as platelet (410×103/mm3[371-449]) and leukocyte content (205×103/mm3[148-262]), platelet activation (resting: 4.3 %[3.1-5.5] and activated: 97.4 %[96.7-98.0]), the concentration of plasma proteins and morphogens, including immunoglobulins A (210.7 mg/dL[191.8-229.6]), G (933.1 mg/dL[887.2-978.9]), E (783.5 mg/dL[54.4-1512.6]), and M (115.0 mg/dL[97.1-133.0]), Complement Protein (31.6 mg/mL[26.6-36.6]), C-Reactive protein (3.1 mg/L[2.0-4.1]), TGF-β1 (35975.6 pg/mL[34221.3-37729.8]), fibronectin (146410.0 ng/mL[136518.3-156301.7]), PDGF-AB (13308.5 pg/mL[12401.0-14216.0]), CD40L (2389.3 pg/mL[1887.7-2890.8]), IL-4 (0.12 pg/mL[0.07-0.18]), IL-13 (35.4 pg/mL[21.0-49.7]), IL-1β (0.09 pg/mL[0.06-0.11]) and TNF-α (0.31 pg/mL[0.24-0.38]), and also for cell proliferation (332.9ngDNA/mL[317.4-348.3]), viability (135.6 %[132.0-139.2]) and migration (103.8cells/mm2[98.3-109.3]). Plasma from AD donors presented increased Immunoglobulin E (IgE) that was significantly reduced after Immunosafe along with the complement system and autoantibodies. Platelet functionality was altered for AD, but no microstructure differences were identified. Pathological groups presented reduced concentration of fibronectin (AD/LS) and Platelet-Derived Growth Factor (PDGF-AB) (P). Immunosafe treatment reduced Cluster of Differentiation 40 Protein (CD40L), interleukin 1β (IL-1β), and Tumor Necrosis Factor α (TNF-α) concentrations. Fibroblasts supplemented with PRGF obtained from pathological patients (PS/AD) showed reduced viability but Immunosafe increased cell proliferation and migration in SP (LS) and L-SP samples (PS/AD). In conclusion, PRGF derived from pathological patients present autoimmune components, but heat-inactivation or leukocyte exclusion could minimize local side effects.

Macrophage Polarization: A Novel Target and Strategy for Pathological Scarring

BACKGROUND

Abnormal scarring imposes considerable challenges and burdens on the lives of patients and healthcare system. Macrophages at the wound site are found to be of great concern to overall wound healing. There have been many studies indicating an inextricably link between dysfunctional macrophages and fibrotic scars. Macrophages are not only related to pathogen destruction and phagocytosis of apoptotic cells, but also involved in angiogenesis, keratinization and collagen deposition. These abundant cell functions are attributed to specific heterogeneity and plasticity of macrophages, which also add an extra layer of complexity to correlational researches.

METHODS

This article summarizes current understanding of macrophage polarization in scar formation and several prevention and treatment strategies on pathological scarring related to regulation of macrophage behaviors by utilizing databases such as PubMed, Google Scholar and so on.

RESULTS

There are many studies proving that macrophages participate in the course of wound healing by converting their predominant phenotype. The potential of macrophages in managing hypertrophic scars and keloid lesions have been underscored.

CONCLUSION

Macrophage polarization offers new prevention strategies for pathological scarring. Learning about and targeting at macrophages may be helpful in achieving optimum wound healing.

A Multi-Responsive Hydrogel Combined With Mild Heat Stimulation Promotes Diabetic Wound Healing by Regulating Inflammatory and Enhancing Angiogenesis

The repair of diabetic wound still encounters huge challenges, such as disordered inflammatory regulation and impaired neovascularization. Here, a pH/ROS/glucose responsive and photothermal hydrogel is developed for diabetic wound healing. The hydrogel is formed through cross-linkage between phenylboronic acid-modified carboxymethyl chitosan (CMCS-PBA) and oxide dextran (OXD), utilizing Schiff base and phenylboronate ester bonds. Additionally, insulin-like growth factor 1 C domain (IGF-1C) and deferoxamine-loaded polydopamine nanoparticles (D@P) are incorporated into the hydrogel. The hydrogel demonstrates sustained drug release, excellent photo thermal effect, prominent antioxidant, antibacterial and anti-inflammatory activities, desirable mechanical and tissue adhesive properties, enhanced tube formation, and cell migration. Furthermore, the hydrogel combined with mild heat treatment can regulate chronic inflammation by promoting the transformation of macrophages from M1 phenotype to M2 phenotype and enhance angiogenesis by up-regulating the expression levels of angiogenesis-related factors such as hypoxia-inducible factor-1 alpha (HIF-1α), vascular endothelial growth factor (VEGF), CD31, and α-SMA, thus greatly accelerates the wound healing in streptozotocin (STZ)-induced diabetic mice. Therefore, this multi-responsive and multifunctional hydrogel holds potential as a therapeutic strategy for diabetic wounds.

Nanosponge hydrogel of octadecyl 3-(3,5-di-tert-butyl-4-hydroxyphenyl) propanoate of Alcaligenes faecalis

Octadecyl 3-(3,5-di-tert-butyl-4-hydroxyphenyl) propanoate (ODHP) was extracted in a previous study from the culture broth of soil isolate Alcaligenes faecalis MT332429 and showed a promising antimycotic activity. This study was aimed to formulate ODHP loaded β-cyclodextrins (CD) nanosponge (NS) hydrogel (HG) to control skin fungal ailments since nanosponges augment the retention of tested agents in the skin. Box-Behnken design was used to produce the optimized NS formulation, where entrapment efficiency percent (EE%), polydispersity index (PDI), and particle size (PS) were assigned as dependent parameters, while the independent process parameters were polyvinyl alcohol % (w/v %), polymer-linker ratio, homogenization time, and speed. The carbopol 940 hydrogel was then created by incorporating the nanosponges. The hydrogel fit Higuchi's kinetic release model the best, according to in vitro drug release. Stability and photodegradation studies revealed that the NS-HG remained stable under tested conditions. The formulation also showed higher in vitro antifungal activity against Candida albicans compared to the control fluconazole. In vivo study showed that ODHP-NS-HG increased survival rates, wound contraction, and healing of wound gap and inhibited the inflammation process compared to the other control groups. The histopathological examinations and Masson's trichrome staining showed improved healing and higher records of collagen deposition. Moreover, the permeability of ODHP-NS-HG was higher through rats' skin by 1.5-folds compared to the control isoconazole 1%. Therefore, based on these results, NS-HG formulation is a potential carrier for enhanced and improved topical delivery of ODHP. Our study is a pioneering research on the development of a formulation for ODHP produced naturally from soil bacteria. KEY POINTS: • Octadecyl 3-(3,5-di-tert-butyl-4-hydroxyphenyl) propanoate was successfully formulated as a nanosponge hydrogel and statistically optimized. • The new formula exhibited in vitro good stability, drug release, and higher antifungal activity against C. albicans as compared to the fluconazole. • Ex vivo showed enhanced skin permeability, and in vivo analysis showed high antifungal activity as evidenced by measurement of various biochemical parameters and histopathological examination.

Aptamer modified CeCo MOF hybrid catalysts with multiple enzymatic activities for enhanced catalytic therapy of infected wounds

Designing and inventing synergistic emerging antimicrobial strategies is critical for mitigating potential resistance to conventional antibiotics. This task is challenging because these antimicrobial agents should need to eliminate bacteria, slow oxidative stress in wounds, and be safe and nontoxic. Here, we report a highly safe antimicrobial nanocatalyst for bacterial scavenging through aptamer-synergistic multienzyme activity. The nanocatalysts (termed as ASCM) were constructed by loading copper nanoparticles (Cu NPs), natural superoxide dismutase (SOD), and functionalized aptamers on bimetallic metal-organic frameworks (CeCo MOFs). The hybrid nanocatalysts exhibit remarkable SOD-like activity as well as its catalase (CAT)-, peroxidase (POD)- and glutathione peroxidase (GPx)-like activities to release highly toxic hydroxyl radicals (•OH) and oxygen (O2) to kill bacteria and relieve wound hypoxia. Systematic antimicrobial testing revealed that ASCM exhibited a high inactivation efficiency (>99 %) against both methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PA). Animal experiments have shown that ASCM can effectively treat MRSA-infected wounds and has a good biosafety profile while inhibiting the inflammatory response. Overall, this work describes the design of an efficient, strategically synergistic antibacterial nanocatalysts that can achieve safe bacterial scavenging and alleviate oxidative stress.

Recombinant human amelogenin promotes wound healing by enhancing angiogenesis

The first barrier of the human body is the skin, and more serious harm may occur when skin wound healing is delayed. One of the components of enamel matrix proteins is amelogenin, which inhibits inflammation and promotes periodontal tissue regeneration. However, its role in skin wound healing and angiogenesis is inconclusive. Thus, this study aimed to assess the therapeutic effect of recombinant human amelogenin (rhAM) on mouse skin wounds and to determine its effect on angiogenesis and its underlying mechanism. rhAM was expressed in Escherichia coli and purified using the optimized acetic acid method. A skin injury mouse model was established to explore the effects of rhAM on skin wound healing. After treatment with rhAM for 7 days, the wound healing rate was calculated, and the therapeutic effect of rhAM on skin wounds was assessed using hematoxylin & eosin (HE), Masson, and CD31 immunofluorescence staining. The expression of growth and inflammatory factors in wound tissues were detected using Western Blot. In addition, the rhAM effects on the proliferation and migration of human umbilical vein endothelial cells (HUVEC) and mouse fibroblasts (NIH 3T3) were studied in vitro using the Cell Counting Kit-8, cell scratch, cytoskeleton staining, and qPCR. The rhAM effect on HUVEC angiogenesis and its potential mechanism was studied using tube formation and Western Blot. The results showed that the purity of the obtained rhAM was more than 90 % using the optimized acetic acid method, and high-dose rhAM treatment could improve wound healing rate in mice. Additionally, more blood vessels and collagen were produced in the skin wound, and the expression of angiopoietin-related protein 2 (ANGPTL2) and transforming growth factor (TGF)-β1 was upregulated; however, that of interleukin-6 was down-regulated. We also found that rhAM promoted the proliferation and migration of HUVEC and NIH 3T3, the mRNA levels of vascular endothelial growth factor (VEGF), fibroblast growth factor, TGF-β1 and ANGPTL2 in HUVEC cells were upregulated, and expression of VEGF and phosphorylation of the p38 mitogen-activated protein kinase were activated. Therefore, rhAM could promote skin wound healing by upregulating angiogenesis and inhibiting inflammation.

Manufacturing exosomes for wound healing: Comparative analysis of culture media

Mesenchymal stem cell (MSC)-derived exosomes (EXs) have emerged as promising therapeutic agents for wound healing. However, the optimal conditions for manufacturing MSC-derived EXs that maximize their wound-healing potential have yet to be established. Hence, we compared the efficacy of five different MSC culture media, including three different serum-free, a platelet-supplemented, and a fetal bovine serum-supplemented media, in exosome manufacturing for wound healing applications. Although umbilical cord-derived MSCs (UCMSCs) cultured in these media exhibited similar proliferation, morphology, MSC surface marker expression, and stemness, EXs derived from UCMSCs cultured in different culture media displayed varying levels of growth factors and cytokines. Notably, EXs derived from platelet-supplemented media (DM-PLT_EXs) exhibited significantly higher concentrations of keratinocyte growth factor (KGF), vascular endothelial growth factor (VEGF-A), platelet-derived growth factor (PDGF-BB), interleukin 6 (IL-6), interleukin 7 (IL-7), and interleukin 8 (IL-8) than EXs from other media. These differences correlated with the superior capability of DM-PLT_EXs to promote human skin fibroblast proliferation and stimulate angiogenesis of human umbilical vein endothelial cells, making them a more suitable choice for wound healing applications. Our findings emphasize the significance of the culture medium selection in tailoring the therapeutic potential of UCMSC-derived EXs for wound healing.

Dual-Responsive Antibacterial Hydrogel Patch for Chronic-Infected Wound Healing

Bacterial infections in chronic wounds, such as bedsores and diabetic ulcers, present significant healthcare challenges. Excessive antibiotic use leads to drug resistance and lacks precision for targeted wound treatment. Our study introduces an innovative solution: a near-infrared (NIR) and pH dual-responsive hydrogel patch incorporating regenerated silk fibroin (RSF) and molybdenum dioxide (MoO2) nanoparticles (NPs), offering enhanced mechanical properties, precise drug release, and superior antibacterial efficacy. The dual-responsive hydrogel patch allows for precise control over antibiotic release triggered by NIR light and pH fluctuations, enabling tailored treatment for infected wounds. First, the pH-responsive characteristic matches the alkaline environment of the infected wound, ensuring on-demand antibiotic release. Second, NIR exposure accelerates antibiotic release, enhancing wound healing and providing additional antibacterial effects. Additionally, the patch further blocks bacterial infection, promotes wound repair, and degrades in sync with the healing process, further bolstering the efficacy against wound infections.

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.

Comparative Bulk RNA-Seq Analysis of Poly-l-Lactic Acid Versus Calcium Hydroxylapatite Reveals a Novel, Adipocyte-Mediated Regenerative Mechanism of Action Unique to PLLA

BACKGROUND

Injectable biostimulators are widely used to improve facial aging signs. This study was performed to compare the genetic pathways affected by 2 different injectable biostimulators.

METHODS

Randomized 13-week study (n = 21) comparing gene expression after poly l-lactic acid (PLLA-SCA) and calcium hydroxylapatite (CaHA-R) injections (baseline [BL] and Day 28) as treatment of nasolabial fold wrinkles. Punch biopsy was performed at BL and day 90; RNA was isolated, gene expression was analyzed, and bulk RNA sequencing performed. Data from both pathways were studied using the Search Tool for Retrieval of Interacting Genes/Proteins and Reactome databases.

RESULTS

Analysis at Day 0 and Day 90 showed differing gene regulation for PLLA-SCA and CaHA-R (after accounting for minor differences at BL, p < .05 at Day 90 for 9-12 genes). PLLA-SCA uniquely correlates with genes involved in adipocyte regeneration, while CaHA-R did not affect these genes. Clinically, this could translate to healthy fat replacement with an enhanced effect beyond the improvement of the collagen structure and a longer-lasting effect with PLLA-SCA. Furthermore, the adipokines that appear to be upregulated are regenerative with a positive impact on skin health.

CONCLUSION

PLLA-SCA has a novel and unique signature, which supports a potential regenerative mechanism of action through its role in the modulation of adipocyte function.

miR-200b-3p accelerates diabetic wound healing through anti-inflammatory and pro-angiogenic effects

The poor healing characteristics of diabetic foot ulcers are partially attributed to diabetes-induced pro-inflammatory wounds. Our previous study reported that both miR-146a-5p and miR-200b-3p decrease endothelial inflammation in human aortic endothelial cells and db/db diabetic mice. Although miR-146a-5p has been reported to improve diabetic wound healing, the role of miR-200b-3p is not clear. This study compared the roles of these miRNAs in diabetic wound healing. Two 8-mm full-thickness wounds were created in 12-week-old male db/db mice on the left and right back. After surgery, 100 ng miR-146a-5p, miR-200b-3p, or miR-negative control (NC) was injected in each wound. Full-thickness skin samples were harvested from mice at the 14th day for real-time polymerase chain reaction and immunohistochemistry analyses. At the 14th day, the miR-200b-3p group showed better wound healing and greater granulation tissue thickness than the miR-146a-5p group. The miR-200b-3p group showed a significant decrease of IL-6 and IL-1β gene expression and a significant increase of Col3α1 gene expression compared to those in the miR-NC group. The miR-200b-3p group had the lowest gene expression of TGF-β1, followed by the miR-146a-5p and miR-NC groups. Our findings suggest that the miR-200b-3p group had better healing characteristics than the other two groups. Immunohistochemical staining revealed that CD68 immunoreactivity was significantly decreased in both the miR-146a-5p and miR-200b-3p groups compared with that in the miR-NC group. In addition, CD31 immunoreactivity was significantly higher in the miR-200b-3p group than in the miR-146a-5p group. In conclusion, these results suggest that miR-200b-3p is more effective than miR-146a-5p in promoting diabetic wound healing through its anti-inflammatory and pro-angiogenic effects.

Enhancing wound healing through innovative technologies: microneedle patches and iontophoresis

Introduction

Wound healing is a complex process involving multiple stages, including inflammation, proliferation, and remodeling. Effective wound management strategies are essential for accelerating healing and improving outcomes. The CELLADEEP patch, incorporating iontophoresis therapy and microneedle technology, was evaluated for its potential to enhance the wound healing process.

Methods

This study utilized a full-thickness skin defect model in Sprague-Dawley rats, researchers compared wound healing outcomes between rats treated with the CELLADEEP Patch and those left untreated. Various histological staining techniques were employed to examine and assess the wound healing process, such as H&E, MT and immunofluorescence staining. Furthermore, the anti-inflammatory and proliferative capabilities were further investigated using biochemical assays.

Results

Macroscopic and microscopic analyses revealed that the CELLADEEP patch significantly accelerated wound closure, reduced wound width, and increased epidermal thickness and collagen deposition compared to an untreated group. The CELLADEEP patch decreased nitric oxide and reactive oxygen species levels, as well as pro-inflammatory cytokines IL-6 and TNF-α, indicating effective modulation of the inflammatory response. Immunofluorescence staining showed reduced markers of macrophage activity (CD68, F4/80, MCP-1) in the patch group, suggesting a controlled inflammation process. Increased levels of vimentin, α-SMA, VEGF, collagen I, and TGF-β1 were observed, indicating enhanced fibroblast activity, angiogenesis, and extracellular matrix production.

Discussion

The CELLADEEP patch demonstrated potential in promoting effective wound healing by accelerating wound closure, modulating the inflammatory response, and enhancing tissue proliferation and remodeling. The CELLADEEP patch offers a promising non-invasive treatment option for improving wound healing outcomes.

GRHL2 regulates keratinocyte EMT-MET dynamics and scar formation during cutaneous wound healing

After cutaneous wounds successfully heal, keratinocytes that underwent the epithelial-mesenchymal transition (EMT) regain their epithelial characteristics, while in scar tissue, epidermal cells persist in a mesenchymal state. However, the regulatory mechanisms governing this reversion are poorly understood, and the impact of persistent mesenchymal-like epidermal cells in scar tissue remains unclear. In the present study, we found that during wound healing, the regulatory factor GRHL2 is highly expressed in normal epidermal cells, downregulated in EMT epidermal cells, and upregulated again during the process of mesenchymal-epithelial transition (MET). We further demonstrated that interfering with GRHL2 expression in epidermal cells can effectively induce the EMT. Conversely, the overexpression of GRHL2 in EMT epidermal cells resulted in partial reversion of the EMT to an epithelial state. To investigate the effects of failed MET in epidermal cells on skin wound healing, we interfered with GRHL2 expression in epidermal cells surrounding the cutaneous wound. The results demonstrated that the persistence of epidermal cells in the mesenchymal state promoted fibrosis in scar tissue, manifested by increased thickness of scar tissue, deposition of collagen and fibronectin, as well as the activation of myofibroblasts. Furthermore, the miR-200s/Zeb1 axis was perturbed in GRHL2 knockdown keratinocytes, and transfection with miR-200s analogs promoted the reversion of EMT in epidermal cells, which indicates that they mediate the EMT process in keratinocytes. These results suggest that restoration of the epithelial state in epidermal cells following the EMT is essential to wound healing, providing potential therapeutic targets for preventing scar formation.

Association between Scabies Treatment and Parkinson's Disease: A Nationwide, Population-Based Study

BACKGROUND

Scabies is typically treated with scabicides like lindane, which poses a risk for acute neural toxicity. Lindane's prolonged use, particularly in agriculture, is linked to neurodegenerative diseases, including Parkinson's disease (PD), the second most common neurodegenerative disorder. This study aimed to evaluate whether scabies patients, particularly those treated with topical lindane, are at increased risk of developing PD.

METHODS

A nationwide population-based cohort study was conducted using data from Taiwan's National Health Research Institutes claims database from 2000 to 2018. The study included 27,173 patients with scabies, matched to a control group, with both groups followed for up to 18 years. The primary outcome was the incidence of newly diagnosed PD, and the hazard ratio (HR) for PD was calculated, focusing on those treated with topical lindane.

RESULTS

Among the 54,346 patients, 1639 (3.0%) were newly diagnosed with PD, with 993 (60.6%) from the scabies group and 646 (39.4%) from the control group. Scabies patients had an adjusted hazard ratio (aHR) of 1.46 (95% CI 1.32-1.63) for developing PD compared to controls. However, patients treated with topical lindane had a significantly lower aHR for PD at 0.15 (95% CI 0.12-0.19; p < 0.001), with a lower cumulative incidence of PD also observed in this group (p < 0.001).

CONCLUSIONS

Scabies patients are at a 1.46-fold increased risk of developing PD, but those treated with lindane exhibit a significantly lower risk, suggesting potential protective effects of lindane against PD.