Obesity and Wound Healing: Focus on Mesenchymal Stem Cells

Multifaceted Pathophysiology and Secondary Complications of Chronic Spinal Cord Injury: Focus on Pressure Injury

Background/Objectives: Spinal cord injury (SCI) is a complex medical condition with widespread effects that extend beyond motor and sensory impairments. In addition to nervous system damage, SCI patients experience various secondary complications, including vascular dysfunction, altered body composition, and metabolic disturbances. Among the most common secondary pathologies is the development of pressure injuries (PIs), chronic wounds that significantly affect quality of life and can be challenging to treat. Understanding the physiological and cellular mechanisms behind these complications is crucial for improving care and therapeutic outcomes. Methods: We conducted a comprehensive literature search in PubMed, Scopus, and Google Scholar using keywords related to spinal cord injury, pressure ulcer/pressure injuries, metabolic and vascular dysfunction, biomechanics, and regenerative therapies. Studies were selected based on their relevance to the pathophysiology, risk factors, and novel therapeutic approaches for PIs in SCI patients. Results: Vascular dysfunction, characterized by impaired blood flow and microcirculatory issues, predisposes SCI patients to ischemia and tissue necrosis, particularly in areas subjected to prolonged pressure. Additionally, changes in body composition, such as increased adiposity and muscle atrophy, further compromise tissue integrity and healing capacity. The inflammatory response, mediated by cytokines such as IL-1, IL-6, and TNF-α, exacerbates these effects by sustaining a pro-inflammatory environment that delays the transition of macrophages to the M2 phenotype, critical for wound healing. External factors, such as poor nutrition, infections, and immobility, also play a significant role in worsening the wound healing process. Conclusions: Chronic SCI induces a cascade of physiological changes that predispose patients to the development of PIs and complicate their recovery. The intricate interplay of vascular, metabolic, and inflammatory responses creates a hostile environment for wound healing. A deeper understanding of these systemic effects is essential not only for developing targeted therapeutic strategies to improve chronic wound healing but also for refining preventive approaches that minimize their occurrence. Advancing this knowledge will ultimately help enhance the quality of life for individuals with SCI.

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.

The Impact of Inflammatory Markers and Obesity in Chronic Venous Disease

Background: Chronic venous disease (CVD) represents a significant health challenge, particularly in obese individuals. This study focuses on the interplay between inflammation, obesity, and CVD, by analyzing the role of inflammatory markers in the disease progression. Methods: Clinical and paraclinical data of 619 patients hospitalized and treated in the Phlebology Department (1stSurgical Department, "Pius Brînzeu" Emergency County Hospital Timișoara, Romania) between 2018 and 2024 were analyzed. Results: The statistical analysis revealed that age, C-reactive protein (CRP), fibrinogen, and absolute neutrophil count (ANC) were key predictors of CVD progression. Specifically, elevated CRP and fibrinogen levels correlated strongly with increased CVD severity, particularly in patients with higher body-mass index (BMI). BMI, while not an independent predictor, contributed indirectly to the disease severity through its association with these inflammatory markers. The logistic regression model incorporating age, BMI, CRP, fibrinogen, and ANC demonstrated a high predictive accuracy, with an area under the curve (AUC) of 0.902, highlighting the models reliability in stratifying patients at risk for severe CVD. Conclusions: This predictive model not only aids in identifying high-risk patients but also reinforces inflammation as a critical therapeutic target in CVD management.

Apelin Counteracts the Effects of Fusobacterium nucleatum on the Migration of Periodontal Ligament Cells In Vitro

To better understand the link between periodontitis and metabolic diseases, our in vitro study aimed to assess the influence of the adipokine apelin and/or the periodontal pathogen Fusobacterium nucleatum on periodontal cells. Periodontal ligament (PDL) cells were exposed to F. nucleatum in the presence and absence of apelin. Scratch assays were used to analyze the in vitro wound healing and velocity of cell migration. To investigate if F. nucleatum and/or apelin have a regulatory effect on cell proliferation and apoptosis, proliferation and viability assays were performed as well as an analysis of caspase 9 expression. Both the in vitro wound closure and the cell migration rate were significantly reduced by F. nucleatum. Simultaneous incubation with apelin counteracted the adverse effects of F. nucleatum. The proliferation assay demonstrated that neither apelin nor F. nucleatum significantly affected PDL cell proliferation. Furthermore, neither apelin nor F. nucleatum was cytotoxic or affected apoptosis after 48 h. Apelin could play a modulatory role in the pathogenesis of periodontitis, as it was able to compensate for the inhibitory effects of the periodontal pathogen F. nucleatum on PDL cell migration in vitro.

Long-term systemic effects of metabolic bariatric surgery: A multidisciplinary perspective

Background

Obesity is a global health crisis with profound implications on various body systems, contributing to a series of comorbidities. Metabolic Bariatric Surgery (MBS) has emerged as an effective treatment option for severe obesity, with significant weight reduction and potential systemic physiological alterations.

Objectives

This narrative review aims to provide a comprehensive analysis of the long-term effects of MBS on a wide array of body systems, including the heart, liver, kidneys, reproductive system, skin, lungs, digestive tract, pancreas, and blood, as well as related cancers of these organs.

Methods

A systematic search was conducted in academic databases (PubMed, ISI Web of Science, and Scopus) for observational studies and reviews published between July 2000 and December 2023, investigating the association between MBS and the subsequent function of different organ systems. High-quality studies were prioritized to ensure reliable evidence synthesis.

Results

MBS has demonstrated favorable outcomes in reducing cardiovascular disease risk, improving cardiac function, and alleviating heart failure symptoms. It has also been associated with improved respiratory function, remission of obstructive sleep apnea, and reduced cancer incidence and mortality. Additionally, MBS has shown benefits in managing gastrointestinal disorders, enhancing glycemic control, and promoting pancreatic beta-cell regeneration in type 2 diabetes mellitus. However, some methods of MBS are associated with a higher risk of cholelithiasis, GERD, and pancreatic exocrine insufficiency.

Conclusion

MBS has far-reaching systemic effects beyond weight loss, offering potential long-term benefits for various organ systems and comorbidities associated with obesity. For many patients with severe obesity, the potential benefits of Metabolic and Bariatric Surgery (MBS) can outweigh the associated risks. However, careful evaluation by a qualified healthcare professional is crucial to determine candidacy and ensure a successful outcome. Further research is needed to fully elucidate the long-term impacts and tailor personalized treatment approaches.

The Mechanisms of Adipose Stem Cell-Derived Exosomes Promote Wound Healing and Regeneration

Chronic wound healing is a class of diseases influenced by multiple complex factors, causing severe psychological and physiological impact on patients. It is an intractable clinical challenge and its possible mechanisms are not yet clear. It has been proven that adipose stem cell-derived exosomes (ADSC-Exos) can promote wound healing and inhibit scar formation by regulating inflammation, promoting cell proliferation, migration, and angiogenesis, regulating matrix remodeling, which provides a new approach for wound healing through biological treatment. This review focuses on the mechanism, treatment, and administration methods of ADSC-Exos in wound healing, providing a comprehensive understanding the mechanisms of ADSC-Exos on wound healing. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

One Molecule, Many Faces: Repositioning Cardiovascular Agents for Advanced Wound Healing

Chronic wound treatments pose a challenge for healthcare worldwide, particularly for the people in developed countries. Chronic wounds significantly impair quality of life, especially among the elderly. Current research is devoted to novel approaches to wound care by repositioning cardiovascular agents for topical wound treatment. The emerging field of medicinal products' repurposing, which involves redirecting existing pharmaceuticals to new therapeutic uses, is a promising strategy. Recent studies suggest that medicinal products such as sartans, beta-blockers, and statins have unexplored potential, exhibiting multifaceted pharmacological properties that extend beyond their primary indications. The purpose of this review is to analyze the current state of knowledge on the repositioning of cardiovascular agents' use and their molecular mechanisms in the context of wound healing.

White adipocyte dysfunction and obesity-associated pathologies in humans

The prevalence of obesity and associated chronic diseases continues to increase worldwide, negatively impacting on societies and economies. Whereas the association between excess body weight and increased risk for developing a multitude of diseases is well established, the initiating mechanisms by which weight gain impairs our metabolic health remain surprisingly contested. In order to better address the myriad of disease states associated with obesity, it is essential to understand adipose tissue dysfunction and develop strategies for reinforcing adipocyte health. In this Review we outline the diverse physiological functions and pathological roles of human white adipocytes, examining our current knowledge of why white adipocytes are vital for systemic metabolic control, yet poorly adapted to our current obesogenic environment.

Nrf2 activation by hydroxytyrosol and dimethyl fumarate ameliorates skin tissue repair in high-fat diet-fed mice by promoting M2 macrophage polarization and normalizing inflammatory response and oxidative damage

Hydroxytyrosol (HT) or dimethyl fumarate (DMF), activators of nuclear factor erythroid 2-related factor 2 (Nrf2), may reduce obesity in high-fat diet (HFD)-fed animals; nevertheless, the role of these activators on skin tissue repair of HFD-fed animals was not reported. This study investigated whether HT or DMF could improve skin wound healing of HFD-fed obese animals. Mice were fed with an HFD, treated with HT or DMF, and full-thickness skin wounds were created. Macrophages isolated from control and obese animals were treated in vitro with HT. DMF, but not HT, reduced the body weight of HFD-fed mice. Collagen deposition and wound closure were improved by HT or DMF in HFD-fed animals. HT or DMF increased anti-inflammatory macrophage phenotype and protein Nrf2 levels in wounds of HFD-fed mice. Lipid peroxidation and protein tumor necrosis factor-α levels were reduced by HT or DMF in wounds of HFD-fed animals. In in vitro, HT stimulated Nrf2 activation in mouse macrophages isolated from obese animals. In conclusion, HT or DMF improves skin wound healing of HFD-fed mice by reducing oxidative damage and inflammatory response. HT or DMF may be used as a therapeutic strategy to improve the skin healing process in individuals with obesity.