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Richards SM, Gubser Keller C, Kreutzer R, Greiner G, Ley S, Doelemeyer A, Dubost V, Flandre T, Kirkland S, Carbone W, Pandya R, Knehr J, Roma G, Schuierer S, Bouchez L, Seuwen K, Aebi A, Westhead D, Hintzen G, Jurisic G, Hossain I, Neri M, Manevski N, Balavenkatraman KK, Moulin P, Begrich A, Bertschi B, Huber R, Bouwmeester T, Driver VR, von Schwabedissen M, Schaefer D, Wettstein B, Wettstein R, Ruffner H. Molecular characterization of chronic cutaneous wounds reveals subregion- and wound type-specific differential gene expression. Int Wound J 2024; 21:e14447. [PMID: 38149752 PMCID: PMC10958103 DOI: 10.1111/iwj.14447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 12/28/2023] Open
Abstract
A limited understanding of the pathology underlying chronic wounds has hindered the development of effective diagnostic markers and pharmaceutical interventions. This study aimed to elucidate the molecular composition of various common chronic ulcer types to facilitate drug discovery strategies. We conducted a comprehensive analysis of leg ulcers (LUs), encompassing venous and arterial ulcers, foot ulcers (FUs), pressure ulcers (PUs), and compared them with surgical wound healing complications (WHCs). To explore the pathophysiological mechanisms and identify similarities or differences within wounds, we dissected wounds into distinct subregions, including the wound bed, border, and peri-wound areas, and compared them against intact skin. By correlating histopathology, RNA sequencing (RNA-Seq), and immunohistochemistry (IHC), we identified unique genes, pathways, and cell type abundance patterns in each wound type and subregion. These correlations aim to aid clinicians in selecting targeted treatment options and informing the design of future preclinical and clinical studies in wound healing. Notably, specific genes, such as PITX1 and UPP1, exhibited exclusive upregulation in LUs and FUs, potentially offering significant benefits to specialists in limb preservation and clinical treatment decisions. In contrast, comparisons between different wound subregions, regardless of wound type, revealed distinct expression profiles. The pleiotropic chemokine-like ligand GPR15L (C10orf99) and transmembrane serine proteases TMPRSS11A/D were significantly upregulated in wound border subregions. Interestingly, WHCs exhibited a nearly identical transcriptome to PUs, indicating clinical relevance. Histological examination revealed blood vessel occlusions with impaired angiogenesis in chronic wounds, alongside elevated expression of genes and immunoreactive markers related to blood vessel and lymphatic epithelial cells in wound bed subregions. Additionally, inflammatory and epithelial markers indicated heightened inflammatory responses in wound bed and border subregions and reduced wound bed epithelialization. In summary, chronic wounds from diverse anatomical sites share common aspects of wound pathophysiology but also exhibit distinct molecular differences. These unique molecular characteristics present promising opportunities for drug discovery and treatment, particularly for patients suffering from chronic wounds. The identified diagnostic markers hold the potential to enhance preclinical and clinical trials in the field of wound healing.
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Affiliation(s)
| | | | - Robert Kreutzer
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- Department of PathologyAnaPath Services GmbHLiestalSwitzerland
| | | | - Svenja Ley
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Arno Doelemeyer
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Valerie Dubost
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Thierry Flandre
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Susan Kirkland
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- Harvantis Pharma Consulting LtdLondonUK
| | - Walter Carbone
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- Research and Development CoordinatorELI TechGroup Corso SvizzeraTorinoItaly
| | - Rishika Pandya
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Judith Knehr
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Guglielmo Roma
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- Discovery Data ScienceGSK VaccinesSienaItaly
| | - Sven Schuierer
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Laure Bouchez
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- Therapeutics Department, Executive in ResidenceGeneral InceptionBaselSwitzerland
| | - Klaus Seuwen
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Alexandra Aebi
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - David Westhead
- Leeds Institute of Data AnalyticsUniversity of LeedsLeedsUK
| | - Gabriele Hintzen
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- Translational ScienceAffimed GmbHMannheimGermany
| | - Giorgia Jurisic
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Imtiaz Hossain
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Marilisa Neri
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Nenad Manevski
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- Translational PKPD and Clinical Pharmacology, Pharmaceutical Sciences, pREDF. Hoffmann‐La Roche AGBaselSwitzerland
| | | | - Pierre Moulin
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Annette Begrich
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | | | - Roland Huber
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | | | - Vickie R. Driver
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- INOVA HealthcareWound Healing and Hyperbaric CentersFalls ChurchVirginiaUSA
| | | | - Dirk Schaefer
- Plastic, Reconstructive, Aesthetic and Hand SurgeryUniversity Hospital BaselBaselSwitzerland
| | - Barbara Wettstein
- Plastic, Reconstructive, Aesthetic and Hand SurgeryUniversity Hospital BaselBaselSwitzerland
| | - Reto Wettstein
- Plastic, Reconstructive, Aesthetic and Hand SurgeryUniversity Hospital BaselBaselSwitzerland
| | - Heinz Ruffner
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
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McDaniel JC, Kim B, McGowan DR. Methods for sampling wound fluid from venous leg ulcers for molecular analyses: A scoping review. Int Wound J 2023; 20:4175-4192. [PMID: 37455090 PMCID: PMC10681520 DOI: 10.1111/iwj.14315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
Determining the precise role of molecular factors present in venous leg ulcer exudate will expedite the identification of biomarkers that can optimally guide treatment. However, there is now no standardized approach for collecting, processing and storing wound fluid samples for molecular analyses. This scoping review was conducted to integrate and summarize the multiple types of methods being used currently in studies of venous leg ulcers for collecting, processing and storing wound fluid prior to analysis. PubMed, CINAHL, EMBASE and Scopus databases were searched for eligible studies between 2012 and 2022. Nineteen studies were selected for this scoping review. Five primary methodological categories for wound fluid sampling were identified. The most commonly used collection method involved extracting the fluid from various absorbent materials, and the majority of studies centrifuged wound fluid before storing it at ultra-low temperatures. This review found the wound fluid sampling methods among the included studies to be heterogeneous. Moreover, the data revealed no definitive patterns. There is a critical need to develop standardized wound fluid sampling methods in research to facilitate accurate comparisons of biomarker data across studies and a more rapid determination of biomarkers that can most effectively guide delivery of tailored venous leg ulcer treatments.
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Affiliation(s)
| | - Bohyun Kim
- College of NursingThe Ohio State UniversityColumbusOhioUSA
| | - Dina Rose McGowan
- Clinical Research CenterThe Ohio State University Wexner Medical CenterColumbusOhioUSA
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Vasalou V, Kotidis E, Tatsis D, Boulogeorgou K, Grivas I, Koliakos G, Cheva A, Ioannidis O, Tsingotjidou A, Angelopoulos S. The Effects of Tissue Healing Factors in Wound Repair Involving Absorbable Meshes: A Narrative Review. J Clin Med 2023; 12:5683. [PMID: 37685753 PMCID: PMC10488606 DOI: 10.3390/jcm12175683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/17/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Wound healing is a complex and meticulously orchestrated process involving multiple phases and cellular interactions. This narrative review explores the intricate mechanisms behind wound healing, emphasizing the significance of cellular processes and molecular factors. The phases of wound healing are discussed, focusing on the roles of immune cells, growth factors, and extracellular matrix components. Cellular shape alterations driven by cytoskeletal modulation and the influence of the 'Formin' protein family are highlighted for their impact on wound healing processes. This review delves into the use of absorbable meshes in wound repair, discussing their categories and applications in different surgical scenarios. Interleukins (IL-2 and IL-6), CD31, CD34, platelet rich plasma (PRP), and adipose tissue-derived mesenchymal stem cells (ADSCs) are discussed in their respective roles in wound healing. The interactions between these factors and their potential synergies with absorbable meshes are explored, shedding light on how these combinations might enhance the healing process. Recent advances and challenges in the field are also presented, including insights into mesh integration, biocompatibility, infection prevention, and postoperative complications. This review underscores the importance of patient-specific factors and surgical techniques in optimizing mesh placement and healing outcomes. As wound healing remains a dynamic field, this narrative review provides a comprehensive overview of the current understanding and potential avenues for future research and clinical applications.
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Affiliation(s)
- Varvara Vasalou
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
- Andreas Syggros Hospital, 11528 Athens, Greece
| | - Efstathios Kotidis
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Dimitris Tatsis
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
- Oral and Maxillofacial Surgery Department, School of Dentistry, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Kassiani Boulogeorgou
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (K.B.)
| | - Ioannis Grivas
- Laboratory of Anatomy, Histology & Embryology, School of Veterinary Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Georgios Koliakos
- Department of Biochemistry, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Angeliki Cheva
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (K.B.)
| | - Orestis Ioannidis
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Anastasia Tsingotjidou
- Laboratory of Anatomy, Histology & Embryology, School of Veterinary Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Stamatis Angelopoulos
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
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Burian EA, Enevold C, Karlsmark T, Ågren MS. A simplified method for monitoring cytokines in wound fluid. Wound Repair Regen 2023; 31:47-55. [PMID: 36168150 PMCID: PMC10092818 DOI: 10.1111/wrr.13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/10/2022] [Accepted: 09/13/2022] [Indexed: 01/27/2023]
Abstract
Cytokines in wound fluid are used as surrogates for wound healing in clinical research. The current methods used to collect and process wound fluid are noninvasive but not optimal. The aim of this prospective study was to evaluate a method (NovaSwab) by which wound fluid is collected by a surface swab and eluted in a physiological buffer for subsequent cytokine analysis. Wound fluid from 12 patients with leg ulcers was assessed by NovaSwab at the start (Day 0) and at the end of a 23-h collection period of wound fluid retained by foam oblates beneath an occlusive film dressing (Day 1). GM-CSF, IL-1α, IL-1β, IL-6, IL-8, PDGF-AA, TNF-α and VEGF levels were measured by multiplex and electrochemiluminescence assays. IL-1α (2.4×), IL-1β (2.0×) and IL-8 (1.8×) levels increased from Day 0 to Day 1 as detected by NovaSwab, indicating local production of these polypeptides in the wounds. On Day 1, the NovaSwab method yielded higher levels of IL-1α (4.0×), IL-1β (2.7×) and IL-6 (2.7×), and 35% lower levels of VEGF than those in wound fluid accumulated for 23 h in foam oblates (on average, 5 ml of wound fluid). In vitro experiments showed that the investigated cytokines in cell-free wound fluid were recovered in a quantitative manner by the NovaSwab method. We conclude that the method presented here is a promising research tool to study the kinetics of soluble cytokines over the course of wound healing. More studies are needed to determine the interobserver variation and reproducibility of the NovaSwab method.
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Affiliation(s)
- Ewa Anna Burian
- Department of Dermato-Venereology and Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian Enevold
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | - Tonny Karlsmark
- Department of Dermato-Venereology and Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Magnus S Ågren
- Department of Dermato-Venereology and Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Menegon MR, Malaquias SG, Silva JAD, Oliveira BGRBD, Medrano JCR, Verdú-Soriano J, Bachion MM. RESVECH 2.0: adaptação transcultural para o Brasil, confiabilidade e validade para avaliação de úlceras venosas. Rev Bras Enferm 2023. [DOI: 10.1590/0034-7167-2022-0185pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
RESUMO Objetivos: adaptar transculturalmente a escala Resultados en la valoración y evolución de la cicatrización de las heridas - RESVECH 2.0 para o português do Brasil; estimar sua consistência interna, validade de construto e de critério para utilização em úlceras venosas. Métodos: estudo metodológico, baseado em diretrizes internacionais para estudos dessa natureza. Realizou-se avaliação das feridas por meio da RESVECH 2.0 e da Pressure Ulcer Scale of Healing 3.0 (PUSH). Empregou-se análise descritiva, análise fatorial confirmatória, alfa de Cronbach e correlação de Spearman (p<0,05). Resultados: participaram 12 enfermeiros e 77 pessoas com 153 úlceras venosas. A tradução foi bem-sucedida, o modelo fatorial proposto foi validado, obteve-se alfa de Cronbach = 0,832 (IC95%=0,780-0,880) e coeficiente de correlação (RESVECH 2.0 e PUSH 3.0) = 0,74. Conclusões: a adaptação da RESVECH 2.0 para o português do Brasil é robusta. A confiabilidade e validade evidenciam compatibilidade para utilização no país e avaliação de úlceras venosas.
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Menegon MR, Malaquias SG, da Silva JA, de Oliveira BGRB, Medrano JCR, Verdú-Soriano J, Bachion MM. RESVECH 2.0: cross-cultural adaptation for Brazil, reliability and validity for the evaluation of venous ulcers. Rev Bras Enferm 2023; 76:e20220185. [PMID: 36995821 PMCID: PMC10042478 DOI: 10.1590/0034-7167-2022-0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 10/02/2022] [Indexed: 03/29/2023] Open
Abstract
Objectives: to cross-culturally adapt the scale Resultados en la valoración y evolución de la cicatrización de las heridas - RESVECH 2.0 for Brazilian Portuguese; to estimate the internal consistency and construct and criterion validity of the scale in the evaluation of venous ulcers. Methods: methodological study, based on international guidelines for studies of this type. Wounds were evaluated using the RESVECH 2.0 and Pressure Ulcer Scale of Healing 3.0 (PUSH). Descriptive analysis, confirmatory factor analysis, Cronbach’s alpha and Spearman’s correlation (p<0.05) were used. Results: 12 nurses and 77 people with 153 venous ulcers participated in the study. The translation was successful, the proposed factor model was validated, and Cronbach ‘s alpha = 0.832 (95%CI, 0.780-0.880) and correlation coefficient (RESVECH 2.0 and PUSH 3.0) = 0.74 were obtained. Conclusions: the adaptation of RESVECH 2.0 to Brazilian Portuguese is robust. Reliability and validity show compatibility for use in the country in the evaluation of venous ulcers.
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Affiliation(s)
| | | | | | - Beatriz Guitton Renaud Baptista de Oliveira
- Universidade Federal Fluminense. Niterói, Rio de Janeiro, Brazil
- Productivity Fellow of the National Council for Scientific and Technological Development - CNPq. Brasília, Distrito Federal, Brazil
| | | | | | - Maria Márcia Bachion
- Universidade Federal de Goiás. Goiânia, Goiás, Brazil
- Productivity Fellow of the National Council for Scientific and Technological Development - CNPq. Brasília, Distrito Federal, Brazil
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Burian EA, Sabah L, Karlsmark T, Kirketerp-Møller K, Moffatt CJ, Thyssen JP, Ågren MS. Cytokines and Venous Leg Ulcer Healing-A Systematic Review. Int J Mol Sci 2022; 23:6526. [PMID: 35742965 DOI: 10.3390/ijms23126526] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 01/01/2023] Open
Abstract
Venous leg ulcers (VLUs) are the most common type of leg ulcers with a significant socioeconomic burden due to slow healing. Cytokines may be involved in the pathogenesis of VLUs. In this systematic review, our objective was to investigate the association between cytokine levels, including growth factors, with the healing of VLUs. PubMed, Embase, Web of Science and Cochrane Library were searched from their inception to August 2021. We retrieved 28 articles investigating 38 different cytokines in 790 patients. Cytokines were most commonly investigated in wound fluid and less frequently in biopsies and serum. The studies were judged as having a moderate to high risk of bias, and the results were often inconsistent and sometimes conflicting. A meta-analysis was not performed due to clinical and methodological heterogeneities. We found weak evidence for elevated IL-1α, IL-6, IL-8, TNF-α and VEGF levels in non-healing VLUs, an elevation that declined with healing. TGF-β1 levels tended to increase with VLU healing. Other cytokines warranting further investigations include EGF, FGF-2, GM-CSF, IL-1β, IL-1Ra and PDGF-AA/PDGF-BB. We conclude that non-healing VLUs may be associated with an elevation of a palette of pro-inflammatory cytokines, possibly reflecting activated innate immunity in these wounds. There is a paucity of reliable longitudinal studies monitoring the dynamic changes in cytokine levels during wound healing.
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Borges EL, Amorim GL, de Miranda MB, Martins FDS, Guedes ACM, Sampaio KH, Spira JAO, Barcelos LDS. Biofilm model on mice skin wounds. Acta Cir Bras 2022; 37:e370306. [PMID: 35674583 PMCID: PMC9161625 DOI: 10.1590/acb370306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/18/2022] [Accepted: 02/19/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate a biofilm model of Pseudomonas aeruginosa in excisional cutaneous wound in mice. METHODS Preclinical, translational study conducted with 64 C57BL/6 mice randomly assigned to control and intervention groups. Evaluation was on days D0, D3, D5, D7 and D10 of wound making. The profile of biofilm formation and induction was evaluated using wound closure kinetics, quantitative culture, and evaluation of wounds using transmission electron microscopy (TEM). Clinical evaluation was performed by liver tissue culture, weight variation, and quantification of leukocytes in peripheral blood. Analyses were performed with GraphPad Prism software. RESULTS Bacterial load for induction of infection with P. aeruginosa and survival of animals was 104 UFC·mL-1. In D5 (p < 0.0001) and D7 (p < 0.01), animals in the intervention group showed a delay in the healing process and had their wounds covered by necrotic tissue until D10. Statistical differences were observed in wound cultures and weight at D5 and D7 (p < 0.01). Liver cultures and leukocyte quantification showed no statistical differences. No bacteria in planktonic or biofilm form were identified by TEM. CONCLUSIONS The findings raise questions about the understanding of the ease of formation and high occurrence of biofilm in chronic wounds.
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Affiliation(s)
- Eline Lima Borges
- PhD. Universidade Federal de Minas Gerais – School of Nursing – Department of Basic Nursing – Belo Horizonte (MG), Brazil
| | - Gilmara Lopes Amorim
- MSc. Universidade Federal de Minas Gerais – School of Nursing – Postgraduate Program – Belo Horizonte (MG), Brazil
| | - Marina Barcelos de Miranda
- MSc. Universidade Federal de Minas Gerais – Institute of Biological Sciences – Department of Physiology and Biophysics – Belo Horizonte (MG), Brazil
| | - Flaviano dos Santos Martins
- PhD. Universidade Federal de Minas Gerais – Institute of Biological Sciences – Department of Microbiology – Belo Horizonte (MG), Brazil
| | - Antônio Carlos Martins Guedes
- PhD. Universidade Federal de Minas Gerais – School of Medicine – Medical Clinic Department – Belo Horizonte (MG), Brazil
| | - Kinulpe Honorato Sampaio
- PhD. Universidade Federal dos Vales Jequitinhonha e Mucuri – Diamantina Department of Medicine – Diamantina (MG), Brazil
| | - Josimare Aparecida Otoni Spira
- MSc. Universidade Federal de Minas Gerais – School of Nursing – Department of Basic Nursing – Belo Horizonte (MG), Brazil
| | - Lucíola da Silva Barcelos
- PhD. Universidade Federal de Minas Gerais – Institute of Biological Sciences – Department of Physiology and Biophysics – Belo Horizonte (MG), Brazil
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Abstract
Background:
Recent advances in care aware that inadequate management of the healing process in wounds and the development of bacterial infections leads to increase morbidity. Health professionals have progressively recognized the value of choosing suitable dressings to manage wounds particularly in developing countries. Honey has been used for thousands of years as a wound dressing and considered as biologic treatment due to its multiple bioactivities related to healing process.
Objective:
The aim of this case report is to demonstrate that Argania Honey dressing improve the healing process in a venous leg ulcer.
Method:
Pure raw Argania honey (Argania spinosa, endemic tree in southwestern of Morocco) with no additives, pasteurization, or manipulation was used and provided from local beekeepers. A mechanical debridement process was achieved previously to the application of honey dressings to a venous leg ulcer of a 67-year-old woman affected by type II diabetes for 11 years.
Results :
The Argania honey dressing accompanied by mechanical debridement process demonstrated a rapid recovery and complete healing of the wound for 12 weeks approximately (79 days).
Conclusion:
This Moroccan honey (Argania) experienced for the first time in venous leg ulcer management may represent a good alternative to treat other types of wounds. Further investigations by using Argania honey dressing are required to explain its effect and the mechanisms involved in the improvement of healing process.
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Affiliation(s)
- Leila Khattabi
- Nurse and schoolteacher at High institute of Nursing professions and Technical healthcare (ISPITS), Tetouan, Morocco
| | - Kawtar Raghay
- Nurse and schoolteacher at High institute of Nursing professions and Technical healthcare (ISPITS), Tetouan, Morocco
| | - Mohamed Dakkach
- Nurse and schoolteacher at High institute of Nursing professions and Technical healthcare (ISPITS), Tetouan, Morocco
| | - Mohamed Allouch
- Laboratory of Chemical Engineering and Resource Valorization (GCVR), Department of chemistry, Faculty of sciences and techniques, University Abdelmalek Essaadi, Tangier, Morocco
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Pompilio G, Nicolaides A, Kakkos SK, Integlia D. Systematic literature review and network Meta-analysis of sulodexide and other drugs in chronic venous disease. Phlebology 2021; 36:695-709. [PMID: 33983078 DOI: 10.1177/02683555211015020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the clinical efficacy of sulodexide, including a comparison with venoactive drugs (VAD) (micronized purified flavonoid fraction, MPFF; hydroxy-ethyl-rutosides, HR; calcium dobesilate;Ruscus extract combined with hesperidin methyl chalcone and vitamin C, Ruscus+HMC+VitC; horse chestnut seed extract, HCSE) and pentoxifylline in patients with chronic venous disease. METHODS We performed a literature search in MEDLINE, Embase, and Cochrane Library for randomized controlled trials (RCTs) and observational studies. Proportion of patients with complete venous ulcer healing was the primary outcome and lower leg volume, foot volume, ankle circumference and symptoms were the secondary outcomes. Bayesian network meta-analysis (NMA) was perfomed with random effects models using only RCTs. A meta-analysis of observational studies was performed for sulodexide because no RCT could be included in NMA for symptoms or signs. RESULTS Forty-five RCTs and eighteen observational studies were identified. Sulodexide was included only in a single NMA for the proportion of patients with complete ulcer healing and it showed to have the highest probability of being the best treatment (48%) compared with pentoxifylline (37%) and MPFF (16%). MPFF was the most effective treatment in reducing lower leg volume, CIVIQ-20 score and pain VAS scale while calcium dobesilate and Ruscus+HMC+VitC were the most effective in reducing foot volume and ankle circumference respectively.Meta-analyses of observational studies for sulodexide showed that it improves significantly the scoring of pain, feeling of swelling, heaviness and parasthesiae measured by Likert scales. CONCLUSIONS Sulodexide is at least as effective as pentoxifylline and more effective than MPFF in improving the rate of ulcer healing in patients with CVD. VADs are effective in improving venous symptoms and signs, as was also shown by sulodexide in the meta-analysis of observational studies. The relative effectiveness of sulodexide and VADs needs to be evaluated by an RCT in order to better inform clinical practice.
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Affiliation(s)
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre, Nicosia, Cyprus.,Department of Surgery, University of Nicosia Medical School, Cyprus
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
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Bignamini AA, Chebil A, Gambaro G, Matuška J. Sulodexide for Diabetic-Induced Disabilities: A Systematic Review and Meta-Analysis. Adv Ther 2021; 38:1483-1513. [PMID: 33502688 PMCID: PMC7932977 DOI: 10.1007/s12325-021-01620-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/06/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Micro- and macrovascular complications of diabetes are leading morbidities in the world population. They are responsible not only for increased mortality but also severe disabilities, which jeopardize quality of life (e.g., blindness, walking limitations, and renal failure requiring dialysis). The new antidiabetic agents (e.g., glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter inhibitors) are increasingly recognized as breakthrough agents in the treatment of diabetes and prevention of diabetic complications. However, drugs effective in preventing and treating diabetic disabilities are still needed and sulodexide could be one of those able to address the unmet clinical needs of the new antidiabetic agents. METHODS We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the World Health Organization (WHO) International Clinical Trials Registry Platform Search Portal. We also manually searched potentially relevant journals, conference proceedings, and journal supplements. Any study monitoring any effect of sulodexide in subjects with diabetes, in relation to renal, vascular, and ocular complication, was considered. Treatment effects were estimated using standardized mean differences (SMDs), mean differences (MDs), and risk ratios (RRs), as appropriate. We calculated 95% confidence interval (CIs) and heterogeneity (Q, tau, and I2). RESULTS The search found 45 studies with 2817 participants (mean age 57 years; 63% male). The 26 randomized controlled studies included 2074 participants (mean age 58.8 years; 66% male). Sulodexide reduced the impact of diabetic retinopathy; increased the pain-free and maximal walking distance in peripheral arterial disease; accelerated the healing of diabetes-associated trophic ulcers; and decreased the rate of albumin excretion in subjects with nephropathy. The risk of adverse events (AEs) was not different between sulodexide and controls. CONCLUSION Sulodexide has a beneficial effect on the ocular, peripheral arterial disease, trophic ulcers, and renal complications of diabetes without increasing the risk of AEs.
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Affiliation(s)
- Angelo A Bignamini
- School of Specialisation in Hospital Pharmacy, Department of Pharmaceutical Sciences, University of Milan, Milan, Italy.
| | - Ahmed Chebil
- Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Ospedale Maggiore, University of Verona, Verona, Italy
| | - Jiří Matuška
- MATMED S.R.O., Private Angiology Facility, Hodonin, Czech Republic
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12
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Hartman E, Wallblom K, van der Plas MJA, Petrlova J, Cai J, Saleh K, Kjellström S, Schmidtchen A. Bioinformatic Analysis of the Wound Peptidome Reveals Potential Biomarkers and Antimicrobial Peptides. Front Immunol 2021; 11:620707. [PMID: 33613550 PMCID: PMC7888259 DOI: 10.3389/fimmu.2020.620707] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/21/2020] [Indexed: 12/18/2022] Open
Abstract
Wound infection is a common and serious medical condition with an unmet need for improved diagnostic tools. A peptidomic approach, aided by mass spectrometry and bioinformatics, could provide novel means of identifying new peptide biomarkers for wound healing and infection assessment. Wound fluid is suitable for peptidomic analysis since it is both intimately tied to the wound environment and is readily available. In this study we investigate the peptidomes of wound fluids derived from surgical drainages following mastectomy and from wound dressings following facial skin grafting. By applying sorting algorithms and open source third party software to peptidomic label free tandem mass spectrometry data we provide an unbiased general methodology for analyzing and differentiating between peptidomes. We show that the wound fluid peptidomes of patients are highly individualized. However, differences emerge when grouping the patients depending on wound type. Furthermore, the abundance of peptides originating from documented antimicrobial regions of hemoglobin in infected wounds may contribute to an antimicrobial wound environment, as determined by in silico analysis. We validate our findings by compiling literature on peptide biomarkers and peptides of physiological significance and cross checking the results against our dataset, demonstrating that well-documented peptides of immunological significance are abundant in infected wounds, and originate from certain distinct regions in proteins such as hemoglobin and fibrinogen. Ultimately, we have demonstrated the power using sorting algorithms and open source software to help yield insights and visualize peptidomic data.
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Affiliation(s)
- Erik Hartman
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Karl Wallblom
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Mariena J. A. van der Plas
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Lund, Sweden
- LEO Foundation Center for Cutaneous Drug Delivery, Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Jitka Petrlova
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jun Cai
- LEO Foundation Center for Cutaneous Drug Delivery, Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Karim Saleh
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Dermatology, Skane University Hospital, Lund, Sweden
| | - Sven Kjellström
- Division of Mass Spectrometry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Artur Schmidtchen
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Dermatology, Skane University Hospital, Lund, Sweden
- Copenhagen Wound Healing Center, Bispebjerg Hospital, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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13
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Raffetto JD, Ligi D, Maniscalco R, Khalil RA, Mannello F. Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment. J Clin Med 2020; 10:jcm10010029. [PMID: 33374372 PMCID: PMC7795034 DOI: 10.3390/jcm10010029] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU affects many individuals worldwide, could pose a significant socioeconomic burden to the healthcare system, and has major psychological and physical impacts on the affected individual. VLU often occurs in association with post-thrombotic syndrome, advanced chronic venous disease, varicose veins, and venous hypertension. Several demographic, genetic, and environmental factors could trigger chronic venous disease with venous dilation, incompetent valves, venous reflux, and venous hypertension. Endothelial cell injury and changes in the glycocalyx, venous shear-stress, and adhesion molecules could be initiating events in VLU. Increased endothelial cell permeability and leukocyte infiltration, and increases in inflammatory cytokines, matrix metalloproteinases (MMPs), reactive oxygen and nitrogen species, iron deposition, and tissue metabolites also contribute to the pathogenesis of VLU. Treatment of VLU includes compression therapy and endovenous ablation to occlude the axial reflux. Other interventional approaches such as subfascial endoscopic perforator surgery and iliac venous stent have shown mixed results. With good wound care and compression therapy, VLU usually heals within 6 months. VLU healing involves orchestrated processes including hemostasis, inflammation, proliferation, and remodeling and the contribution of different cells including leukocytes, platelets, fibroblasts, vascular smooth muscle cells, endothelial cells, and keratinocytes as well as the release of various biomolecules including transforming growth factor-β, cytokines, chemokines, MMPs, tissue inhibitors of MMPs (TIMPs), elastase, urokinase plasminogen activator, fibrin, collagen, and albumin. Alterations in any of these physiological wound closure processes could delay VLU healing. Also, these histological and soluble biomarkers can be used for VLU diagnosis and assessment of its progression, responsiveness to healing, and prognosis. If not treated adequately, VLU could progress to non-healed or granulating VLU, causing physical immobility, reduced quality of life, cellulitis, severe infections, osteomyelitis, and neoplastic transformation. Recalcitrant VLU shows prolonged healing time with advanced age, obesity, nutritional deficiencies, colder temperature, preexisting venous disease, deep venous thrombosis, and larger wound area. VLU also has a high, 50-70% recurrence rate, likely due to noncompliance with compression therapy, failure of surgical procedures, incorrect ulcer diagnosis, progression of venous disease, and poorly understood pathophysiology. Understanding the molecular pathways underlying VLU has led to new lines of therapy with significant promise including biologics such as bilayer living skin construct, fibroblast derivatives, and extracellular matrices and non-biologic products such as poly-N-acetyl glucosamine, human placental membranes amnion/chorion allografts, ACT1 peptide inhibitor of connexin 43, sulodexide, growth factors, silver dressings, MMP inhibitors, and modulators of reactive oxygen and nitrogen species, the immune response and tissue metabolites. Preventive measures including compression therapy and venotonics could also reduce the risk of progression to chronic venous insufficiency and VLU in susceptible individuals.
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Affiliation(s)
- Joseph D. Raffetto
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
- Correspondence: (J.D.R.); (F.M.)
| | - Daniela Ligi
- Department of Biomolecular Sciences, Section of Biochemistry and Biotechnology, Unit of Clinical Biochemistry, University Carlo Bo of Urbino, 61029 Urbino, Italy; (D.L.); (R.M.)
| | - Rosanna Maniscalco
- Department of Biomolecular Sciences, Section of Biochemistry and Biotechnology, Unit of Clinical Biochemistry, University Carlo Bo of Urbino, 61029 Urbino, Italy; (D.L.); (R.M.)
| | - Raouf A. Khalil
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Ferdinando Mannello
- Department of Biomolecular Sciences, Section of Biochemistry and Biotechnology, Unit of Clinical Biochemistry, University Carlo Bo of Urbino, 61029 Urbino, Italy; (D.L.); (R.M.)
- Correspondence: (J.D.R.); (F.M.)
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Abstract
Venous leg ulcers (VLU) respond well to compression, yet many ulcers remain unhealed after 1 year. Practitioners could be reluctant to apply compression to patients with significant ulcer pain. This study aimed to capture the views of practitioners on compression therapy for patients with painful VLU. A survey was conducted at a UK meeting in 2019 using handheld voting pads to capture the anonymous responses to four questions to which a mean of 90 practitioners responded. Nearly 40% of practitioners treat six or more patients a day with painful lower-limb ulcers. Some 80% felt confident in managing patients with painful ulcers; yet, most practitioners suggested they would refer onward for pain management. Some 40% would omit or reduce compression therapy as a pain management strategy. This survey supports the need for technological solutions that reduce VLU pain so that patients receive effective compression therapy.
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Affiliation(s)
- Leanne Atkin
- Vascular Nurse Consultant, Mid Yorks NHS Trust; Lecturer Practitioner, University of Huddersfield
| | - Robin Martin
- Freelance Scientific Consultant, Robin Martin PhD Scientific Consulting, Foggathorpe
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Kalinin RE, Suchkov IA, Kamaev AA, Mzhavanadze ND. [Duration of treatment with phlebotonics in patients with chronic venous disease]. Angiol Sosud Khir 2020; 26:60-67. [PMID: 33063753 DOI: 10.33529/angi02020301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Lower extremity chronic venous disease is a highly prevalent vascular pathology. Progression of the disease exerts a negative impact on the patients' quality of life and imposes a large economic burden on the healthcare systems. Conventional methods of conservative treatment of chronic venous disease include wearing compression knitwear and pharmacological therapy. Although highly effective, compression therapy appears to be associated with lower compliance due to difficulties putting on and taking off the compression stockings. Therefore, the majority of patients prefer pharmacological therapy with phlebotonic drugs. There are many phlebotropic agents possessing particular indications and recommendations regarding the duration of administration. This article presents a review of the available literature addressing the problems related to prescription of pharmacotherapy to patients with lower limb chronic venous disease, also describing the results of published clinical studies evaluating efficacy and safety of phlebotropic drugs, as well as those concerning the duration of the course administration of drugs depending on the severity of the disease, invasive nature of a surgical intervention performed, or sclerotherapy. Besides, analysed is the role of phleboactive agents in correction of pathophysiological mechanisms of the development and progression of venous disease. This is followed by a review of clinical trials studying the influence of phlebotonics on such links of pathogenesis as leukocyte activation, vein-specific inflammation, endothelial dysfunction, and activation of proteolytic enzymes promoting destruction of the extracellular matrix. Based on the above data, proposed herein are appropriate approaches to determining the duration of the courses of phlebotropic therapy with due regard for the patients' status, underlying once again the importance and necessity of a personalized approach to selection of the optimal duration of venotonic therapy.
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Affiliation(s)
- R E Kalinin
- Department of Cardiovascular, Roentgenendovascular, Operative Surgery and Topographic Anatomy, I.P. Pavlov Ryazan State Medical University, Ryazan, Russia
| | - I A Suchkov
- Department of Cardiovascular, Roentgenendovascular, Operative Surgery and Topographic Anatomy, I.P. Pavlov Ryazan State Medical University, Ryazan, Russia
| | - A A Kamaev
- Department of Cardiovascular, Roentgenendovascular, Operative Surgery and Topographic Anatomy, I.P. Pavlov Ryazan State Medical University, Ryazan, Russia
| | - N D Mzhavanadze
- Department of Cardiovascular, Roentgenendovascular, Operative Surgery and Topographic Anatomy, I.P. Pavlov Ryazan State Medical University, Ryazan, Russia
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Elio C, Fontani V, Rinaldi S, Gasbarro V. REAC-induced endogenous bioelectric currents in the treatment of venous ulcers: a three-arm randomized controlled prospective study. Acta Dermatovenerologica Alpina Pannonica et Adriatica 2020. [DOI: 10.15570/actaapa.2020.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Farahpour MR, Pirkhezr E, Ashrafian A, Sonboli A. Accelerated healing by topical administration of Salvia officinalis essential oil on Pseudomonas aeruginosa and Staphylococcus aureus infected wound model. Biomed Pharmacother 2020; 128:110120. [PMID: 32460189 DOI: 10.1016/j.biopha.2020.110120] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/28/2019] [Accepted: 12/15/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Salvia officinalis L. (Lamiaceae) is known to have antibacterial properties possibly conducive to the healing process of infected wounds. PURPOSE The present study aimed to evaluate the effects of an ointment containing Salvia officinalis essential oil (SOO) on an infected wound model. METHODS Essential oil hydrodistillated from the dried leaves of the plant was analyzed by GC-FID and GC-MS. After creating two full-thickness cutaneous wounds, mice were classified into four groups, control, and animals treated with 2 % mupirocin® (standard positive drug), and 2 % and 4 % (w/w) of SOO. In order to evaluate the effects of SOO on the wound healing phases, the expression levels of interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), cyclin-D1, Bcl-2, fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factors (VEGF) were analyzed using qRT-PCR. Immunohistochemistry analysis, tissue total antioxidant capacity (TAC) and malondialdehyde (MDA) were further assessed in all groups. RESULTS Concerning essential oil, the main compounds were found to be cis-thujone (26.8 %), camphor (16.4 %), trans-thujone (14.1 %) and 1,8-cineole (10.8 %). Our findings showed that the topical application of SOO was able to shorten the inflammatory phase and accelerate the cellular proliferation, re-vascularization, collagen deposition and re-epithelialization in comparison to the control group (p < 0.05). Moreover, increased mRNA levels of FGF-2 and VEGF, and up-regulation of cyclin-D1 and Bcl-2 were observed following the topical application of SOO compared to the control group (p < 0.05). The expression levels of IL-6, IL-1β and TNF-α were reduced in animals treated with SOO on days 3, 7 and 14 (p < 0.05). CONCLUSIONS Administration of SOO increased the TAC level and reduced the MDA content and levels of IL-1β and TNF-α. It is concluded that SOO is able to accelerate the wound healing process by regulating the expression of pro-inflammatory cytokines, growth factors, and antioxidant properties.
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Affiliation(s)
- Mohammad Reza Farahpour
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Urmia Branch, Islamic Azad University, Urmia, Iran.
| | - Ehsan Pirkhezr
- Department of Microbiology, Faculty of Veterinary Medicine, Urmia Branch, Islamic Azad University, Urmia, Iran
| | - Ali Ashrafian
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Shabestar Branch, Islamic Azad University, Shabestar, Iran
| | - Ali Sonboli
- Department of Biology, Medicinal Plants and Drugs Research Institute, Shahid Beheshti University, G.C. Evin, Tehran, Iran
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18
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Hadian Y, Fregoso D, Nguyen C, Bagood MD, Dahle SE, Gareau MG, Isseroff RR. Microbiome-skin-brain axis: A novel paradigm for cutaneous wounds. Wound Repair Regen 2020; 28:282-292. [PMID: 32034844 DOI: 10.1111/wrr.12800] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 12/12/2022]
Abstract
Chronic wounds cause a significant burden on society financially, medically, and psychologically. Unfortunately, patients with nonhealing wounds often suffer from comorbidities that further compound their disability. Given the high rate of depressive symptoms experienced by patients with chronic wounds, further studies are needed to investigate the potentially linked pathophysiological changes in wounds and depression in order to improve patient care. The English literature on wound healing, inflammatory and microbial changes in chronic wounds and depression, and antiinflammatory and probiotic therapy was reviewed on PubMed. Chronic wound conditions and depression were demonstrated to share common pathologic features of dysregulated inflammation and altered microbiome, indicating a possible relationship. Furthermore, alternative treatment strategies such as immune-targeted and probiotic therapy showed promising potential by addressing both pathophysiological pathways. However, many existing studies are limited to a small study population, a cross-sectional design that does not establish temporality, or a wide range of confounding variables in the context of a highly complex and multifactorial disease process. Therefore, additional preclinical studies in suitable wound models, as well as larger clinical cohort studies and trials are necessary to elucidate the relationship between wound microbiome, healing, and depression, and ultimately guide the most effective therapeutic and management plan for chronic wound patients.
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Affiliation(s)
- Yasmin Hadian
- Department of Dermatology, School of Medicine, University of California, Davis, California.,Dermatology Section, VA Northern California Health Care System, Mather, California
| | - Daniel Fregoso
- Department of Dermatology, School of Medicine, University of California, Davis, California
| | - Chuong Nguyen
- Department of Dermatology, School of Medicine, University of California, Davis, California
| | - Michelle D Bagood
- Department of Dermatology, School of Medicine, University of California, Davis, California
| | - Sara E Dahle
- Department of Dermatology, School of Medicine, University of California, Davis, California.,Podiatry Section, VA Northern California Health Care System, Mather, California
| | - Melanie G Gareau
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California Davis, Davis, California
| | - Roslyn Rivkah Isseroff
- Department of Dermatology, School of Medicine, University of California, Davis, California.,Dermatology Section, VA Northern California Health Care System, Mather, California
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Audu CO, Gordon AE, Obi AT, Wakefield TW, Henke PK. Inflammatory biomarkers in deep venous thrombosis organization, resolution, and post-thrombotic syndrome. J Vasc Surg Venous Lymphat Disord 2020; 8:299-305. [DOI: 10.1016/j.jvsv.2019.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/11/2019] [Indexed: 12/18/2022]
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Abstract
INTRODUCTION Chronic venous disease (CVD) is a common condition associated with valvular dysfunction, venous hypertension and endothelial inflammation. Sulodexide facilitates the healing of venous ulcers and is frequently used in patients with CVD without ulcer. This review assessed the efficacy and safety of sulodexide for treatment of signs and symptoms of lower extremity CVD. METHODS We searched MEDLINE, EMBASE, CINAHL and AMED as well as the Cochrane Central Register of Controlled Trials and the World Health Organisation (WHO) International Clinical Trials Registry Platform Search Portal. We also manually searched potentially relevant journals, conference proceedings and journal supplements. Any study monitoring any effect of sulodexide in patients with CVD at any stage of the disease, classified or non-classified, was considered. Treatment effects were estimated using standardised mean differences (SMDs), mean differences (MDs) and risk ratios (RRs), as appropriate. We calculated 95% confidence intervals (CIs) and heterogeneity (Q, tau and I2). RESULTS The search found 64 studies, but only 23 provided data on 7153 participants (mean age 55 years; 68% female). The 13 studies providing extractable quantitative information included 1901 participants (mean age 55.2 years; 65% female). Sulodexide decreased the intensity of pain, cramps, heaviness, oedema and total symptom score and reduced inflammatory mediators in patients with CVD. The risk of adverse events (AEs) was not different between sulodexide and placebo or heparan sulphate (RR 1.31, 95% CI 0.74-2.32; I2 = 0%; 270 participants). The overall risk of AEs with sulodexide was low: 3% (95% CI 1-4%) estimated from 3656 participants. CONCLUSION Sulodexide was found to have a beneficial venoactive effect on the major signs and symptoms of CVD such as pain, cramps, heaviness and oedema without increasing the risk of AEs. It is also likely to exert a systemic effect on the course of CVD by interfering with inflammatory chemokines.
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Affiliation(s)
- Angelo A Bignamini
- Department of Pharmaceutical Sciences, School of Specialisation in Hospital Pharmacy, University of Milan, Milano, Italy.
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21
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Hadian Y, Bagood MD, Dahle SE, Sood A, Isseroff RR. Interleukin-17: Potential Target for Chronic Wounds. Mediators Inflamm 2019; 2019:1297675. [PMID: 31827374 DOI: 10.1155/2019/1297675] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/16/2019] [Accepted: 10/15/2019] [Indexed: 02/06/2023] Open
Abstract
Chronic wounds exhibit persistent inflammation with markedly delayed healing. The significant burden of chronic wounds, which are often resistant to standard therapy, prompts further research on novel therapies. Since the interleukin-17 family has been implicated as a group of proinflammatory cytokines in immune-mediated diseases in the gut and connective tissue, as well as inflammatory skin conditions, we consider here if it may contribute to the pathogenesis of chronic wounds. In this review, we discuss the interleukin-17 family's signaling pathways and role in tissue repair. A PubMed review of the English literature on interleukin-17, wound healing, chronic wounds, and inflammatory skin conditions was conducted. Interleukin-17 family signaling is reviewed in the context of tissue repair, and preclinical and clinical studies examining its role in the skin and other organ systems are critically reviewed. The published work supports a pathologic role for interleukin-17 family members in chronic wounds, though this needs to be more conclusively proven. Clinical studies using monoclonal interleukin-17 antibodies to improve healing of chronic skin wounds have not yet been performed, and only a few studies have examined interleukin-17 family expression in chronic skin wounds. Furthermore, different interleukin-17 family members could be playing selective roles in the repair process. These studies suggest a therapeutic role for targeting interleukin-17A to promote wound healing; therefore, interleukin-17A may be a target worthy of pursuing in the near future.
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22
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Abstract
In general, the systems intended for the treatment and recovery of wounds, seek to act as a coating for the damaged area, maintaining an adequate level of humidity, reducing pain, and preventing the invasion and proliferation of microorganisms. Although many of the systems that are currently on the market meet the purposes mentioned above, with the arrival of nanotechnology, it has sought to improve the performance of these coatings. The variety of nano-systems that have been proposed is very extensive, including the use of very different materials (natural or synthetic) ranging from polymers or lipids to systems derived from microorganisms. With the objective of improving the performance of the systems, seeking to combat several of the problems that arise in a wound, especially when it is chronic, these materials have been combined, giving rise to nanocomposites or scaffolds. In recent years, the interest in the development of systems for the treatment of wounds is notable, which is reflected in the increase in publications related to the subject. Therefore, this document presents generalities of systems involving nanocarriers, mentioning some examples of representative systems of each case.
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Affiliation(s)
- S Bernal-Chávez
- a División de Estudios de Posgrado (Tecnología Farmacéutica), Facultad de Estudios Superiores Cuautitlán , Universidad Nacional Autónoma de México , Cuautitlán Izcalli , Mexico
| | - M G Nava-Arzaluz
- a División de Estudios de Posgrado (Tecnología Farmacéutica), Facultad de Estudios Superiores Cuautitlán , Universidad Nacional Autónoma de México , Cuautitlán Izcalli , Mexico
| | - R I Y Quiroz-Segoviano
- a División de Estudios de Posgrado (Tecnología Farmacéutica), Facultad de Estudios Superiores Cuautitlán , Universidad Nacional Autónoma de México , Cuautitlán Izcalli , Mexico
| | - A Ganem-Rondero
- a División de Estudios de Posgrado (Tecnología Farmacéutica), Facultad de Estudios Superiores Cuautitlán , Universidad Nacional Autónoma de México , Cuautitlán Izcalli , Mexico
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23
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Stechmiller JK, Lyon D, Schultz G, Gibson DJ, Weaver MT, Wilkie D, Ferrell AV, Whitney J, Kim J, Millan SB. Biobehavioral Mechanisms Associated With Nonhealing Wounds and Psychoneurologic Symptoms (Pain, Cognitive Dysfunction, Fatigue, Depression, and Anxiety) in Older Individuals With Chronic Venous Leg Ulcers. Biol Res Nurs 2019; 21:407-419. [PMID: 31142148 DOI: 10.1177/1099800419853881] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The prevalence and incidence of chronic venous leg ulcers (CVLUs) are increasing worldwide, as are the associated financial costs. Although it has long been known that their underlying etiology is venous insufficiency, the molecular aspects of healing versus nonhealing, as well as the psychoneurologic symptoms (PNS; pain, cognitive dysfunction, fatigue, depression, and anxiety) associated with CVLUs remain understudied. In this biobehaviorally focused review, we aim to elucidate the complex mechanisms that link the biological and molecular aspects of CLVUs with their PNS. Innovations in "omics" research have increased our understanding of important wound microenvironmental factors (e.g., inflammation, microbial pathogenic biofilm, epigenetic processes) that may adversely alter the wound bed's molecular milieu so that microbes evade immune detection. Although these molecular factors are not singularly responsible for wound healing, they are major components of wound development, nonhealing, and PNS that, until now, have not been amenable to systematic study, especially over time. Further, this review explores our current understanding of the molecular mechanisms by which the immune activation that contributes to the development and persistence of CVLUs also leads to the development, persistence, and severity of wound-related PNS. We also make recommendations for future research that will expand the field of biobehavioral wound science. Biobehavioral research that focuses on the interrelated mechanisms of PNS will lead to symptom-management interventions that improve quality of life for the population burdened by CVLUs.
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Affiliation(s)
- Joyce K Stechmiller
- 1 Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Debra Lyon
- 2 College of Nursing, University of Florida, Gainesville, FL, USA
| | - Gregory Schultz
- 3 Department of Obstetrics and Gynecology, Institute for Wound Research, University of Florida, Gainesville, FL, USA
| | - Daniel J Gibson
- 3 Department of Obstetrics and Gynecology, Institute for Wound Research, University of Florida, Gainesville, FL, USA
| | - Michael T Weaver
- 2 College of Nursing, University of Florida, Gainesville, FL, USA
| | - Diana Wilkie
- 4 Center for Palliative Care Research and Education, University of Florida, Gainesville, FL, USA
| | | | - Joanne Whitney
- 5 School of Nursing, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Junglyun Kim
- 2 College of Nursing, University of Florida, Gainesville, FL, USA
| | - Susan B Millan
- 6 UF Health Wound Care and Hyperbaric Center, Gainesville, FL, USA
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24
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Biranvand AS, Khosravi M, Esfandiari G, Poursaleh A, Hosseini-Fard SR, Amirfarhangi A, Najafi M. Associations between miR-661, miR-1202, lncRNA-HOTAIR, lncRNA-GAS5 and MMP9 in differentiated M2-macrophages of patients with varicose veins. INT ANGIOL 2019; 37:451-456. [PMID: 30558403 DOI: 10.23736/s0392-9590.18.04022-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The venous hypertension is suggested as the main cause of varicose disease. Some mediators and growth factors are known as the responsible of cellular events for the progression of venous perturbations. The aim of this study was to investigate non-coding (nc) RNA and MMP9 expression levels in macrophages differentiated from monocytes of patients with varicose veins. METHODS The monocytes were isolated from the whole blood samples by RosetteSep kit and were differentiated to macrophages M2 using M-CSF factor. The based on ncRNA-gene network, lncRNA-GAS5, lncRNA-HOTAIR, miRNA-661, miRNA-1202, and MMP9 were selected. The gene expression levels were measured by RT-qPCR technique. RESULTS Data showed that the MMP9 gene expression increased (P=0.003) while the GAS5, miRNA-661, and miRNA-1202 expression levels reduced significantly in the differentiated macrophages of patients (P=0.035, P=0.009, and P=0.015, respectively). Furthermore, the MMP9 gene expression levels were conversely related to the GAS5, HOTAIR, miRNA-661 and miRNA-1202 expression levels. CONCLUSIONS The results suggested that the lncRNA-GAS5, miRNA-661, miRNA-1202 and MMP9 are involved in varicose disease.
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Affiliation(s)
- Azin S Biranvand
- Cellular and Molecular Research Center, Biochemistry Department, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Khosravi
- Cellular and Molecular Research Center, Biochemistry Department, Iran University of Medical Sciences, Tehran, Iran
| | - Golnaz Esfandiari
- Cellular and Molecular Research Center, Biochemistry Department, Iran University of Medical Sciences, Tehran, Iran
| | - Adeleh Poursaleh
- Cellular and Molecular Research Center, Biochemistry Department, Iran University of Medical Sciences, Tehran, Iran
| | - Sayed R Hosseini-Fard
- Cellular and Molecular Research Center, Biochemistry Department, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Najafi
- Cellular and Molecular Research Center, Biochemistry Department, Iran University of Medical Sciences, Tehran, Iran - .,Firoozabadi Hospital, Tehran, Iran
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25
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Atkin L, Bućko Z, Montero EC, Cutting K, Moffatt C, Probst A, Romanelli M, Schultz GS, Tettelbach W. Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care 2019; 23:S1-S50. [DOI: 10.12968/jowc.2019.28.sup3a.s1] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Leanne Atkin
- Vascular Nurse Consultant. Mid Yorkshire NHS Trust/University of Huddersfield, England
| | - Zofia Bućko
- Head of Non-Healing Wounds Department, Centrum Medycznym HCP, Poznań, Poland
| | - Elena Conde Montero
- Specialist in Dermatology. Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Keith Cutting
- Clinical Research Consultant, Hertfordshire, Honorary, Tissue Viability Specialist, First Community Health and Care, Surrey, England
| | - Christine Moffatt
- Professor of Clinical Nursing Research, University of Nottingham, and Nurse Consultant, Derby Hospitals NHS Foundation Trust Lymphoedema Service, England
| | - Astrid Probst
- Advanced Nurse Practitioner Wound Care, Klinikum am Steinenberg/Ermstalklinik, Reutlingen, Germany
| | - Marco Romanelli
- President WUWHS, Associate Professor of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Gregory S Schultz
- Researcher, Professor of Obstetrics and Gynaecology, University of Florida, Gainesville, Florida, US
| | - William Tettelbach
- Associate Chief Medical Officer, MiMedx, Georgia. Adjunct Assistant Professor, Duke University School of Medicine, Durham, North Carolina. Medical Director of Wound Care and Infection Prevention, Landmark Hospital, Salt Lake City, Utah, US
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26
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Nordli HR, Pukstad B, Chinga-Carrasco G, Rokstad AM. Ultrapure Wood Nanocellulose—Assessments of Coagulation and Initial Inflammation Potential. ACS Appl Bio Mater 2019; 2:1107-1118. [DOI: 10.1021/acsabm.8b00711] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Henriette R. Nordli
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
| | - Brita Pukstad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
- Department of Dermatology, St. Olavs Hospital, Trondheim University Hospital, NO-7006 Trondheim, Norway
| | | | - Anne M. Rokstad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
- Centre of Molecular Inflammation Research, NO-7491 Trondheim, Norway
- Clinic of Surgery, Centre for Obesity, St. Olavs University Hospital, NO-2006 Trondheim, Norway
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Abstract
Sulodexide is a glycosaminoglycan extracted from porcine intestinal mucosa. The purpose of this review is to discuss sulodexide's complex pharmacological profile and its clinical applications for venous disease. Sulodexide has wide-ranging biological effects on the vascular system, including antithrombotic, profibrinolytic, anti-inflammatory, endothelial protective and vasoregulatory effects. Sulodexide has emerged as a potential therapeutic option for the management of chronic venous insufficiency, including venous ulceration, and the prevention of recurrent venous thromboembolism, with a low rate of major bleeding complications. Sulodexide's pleiotropic vascular effects may facilitate the management of common venous disorders.
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Affiliation(s)
- B J Carroll
- Division of Cardiovascular Medicine, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - G Piazza
- Division of Cardiovascular Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - S Z Goldhaber
- Division of Cardiovascular Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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28
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Niderla-Bielińska J, Bartkowiak K, Ciszek B, Jankowska-Steifer E, Krejner A, Ratajska A. Sulodexide inhibits angiogenesis via decreasing Dll4 and Notch1 expression in mouse proepicardial explant cultures. Fundam Clin Pharmacol 2018; 33:159-169. [PMID: 30246884 DOI: 10.1111/fcp.12418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/17/2018] [Accepted: 09/19/2018] [Indexed: 12/28/2022]
Abstract
Sulodexide (SDX) is a mixed drug containing low-molecular-weight heparin sulfate and dermatan sulfate. It exerts mild anticoagulant action but can also affect leukocytes, macrophages, and cell-cell adhesion and may interact with growth factors although its direct influence on endothelial cells is not well described. Clinically, SDX is used for the treatment of cardiovascular diseases, where it exerts anti-inflammatory and endothelial protective effects. The aim of this study was to determine the influence of SDX on tubule formation and angiogenesis-related proteins' mRNA expression in endothelial cell line C166 and mouse proepicardial explants. C166 cells and explants were stimulated with a proangiogenic cocktail containing bFGF/VEGF-A120 /VEGF-A164 enriched with SDX. After stimulation, the number and morphology of tubules stained with anti-CD31 antibody were examined under confocal microscope and expression of mRNA for VEGF-A, VEGF-B, VEGF-C, bFGF, IGF-1, Dll4, and Notch1 was measured with real-time PCR. In C166 cell line, there was no difference in tubule formation and mRNA expression, but in proepicardial explants, we observed reduction in tubule number and in mRNA level for DLL4 and Notch1 after SDX administration. In conclusion, SDX indirectly inhibits angiogenesis in mouse proepicardial explant cultures but has no direct effect on the C166 endothelial cell line.
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Affiliation(s)
- Justyna Niderla-Bielińska
- Department of Histology and Embryology, Medical Univertiry of Warsaw, Chałubinskiego 5 St, Warsaw, 02-004, Poland
| | - Krzysztof Bartkowiak
- Department of Histology and Embryology, Medical Univertiry of Warsaw, Chałubinskiego 5 St, Warsaw, 02-004, Poland
| | - Bogdan Ciszek
- Department of Clinical Anatomy, Medical Univertiry of Warsaw, Chałubinskiego 5 St, Warsaw, 02-004, Poland
| | - Ewa Jankowska-Steifer
- Department of Histology and Embryology, Medical Univertiry of Warsaw, Chałubinskiego 5 St, Warsaw, 02-004, Poland
| | - Alicja Krejner
- Department of Histology and Embryology, Medical Univertiry of Warsaw, Chałubinskiego 5 St, Warsaw, 02-004, Poland
| | - Anna Ratajska
- Department of Pathology, Medical University of Warsaw, Chałubinskiego 5 St, Warsaw, 02-004, Poland
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Ligi D, Croce L, Mannello F. Chronic Venous Disorders: The Dangerous, the Good, and the Diverse. Int J Mol Sci 2018; 19:E2544. [PMID: 30154324 DOI: 10.3390/ijms19092544] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/20/2018] [Accepted: 08/25/2018] [Indexed: 12/28/2022] Open
Abstract
Chronic venous disorders are common vascular pathology of great medical and socioeconomic impact, characterized by a wide spectrum of clinical manifestations occurring with symptoms and/or signs that vary in type and severity. The predominant pathophysiological mechanisms of chronic venous disease start from the development of venous hypertension from shear stress and reflux, leading to endothelial dysfunction and venous wall dilatation. The altered hemodynamic transduces physical signals into harmful bio-molecular pathways, creating a vicious cycle among shear stress, proteolytic remodeling, and inflammatory processes. This intricate network is further exacerbated by the degradation of protective endothelial glycocalyx. In this special issue, at least three main aspects of these interactions are highlighted: the dangerous, the good, and the diverse, which may help to focus attention on the biomolecular mechanisms and the possible targeted therapy of chronic venous disorders (CVeD).
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Mansilha A, Sousa J. Pathophysiological Mechanisms of Chronic Venous Disease and Implications for Venoactive Drug Therapy. Int J Mol Sci 2018; 19:ijms19061669. [PMID: 29874834 PMCID: PMC6032391 DOI: 10.3390/ijms19061669] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 11/16/2022] Open
Abstract
Chronic venous disease (CVD) is a common pathology, with significant physical and psychological impacts for patients and high economic costs for national healthcare systems. Throughout the last decades, several risk factors for this condition have been identified, but only recently, have the roles of inflammation and endothelial dysfunction been properly assessed. Although still incompletely understood, current knowledge of the pathophysiological mechanisms of CVD reveals several potential targets and strategies for therapeutic intervention, some of which are addressable by currently available venoactive drugs. The roles of these drugs in the clinical improvement of venous tone and contractility, reduction of edema and inflammation, as well as in improved microcirculation and venous ulcer healing have been studied extensively, with favorable results reported in the literature. Here, we aim to review these pathophysiological mechanisms and their implications regarding currently available venoactive drug therapies.
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Affiliation(s)
- Armando Mansilha
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal.
- Departamento de Angiologia e Cirurgia Vascular, Hospital CUF Porto, 4100-180 Porto, Portugal.
| | - Joel Sousa
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal.
- Departamento de Angiologia e Cirurgia Vascular, Hospital CUF Porto, 4100-180 Porto, Portugal.
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32
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Opdenakker G, Van Damme J, Vranckx JJ. Immunomodulation as Rescue for Chronic Atonic Skin Wounds. Trends Immunol 2018; 39:341-354. [PMID: 29500031 DOI: 10.1016/j.it.2018.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/08/2017] [Accepted: 01/24/2018] [Indexed: 12/11/2022]
Abstract
Chronic skin wounds, caused by arterial or venous insufficiency or by physical pressure, constitute an increasing medical problem as populations age. Whereas typical wounds are characterized by local inflammation that participates in the healing process, atonic wounds lack inflammatory markers, such as neutrophil infiltration, and generally do not heal. Recently, prominent roles in the immunopathology of chronic wounds were attributed to dysregulations in specific cytokines, chemokines, matrix metalloproteinases (MMPs), and their substrates. Together with the complement system, these molecular players provide necessary defense against infections, initiate angiogenesis, and prepare tissue reconstitution. Here, we review the current state of the field and include the concept that, aside from surgery and stem cell therapy, healing may be enhanced by immunomodulating agents.
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Affiliation(s)
- Ghislain Opdenakker
- Laboratory of Immunobiology and Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium; The Glycobiology Institute, University of Oxford, Oxford, UK.
| | - Jo Van Damme
- Laboratory of Immunobiology and Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | - Jan Jeroen Vranckx
- Department of Development & Regeneration & Department of Plastic & Reconstructive Surgery, University Hospitals Leuven and KU Leuven, Leuven, Belgium
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33
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Castro-Ferreira R, Cardoso R, Leite-Moreira A, Mansilha A. The Role of Endothelial Dysfunction and Inflammation in Chronic Venous Disease. Ann Vasc Surg 2018; 46:380-393. [DOI: 10.1016/j.avsg.2017.06.131] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/15/2017] [Accepted: 06/21/2017] [Indexed: 12/14/2022]
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34
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Serralheiro P, Novais A, Cairrão E, Maia C, Costa Almeida CM, Verde I. Variability of MMP/TIMP and TGF-β1 Receptors throughout the Clinical Progression of Chronic Venous Disease. Int J Mol Sci 2017; 19:ijms19010006. [PMID: 29267209 PMCID: PMC5795958 DOI: 10.3390/ijms19010006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/13/2017] [Accepted: 12/19/2017] [Indexed: 01/30/2023] Open
Abstract
Chronic venous disease (CVeD) is a prevalent condition with a significant socioeconomic burden, yet the pathophysiology is only just beginning to be understood. Previous studies concerning the dysregulation of matrix metalloproteinases (MMPs) and their inhibitors (tissue inhibitors of metalloproteinases (TIMPs)) within the varicose vein wall are inconsistent and disregard clinical progression. Moreover, it is highly plausible that MMP and TIMP expression/activity is affected by transforming growth factor (TGF)-β1 and its signaling receptors (TGFβRs) expression/activity in the vein wall. A case–control study was undertaken to analyze genetic and immunohistochemical differences between healthy (n = 13) and CVeD (early stages: n = 19; advanced stages: n = 12) great saphenous vein samples. Samples were grouped based on anatomic harvest site and subjected to quantitative polymerase chain reaction for MMP1, MMP2, MMP8, MMP9, MMP12, MMP13, TIMP1, TIMP2, TIMP3, TIMP4, TGFβR1, TGFβR2, and TGFβR3 gene expression analysis, and then to immunohistochemistry for immunolocalization of MMP2, TIMP2, and TGFβR2. Decreased gene expression of MMP12, TIMP2, TIMP3, TIMP4, and TGFβR2 was found in varicose veins when compared to controls. Regarding CVeD clinical progression, two facts arose: results across anatomical regions were uneven; decreased gene expression of MMP9 and TGFβR3 and increased gene expression of MMP2 and TIMP3 were found in advanced clinical stages. Most immunohistochemistry results for tunica intima were coherent with qPCR results. In conclusion, decreased expression of TGFβRs might suggest a reduction in TGF-β1 participation in the MMP/TIMP imbalance throughout CVeD progression. Further studies about molecular events in the varicose vein wall are required and should take into consideration the venous anatomical region and CVeD clinical progression.
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Affiliation(s)
- Pedro Serralheiro
- Norfolk and Norwich University Hospital, Norwich NR47UY, UK.
- Faculty of Health Sciences, CICS-UBI-Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal.
| | - António Novais
- Faculty of Health Sciences, CICS-UBI-Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal.
| | - Elisa Cairrão
- Faculty of Health Sciences, CICS-UBI-Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal.
| | - Cláudio Maia
- Faculty of Health Sciences, CICS-UBI-Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal.
| | - Carlos M Costa Almeida
- Department of General Surgery (C), Coimbra University Hospital Centre, 3041-801 Coimbra, Portugal.
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
| | - Ignacio Verde
- Faculty of Health Sciences, CICS-UBI-Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal.
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Ligi D, Croce L, Mosti G, Raffetto JD, Mannello F. Chronic Venous Insufficiency: Transforming Growth Factor-β Isoforms and Soluble Endoglin Concentration in Different States of Wound Healing. Int J Mol Sci 2017; 18:E2206. [PMID: 29065449 DOI: 10.3390/ijms18102206] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 01/01/2023] Open
Abstract
Venous leg ulcer (VLU) is a huge healthcare problem with poorly understood pathophysiology. Transforming growth factor-β (TGF-β) and endoglin (Eng), are inflammatory and wound healing mediators. Eng, co-receptor for TGF-β type-II receptors, may be cleaved forming soluble Eng (sEng), antagonizing TGF-β signaling, a crucial process in vascular pathologies. We evaluated the accumulation in wound fluid (WF) of TGF-β isoforms and sEng in healing stages, showing the effects of sulodexide treatments, a glycosaminoglycan with clinical efficacy in VLU healing. Patients with inflammatory (Infl) and granulating (Gran) VLU were recruited. WFs and THP-1 monocytes exposed to Infl and Gran WF (treated/untreated with sulodexide) were analyzed for TGF-β isoforms and sEng by multiplex immunoassay. In both Infl and Gran WF, TGF-β1 and β2 were similar; TGF-β3 was significantly increased in Infl compared to Gran WFs (p = 0.033). sEng was significantly elevated in Gran compared to Infl WFs (p = 0.002). In THP-1 monocytes there was a significant increase in sEng after co-treatment of WF and sulodexide. The increase in TGF-β3 found in Infl WF highlights its negative effect on wound healing, while the increased levels of sEng in Gran WF affects the leukocyte adhesion/transmigration through the endothelium, reducing the inflammatory response and favoring the wound healing. Glycosaminoglycan sulodexide potentiates the effects of sEng release from monocyte, representing an important therapeutic option for wound healing.
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