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Qin Q, Haba D, Takizawa C, Tomida S, Kunimitsu M, Minematsu T, Sanada H, Nakagami G. A method for harvesting viable cells from wound dressings. Exp Dermatol 2023; 32:1521-1530. [PMID: 37345866 DOI: 10.1111/exd.14857] [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: 01/19/2023] [Revised: 05/08/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023]
Abstract
Wound fluid has been well studied for exploring protein biomarkers contained in it. However, cells in wound fluid have not received much attention due to the difficulty in their collection. Our study aimed to establish a method for collecting viable cells from discarded wound dressings. A protocol was designed to wash out nonadherent cells and detach adherent cells from silicone-faced foam wound dressings using trypsin-EDTA. The optimal concentration and incubation time of trypsin-EDTA for collecting equivalent proportions of different cell types to the original cell population were determined in vitro. Cell composition and gene expression changes in monocytes, lymphocytes, neutrophils, fibroblasts and keratinocytes were confirmed using immunocytochemistry and RNA-sequencing ex vivo. Full-thickness wounds were created on 9-week-old male C57BL/6J mice. Wound fluid was collected, and half of it was applied to the wound dressings. The original cell population in the wound fluid and the cell population collected from wound dressings were compared. In the in vitro study, 0.25% trypsin-EDTA and 2.5-min incubation time were considered optimal for collecting adherent cells from wound dressings. In the ex vivo study, among all cell types, only CD3+ lymphocytes showed a significantly higher cell proportion in the collected group. The relative gene expression of the five selected cells showed no significant changes (p-value >0.05, |log2 fold change| < 1.5, differential gene expression analysis). Viable nonadherent and adherent cells were collected from wound dressings without altering gene expression and could be used in future studies for cellular analysis of wound fluid.
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Affiliation(s)
- Qi Qin
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daijiro Haba
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chihiro Takizawa
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sanai Tomida
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mao Kunimitsu
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Ishikawa Prefectural Nursing University, Kahoku, Ishikawa, Japan
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Ishikawa Prefectural Nursing University, Kahoku, Ishikawa, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Augustin M, Herberger K, Wille A, Twarock S. Impact of human wound exudate on the bactericidal efficacy of commercial antiseptic products. J Wound Care 2023; 32:422-427. [PMID: 37405941 DOI: 10.12968/jowc.2023.32.7.422] [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] [Indexed: 07/07/2023]
Abstract
OBJECTIVE By default, the antimicrobial efficacy of antiseptics used in wound management is tested in vitro under standardised conditions according to European standard DIN EN 13727, with albumin and sheep erythrocytes used as organic challenge. However, it is not clear whether these testing conditions adequately reflect the wound bed environment and its interaction with antiseptic products intended to be used in wounds in humans. METHOD This study compared the efficacy of different commercial antiseptic products based on octenidine dihydrochloride (OCT), polyhexamethylene biguanide (PHMB) and povidone-iodine under challenge with human wound exudate collected from the hard-to-heal wounds of patients, compared to the standardised organic load, in an in vitro setting according to DIN EN 13727. RESULTS The bactericidal efficacy of the tested products was reduced to a different extent when challenged with human wound exudate, compared to the standardised conditions. Overall, OCT-based products showed the necessary germ count reductions at the shortest exposure times (e.g., 15 seconds for Octenisept (Schülke & Mayr GmbH, Germany)). PHMB-based products were the least efficient. In addition to the protein content, other components of wound exudate, such as the microbiota, seem to influence the efficacy of antiseptics. CONCLUSION This study demonstrated that the standardised in vitro test conditions may only partially reflect actual wound bed conditions in humans.
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Affiliation(s)
| | | | - Andreas Wille
- Hamburg Institute for Hygiene and Environment, Hamburg, Germany
| | - Sören Twarock
- Institut für Pharmakologie und Klinische Pharmakologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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Takizawa C, Minematsu T, Nakagami G, Kitamura A, Koudounas S, Kunimitsu M, Sanada H. Expression levels of NPPB, ITGB6, CPNE4, EML5, and ITSN1 in fresh exudates swabbed from critically colonised and infected full-thickness wounds in rats. Int Wound J 2023; 20:1088-1097. [PMID: 36307995 PMCID: PMC10031246 DOI: 10.1111/iwj.13965] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/30/2022] [Accepted: 09/11/2022] [Indexed: 11/27/2022] Open
Abstract
Pressure injury management requires reliable identification of critical colonisation due to lack of infection signs. Our research group previously proposed the mRNAs natriuretic peptide B (Nppb), integrin subunit beta 6 (Itgb6), copine 4 (Cpne4), echinoderm microtubule-associated protein like 5, and intersectin 1 as candidate markers in pooled exudates of critically colonised wounds. However, it is unclear whether mRNAs or proteins of the candidate genes would be suitable as biomarkers in fresh exudate. Therefore, this study aimed to evaluate the validity of the mRNAs and proteins as fresh exudate markers for critical colonisation. Three wound models of normal healing, critical colonisation, and infection were created in rats. Fresh swab-collected exudates were collected, and mRNA and protein expression levels were measured. In the fresh wound exudates, the detection frequency of Itgb6 tended to decrease in the critically colonised and infected wounds (P = .067), and those of Cpne4 and Nppb tended to be lower in the infected wounds than in the normal healing and critically colonised wounds (P = .006 and .067, respectively). In contrast, there was no difference in protein expression in the exudates. This study suggests that Itgb6 mRNA in fresh exudates is a promising biomarker for critical colonisation.
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Affiliation(s)
- Chihiro Takizawa
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Kitamura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sofoklis Koudounas
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mao Kunimitsu
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Gao L, Liu X, Zhao W, Li C, Wang F, Gao J, Liao X, Wei L, Wu H, Zheng Y, Wang L. Extracellular-matrix-mimicked 3D nanofiber and hydrogel interpenetrated wound dressing with a dynamic autoimmune-derived healing regulation ability based on wound exudate. Biofabrication 2022; 15. [PMID: 36579621 DOI: 10.1088/1758-5090/acaa01] [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: 07/21/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
Dynamic regulation of wound physiological signals is the basis of wound healing. Conventional biomaterials delivering growth factors to drive wound healing leads to the passive repair of soft tissues because of the mismatch of wound healing stages. Meanwhile, the bioactivity of wound exudate is often restricted by oxidation and bacterial contamination. Herein, an extracellular matrix mimicked nanofiber/hydrogel interpenetrated network (NFHIN) was constructed with a 3D nanofibrous framework for cell immigration, and interfiled aerogel containing cross-linked hyaluronic acid and hyperbranched polyamidoamine to balance the wound microenvironment. The aerogel can collect wound exudate and transform into a polycationic hydrogel with contact-killing effects even against intracellular pathogens (bactericidal rate > 99.9% in 30 min) and real-time scavenging property of reactive oxygen species. After co-culturing with the NFHIN, the bioactivity of fibroblast in theex vivoblister fluid was improved by 389.69%. The NFHIN showed sustainable exudate management with moisture-vapor transferring rate (6000 g m-2×24 h), equilibrium liquid content (75.3%), Young's modulus (115.1 ± 7 kPa), and anti-tearing behavior similar to human skin. The NFHIN can collect and activate wound exudate, turning it from a clinical problem to an autoimmune-derived wound regulation system, showing potential for wound care in critical skin diseases.
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Affiliation(s)
- Liheng Gao
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, People's Republic of China
| | - Xingxing Liu
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, People's Republic of China
| | - Wenshuo Zhao
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, People's Republic of China
| | - Chaojin Li
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, People's Republic of China
| | - Fujun Wang
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, People's Republic of China
| | - Jing Gao
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, People's Republic of China
| | - Xinqin Liao
- School of Electrical and Electronic Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798, Singapore
| | - Lei Wei
- School of Electrical and Electronic Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798, Singapore
| | - Hao Wu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
| | - Yuanjin Zheng
- School of Electrical and Electronic Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798, Singapore
| | - Lu Wang
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, People's Republic of China
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Pei X, Sun M, Wang J, Bai J, Bo X, Zhou M. A Bifunctional Fully Integrated Wearable Tracker for Epidermal Sweat and Wound Exudate Multiple Biomarkers Monitoring. Small 2022; 18:e2205061. [PMID: 36180393 DOI: 10.1002/smll.202205061] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/13/2022] [Indexed: 05/16/2023]
Abstract
Fully integrated wearable electronics that combine the extraordinary feature of incessant and on-body operation with the distinctive external equipment-free trait are the ultimate goal of modern wearables. Epidermal sweat and wound exudate, as two noninvasively accessible biofluids on/surrounding the skin, reflect underlying health conditions. However, the design of universal wearable sensors with the bifunctional capability to monitor both epidermal secretions is still a challenge. Here, a single bifunctional fully integrated wearable tracker for wirelessly, simultaneously, and dynamically in situ measuring multiple epidermal sweat or wound exudate biomarkers is propos. Considering the electrolytes (e.g., Na+ , K+ , and H+ ) and metabolites (e.g., uric acid (UA)) levels in sweat or wound exudate may correlate with health or wound conditions, the dynamic and skin-on tracking of the biomarkers of Na+ , K+ , pH, and UA levels in sweat under subjects' exercise and in wound exudate during subjects' wound healing are performed through the seamless integration of microfluidic, sensing, and electronic modules. Its applicability is evaluated for noninvasive hyperuricemia management in hyperuricemia/healthy subjects through a purine-rich intake test and for wound management in subjects' infected wounds through a control medical treatment.
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Affiliation(s)
- Xinyi Pei
- Key Laboratory of Polyoxometalate and Reticular Material Chemistry of Ministry of Education, Key Laboratory of Nanobiosensing and Nanobioanalysis at Universities of Jilin Province, Analysis and Testing Center, Department of Chemistry, Northeast Normal University, Changchun, Jilin Province, 130024, P. R. China
| | - Mimi Sun
- Key Laboratory of Polyoxometalate and Reticular Material Chemistry of Ministry of Education, Key Laboratory of Nanobiosensing and Nanobioanalysis at Universities of Jilin Province, Analysis and Testing Center, Department of Chemistry, Northeast Normal University, Changchun, Jilin Province, 130024, P. R. China
| | - Jingjuan Wang
- Key Laboratory of Polyoxometalate and Reticular Material Chemistry of Ministry of Education, Key Laboratory of Nanobiosensing and Nanobioanalysis at Universities of Jilin Province, Analysis and Testing Center, Department of Chemistry, Northeast Normal University, Changchun, Jilin Province, 130024, P. R. China
| | - Jing Bai
- Key Laboratory of Polyoxometalate and Reticular Material Chemistry of Ministry of Education, Key Laboratory of Nanobiosensing and Nanobioanalysis at Universities of Jilin Province, Analysis and Testing Center, Department of Chemistry, Northeast Normal University, Changchun, Jilin Province, 130024, P. R. China
| | - Xiangjie Bo
- Key Laboratory of Polyoxometalate and Reticular Material Chemistry of Ministry of Education, Key Laboratory of Nanobiosensing and Nanobioanalysis at Universities of Jilin Province, Analysis and Testing Center, Department of Chemistry, Northeast Normal University, Changchun, Jilin Province, 130024, P. R. China
| | - Ming Zhou
- Key Laboratory of Polyoxometalate and Reticular Material Chemistry of Ministry of Education, Key Laboratory of Nanobiosensing and Nanobioanalysis at Universities of Jilin Province, Analysis and Testing Center, Department of Chemistry, Northeast Normal University, Changchun, Jilin Province, 130024, P. R. China
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Severing AL, Borkovic M, Stuermer EK, Rembe JD. Composition of Challenge Substance in Standardized Antimicrobial Efficacy Testing of Wound Antimicrobials Is Essential to Correctly Simulate Efficacy in the Human Wound Micro-Environment. Biomedicines 2022; 10:2751. [PMID: 36359272 PMCID: PMC9687328 DOI: 10.3390/biomedicines10112751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 07/30/2023] Open
Abstract
Current standards insufficiently acknowledge the influence of the wound micro-environment on the efficacy of antimicrobial agents. To address this, octenidine/phenoxyethanol, polyhexanide, povidone-iodine, and sodium-hypochloride/hypochlorous acid solutions were submitted to standard-based (DIN-EN-13727) or modified peptide-based challenges and compared to a simulated clinical reference using human acute or chronic wound exudate (AWF/CWF). Antimicrobial efficacy against S. aureus and P. aeruginosa was compared using a quantitative suspension method. Agreement between methods were investigated using Bland-Altman (B&A) analysis. Different substances and challenges demonstrated diverging results, depending on class and concentration of agent and challenge. Highly concentrated antiseptics maintained a high efficacy under complex challenges, while especially chlorine-based irrigation solutions showed a remarkably reduced antimicrobial effect. Composition of challenge substance proved more relevant than pure concentration. Therefore, the current standard challenge conditions did not adequately reflect the wound micro-environment with over- or under-estimating antimicrobial efficacy, whilst the modified peptide-challenge showed a higher level of agreement with simulated realistic conditions (AWF/CWF). The results emphasize that a "one-fits-all" approach is not feasible to generalize antimicrobial efficacy, as certain aspects of the complex micro-environment pose a differing influence on varying agents. Based on these results, revision and target focused adaptation of the current standards should be considered.
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Affiliation(s)
- Anna-Lena Severing
- Department of Dermatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf (HHU), Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Mia Borkovic
- Department of Vascular Medicine, University Heart & Vascular Center (UHZ), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20251 Hamburg, Germany
| | - Ewa K. Stuermer
- Department of Vascular Medicine, University Heart & Vascular Center (UHZ), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20251 Hamburg, Germany
| | - Julian-Dario Rembe
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf (HHU), Moorenstrasse 5, 40225 Düsseldorf, Germany
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Nurzynska A, Klimek K, Palka K, Szajnecki Ł, Ginalska G. Curdlan-Based Hydrogels for Potential Application as Dressings for Promotion of Skin Wound Healing-Preliminary In Vitro Studies. Materials (Basel) 2021; 14:ma14092344. [PMID: 33946409 PMCID: PMC8125403 DOI: 10.3390/ma14092344] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/24/2021] [Accepted: 04/28/2021] [Indexed: 02/03/2023]
Abstract
The aim of this work was to establish whether novel curdlan-based hydrogels enriched with Ca2+ ions may be considered as potential candidates for dressings, for the acceleration of skin wound healing. Firstly, biomaterials were allocated for evaluation of structural and mechanical properties. Subsequently, the ability of hydrogels to absorb simulated wound fluid and water vapor permeability, as well their capacity to release calcium ions, was evaluated. The biocompatibility of biomaterials was assessed using normal human skin fibroblasts. Importantly, the main features of the obtained curdlan-based hydrogels were compared with those of KALTOSTAT® (a commercial calcium sodium alginate wound dressing). The obtained results showed that curdlan-based biomaterials possessed a mesoporous structure (pore diameter ranged from 14–48 nm) and exhibited a good ability to absorb simulated wound fluid (swelling ratio close to 974–1229%). Moreover, in a wet state, they enabled proper water vapor transmission rate (>2000 g/m2/day), thanks to their hydrogel structure. Finally, it was found that biomaterial composed of 11 wt.% of curdlan (Cur_11%) possessed the most desirable biological properties in vitro. It released a beneficial amount of calcium ions to the aqueous environment (approximately 6.12 mM), which significantly enhanced fibroblast viability and proliferation. Taking into account the beneficial properties of Cur_11% biomaterial, it seems justified to subject it to more advanced cell culture experiments in vitro and to in vivo studies in order to determine its precise influence on skin wound healing.
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Affiliation(s)
- Aleksandra Nurzynska
- Department of Biochemistry and Biotechnology, Medical University of Lublin, Chodzki 1 Street, 20-093 Lublin, Poland; (A.N.); (G.G.)
| | - Katarzyna Klimek
- Department of Biochemistry and Biotechnology, Medical University of Lublin, Chodzki 1 Street, 20-093 Lublin, Poland; (A.N.); (G.G.)
- Correspondence: ; Tel.: +48-81-448-7028 or +48-81-448-7020
| | - Krzysztof Palka
- Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 26 Street, 20-618 Lublin, Poland;
| | - Łukasz Szajnecki
- Department of Polymer Chemistry, Maria Curie-Skłodowska University in Lublin, M. Curie-Skłodowska Sq. 2, 20-031 Lublin, Poland;
| | - Grazyna Ginalska
- Department of Biochemistry and Biotechnology, Medical University of Lublin, Chodzki 1 Street, 20-093 Lublin, Poland; (A.N.); (G.G.)
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8
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Brunauer A, Verboket RD, Kainz DM, von Stetten F, Früh SM. Rapid Detection of Pathogens in Wound Exudate via Nucleic Acid Lateral Flow Immunoassay. Biosensors (Basel) 2021; 11:bios11030074. [PMID: 33800856 PMCID: PMC8035659 DOI: 10.3390/bios11030074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/24/2021] [Accepted: 03/03/2021] [Indexed: 12/15/2022]
Abstract
The rapid detection of pathogens in infected wounds can significantly improve the clinical outcome. Wound exudate, which can be collected in a non-invasive way, offers an attractive sample material for the detection of pathogens at the point-of-care (POC). Here, we report the development of a nucleic acid lateral flow immunoassay for direct detection of isothermally amplified DNA combined with fast sample preparation. The streamlined protocol was evaluated using human wound exudate spiked with the opportunistic pathogen Pseudomonas aeruginosa that cause severe health issues upon wound colonization. A detection limit of 2.1 × 105 CFU per mL of wound fluid was achieved, and no cross-reaction with other pathogens was observed. Furthermore, we integrated an internal amplification control that excludes false negative results and, in combination with the flow control, ensures the validity of the test result. The paper-based approach with only three simple hands-on steps has a turn-around time of less than 30 min and covers the complete analytical process chain from sample to answer. This newly developed workflow for wound fluid diagnostics has tremendous potential for reliable pathogen POC testing and subsequent target-oriented therapy.
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Affiliation(s)
- Anna Brunauer
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - René D Verboket
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Daniel M Kainz
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Felix von Stetten
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Susanna M Früh
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
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9
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Radischat N, Augustin M, Herberger K, Wille A, Goroncy-Bermes P. Influence of human wound exudate on the bactericidal efficacy of antiseptic agents in quantitative suspension tests on the basis of European Standards (DIN EN 13727). Int Wound J 2020; 17:781-789. [PMID: 32133774 DOI: 10.1111/iwj.13336] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/23/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 01/22/2023] Open
Abstract
The antimicrobial efficacy of antiseptics used in wound management is tested in vitro under standardised conditions according to DIN EN 13727, with albumin and sheep erythrocytes used as organic challenge. However, these testing conditions do not adequately simulate the wound bed environment. Thus, the aim of this study was to compare the efficacy of different antiseptics such as octenidine dihydrochloride (OCT), chlorhexidine digluconate (CHX), polyhexamethylene biguanide (PHMB), and povidone-iodine under challenge with human wound exudate instead of standardised organic load in an in vitro setting according to DIN EN 13727. Moreover, protein contents, pH, and temperature were compared with standardised testing conditions. The tested antiseptic agents were reduced to different extents based on their bactericidal efficacy, when challenged with human wound exudate compared with standardised conditions. Overall, 0.10% OCT showed the highest effects reaching full efficacy after 30 seconds. CHX and PHMB were the least efficient. Next to the protein content, other components of wound exudate, such as the microflora, seem to influence the efficacy of antiseptics. In summary, the optimisation of in vitro testing conditions in future applications, to more adequately simulate the wound bed environment, will allow a more realistic picture on the potential performance of antiseptics in clinical practice.
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Affiliation(s)
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Katharina Herberger
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Andreas Wille
- Institute for Hygiene and Environment, Hamburg, Germany
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10
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Macêdo JKA, Joseph JK, Menon J, Escalante T, Rucavado A, Gutiérrez JM, Fox JW. Proteomic Analysis of Human Blister Fluids Following Envenomation by Three Snake Species in India: Differential Markers for Venom Mechanisms of Action. Toxins (Basel) 2019; 11:toxins11050246. [PMID: 31052189 PMCID: PMC6563188 DOI: 10.3390/toxins11050246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/11/2019] [Revised: 04/25/2019] [Accepted: 04/27/2019] [Indexed: 01/28/2023] Open
Abstract
Skin blistering as a result of snakebite envenomation is characteristic of some bites, however little is known regarding the mechanism of blister formation or the composition of the blister fluid. In order to investigate if blister fluid proteomes from humans suffering snakebite envenomation could provide insights on the pathophysiology of these skin alterations, blister fluid was collected from six patients upon presentation at a clinic in India bitten by three species of snakes, Daboia russelii (3), Hypnale hypnale (2), or Naja naja (1). Standard clinical data were recorded throughout the treatment. Approximately 805 proteins were identified in blister fluids using proteomic analyses. Informatics analyses of the proteomes identified the top biological response categories as: platelet degranulation, innate immune response, receptor-mediated endocytosis, complement activation, and blood coagulation. Hierarchical clustering did not show a clear segregation of patients' proteomes being associated with the species of snake involved, suggesting that either the proteomic profiles described reflect a general response to venom-induced tissue damage or more patient data sets will be required to observe significant differences. Finally, it is of interest that venom proteins were also identified in the blister fluids suggesting that this fluid may serve as a reservoir of venom biologically active proteins/toxins, and as such, may indicate the clinical value of removing blister fluid to attenuate further tissue damage.
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Affiliation(s)
- Jéssica K A Macêdo
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia, School of Medicine, Charlottesville, VA 22908-734, USA.
- Department of Cell Biology, Brazilian Center of Protein Research, University of Brasilia, Brasilia/DF 70297-400, Brazil.
| | | | - Jaideep Menon
- Sree Naryana Institute of Medical Science, Kerala 683594, India.
| | - Teresa Escalante
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San José 11501-2060, Costa Rica.
| | - Alexandra Rucavado
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San José 11501-2060, Costa Rica.
| | - José María Gutiérrez
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San José 11501-2060, Costa Rica.
| | - Jay W Fox
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia, School of Medicine, Charlottesville, VA 22908-734, USA.
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11
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Cerveró-Ferragut S, López-Riquelme N, Martín-Tomás E, Massa-Domínguez B, Pomares-Vicente J, Soler-Pérez M, Sánchez-Hernández JF. Quantitative analysis of blood cells and inflammatory factors in wounds. J Wound Care 2017; 26:121-125. [PMID: 28277999 DOI: 10.12968/jowc.2017.26.3.121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to quantify blood cells and inflammatory markers, involved in the healing process, in exudates from wounds in different healing phases, to assess these markers in order to identify the inflammatory phase of the wounds. METHOD Patients who presented with postsurgical wounds, which closed by first and second intention, and those who presented with pressure ulcers (PUs), which were closed by second intention, were included in the study. RESULTS We examined wounds from 37 patients and collected samples from 52 wounds in the inflammatory phase, 30 in the proliferative phase and 29 in the maturation phase. The number of neutrophils and platelets in the exudate collected from wounds in the inflammatory phase was significantly higher (p<0.001), while the number of lymphocytes, was significantly lower in exudate from wounds in the inflammatory phase (p<0.001). Wound c-reactive protein (CRP) and immunoglobulin G (IgG) levels were higher in the inflammatory group (p<0.001). We found a significantly positive correlation between CRP levels and the percentage of neutrophils and monocytes (r=0.346, p=0.004; r=0.293, p=0.015), and a significantly negative correlation between CRP levels and the percentage of lymphocytes (r=-0.503, p<0.001). A stepwise logistic regression analysis was used to identify an optimal combination of these biomarkers. The optimal biomarker combinations were neutrophils + monocytes + platelets + IgG + CRP, with an area under the curve (AUC) of 0.981 [confidence interval (CI) 95%: 0.955-1.000, p<0.001] for the diagnosis of wounds in the inflammatory phase. The optimal cutpoint yielded 96.9 % sensitivity and 94.6 % specificity. The biomarker combination predicted the inflammatory phase and was superior to individual biomarkers. CONCLUSION Our findings suggest that the combination of the markers, percentage of neutrophils and monocytes, platelets, CRP and IgG levels could be useful prognostic indicators of the inflammatory phase.
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Affiliation(s)
- S Cerveró-Ferragut
- Wound Department, General University Hospital of Elche (Alicante), Spain
| | - N López-Riquelme
- Department of Laboratory Medicine, University Clinical Hospital Virgen de la Arrixaca, El Palmar (Murcia), Spain
| | - E Martín-Tomás
- Laboratory Medicine Department, General University Hospital of Elche (Alicante), Spain
| | - B Massa-Domínguez
- Wound Department, General University Hospital of Elche (Alicante), Spain
| | - J Pomares-Vicente
- Wound Department, General University Hospital of Elche (Alicante), Spain
| | - M Soler-Pérez
- Wound Department, General University Hospital of Elche (Alicante), Spain
| | - J F Sánchez-Hernández
- Laboratory Medicine Department, General University Hospital of Elche (Alicante), Spain
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12
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Madisetti M, Kelechi TJ, Mueller M, Amella EJ, Prentice MA. Feasibility, acceptability, and tolerability of RGN107 in the palliative wound care management of chronic wound symptoms. J Wound Care 2017; 26:S25-S34. [PMID: 28105900 PMCID: PMC10580812 DOI: 10.12968/jowc.2017.26.sup1.s25] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE To assess the feasibility, acceptability and tolerability of RGN107 use, a natural powder blend of Arnica Montana, Calendula Officinalis, Mentha Arvensis and Santalum Album, among hospice patients and their wound caregivers in the palliative wound care management of chronic wound symptoms at end-of-life. METHOD Data were collected between May 2013 and November 2015. A pilot trial conducted among 50 hospice patients with symptomatic (pain, odour, or exudate) chronic wounds. Caregivers received initial RGN107 protocol training, actively applied the powder to patient wounds for 4-weeks, and completed an 8-week retrospective survey. Feasibility was assessed by measuring process outcomes, including the number and proportion of participants referred, screened eligible, enrolled, withdrawn and successfully completed. Acceptability measures included: a protocol training evaluation, caregiver pre and post self-efficacy ratings, retrospective usability, symptom control management and comparative technique caregiver ratings, and recorded open-ended comments. Tolerability was assessed through a 12-week cumulative review of the study adverse event profile. RESULTS Feasibility, tolerability and acceptability of use of the RGN107 powder for chronic wounds were established. Recruitment goals were achieved and 92 % of the patients successfully completed the study. 95 % of wound caregivers would recommend the powder for use in this population. CONCLUSION This study supports the feasibility, acceptability and tolerability of a wound care powder that espouses a multi-symptom palliative comfort care approach for hospice patients with chronic wounds at end-of-life. Further research is needed to establish the efficacy of the powder.
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Affiliation(s)
- M Madisetti
- Project Director, Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston SC 29425
| | - T J Kelechi
- Professor and David and Margaret Clare Endowed Chair, Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston SC 29425
| | - M Mueller
- Associate Professor, Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston SC 29425
| | - E J Amella
- Professor, Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston SC 29425
| | - M A Prentice
- Research Coordinator, Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston SC 29425
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13
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Abstract
Necrotizing soft tissue injury (NSTI) is rare with an impressively difficult and dangerous clinical course. While the importance of nutrition as part of the treatment plan for NSTI is recognized as essential to recovery, specific recommendations have not been elucidated. A review of the evidence-based guidelines and published research to accomplish wound healing is presented. The nutrition considerations in the setting of organ failure are also discussed. This article outlines a complicated case of a septic, malnourished man with Fournier's gangrene and acute kidney injury. Protein loss from exudate extracted from a negative-pressure vacuum helped estimate the amount of protein needed to accomplish wound healing and guide clinical care. Development of acute kidney injury resulted in protein restriction at the request of the consulting renal service. This restriction led to insufficient protein intake to meet needs required for wound healing as evidenced by a nitrogen balance study and analysis of wound exudate. The estimated daily protein losses through the wound were within 11-26 g protein (2-4 g nitrogen) per day. Inclusion of wound exudate nitrogen loss in nitrogen balance analyses helped resolve conflicting treatment approaches. Estimating protein loss from wound exudate allows for individualization of protein requirements.
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Affiliation(s)
- Desiree Gregg
- 1 James A. Haley Veterans' Hospital, Tampa, Florida, USA.,2 St. Joseph's Hospital, Tampa, Florida, USA
| | - Lynn Hiller
- 1 James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Peter Fabri
- 1 James A. Haley Veterans' Hospital, Tampa, Florida, USA.,3 University of South Florida, Tampa, Florida, USA
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14
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Abstract
A survey was undertaken with the aim of identifying health professionals' understanding of wound exudate and their ability to assess and manage it. The survey was carried out at Wound Expo, which is a large annual event that provides generalist nurses with interactive education on the core aspects of wound care, including wound exudate. The sample comprised 223 delegates. Almost all delegates (89%) included exudate in every wound assessment, but only 20% based assessment of excess exudate on colour, viscosity and malodour, with the majority (67%) basing it on leakage and increased frequency of dressing changes. While almost all (94%) delegates said they always assess exudate colour and most (80%) that they always assess its viscosity, 18% did not understand the clinical significance of exudate colour and 29% were unable to correctly identify the characteristics of low-viscosity exudate. Furthermore, one quarter of the sample did not always take absorbency into account when selecting a wound dressing. The results indicate that exudate assessment is often subjective, and there is scope for greater use of wound exudate assessment tools and exudate descriptors.
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Affiliation(s)
- Joy Tickle
- Tissue Viability Specialist, Shropshire Community NHS Trust
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15
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Sismaet HJ, Banerjee A, McNish S, Choi Y, Torralba M, Lucas S, Chan A, Shanmugam VK, Goluch ED. Electrochemical detection of Pseudomonas in wound exudate samples from patients with chronic wounds. Wound Repair Regen 2016; 24:366-72. [PMID: 26815644 PMCID: PMC4853203 DOI: 10.1111/wrr.12414] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/23/2016] [Indexed: 01/13/2023]
Abstract
In clinical practice, point-of-care diagnostic testing has progressed rapidly in the last decade. For the field of wound care, there is a compelling need to develop rapid alternatives for bacterial identification in the clinical setting, where it generally takes over 24 hours to receive a positive identification. Even new molecular and biochemical identification methods require an initial incubation period of several hours to obtain a sufficient number of cells prior to performing the analysis. Here we report the use of an inexpensive, disposable electrochemical sensor to detect pyocyanin, a unique, redox-active quorum sensing molecule released by Pseudomonas aeruginosa, in wound fluid from patients with chronic wounds enrolled in the WE-HEAL Study. By measuring the metabolite excreted by the cells, this electrochemical detection strategy eliminates sample preparation, takes less than a minute to complete, and requires only 7.5 μL of sample to complete the analysis. The electrochemical results were compared against 16S rRNA profiling using 454 pyrosequencing. Blind identification yielded 9 correct matches, 2 false negatives, and 3 false positives giving a sensitivity of 71% and specificity of 57% for detection of Pseudomonas. Ongoing enhancement and development of this approach with a view to develop a rapid point-of-care diagnostic tool is planned.
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Affiliation(s)
- Hunter J. Sismaet
- Department of Chemical Engineering, Northeastern University, 360 Huntington Ave, 313 Snell Engineering, Boston, MA 02115 USA
| | - Anirban Banerjee
- Division of Rheumatology, Ideas to Health Laboratory, The George Washington University, School of Medicine and Health Sciences, 701 Ross Hall, 2300 Eye Street, NW, Washington, DC 20037
| | - Sean McNish
- Division of Rheumatology, Ideas to Health Laboratory, The George Washington University, School of Medicine and Health Sciences, 701 Ross Hall, 2300 Eye Street, NW, Washington, DC 20037
| | - Yongwook Choi
- The J. Craig Venter Institute, 9704 Medical Center Drive, Rockville, MD, 20850
| | - Manolito Torralba
- The J. Craig Venter Institute, 9704 Medical Center Drive, Rockville, MD, 20850
| | - Sarah Lucas
- The J. Craig Venter Institute, 9704 Medical Center Drive, Rockville, MD, 20850
| | - Agnes Chan
- The J. Craig Venter Institute, 9704 Medical Center Drive, Rockville, MD, 20850
| | - Victoria K. Shanmugam
- Division of Rheumatology, Ideas to Health Laboratory, The George Washington University, School of Medicine and Health Sciences, 701 Ross Hall, 2300 Eye Street, NW, Washington, DC 20037
| | - Edgar D. Goluch
- Department of Chemical Engineering, Northeastern University, 360 Huntington Ave, 313 Snell Engineering, Boston, MA 02115 USA
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