Wound Repair and Regeneration最新文献

Optimal healing of full-thickness skin wounds remains a clinical challenge. While current skin substitutes aid burn wound management, there is still a need to effectively minimize scarring. Therefore, we developed type I collagen scaffolds with covalently bound ReGeneraTing Agent (RGTA) OTR4120 (OTR), a synthetic heparan sulphate analogue resistant to glycanase degradation (Col I + OTR). To further stimulate skin regeneration, collagen scaffolds with and without OTR4120 were subsequently loaded with sonic hedgehog (SHH), a key effector molecule in embryogenesis. The presence of OTR4120 and SHH in scaffolds was biochemically and histologically confirmed after crosslinking and sterilization. SHH was found deeper into collagen scaffolds in the presence of OTR4120. Addition of SHH to scaffolds showed lower expression of M1-like cell surface markers, while Col I + OTR significantly enhanced IL-10 production. The potential of OTR4120 in wound healing was further evaluated in vivo using a rat full-thickness wound model over 28 days. By day 14, macroscopic images revealed that OTR-treated wounds better maintained the original wound shape. Histological analysis showed increased blood vessel formation, fewer scaffold remnants and more contiguous sebaceous glands in the granulation tissue with Col I + OTR scaffolds. This study demonstrates that OTR4120 could be a promising addition to acellular skin substitutes for improving acute wound healing.

Globally, there are 537 million people with diabetes, with an estimated 19%-344% of these people developing a diabetic foot ulcer, and 10% dying within a year of being diagnosed with a diabetic foot ulcer. Risk factors for developing a diabetic foot ulcer include age, sex, ethnicity, chronically elevated HbA_1c, smoking history, cardiovascular disease, end-stage renal disease, and retinopathy. Diabetic foot ulcer recurrence rates are as high as 20%, and they have vast complications, including lower-extremity amputations. More recently, there has been a surge in the use of glucagon-like peptide 1 receptor agonists in managing diabetes and weight loss. The use of glucagon-like peptide 1 receptor agonists in treating diabetic foot ulcers in humans has not been extensively studied, but there are reports of using glucagon-like peptide 1 receptor agonists in other dermatologic diseases with positive outcomes, including androgenetic alopecia and hidradenitis suppurativa. This review aims to explore the potential of using systemic glucagon-like peptide 1 receptor agonists in managing diabetic foot ulcers, describing their effects on modulating wound repair, microvascular function, neuropathic symptoms, apoptosis, weight loss, oxidative stress, and inflammation. Additionally, a systematic review, following PRISMA guidelines, was conducted assessing the rate of diabetic foot complications in patients using glucagon-like peptide 1 receptor agonists when compared to a control group, with the results suggesting their potentially protective role. By managing multiple facets of diabetic foot ulcer pathophysiology, the use of glucagon-like peptide 1 receptor agonists may aid in their management and thus prevent recurrence.

The research underscores an important gap in the management of chronic wounds, which frequently exhibit resistance to standard therapies. Maggot debridement therapy shows promise in removing necrotic tissue; however, data comparing its efficacy to conventional treatments is limited. We conducted a systematic review and meta-analysis of randomised controlled trials to assess the effectiveness of maggot debridement therapy versus conventional therapies, including commonly used wound care interventions such as hydrogel dressings, compression therapy, vacuum-assisted closure (VAC) therapy, sharp debridement, and so on. The population was defined as patients with chronic wounds, including venous leg ulcers, arterial ulcers, mixed arterial-venous leg ulcers, diabetic foot ulcers, and full-thickness burns. Primary outcomes assessed were the proportion of wound healing and time to wound healing, while secondary outcomes were time to wound debridement, reduction of slough, infection-free rate, eradication of Staphylococcus aureus and Pseudomonas aeruginosa, and ulcer-related pain. Ten randomised controlled trials involving 839 participants were incorporated. Maggot debridement therapy markedly decreased the duration of wound debridement compared to conventional treatment (hazard ratio: 5.16, p = 0.0006) and showed a borderline significant reduction in slough during the first week (mean difference: 17.06, p = 0.05). Maggot debridement therapy and conventional treatment did not vary in the proportion of wound healing (p = 0.17), time to wound healing (p = 0.14), infection-free rates (p = 0.10), eradication of Staphylococcus aureus (p = 0.11) and Pseudomonas aeruginosa (p = 0.46), or ulcer-related pain (p = 0.54). Maggot debridement therapy may be an effective preliminary debridement technique for wound bed preparation in chronic wounds, especially before advanced interventions such as skin grafting, and is particularly advantageous for chronic wounds unresponsive to conventional therapies. Further research is required to confirm the findings.

Dipeptidyl-peptidase 4 inhibitors, DPP-4i, are an established antiglycaemic medication for Type 2 Diabetes. There has been a growing interest in DPP-4i's potential to improve wound healing and reduce fibrosis. The purpose of this study is to survey the current literature for applications of DPP-4i in wound healing and scars, and explore their potential outside of glycaemic control. A systematic review was performed by three independent reviewers according to PRISMA guidelines using PubMed, SCOPUS, Embase and Cochrane CENTRAL databases. Search terms were synonymous with 'DPP-4i', 'diabetic wounds', 'wound healing', 'scars' and 'skin'. Studies that used DPP-4i in the context of wound healing, scarring, or psoriasis were included for data extraction. A total of 2139 articles were screened, resulting in 31 human, animal and in vitro studies. Human studies showed DPP-4i led to faster wound closure rates, clinical improvement in psoriasis and a reduced risk of keloid formation after sternotomy. In vitro studies reported an increase in cell migration, proliferation and angiogenesis with DPP-4 inhibition. DPP-4i was found to attenuate markers of fibrosis in multiple wound healing models and downregulate TGF-β, pSmad2/3, α-SMA, Col1, Col3 and downstream effectors of the MAPK-NF-κB pathway. This systematic review is the first to summarise and shed light on DPP-4i therapeutic benefits for wound healing and scarring. In multiple in vitro, animal and human studies, DPP-4i have a net positive effect on cutaneous healing. Further studies are needed to reveal the specific molecular pathways through which DPP-4 exerts its effects, particularly in relation to wound healing, scar formation and angiogenesis.

Diabetes is a chronic metabolic disorder characterised by elevated blood glucose levels, leading to widespread systemic and localised complications, including weakened wound healing. Diabetic wounds, particularly diabetic foot ulcers (DFUs), are related to delayed healing, chronic inflammation, and increased risk of amputation. Key pathological factors include hyperglycemia-induced oxidative stress, neuropathy, immune dysfunction, and impaired angiogenesis. Among various therapeutic approaches, topical insulin has emerged as a promising strategy to accelerate wound repair in diabetic patients. Insulin's ability to regulate glucose metabolism, promote angiogenesis, and stimulate cellular repair mechanisms underscores its potential role in tissue regeneration. Recent advances in nanotechnology-based drug delivery systems (DDSs) have further improved the targeted delivery and sustained insulin release at wound sites. These nanotherapeutics enhance drug efficacy, cell specificity, and controlled release, fostering rapid and efficient tissue repair. Future research focusing on optimised formulations, personalised treatment approaches, and clinical validation could revolutionise the management of diabetic wounds, improve patient outcomes, and reduce complications associated with chronic diabetes.

To evaluate the impact of a nurse-led, multidisciplinary education programme on wound healing, patient knowledge, and adherence to compression therapy, physical activity, and nutrition in individuals with venous leg ulcers (VLU). In this randomised controlled trial, 87 patients with VLU from three outpatient clinics in Western Switzerland were allocated to an intervention group (IG) receiving structured education plus standard care, or a control group (CG) receiving standard care alone. The 12-month intervention included in-person education, counselling, and follow-ups. The primary outcome was complete wound closure at 12 months. Secondary outcomes included wound area reduction, patient knowledge, adherence behaviours, and ulcer recurrence. At 12 months there was no significant difference in complete wound closure between groups (p = 0.668). Wound area reduction was significantly greater in the IG at 1 month (54.0% vs. 35.6%, p = 0.041). The IG showed earlier and greater improvements in knowledge, self-efficacy, and adherence to compression therapy and mobility. No significant differences in nutritional behaviour or body weight were observed. Nurse-led education improved early healing and patient engagement. Sustained behaviour change may require longer-term support and targeted nutritional interventions. Future research should explore adaptive education models and digital tools for long-term VLU management.