Wound Repair and Regeneration最新文献

Venous ulcers are among the most common chronic wounds, considerably impacting quality of life and causing substantial economic burden. This study aimed to determine if race and ethnicity are predictors for ulceration among ambulatory patients with venous insufficiency. Physician-reported data were extracted from the National Ambulatory Medical Care Survey (NAMCS) collected between 2014 and 2019. An estimated 42.7 (95% Confidence Interval (CI) 39.9-45.5) million outpatient visits with a diagnosis of venous insufficiency, unspecified chronic wound, or varicose veins were included in the analysis. Patient race and ethnicity were not associated with differences in the likelihood of ulceration. However, venous ulceration was associated with the male sex (Adjusted Odds Ratio (aOR) 2.5; 95% CI 1.2-5.2, p = 0.02) and was more likely among visits with surgical specialties (aOR 5.2; 95% CI 2.1-13.4, p = 0.0005). While prior studies report greater chronic wound treatment rates among non-White racial minority patients, these findings do not demonstrate differences in ambulatory care for venous ulceration within nationally representative data.

This study investigates the potential of wound bed temperature, measured using an IR camera, to aid in the clinical assessment of chronic wounds. The study captured thermal images from 267 patients with chronic wounds (diabetic foot ulcers, pressure ulcers, venous leg ulcers and arterial ulcers) with corresponding photographic images and clinical data. Temperature measurements were extracted from thermal images, focusing on both the centre of the wound and the surrounding periwound skin. Statistical analyses were employed to evaluate the relationship between wound temperature distribution and clinical diagnosis. The results showed a strong correlation between wound centre temperature and the average temperature across the entire wound (R² = 0.977). This indicates that a single-point measurement is representative of the entire wound, simplifying wound temperature assessment. A fair correlation was found between the temperature difference between the wound and periwound and the clinician's assessment of infection status (Pearson coefficient = 0.32). The study concludes that thermal imaging holds promise as a supplementary tool for clinicians in assessing chronic wound status, especially in cases where infection is unclear. It is a low-cost, non-contact, and easy-to-use technique.

This study examines immune and inflammatory responses in draining wound fluid over the course of the early stages of wound healing in patients recovering from spinal fusion surgery. The inflammatory phase of wound healing is essential for setting the stage for successful tissue repair and preventing chronic or poorly healing wounds. Scoliosis can be idiopathic or occur secondary to neuromuscular disorders, which are known to be associated with poor wound healing outcomes. We hypothesised that neuromuscular scoliosis patients would exhibit differences in inflammatory wound healing markers compared to idiopathic scoliosis patients. Comparison of the cellular and cytokine contents of draining wound fluid revealed that several inflammatory cytokines were elevated in the neuromuscular scoliosis patient group compared to idiopathic, whereas the leukocyte contents were the same between groups. This study shows that draining wound fluid is a good source of cellular and soluble biomarkers for acute wound healing and can be used to determine changes in individuals at risk for wound healing complications.

We tested if hyperoxic conditions can reduce the proportion of active myofibroblasts, which are assumed to be a major driver of head and neck radiation-induced fibrosis, as measured by expression levels of pro-fibrotic genes. Radiated, non-cancerous soft tissue from the head and neck and skin/soft tissue from non-radiated flap donor site were collected from each patient. Myofibroblast density was quantified using immunofluorescence staining with α-SMA and DAPI and visualisation under confocal microscopy and compared between baseline non-radiated and radiated tissue from the same patient. From each tissue specimen, fibroblast cell lines were cultured and exposed to either normoxic, hypoxic, or hyperoxic conditions for 10 days. Total RNA was extracted and reverse-transcribed, and gene expression levels were quantified using RT-PCR. Relative gene expression levels of pro-fibrotic genes COL1A1, COL3A1, FN-EDA, α-SMA, HIF-1α, VEGFα, and VEGFR were compared between normoxic, hypoxic, and hyperoxic treatment groups. Three patients with six total tissue samples were acquired. Radiated tissue contained a higher density of myofibroblasts (calculated as cells/mm²) and demonstrated higher expression of pro-fibrotic genes than non-radiated donor site tissue. Hyperoxia decreases expression levels of pro-fibrotic genes in radiated and non-radiated tissue, while hypoxia increases pro-fibrotic gene expression levels in radiated and non-radiated tissue. Study findings indicate that hypoxia is a driver of myofibroblast activation and that subjects with radiation-induced fibrosis of the head and neck have increased expression of myofibroblastic phenotype. Hyperoxygenation can reduce the proportion of active myofibroblasts, revealing a potential therapeutic method to halt chronic fibrotic pathways.

Intralesional 5-fluorouracil (5-FU) injections are effective for treating keloid scars but are often associated with pain, hyperpigmentation and ulceration, limiting patient compliance. Dissolving microneedle (DMN) patches offer a novel, minimally invasive and potentially painless alternative for drug delivery. This study aimed to compare the efficacy and safety of 5-FU DMN patches with intralesional 5-FU injections for the treatment of keloid scars. A total of 37 patients were enrolled in this randomised, single-blind clinical trial. Each scar was split in half, with one half treated weekly using 5-FU DMN patches for 12 weeks and the other half receiving monthly intralesional 5-FU injections over the same period. Outcomes were assessed using the Patient and Observer Scar Assessment Scale (POSAS) and scar volume measurements via multispectral imaging at baseline and Weeks 4, 8, 12 and 24. Both treatments significantly improved POSAS scores and reduced keloid volume over time. Intralesional injections resulted in a faster response and significantly greater volume reduction at Week 12 (p = 0.008), but by Week 24, no significant difference in efficacy was observed between the two methods. DMN patches were associated with significantly less pain and better patient comfort. These findings support the use of 5-FU DMN patches as a minimally invasive, patient-friendly alternative to injections for the long-term management of keloid scars.

Histologic analyses of burn tissue are unable to discern reversible injury. Advanced molecular profiling, such as bulk RNA-sequencing, provides more detail; however, these methods lose spatial context. Spatial transcriptomics allows gene transcripts to be mapped to tissue locations, revealing the molecular pathways activated in the burn tissue microenvironment, where the depth of injury guides prognosis. This work demonstrates the capability of spatial transcriptomics to detect spatial gene expression patterns in burn tissue. Specifically, we show that (i) spatially variable expressed genes are distinct across different burn depth regions, which would not be identified with bulk RNA-sequencing, (ii) transcriptionally distinct burn tissue regions are defined by gene signatures associated with diverse cell types and biological pathways, and (iii) these spatial gene signatures are identified in a subset of previously published bulk samples, suggesting their potential application in large-scale and integrated studies. Caveats of this technology in burn tissue are provided to guide future research. This study highlights the promise of spatial transcriptomics to understand the human burn wound microenvironment and identify specific regions with regenerative potential that can be the target of tailored therapeutics, providing an alternative to imprecise excision and skin grafting.

Macrophages play a critical role in wound healing. Modulating macrophage activity has thus been identified as a potential strategy to stimulate immune-mediated tissue regeneration. This study utilised endotoxin tolerization as a strategy to dampen cytokine production upon the ex vivo activation of M2 monocytic cells before collecting their secretome for therapeutic application. The M2 derived secretome was harvested from GM-CSF differentiated THP-1 cells followed by IL4-induced M2 polarisation with or without prior endotoxin tolerization. The protein constituents of the secretome were determined and quantified using label free LC-MS/MS analysis and cytokine levels using enzyme-linked immunosorbent assays. The efficacy of the M2 derived secretome (with and without prior tolerization) to stimulate fibroblast activity was assessed in vitro (scratch assay) and in vivo (murine full thickness wound model). In culture, the secretome (regardless of tolerization) stimulated fibroblast migration and increased the release of hydroxyproline, which is an essential requirement for collagen synthesis. Similarly, in full thickness excisional wounds, a single application of the M2 monocytic cell secretory products post wounding significantly increased collagen deposition within the wounded area compared to controls. There was however no difference evident in the healing outcomes between the wounds treated with M2 monocytic cell derived secretome without tolerization and those treated with secretome derived from tolerized M2 monocytic cells. Despite its impact on ECM deposition in the wound bed, the secretome showed no benefit for superficial wound closure and did not improve the overall histology score. Taken together, the data suggest that M2 secretory products pose a risk for excessive scar formation.

Chronic wounds are a major healthcare problem, consuming resources globally and necessitating innovative wound dressing development. All antimicrobial wound dressings must be tested for safety and antibacterial effectiveness prior to patient use. This study aimed to develop a rapid, economical in vitro assay and biorelevant ex vivo wound biofilm model on porcine skin to test the antibacterial efficacy of antimicrobial wound dressings. The methods were validated using five commercially available wound dressings and experimental electrospun (ES) wound dressing containing chloramphenicol in polycaprolactone and polyethylene oxide fibres (PCL/PEO/CAM). An in vitro assay was used to assess the growth inhibition, killing efficacy, and dressing sterility against multiple bacterial strains and inoculum sizes. Ex vivo models using porcine skin were used to evaluate biofilm inhibition with dressings on top of or inside infected wounds. The in vitro assay allowed rapid initial screening, whilst ex vivo models provided more biorelevant conditions for understanding the efficacy in wound-mimicking environments. The assay and model are suitable for rapid evaluation of antimicrobial efficacy before animal studies and clinical trials. Using various commercially available wound dressings alongside novel dressings for validation ensures that the method is broadly applicable. The antibacterial efficacy of commercial antimicrobial wound dressings and experimental ES PCL/PEO/CAM fibre mat was confirmed. This study highlights the importance of using multiple complementary assays and models to comprehensively assess antimicrobial wound dressing materials.