Differential Therapeutic Effect of Extracellular Vesicles Derived by Bone Marrow and Adipose Mesenchymal Stem Cells on Wound Healing of Diabetic Ulcers and Correlation to Their Cargoes

Extracellular vesicles (EVs) derived from mesenchymal stem cells isolated from both bone marrow (BMSCs) and adipose tissue (ADSCs) show potential therapeutic effects. These vesicles often show a similar beneficial effect on tissue regeneration, but in some contexts, they exert different biological properties. To date, a comparison of their molecular cargo that could explain the different biological effect is not available. Here, we demonstrated that ADSC-EVs, and not BMSC-EVs, promote wound healing on a murine model of diabetic wounds. Besides a general similarity, the bioinformatic analysis of their protein and miRNA cargo highlighted important differences between these two types of EVs. Molecules present exclusively in ADSC-EVs were highly correlated to angiogenesis, whereas those expressed in BMSC-EVs were preferentially involved in cellular proliferation. Finally, in vitro analysis confirmed that both ADSC and BMSC-EVs exploited beneficial effect on cells involved in skin wound healing such as fibroblasts, keratinocytes and endothelial cells, but through different cellular processes. Consistent with the bioinformatic analyses, BMSC-EVs were shown to mainly promote proliferation, whereas ADSC-EVs demonstrated a major effect on angiogenesis. Taken together, these results provide deeper comparative information on the cargo of ADSC-EVs and BMSC-EVs and the impact on regenerative processes essential for diabetic wound healing.     

Human Mesenchymal Stromal Cell-Derived Exosomes Promote In Vitro Wound Healing by Modulating the Biological Properties of Skin Keratinocytes and Fibroblasts and Stimulating Angiogenesis

Bone marrow-derived mesenchymal stromal cells (MSCs) are major players in regenerative therapies for wound healing via their paracrine activity, mediated partially by exosomes. Our purpose was to test if MSC-derived exosomes could accelerate wound healing by enhancing the biological properties of the main cell types involved in the key phases of this process. Thus, the effects of exosomes on (i) macrophage activation, (ii) angiogenesis, (iii) keratinocytes and dermal fibroblasts proliferation and migration, and (iv) the capacity of myofibroblasts to regulate the turnover of the extracellular matrix were evaluated. The results showed that, although exosomes did not exhibit anti-inflammatory properties, they stimulated angiogenesis. Exposure of keratinocytes and dermal (myo)fibroblasts to exosomes enhanced their proliferation and migratory capacity. Additionally, exosomes prevented the upregulation of gene expression for type I and III collagen, α-smooth muscle actin, and MMP2 and 14, and they increased MMP13 expression during the fibroblast–myofibroblast transition. The regenerative properties of exosomes were validated using a wound healing skin organotypic model, which exhibited full re-epithelialization upon exosomes exposure. In summary, these data indicate that exosomes enhance the biological properties of keratinocytes, fibroblasts, and endothelial cells, thus providing a reliable therapeutic tool for skin regeneration.     

In Vitro Wound Healing Properties of Novel Acidic Treatment Regimen in Enhancing Metabolic Activity and Migration of Skin Cells

Strategies that alter the pH of wounds to improve healing outcomes are an emerging area of interest. Currently, there is limited understanding of the effect of hydrogen (H⁺) on the functionality of skin cells during proliferation and migration, highlighting the need for research to determine the effect of pH during wound healing. This study aimed to determine the effect of acidification on the metabolic activity and migration of human immortalized keratinocytes (HaCaT) and human foreskin fibroblasts (HFF). In vitro models were used with phosphoric and citric acid buffers at a pH range between 3 and 7. Our results showed that cells were more viable in buffers with low rather than high ionic strength. A time-dependent effect of the acidification treatment was also observed with cell metabolic activity varying with treatment duration and frequency. Our results showed that a 24 h treatment and subsequent resting phase significantly improved cell proliferation and migration. This in vitro study is the first to establish a correlation between the role of acidic pH, molarity and treatment regimen in cellular activity. Our data demonstrated a positive effect of acidic pH on cell metabolic activity and migration rate, suggesting a clinical potential in indications such as wound healing.     

Keratin-Alginate Sponges Support Healing of Partial-Thickness Burns

Deep partial-thickness burns damage most of the dermis and can cause severe pain, scarring, and mortality if left untreated. This study serves to evaluate the effectiveness of crosslinked keratin–alginate composite sponges as dermal substitutes for deep partial-thickness burns. Crosslinked keratin–alginate sponges were tested for the ability to support human dermal fibroblasts in vitro and to support the closure and healing of partial-thickness burn wounds in Sus scrofa pigs. Keratin–alginate composite sponges supported the enhanced proliferation of human dermal fibroblasts compared to alginate-only sponges and exhibited decreased contraction in vitro when compared to keratin only sponges. As dermal substitutes in vivo, the sponges supported the expression of keratin 14, alpha-smooth muscle actin, and collagen IV within wound sites, comparable to collagen sponges. Keratin–alginate composite sponges supported the regeneration of basement membranes in the wounds more than in collagen-treated wounds and non-grafted controls, suggesting the subsequent development of pathological scar tissues may be minimized. Results from this study indicate that crosslinked keratin–alginate sponges are suitable alternative dermal substitutes for clinical applications in wound healing and skin regeneration.     

Silver nanoparticle incorporated poly(l‐lactide‐co‐glycolide) nanofibers: Evaluation of their biocompatibility and antibacterial properties

The objective of this work is the fabrication of poly(l ‐lactide‐co‐glycolide) or PLGA (with LA/GA ratios of 50/50 and 75/25) nanofibers containing silver nanoparticles (AgNPs) by the method of electrospinning. The incorporation of AgNPs in PLGA was carried out in three different concentrations (1, 3, 6 w/w %).The electrospun nanofibers were evaluated for their morphology by scanning electron microscopy and their fiber diameters ranged between 487 and 781 nm. Integration of AgNPs within the fibers was verified by spectroscopy studies, while the mechanical properties of the developed fibers were found comparable to the mechanical properties of the human skin. Proliferation of human dermal fibroblasts (HDF) demonstrated minimal cytotoxicity on fibers containing 1 wt % and 3 wt % of AgNPs, while 6 wt % of AgNPs inhibited cell proliferation. Antimicrobial activity was studied using three different strains of Gram‐positive and Gram‐negative bacteria. Results of the HDF proliferation and antimicrobial studies showed that the electrospun PLGA75/25 containing 3 wt % AgNP can function as a suitable substrate for wound dressing, compared to the other scaffolds of this study. © 2015 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2015 , 132, 42686.     

A Dual-Acting Nitric Oxide Donor and Phosphodiesterase 5 Inhibitor Activates Autophagy in Primary Skin Fibroblasts

Wound healing pathologies are an increasing problem in ageing societies. Chronic, non-healing wounds, which cause high morbidity and severely reduce the quality of life of affected individuals, are frequently observed in aged individuals and people suffering from diseases affected by the Western lifestyle, such as diabetes. Causal treatments that support proper wound healing are still scarce. Here, we performed expression proteomics to study the effects of the small molecule TOP-N53 on primary human skin fibroblasts and keratinocytes. TOP-N53 is a dual-acting nitric oxide donor and phosphodiesterase-5 inhibitor increasing cGMP levels to support proper wound healing. In contrast to keratinocytes, which did not exhibit global proteome alterations, TOP-N53 had profound effects on the proteome of skin fibroblasts. In fibroblasts, TOP-N53 activated the cytoprotective, lysosomal degradation pathway autophagy and induced the expression of the selective autophagy receptor p62/SQSTM1. Thus, activation of autophagy might in part be responsible for beneficial effects of TOP-N53.     

Extracellular Nucleotides Affect the Proangiogenic Behavior of Fibroblasts,Keratinocytes, and Endothelial Cells

Chronic wound healing is currently a severe problem due to its incidence and associated complications. Intensive research is underway on substances that retain their biological activity in the wound microenvironment and stimulate the formation of new blood vessels critical for tissue regeneration. This group includes synthetic compounds with proangiogenic activity. Previously, we identified phosphorothioate analogs of nucleoside 5′-O-monophosphates as multifunctional ligands of P2Y6 and P2Y14 receptors. The effects of a series of unmodified and phosphorothioate nucleotide analogs on the secretion of VEGF from keratinocytes and fibroblasts, as well as their influence on the viability and proliferation of keratinocytes, fibroblasts, and endothelial cells were analyzed. In addition, the expression profiles of genes encoding nucleotide receptors in tested cell models were also investigated. In this study, we defined thymidine 5′-O-monophosphorothioate (TMPS) as a positive regulator of angiogenesis. Preliminary analyses confirmed the proangiogenic potency of TMPS in vivo.     

In vitro and in vivo investigational studies of a nanocomposite‐hydrogel‐based dressing with a silver‐coated chitosan wafer for full‐thickness skin wounds

A nanocomposite reservoir‐type hydrogel dressing of poly vinyl alcohol (PVA) was fabricated by a freeze–thaw method and loaded with silver‐nanoparticle‐coated chitosan wafers (Ag–CHWs). The Ag–CHWs were synthesized by a sonication technique with silver nitrate (AgNO₃) and chitosan powder. Scanning electron microscopy images showed silver nanoparticles (AgNPs) with a size range of 10 ± 4 nm on the surface of the chitosan wafers, and the antibacterial efficacy (minimum inhibitory concentration) of the Ag–CHWs was measured against Pseudomonas aeruginosa (32 µg/mL), Staphylococcus aureus, (30 µg/mL) and Escherichia coli (32 µg/mL). The antimicrobial PVA hydrogel showed an improved tensile strength (～0.28 MPa) and gel content (～92%) in comparison with the blank hydrogels. Full‐thickness‐excision wound studies of the nanocomposite dressing on Wistar rats revealed enhanced wound contraction, improved inflammation response, re‐epithelization rate, neoangiogenesis, and granulation tissue formation in comparison to the control group. A flexible, biocompatible, nanocomposite reservoir dressing not only established the chitosan as a stabilizer but also proved the efficacious and safe utility of AgNPs toward chronic wound management. © 2016 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2016 , 133, 43472.     

The Ambivalent Role of Skin Microbiota and Adrenaline in Wound Healing and the Interplay between Them

After skin injury, wound healing sets into motion a dynamic process to repair and replace devitalized tissues. The healing process can be divided into four overlapping phases: hemostasis, inflammation, proliferation, and maturation. Skin microbiota has been reported to participate in orchestrating the wound healing both in negative and positive ways. Many studies reported that skin microbiota can impose negative and positive effects on the wound. Recent findings have shown that many bacterial species on human skin are able to convert aromatic amino acids into so-called trace amines (TAs) and convert corresponding precursors into dopamine and serotonin, which are all released into the environment. As a stress reaction, wounded epithelial cells release the hormone adrenaline (epinephrine), which activates the β2-adrenergic receptor (β2-AR), impairing the migration ability of keratinocytes and thus re-epithelization. This is where TAs come into play, as they act as antagonists of β2-AR and thus attenuate the effects of adrenaline. The result is that not only TAs but also TA-producing skin bacteria accelerate wound healing. Adrenergic receptors (ARs) play a key role in many physiological and disease-related processes and are expressed in numerous cell types. In this review, we describe the role of ARs in relation to wound healing in keratinocytes, immune cells, fibroblasts, and blood vessels and the possible role of the skin microbiota in wound healing.     

Nitrofurazone‐loaded PVA–PEG semi‐IPN for application as hydrogel dressing for normal and burn wounds

Hydrogels have been used in a wide variety of biomedical devises, particularly in the field of drug delivery, tissue engineering, and wound healing. In this study, a polyvinyl alcohol (PVA)–polyethylene glycol (PEG) semi‐interpenetrating hydrogel network (IPN)‐based wound dressing system containing nitrofurazone (NFZ) was synthesized by chemical crosslinking technique. The introduction of PEG to PVA matrix led to reduction in the water vapor transmission rate, which in‐turn resulted in improved healing activity. Drug‐loaded IPNs were prepared by mixing aqueous solution of NFZ with the optimized PVA–PEG formulation subsequent to the crosslinking step. The in vitro diffusion studies of NFZ indicated a relatively slow release of drug resulting from its microencapsulation in the polymeric matrix. Subsequently, in vivo wound healing efficacy toward acute and burn wound healing in experimental rats was investigated. Semi‐IPN hydrogel loaded with NFZ dressing improved the overall healing rate in both acute and burn wounds, as evidenced by significant increase in total protein, hydroxyproline and hexosamine contents. Histological examinations also correlated well with the biochemical findings. A faster wound contraction was also observed in hydrogel treated acute and burn wounds. The results indicated that PVA–PEG semi‐IPN hydrogel based dressing systems containing NFZ could be used as an effective wound dressing material. © 2012 Wiley Periodicals, Inc. J. Appl. Polym. Sci., 2013     

Phloroglucinol Derivative Carbomer Hydrogel Accelerates MRSA-Infected Wounds’ Healing

Globally, wound infection is considered to be one of the major healthcare problems, with bacterial infections being the most critical threat, leading to poor and delayed wound healing, and even death. As a superbug, methicillin-resistant Staphylococcus aureus (MRSA) causes a profound hazard to public health safety, prompting us to search for alternative treatment approaches. Herein, the MTT test and Hoechst/propidium iodide (PI) staining demonstrated that PD was slightly less toxic to human fibroblasts including Human keratinocytes (HaCaT) cell line than Silver sulfadiazine (SSD), and Vancomycin (Van). In the MRSA-infected wound model, PD hydrogel (1%, 2.5%) was applied with for 14 days. The wound healing of PD hydrogel groups was superior to the SSD, Van, and control groups. Remarkably, the experimental results showed that PD reduced the number of skin bacteria, reduced inflammation, and upregulated the expression of PCNA (keratinocyte proliferation marker) and CD31 (angiogenesis manufacturer) at the wound site by histology (including hematoxylin–eosin (HE) staining, Masson staining) and immunohistochemistry. Additionally, no toxicity, hemocompatibility or histopathological changes to organs were observed. Altogether, these results suggested the potential of PD hydrogel as a safe, effective, and low toxicity hydrogel for the future clinical treatment of MRSA-infected wounds.     

Development of Novel Green Synthesized Silver Nanoparticles with Superior Antibacterial and Wound Healing Properties in Nursing Care After Rectal Surgery

The present investigation showed the green synthesis of silver nanoparticles (AgNPs) using Ficus benghalensis (F. benghalensis) leaf extract. UV–Vis spectra of the biofabricated AgNPs displayed its maximum peak of absorption at 461 nm. High resolution-transmission electron microscopy images displayed the shape of AgNPs as spherical with an average diameter of 35 nm size. The analysis of X-ray diffraction confirmed the presence of crystalline AgNPs. The analysis of Fourier-transform infrared spectroscopy confirmed the existence of bioconstituents such as terpenoids, phenolics and flavonoids, which functions as bio-reducing agents. When compared with F. benghalensis extract, AgNPs displayed the considerably greater bioactivities. The exceptional antimicrobial functionalities of AgNPs against both the gram positive and gram negative bacteria makes them appropriate candidates for the production of antibiotics against the species that are resistant to traditional antibiotics. The assay of HDFa cell scratch confirmed that the AgNPs have greater ability of wound healing than the leaf extract of F. benghalensis. Altogether, the obtained results showed the application of synthesized AgNPs in the production of novel drugs that are used for wound healing in nursing care after rectal surgery.

     

Effects of the Novel Compound DK223 ([1E,2E-1,2-Bis(6-methoxy-2H-chromen-3-yl)methylene]hydrazine) on Migration and Proliferation of Human Keratinocytes and Primary Dermal Fibroblasts

Wound healing plays an important role in protecting the human body from external infection. Cell migration and proliferation of keratinocytes and dermal fibroblasts are essential for proper wound healing. Recently, several studies have demonstrated that secondary compounds produced in plants could affect skin cells migration and proliferation. In this study, we identified a novel compound DK223 ([1E,2E-1,2-bis(6-methoxy-2H-chromen-3-yl)methylene]hydrazine) that concomitantly induced human keratinocyte migration and dermal fibroblast proliferation. We evaluated the regulation of epithelial and mesenchymal protein markers, such as E-cadherin and Vimentin, in human keratinocytes, as well as extracellular matrix (ECM) secretion and metalloproteinase families in dermal fibroblasts. DK223 upregulated keratinocyte migration and significantly increased the epithelial marker E-cadherin in a time-dependent manner. We also found that reactive oxygen species (ROS) increased significantly in keratinocytes after 2 h of DK223 exposure, returning to normal levels after 24 h, which indicated that DK223 had an early shock effect on ROS production. DK223 also stimulated fibroblast proliferation, and induced significant secretion of ECM proteins, such as collagen I, III, and fibronectin. In dermal fibroblasts, DK223 treatment induced TGF-β1, which is involved in a signaling pathway that mediates proliferation. In conclusion, DK223 simultaneously induced both keratinocyte migration via ROS production and fibroblast proliferation via TGF-β1 induction.     

A poly(γ‐glutamic acid)‐based hydrogel loaded with superoxide dismutase for wound healing

The purpose of this study was to develop a poly(γ‐glutamic acid) (γ‐PGA)‐based hydrogel loaded with superoxide dismutase (SOD) to accelerate wound healing. First, γ‐PGA was modified with taurine (γ‐PGAS), and then the SOD‐loaded γ‐PGAS/γ‐PGA hydrogel (SOD‐PGAS/PGA‐H) was prepared by cross‐linking of ethylene glycol diglycidyl ether. The swelling behavior and water vapor transmission rate revealed that PGAS/PGA‐H could create a moist environment for wound surface. In vitro kinetics of SOD release showed that SOD released from PGAS/PGA‐H maintained high activity and SOD‐PGAS/PGA‐H effectively scavenged the superoxide anion. The results of our fibroblast proliferation experiments showed that PGAS/PGA‐H had good cytocompatibility. The effects of SOD‐PGAS/PGA‐H on wound healing were examined in a Type I diabetic rat model with full‐thickness wounds. Twenty‐one days after grafted to wounds, SOD‐PGAS/PGA‐H exhibited a higher rate of wound healing than control group and showed increased collagen deposition and epithelialization. SOD‐PGAS/PGA‐H seems to promote better wound healing and thus might be a promising candidate for wound healing management. © 2015 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2015 , 132, 42033.     

Advances in Nanotechnology towards Development of Silver Nanoparticle-Based Wound-Healing Agents

Since antiquity, silver-based therapies have been used in wound healing, wound care and management of infections to provide adequate healing. These therapies are associated with certain limitations, such as toxicity, skin discolouration and bacterial resistance, which have limited their use. As a result, new and innovative wound therapies, or strategies to improve the existing therapies, are sought after. Silver nanoparticles (AgNPs) have shown the potential to circumvent the limitations associated with conventional silver-based therapies as described above. AgNPs are effective against a broad spectrum of microorganisms and are less toxic, effective at lower concentrations and produce no skin discolouration. Furthermore, AgNPs can be decorated or coupled with other healing-promoting materials to provide optimum healing. This review details the history and impact of silver-based therapies leading up to AgNPs and AgNP-based nanoformulations in wound healing. It also highlights the properties of AgNPs that aid in wound healing and that make them superior to conventional silver-based wound treatment therapies.     

The Role of Calcium in Wound Healing

Skin injury is quite common, and the wound healing is a complex process involving many types of cells, the extracellular matrix, and soluble mediators. Cell differentiation, migration, and proliferation are essential in restoring the integrity of the injured tissue. Despite the advances in science and technology, we have yet to find the ideal dressing that can support the healing of cutaneous wounds effectively, particularly for difficult-to-heal chronic wounds such as diabetic foot ulcers, bed sores, and venous ulcers. Hence, there is a need to identify and incorporate new ideas and methods to design a more effective dressing that not only can expedite wound healing but also can reduce scarring. Calcium has been identified to influence the wound healing process. This review explores the functions and roles of calcium in skin regeneration and reconstruction during would healing. Furthermore, this review also investigates the possibility of incorporating calcium into scaffolds and examines how it modulates cutaneous wound healing. In summary, the preliminary findings are promising. However, some challenges remain to be addressed before calcium can be used for cutaneous wound healing in clinical settings.     

Evaluation of Wound Healing Activity of Salvianolic Acid B on In Vitro Experimental Model

Despite a wide range of bactericides and antiseptics, the treatment of chronic or complicated wounds is still a major challenge for modern medicine. Topical medications are the most sought-after new agents for use as treatment. The therapeutic concentration of their active substances is easy to achieve with the lowest possible burden on the patient’s body. This study assesses the effect of salvianolic acid B (Sal B) on the proliferation, migration, and production of collagen type III by fibroblasts, which are the most important processes in wound healing. The study was conducted on human gingival fibroblasts obtained from primary cell culture. The results showed that Sal B at a dose of 75 µg/mL increases the cell viability with significant stimulation of the cell migration as demonstrated in the wound healing assay, as well as an increase in the expression of collagen type III, which has great importance in the initial stages of wound scarring. The results obtained in the conducted studies and previous scientific reports on the antibacterial properties and low toxicity of Sal B indicate its high potential in wound healing.     

Hydrogel–silver nanoparticle composites: A new generation of antimicrobials

Design of consistant and eco‐friendly methods for the synthesis of silver nanoparticles (AgNPs) is a significant forward direction in the field of application of antibacterial bionanotechnology. One among the available options is hydrogel templates, which are highly useful to achieve this goal. This investigation involves the development of poly(acrylamide)/poly(vinyl alcohol) hydrogel–silver nanocomposites (HSNCs) to achieve AgNPs of ～2–3 nm size in gel networks. The nanocomposite synthesis process is quite convenient, direct, and very fast, and the obtained hydrogel AgNP composites can be used for antibacterial and wound dressing applications. All the nanocomposite aqueous solutions have shown absorption peaks at 420 nm in UV–visible absorption spectrum corresponding to the Plasmon absorbance of AgNPs. X‐ray diffraction spectrum of the HSNC exhibited 2θ values matching with silver nanocrystals. Transmission electron microscopy images of nanocomposites represent discrete AgNPs throughout the gel networks in the range of 2–3 nm. The developed nanocomposites were evaluated for antibacterial application on E. coli. © 2009 Wiley Periodicals, Inc. J Appl Polym Sci, 2010     

Polymerizable Skin Hydrogel for Full Thickness Wound Healing

The skin is the largest organ in the human body, comprising the main barrier against the environment. When the skin loses its integrity, it is critical to replace it to prevent water loss and the proliferation of opportunistic infections. For more than 40 years, tissue-engineered skin grafts have been based on the in vitro culture of keratinocytes over different scaffolds, requiring between 3 to 4 weeks of tissue culture before being used clinically. In this study, we describe the development of a polymerizable skin hydrogel consisting of keratinocytes and fibroblast entrapped within a fibrin scaffold. We histologically characterized the construct and evaluated its use on an in vivo wound healing model of skin damage. Our results indicate that the proposed methodology can be used to effectively regenerate skin wounds, avoiding the secondary in vitro culture steps and thus, shortening the time needed until transplantation in comparison with other bilayer skin models. This is achievable due to the instant polymerization of the keratinocytes and fibroblast combination that allows a direct application on the wound. We suggest that the polymerizable skin hydrogel is an inexpensive, easy and rapid treatment that could be transferred into clinical practice in order to improve the treatment of skin wounds.