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Unexpected Helpers in Wound Healing

Discussion in 'Diabetic Foot & Wound Management' started by NewsBot, Jan 24, 2018.

  1. NewsBot

    NewsBot The Admin that posts the news.

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    News release, 24 January 2018
    Unexpected Helpers in Wound Healing
    Nerve cells in the skin help wounds to heal. When an injury occurs, cells known as glial cells change into repair cells and disseminate into the wound, where they help the skin to regenerate, researchers from the University of Zurich have shown.

    An essential step in skin wound healing is wound closure, which is why shortly after an injury occurs, blood coagulates and seals the wound. For the injury to be able to heal permanently, however, the affected layers of the skin need to be newly formed. For that to happen, a complex, only partially understood interplay takes place between various cell types in our skin. Together with a team from ETH, Lukas Sommer, a professor in the Institute of Anatomy at the University of Zurich, and his research group have now been able to show that peripheral nerve cells play a central role in this healing process. The research group is part of “Skintegrity,” a flagship project of the University Medicine Zurich initiative.

    Glial cells change their identity
    There have long been indications that for optimal healing to occur, a tissue needs to be innervated (i.e. supplied with nerves). The reason, however, remained unclear. With the help of an animal model, the researchers from Skintegrity discovered that fine nerve bundles change drastically if they are injured when a skin wound occurs. Cells along the injured nerve bundles, known as glial cells, change their original identity and are reprogrammed to “repair cells.” They thereby lose their contact to the nerve bundles and disseminate into the wound bed. “There, they distribute a diverse cocktail of factors, which support the wound healing,” explains Lukas Sommer. Through genetic experiments, he was able to prove that, among other things, these repair cells were important to help the wound close as they support the necessary reconstitution of the dermis.

    Healing chronic wounds
    In older people or people with diabetes, for example, wounds often heal slowly or, in some cases, not at all. Such chronic wounds usually cause serious health problems and treatment is currently unsatisfactory. Interestingly, the researchers from Skintegrity also found reprogrammed peripheral nerve cells in human skin wounds. “Now we want to work together with clinicians from the University Hospital Zurich to better characterize the wound healing factors that are distributed by nerve cells,” says Sommer. “This may lead to an effective treatment for chronic wounds in the future.”

    Literature:
    Vadims Parfejevs, Julien Debbache, Olga Shakhova, Simon M. Schaefer, Mareen Glausch, Michael Wegner, Ueli Suter, Una Riekstina, Sabine Werner und Lukas Sommer. Injury-activated glial cells promote wound healing of the adult skin in mice. Nature Communications. January 16, 2018. DOI: 10.1038/s41467-017-01488-2.
     
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    NEWS RELEASE 15-SEP-2020
    A new approach to understanding the biology of wound healing
    Researchers use discarded wound dressings as a novel and non-invasive way to study the mechanisms that promote healing

    PHILADELPHIA - Our bodies frequently heal wounds, like a cut or a scrape, on their own. However patients with diabetes, vascular disease, and skin disorders, sometimes have difficulty healing. This can lead to chronic wounds, which can severely impact quality of life. The management of chronic wounds is a major cost to healthcare systems, with the U.S alone spending an estimated 10-20 billion dollars per year. Still, we know very little about why some wounds become chronic, making it hard to develop effective therapeutics to promote healing. New research from Jefferson describes a novel way to sample the cells found at wounds - using discarded wound dressings. This non-invasive approach opens a window into the cellular composition of wounds, and an opportunity to identify characteristics of wounds likely to heal versus those that become chronic, as well as inform the development of targeted therapies.

    The study was published in Scientific Reports on September 15th.

    "Studying wound healing in humans is very challenging, and we know very little about the process in humans," says Andrew South, PhD, Associate Professor in the Department of Dermatology and Cutaneous Biology and one of the lead authors of the study. "What we do know is from animal studies, and animal skin and the way it heals is very different from human skin."

    Dr. South and his lab study a group of inherited skin diseases called epidermolysis bullosa (EB), where wound healing is severely impaired. Patients, often from birth, suffer from blisters and lesions that are slow to heal, and some become chronic. In a subset of patients, chronic wounds are at high risk of developing into aggressive skin cancer. At this time, it is very difficult to predict which wounds in a given patient will heal, and which won't. Being able to sample the wounds is a key to understanding the mechanisms behind healing.

    "Performing a biopsy to sample the cells in the wound would help us understand the differences between these wounds," says Dr. South "But biopsy in these patients is extremely painful and could delay healing of the wound even further. On the other hand, collecting these bandages that are just going to be thrown away, it poses no harm to the patient, and can be applied to a variety of conditions where wounds don't heal properly."

    The researchers, which included collaborators in Chile and Austria, collected and analyzed 133 discarded wound dressings from 51 EB patients. Both acute and chronic wounds were sampled, with acute defined as present for 21 days or less, and chronic as present for more than 3 months.

    "Previous studies had used wound dressings or bandages to collect fluid and look at what proteins are in there," says Dr. South. "But no one has actually looked at what cells are present. Applying the techniques our lab frequently uses, we were able to isolate viable or living cells from the dressings."

    The researchers recovered a large number of cells from the dressings, often in excess of a 100 million. The larger the wound, and the more time a dressing was on a wound, the more number of cells were recovered.

    The researchers then characterized the cells to see what type of cells are present at the wound. They detected a variety of immune cells including lymphocytes, granulocytes or neutrophils, and monocytes or macrophages. When comparing dressings from acute and chronic wounds, they found a significantly higher number of neutrophils at chronic wound sites. Neutrophils are the first line of defense in our immune system, and when a wound starts to form, they're the first ones to arrive at the scene.

    "Previous findings from animal studies and protein analysis of human wound dressings had supported the idea that when neutrophils hang around longer than they should, that stalls the healing process and can lead to chronicity," says Dr. South. "Our findings support that theory more definitively, by showing that chronic wounds are characterized by higher levels of neutrophils."

    These findings give more insight into wound healing, and could help develop therapies that promote the process; for instance, those that neutralize excess neutrophils, or recruit macrophages, the immune cells that begin the next stage in healing after neutrophils.

    The researchers now plan to expand on their technique, by further analyzing the individual cells collected from the wound dressings, and the genetic material inside them. "Currently we're working with colleagues in Santiago, Chile on collecting dressings from EB patients over a period of time," says Dr. South. "This allows us to follow patients longitudinally, and observe a wound and how its cellular composition changes as it heals or doesn't heal."

    The team hopes that this will reveal genetic markers that can predict healing or chronicity.

    "This method of sampling could be an alternative to bothersome swabs or blood draws, which are especially hard to do in newborns," says Dr. South. "Since we know EB can present at birth, this technique could give us really early insight into the how severe the disease might be."

    While the current study focuses on EB, Dr. South and his colleagues hope that this technique can be applied to a variety of other conditions, such as diabetic foot ulcers and vascular leg ulcers.

    "The field of wound healing has been crying out for a better understanding of what drives a chronic wound," says Dr. South. "This technique could be transformative, and eventually help patients live more comfortable and healthy lives."
     
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