Tarlton John F, Munro Hugh S
Matrix Biology Research Group, University of Bristol, Langford, Bristol, UK; email:
First Water Ltd, Ramsbury, Marlborough, Wiltshire, UK.
Wounds. 2013 Feb;25(2):51-7.
With more than 6 million patients affected with them in the United States, chronic ulcers represent one of the greatest problems in wound care. High levels of corrosive proteases, particularly matrix metalloproteinases (MMPs), within the wound environment are thoughtto contribute to the persistence of these wounds through denaturation of connective tissue proteins crucial to healing progression. Therefore, there is considerable interest in protease modulation using wound dressings to promote healing in chronic wounds. Such modulation could be achieved by direct absorption of proteases, by depleting co- factors within the wound, or by release of protease inhibitors.
The aim of this study is to examine protease modulation of a range of dressings with different chemistries, particularly those having demonstrated efficacy in chronic wound healing.
XTRASORB® HCS (dressing A) and XTRASORB® Foam (dressing B) were able to modulate proteases by both direct absorption of MMPs and depleting metal ion co-factors, and resulted in complete elimination of protease activity in the assay used. Duoderm® (dressing C) was able to modulate proteases by direct absorption only, and not by co-factor depletion. Promogran® (dressing D) was able to reduce MMP activity, but this was shown to be pH dependant, with any protease modulation being lost at neutral pH. Neither Allevyn® (dressing E) nor Vigilon® (dressing F) were able to modulate proteases by any mechanism. None of the protease modulating dressings acted through the release of protease inhibitors.
Of the dressings studied, dressing A and dressing B were the most effective protease modulators due to their acting through 2 separate mechanisms. .
在美国，有超过600万患者受慢性溃疡影响，慢性溃疡是伤口护理中最严重的问题之一。伤口环境中高浓度的腐蚀性蛋白酶，特别是基质金属蛋白酶（MMPs），被认为通过使对愈合进程至关重要的结缔组织蛋白变性，导致这些伤口持续不愈。因此，人们对使用伤口敷料调节蛋白酶以促进慢性伤口愈合有着浓厚兴趣。这种调节可以通过直接吸收蛋白酶、耗尽伤口内的辅助因子或释放蛋白酶抑制剂来实现。
本研究的目的是检测一系列具有不同化学性质的敷料对蛋白酶的调节作用，特别是那些已证明对慢性伤口愈合有效的敷料。
XTRASORB® HCS（敷料A）和XTRASORB® Foam（敷料B）能够通过直接吸收MMPs和耗尽金属离子辅助因子来调节蛋白酶，并在所用检测中完全消除了蛋白酶活性。Duoderm®（敷料C）仅能通过直接吸收来调节蛋白酶，而不能通过耗尽辅助因子来调节。Promogran®（敷料D）能够降低MMP活性，但这被证明是pH依赖性的，在中性pH下任何蛋白酶调节作用都会丧失。Allevyn®（敷料E）和Vigilon®（敷料F）都不能通过任何机制调节蛋白酶。没有一种蛋白酶调节敷料是通过释放蛋白酶抑制剂起作用的。
在所研究的敷料中，敷料A和敷料B是最有效的蛋白酶调节剂，因为它们通过两种不同的机制起作用。
