Scalise A, Bianchi A, Tartaglione C, Bolletta E, Pierangeli M, Torresetti M, Marazzi M, Di Benedetto G
Department of Plastic and Reconstructive Surgery, Università Politecnica delle, Marche, Ancona, Italy.
Department of Plastic and Reconstructive Surgery, Università Politecnica delle, Marche, Ancona, Italy.
Semin Vasc Surg. 2015 Sep-Dec;28(3-4):151-9. doi: 10.1053/j.semvascsurg.2016.01.003. Epub 2016 Jan 21.
Wound healing is a systemic response to injury that impacts the entire body and not just the site of tissue damage; it represents one of the most complex biological processes. Our knowledge of wound healing continues to evolve and it is now clear that the wound microenvironment plays a crucial role. The interactions between cells and the surface microenvironment, referred to as the "biofilm," contributes to skin homeostasis and healing. Understanding the functional complexity of the wound microenvironment informs how various factors such as age, ischemia, or bacterial infections can impair or arrest the normal healing processes, and it also allows for the possibility of acting therapeutically on healing defects with microenvironment manipulation. Microbes represent a particularly important factor for influencing the wound microenvironment and therefore wound healing. Moreover, the role of infections, particularly those that are sustained by biofilm-forming bacteria, is mutually related to other microenvironment aspects, such as humidity, pH, metalloproteinases, and reactive oxygen species, on which the modern research of new therapeutic strategies is focused. Today, chronic wounds are a rapidly growing health care burden and it is progressively understood that many non-healing wounds might benefit from therapies that target microorganisms and their biofilm communities. There is no doubt that host factors like perfusion impairments, venous insufficiency, pressure issues, malnutrition, and comorbidities strongly impact the healing processes and therefore must be targeted in the therapeutic management, but this approach might be not enough. In this article, we detail how bacterial biofilms and related factors impair wound healing, the reasons they must be considered a treatment target that is as important as the host's local and systemic pathologic conditions, and the latest therapeutic strategies derived from the comprehension of the wound microenvironment.
伤口愈合是机体对损伤的一种全身性反应，影响的是整个身体而非仅仅是组织损伤部位；它是最复杂的生物过程之一。我们对伤口愈合的认识在不断发展，现在很清楚伤口微环境起着关键作用。细胞与被称为“生物膜”的表面微环境之间的相互作用有助于皮肤的稳态和愈合。了解伤口微环境的功能复杂性有助于我们理解诸如年龄、缺血或细菌感染等各种因素如何损害或阻止正常愈合过程，同时也使得通过操纵微环境来治疗愈合缺陷成为可能。微生物是影响伤口微环境进而影响伤口愈合的一个特别重要的因素。此外，感染的作用，尤其是由形成生物膜的细菌所引发的感染，与其他微环境因素相互关联，如湿度、pH值、金属蛋白酶和活性氧，而新型治疗策略的现代研究正是聚焦于这些因素。如今，慢性伤口给医疗保健带来的负担正在迅速增加，人们越来越认识到许多不愈合的伤口可能会从针对微生物及其生物膜群落的治疗中受益。毫无疑问，诸如灌注障碍、静脉功能不全、压力问题、营养不良和合并症等宿主因素会强烈影响愈合过程，因此在治疗管理中必须针对这些因素，但这种方法可能还不够。在本文中，我们详细阐述细菌生物膜及相关因素如何损害伤口愈合，为何必须将它们视为与宿主局部和全身病理状况同等重要的治疗靶点，以及基于对伤口微环境的理解而产生的最新治疗策略。
