Kotwal Girish J, Chien Sufan
Noveratech LLC, Louisville, KY, USA.
Department of Surgery, University of Louisville, School of Medicine, Louisville, KY, USA.
Results Probl Cell Differ. 2017;62:353-364. doi: 10.1007/978-3-319-54090-0_14.
Chronic wounds pose considerable public health challenges and burden. Wound healing is known to require the participation of macrophages, but mechanisms remain unclear. The M1 phenotype macrophages have a known scavenger function, but they also play multiple roles in tissue repair and regeneration when they transition to an M2 phenotype. Macrophage precursors (mononuclear cells/monocytes) follow the influx of PMN neutrophils into a wound during the natural wound-healing process, to become the major cells in the wound. Natural wound-healing process is a four-phase progression consisting of hemostasis, inflammation, proliferation, and remodeling. A lag phase of 3-6 days precedes the remodeling phase, which is characterized by fibroblast activation and finally collagen production. This normal wound-healing process can be accelerated by the intracellular delivery of ATP to wound tissue. This novel ATP-mediated acceleration arises due to an alternative activation of the M1 to M2 transition (macrophage polarization), a central and critical feature of the wound-healing process. This response is also characterized by an early increased release of pro-inflammatory cytokines (TNF, IL-1 beta, IL-6), a chemokine (MCP-1), an activation of purinergic receptors (a family of plasma membrane receptors found in almost all mammalian cells), and an increased production of platelets and platelet microparticles. These factors trigger a massive influx of macrophages, as well as in situ proliferation of the resident macrophages and increased synthesis of VEGFs. These responses are followed, in turn, by rapid neovascularization and collagen production by the macrophages, resulting in wound covering with granulation tissue within 24 h.
慢性伤口给公共卫生带来了巨大挑战和负担。已知伤口愈合需要巨噬细胞的参与,但其机制尚不清楚。M1表型巨噬细胞具有已知的清除功能,但当它们转变为M2表型时,在组织修复和再生中也发挥多种作用。在自然伤口愈合过程中,巨噬细胞前体(单核细胞/单核)跟随PMN中性粒细胞流入伤口,成为伤口中的主要细胞。自然伤口愈合过程是一个由止血、炎症、增殖和重塑组成的四阶段进程。在重塑阶段之前有一个3 - 6天的延迟期,其特征是成纤维细胞活化并最终产生胶原蛋白。通过将ATP细胞内递送至伤口组织可加速这种正常的伤口愈合过程。这种由ATP介导的新型加速现象源于M1向M2转变(巨噬细胞极化)的替代激活,这是伤口愈合过程的核心和关键特征。这种反应的特征还包括促炎细胞因子(TNF、IL - 1β、IL - 6)、趋化因子(MCP - 1)的早期释放增加,嘌呤能受体(几乎在所有哺乳动物细胞中发现的一类质膜受体)的激活,以及血小板和血小板微粒的产生增加。这些因素引发巨噬细胞的大量涌入,以及驻留巨噬细胞的原位增殖和VEGF合成增加。继而,这些反应之后是巨噬细胞迅速进行新血管生成和胶原蛋白产生,导致在24小时内伤口被肉芽组织覆盖。