Larouche Jacqueline, Sheoran Sumit, Maruyama Kenta, Martino Mikaël M
European Molecular Biology Laboratory Australia, Australian Regenerative Medicine Institute, Monash University, Victoria, Australia.
WPI Immunology Frontier Research Center, Osaka University, Osaka, Japan.
Adv Wound Care (New Rochelle). 2018 Jul 1;7(7):209-231. doi: 10.1089/wound.2017.0761.
The immune system plays a central role in orchestrating the tissue healing process. Hence, controlling the immune system to promote tissue repair and regeneration is an attractive approach when designing regenerative strategies. This review discusses the pathophysiology of both acute and chronic wounds and possible strategies to control the immune system to accelerate chronic wound closure and promote skin regeneration (scar-less healing) of acute wounds. Recent studies have revealed the key roles of various immune cells and immune mediators in skin repair. Thus, immune components have been targeted to promote chronic wound repair or skin regeneration and several growth factors, cytokines, and biomaterials have shown promising results in animal models. However, these novel strategies are often struggling to meet efficacy standards in clinical trials, partly due to inadequate drug delivery systems and safety concerns. Excess inflammation is a major culprit in the dysregulation of normal wound healing, and further limiting inflammation effectively reduces scarring. However, current knowledge is insufficient to efficiently control inflammation and specific immune cells. This is further complicated by inadequate drug delivery methods. Improving our understanding of the molecular pathways through which the immune system controls the wound healing process could facilitate the design of novel regenerative therapies. Additionally, better delivery systems may make current and future therapies more effective. To promote the entry of current regenerative strategies into clinical trials, more evidence on their safety, efficacy, and cost-effectiveness is also needed.
免疫系统在协调组织愈合过程中发挥着核心作用。因此，在设计再生策略时，控制免疫系统以促进组织修复和再生是一种具有吸引力的方法。本综述讨论了急性和慢性伤口的病理生理学，以及控制免疫系统以加速慢性伤口愈合和促进急性伤口皮肤再生（无瘢痕愈合）的可能策略。最近的研究揭示了各种免疫细胞和免疫介质在皮肤修复中的关键作用。因此，免疫成分已成为促进慢性伤口修复或皮肤再生的靶点，并且几种生长因子、细胞因子和生物材料在动物模型中已显示出有前景的结果。然而，这些新策略在临床试验中往往难以达到疗效标准，部分原因是药物递送系统不足和安全性问题。过度炎症是正常伤口愈合失调的主要原因，有效限制炎症可进一步减少瘢痕形成。然而，目前的知识不足以有效控制炎症和特定免疫细胞。药物递送方法不足使这一情况更加复杂。增进我们对免疫系统控制伤口愈合过程的分子途径的理解，可能有助于设计新的再生疗法。此外，更好的递送系统可能会使当前和未来的疗法更有效。为了促进当前再生策略进入临床试验，还需要更多关于其安全性、疗效和成本效益的证据。
