Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N3M5, Canada.
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S1A8, Canada.
Int J Mol Sci. 2020 Jun 29;21(13):4604. doi: 10.3390/ijms21134604.
Burns in the elderly continue to be a challenge despite advances in burn wound care management. Elderly burn patients continue to have poor outcomes compared to the younger population. This is secondary to changes in the quality of the aged skin, leading to impaired wound healing, aggravated immunologic and inflammatory responses, and age-related comorbidities. Considering the fast-growing elderly population, it is imperative to understand the anatomic, physiologic, and molecular changes of the aging skin and the mechanisms involved in their wound healing process to prevent complications associated with burn wounds. Various studies have shown that stem cell-based therapies improve the rate and quality of wound healing and skin regeneration; however, the focus is on the younger population. In this paper, we start with an anatomical, physiological and molecular dissection of the elderly skin to understand why wound healing is delayed. We then review the potential use of stem cells in elderly burn wounds, as well as the mechanisms by which mesenchymal stem cell (MSCs)-based therapies may impact burn wound healing in the elderly. MSCs improve burn wound healing by stimulating and augmenting growth factor secretion and cell proliferation, and by modulating the impaired elderly immune response. MSCs can be used to expedite healing in superficial partial thickness burns and donor site wounds, improve graft take and prevent graft breakdown.
尽管烧伤创面处理管理取得了进展，但老年人烧伤仍然是一个挑战。与年轻人群相比，老年烧伤患者的预后仍然较差。这是由于老年皮肤的质量变化导致的，从而导致伤口愈合受损、免疫和炎症反应加重以及与年龄相关的合并症。考虑到快速增长的老年人口，了解衰老皮肤的解剖、生理和分子变化以及其伤口愈合过程中涉及的机制以预防与烧伤相关的并发症至关重要。各种研究表明，基于干细胞的疗法可提高伤口愈合和皮肤再生的速度和质量；然而，重点是年轻人群。在本文中，我们首先从解剖、生理和分子水平剖析老年皮肤，以了解为什么伤口愈合会延迟。然后，我们回顾了干细胞在老年烧伤创面中的潜在应用，以及间充质干细胞（MSCs）治疗可能影响老年烧伤创面愈合的机制。MSCs 通过刺激和增强生长因子分泌和细胞增殖，并调节受损的老年免疫反应来促进烧伤创面愈合。MSCs 可用于加速浅二度和供皮区创面的愈合，提高移植物成活率并防止移植物破裂。
