Ambrose Lenuta, Dinu Ciprian Adrian, Gurau Gabriela, Maftei Nicoleta-Maricica, Matei Madalina Nicoleta, Hincu Maria-Andrada, Radu Marius, Mehedinti Mihaela-Cezarina
Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800008 Galati, Romania.
Research Centre in the Medical-Pharmaceutical Field, "Dunarea de Jos" University of Galati, 800010 Galati, Romania.
Life (Basel). 2025 Sep 12;15(9):1434. doi: 10.3390/life15091434.
In the context of thermal injury, local tissue integrity and systemic homeostasis are compromised, often resulting in delayed healing, infections, and disturbances of the skin and intestinal microbial balance. Despite several reviews addressing probiotics in wound healing, none has specifically focused on their role in thermal injuries and burn-associated pathophysiology. This review uniquely integrates evidence on the gut-skin axis, postbiotic innovations, and regenerative perspectives tailored to burn care. We conducted a critical synthesis of recent preclinical and clinical trials evaluating the use of probiotics and their derivatives to promote tissue regeneration following burn injury. Previous reviews have addressed probiotics in general wound repair, but the present synthesis advances the field by bridging mechanistic insights (immune modulation, angiogenesis, microbiome restoration) with translational evidence in burn patients, offering a framework for personalized regenerative approaches. Based on a structured review of the literature-including in vitro models, animal experiments, and randomized trials with topical, enteral, and systemic administration of probiotic-we identified four main mechanisms of action: modulation of the immune response by balancing cytokines and polarization of T lymphocytes; stimulation of tissue repair by increasing the proliferation of keratinocytes and fibroblasts, increased collagen synthesis, and induction of angiogenesis; direct antimicrobial activity against biofilms and multiresistant pathogens; and the restoration of eubiosis with the improvement of the function of epithelial barriers. While these findings endorse the adjunctive use of probiotics in burn management, large multicenter trials are required to standardize strains, dosages, and formulations before their routine clinical adoption.
在热损伤的情况下，局部组织完整性和全身稳态受到损害，常常导致愈合延迟、感染以及皮肤和肠道微生物平衡紊乱。尽管有几篇综述探讨了益生菌在伤口愈合中的作用，但没有一篇专门关注其在热损伤和烧伤相关病理生理学中的作用。本综述独特地整合了关于肠-皮肤轴、后生元创新以及针对烧伤护理的再生观点的证据。我们对最近评估使用益生菌及其衍生物促进烧伤后组织再生的临床前和临床试验进行了批判性综合分析。以前的综述涉及益生菌在一般伤口修复中的作用，但本综述通过将机制性见解（免疫调节、血管生成、微生物群恢复）与烧伤患者的转化证据相结合，推动了该领域的发展，为个性化再生方法提供了一个框架。基于对文献的结构化综述，包括体外模型、动物实验以及益生菌局部、肠内和全身给药的随机试验，我们确定了四种主要作用机制：通过平衡细胞因子和T淋巴细胞极化来调节免疫反应；通过增加角质形成细胞和成纤维细胞的增殖、增加胶原蛋白合成以及诱导血管生成来刺激组织修复；对生物膜和多重耐药病原体的直接抗菌活性；以及通过改善上皮屏障功能来恢复微生态平衡。虽然这些发现支持在烧伤管理中辅助使用益生菌，但在其常规临床应用之前，需要进行大型多中心试验来标准化菌株、剂量和制剂。
