Efficacy of MMP-inhibiting wound dressings in the treatment of chronic wounds: a systematic review

Dissemond, Joachim; Augustin, Matthias; Dietlein, Michael; Faust, Uta; Keuthage, Winfried; Lobmann, Ralf; Münter, Karl-Christian; Strohal, Robert; Stücker, Markus; Traber, Jürg; Vanscheidt, Wolfgang; Läuchli, Severin

doi:10.12968/jowc.2020.29.2.102

Cited by 29 publications

(16 citation statements)

References 57 publications

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“…Another systematic review evaluating the effect of MMP inhibition determined that, from 16 studies utilizing collagen-based and lipido-colloid nano oligosaccharide factor dressings, there was a clear benefit in a variety of ulcers including diabetic, venous, and mixed origin. The major outcomes focused on wound closure, wound size reduction, healing time, and healing rate [174]. Further studies are required to determine which MMPs to target, to focus on VLU etiology and RCT trials, and to determine ulcer free intervals and cost analysis as well as specific biomarkers (e.g., reduction in gelatinase activity in the wound bed) that demonstrate positive progress.…”

Section: Latest Innovations In Surgical Treatment and Drug Therapiesmentioning

confidence: 99%

Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

Raffetto

Ligi

Maniscalco

et al. 2020

JCM

146

114

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Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU affects many individuals worldwide, could pose a significant socioeconomic burden to the healthcare system, and has major psychological and physical impacts on the affected individual. VLU often occurs in association with post-thrombotic syndrome, advanced chronic venous disease, varicose veins, and venous hypertension. Several demographic, genetic, and environmental factors could trigger chronic venous disease with venous dilation, incompetent valves, venous reflux, and venous hypertension. Endothelial cell injury and changes in the glycocalyx, venous shear-stress, and adhesion molecules could be initiating events in VLU. Increased endothelial cell permeability and leukocyte infiltration, and increases in inflammatory cytokines, matrix metalloproteinases (MMPs), reactive oxygen and nitrogen species, iron deposition, and tissue metabolites also contribute to the pathogenesis of VLU. Treatment of VLU includes compression therapy and endovenous ablation to occlude the axial reflux. Other interventional approaches such as subfascial endoscopic perforator surgery and iliac venous stent have shown mixed results. With good wound care and compression therapy, VLU usually heals within 6 months. VLU healing involves orchestrated processes including hemostasis, inflammation, proliferation, and remodeling and the contribution of different cells including leukocytes, platelets, fibroblasts, vascular smooth muscle cells, endothelial cells, and keratinocytes as well as the release of various biomolecules including transforming growth factor-β, cytokines, chemokines, MMPs, tissue inhibitors of MMPs (TIMPs), elastase, urokinase plasminogen activator, fibrin, collagen, and albumin. Alterations in any of these physiological wound closure processes could delay VLU healing. Also, these histological and soluble biomarkers can be used for VLU diagnosis and assessment of its progression, responsiveness to healing, and prognosis. If not treated adequately, VLU could progress to non-healed or granulating VLU, causing physical immobility, reduced quality of life, cellulitis, severe infections, osteomyelitis, and neoplastic transformation. Recalcitrant VLU shows prolonged healing time with advanced age, obesity, nutritional deficiencies, colder temperature, preexisting venous disease, deep venous thrombosis, and larger wound area. VLU also has a high, 50–70% recurrence rate, likely due to noncompliance with compression therapy, failure of surgical procedures, incorrect ulcer diagnosis, progression of venous disease, and poorly understood pathophysiology. Understanding the molecular pathways underlying VLU has led to new lines of therapy with significant promise including biologics such as bilayer living skin construct, fibroblast derivatives, and extracellular matrices and non-biologic products such as poly-N-acetyl glucosamine, human placental membranes amnion/chorion allografts, ACT1 peptide inhibitor of connexin 43, sulodexide, growth factors, silver dressings, MMP inhibitors, and modulators of reactive oxygen and nitrogen species, the immune response and tissue metabolites. Preventive measures including compression therapy and venotonics could also reduce the risk of progression to chronic venous insufficiency and VLU in susceptible individuals.

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Section: Latest Innovations In Surgical Treatment and Drug Therapiesmentioning

confidence: 99%

Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

Raffetto

Ligi

Maniscalco

et al. 2020

JCM

146

114

View full text Add to dashboard Cite

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“…Several studies have also assessed the efficacy of ORC/ collagen dressing and ORC/collagen/silver-ORC dressings for wound management [16,17]. However, to the best of our knowledge, no meta-analysis has been conducted till date proving the efficacy of ORC/collagen in different chronic skin wounds.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Oxidized Regenerated Cellulose/Collagen Dressing for Management of Skin Wounds: A Systematic Review and Meta-Analysis

Zhang

Wang

Tan

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Objective. The purpose of this study was to evaluate the wound healing efficacy of oxidized regenerated cellulose (ORC)/collagen dressing and ORC/collagen/silver-ORC dressings compared to standard of care or control in treatment of chronic skin wounds such as diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), and pressure injuries sore ulcers (PISUs). Methods. An electronic search was carried out in four popular databases PubMed, Scopus, Embase, and CENTRAL to identify thirteen included studies, comparing the clinical efficacy of ORC/collagen dressings when compared to control in management of chronic skin wounds, especially DFUs, VLUs, and PISUs, and skin graft donor site wounds. Results. Consolidated data from thirteen comparative clinical studies undertaken for management of DFUs, VLUs, and PISUs showed favorable outcomes towards use of ORC/collagen compared to other traditional and hydrocolloid foam dressings in terms of wound healing rate ( P = 0.02 ) and percentage wound relative reduction ( P = 0.003 ). The time taken to achieve complete wound healing in the included studies did not show any statistical significant difference ( P = 0.24 ). There was no significant difference in adverse events between ORC/collagen-treated group and comparative group ( P = 0.19 ). Conclusion. ORC/collagen wound dressings are beneficial in terms of improved wound healing rate and percentage wound relative reduction compared to already existing traditional standard of care with non-MMP, inhibiting biomaterials such as moistened gauze, autologous growth factors, hydrocolloid foam dressings, or ovine extracellular matrix.

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“…MMPs mediate the destruction of damaged tissue early in the healing process while at the later stages, MMPs inhibit the formation of new tissue. At these stages, TIMPs play an important role by suppressing the activity of MMPs [ 70 ].…”

Section: Resultsmentioning

confidence: 99%

Collagen/Chitosan Gels Cross-Linked with Genipin for Wound Healing in Mice with Induced Diabetes

et al. 2021

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Diabetes mellitus continues to be one of the most common diseases often associated with diabetic ulcers. Chitosan is an attractive biopolymer for wound healing due to its biodegradability, biocompatibility, mucoadhesiveness, low toxicity, and hemostatic effect. A panel of hydrogels based on chitosan, collagen, and silver nanoparticels were produced to treat diabetic wounds. The antibacterial activity, cytotoxicity, swelling, rheological properties, and longitudinal sections of hydrogels were studied. The ability of the gels for wound healing was studied in CD1 mice with alloxan-induced diabetes. Application of the gels resulted in an increase in VEGF, TGF-b1, IL-1b, and TIMP1 gene expression and earlier wound closure in a comparison with control untreated wounds. All gels increased collagen deposition, hair follicle repair, and sebaceous glands formation. The results of these tests show that the obtained hydrogels have good mechanical properties and biological activity and have potential applications in the field of wound healing. However, clinical studies are required to compare the efficacy of the gels as animal models do not reproduce full diabetes pathology.

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Efficacy of MMP-inhibiting wound dressings in the treatment of chronic wounds: a systematic review

Cited by 29 publications

References 57 publications

Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

Efficacy of Oxidized Regenerated Cellulose/Collagen Dressing for Management of Skin Wounds: A Systematic Review and Meta-Analysis

Collagen/Chitosan Gels Cross-Linked with Genipin for Wound Healing in Mice with Induced Diabetes

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