Nanomedicine and advanced technologies for burns: Preventing infection and facilitating wound healing

Abstract

According to the latest report from the World Health Organization, an estimated 265,000 deaths still occur every year as a direct result of burn injuries. A widespread range of these deaths induced by burn wound happens in low- and middle-income countries, where survivors face a lifetime of morbidity. Most of the deaths occur due to infections when a high percentage of the external regions of the body area is affected. Microbial nutrient availability, skin barrier disruption, and vascular supply destruction in burn injuries as well as systemic immunosuppression are important parameters that cause burns to be susceptible to infections. Topical antimicrobials and dressings are generally employed to inhibit burn infections followed by a burn wound therapy, because systemic antibiotics have problems in reaching the infected site, coupled with increasing microbial drug resistance. Nanotechnology has provided a range of molecular designed nanostructures (NS) that can be used in both therapeutic and diagnostic applications in burns. These NSs can be divided into organic and non-organic (such as polymeric nanoparticles (NPs) and silver NPs, respectively), and many have been designed to display multifunctional activity. The present review covers the physiology of skin, burn classification, burn wound pathogenesis, animal models of burn wound infection, and various topical therapeutic approaches designed to combat infection and stimulate healing. These include biological based approaches (e.g. immune-based antimicrobial molecules, therapeutic microorganisms, antimicrobial agents, etc.), antimicrobial photo- and ultrasound-therapy, as well as nanotechnology-based wound healing approaches as a revolutionizing area. Thus, we focus on organic and non-organic NSs designed to deliver growth factors to burned skin, and scaffolds, dressings, etc. for exogenous stem cells to aid skin regeneration. Eventually, recent breakthroughs and technologies with substantial potentials in tissue regeneration and skin wound therapy (that are as the basis of burn wound therapies) are briefly taken into consideration including 3D-printing, cell-imprinted substrates, nano-architectured surfaces, and novel gene-editing tools such as CRISPR-Cas.

New Nanotechnologies for the Treatment and Repair of Skin Burns Infections

“…An injured skin derived from a burn wound can be classified according to the depth of the thermal damage (classified into four degrees) and the estimation of percentage of total body surface area (TBSA) that has been affected (determined by the rule of nines) [1]. The susceptibility to infection is highly influenced by the severity of the damage and may cause, in some more advanced cases, severe lesions to the underlying tissues of the skin.…”

“…Burn injuries are one of the most frequent causes of trauma, leading to morbidity and mortality mostly in low and middle-income countries. Burns can be caused by the (i) contact to high temperature materials (e.g., contact with fire or hot liquids, solids or gases), or by the (ii) exposure to cold environments, chemical agents (e.g., strong acids or bases), electricity or radiation exposure (e.g., ultra-violet light, X-ray, microwaves and others) [1]. Scald injuries are the most common type of burns in children, adults, and elderly patients [2].…”

Ångstrom‐Scale Silver Particles as a Promising Agent for Low‐Toxicity Broad‐Spectrum Potent Anticancer Therapy

“…Nanoparticles tend to preferentially accumulate in tumor tissues without the assistance of targeting agents relying on enhanced permeability and retention (EPR) effect, thus enhancing their bioavailability at disease sites and reducing systemic toxicity . Silver nanoparticles (AgNPs) are frequently used in consumer and medical products owing to their antimicrobial, anti‐inflammatory, and pro‐wound healing activities . Recent evidences reveal the potential of AgNPs as antitumor agents.…”

Efficacy of erythropoietin-pretreated mesenchymal stem cells in murine burn wound healing: possible in vivo transdifferentiation into keratinocytes

“…Stem cells, by pronounced anti-inflammatory and angiogenic role, can improve wound healing through differentiation into skin cells. For so, stem cells have shown promising potential to treat burn wounds [21]. The unique abilities of mesenchymal stem cells (MSCs) to suppress the immune response, to secrete a large number of cytokines and chemokines, together with their potential for multilineage differentiation make them suitable for tissue regeneration through cell replacement and repair [15].…”