Refined Spruce Resin to Treat Chronic Wounds: Rebirth of an Old Folkloristic Therapy

Abstract

Significance: The treatment of chronic wounds results in an enormous drain on healthcare resources in terms of workload, costs, frustration, and impaired quality of life, and it presents a clinical challenge for physicians worldwide. Effective local treatment of a chronic wound has an important role, particularly in patients who are-because of their poor general condition, diminished life expectancy, or unacceptable operative risk-outside of surgical treatment. Recent Advances: Since 2002, our multidisciplinary research group has investigated the properties of Norway spruce (Picea abies) resin in wound healing and its therapeutic applications in wound care. Resin is a complex mixture of resin acids (e.g., abietic, neoabietic, dehydroabietic, pimaric, isopimaric, levopimaric, sandrakopimaric, and palustric acids) and lignans (e.g., pino-, larici-, matairesinol, and p-hydroxycinnamic acid) having substantial antimicrobial, wound-healing, and skin regeneration enhancing properties. Critical Issues: The cornerstone in successful wound care is an efficient causal treatment of the underlying co-morbidities, for example, diabetes, malnutrition, vascular-or certain systemic diseases. However, definitive diagnosis and specific therapy of a chronic wound is often difficult, because the etiology is practically always multi-factorial, and in the chronic phase, confounding factors such as infections invariably impede wound healing. Future Directions: To study the exact molecular mechanism of actions by which resin promotes cellular regeneration and epithelialization during the wound-healing process. To investigate potential antimicrobial properties of resin against the most ominous multidrug-resistant beta-lactamase (including carbapenemases and metallo-b-lactamases) producing bacteria, and to individualize those pharmacologically active compounds which are responsible for the antimicrobial activity of resin. SCOPE AND SIGNIFICANCEAlthough at least 170 topical wound care products are available, 1,2 well-designed randomized and controlled clinical trials regarding wound care products are rare, and the number of case-control or observational studies is limited. [3][4][5] It is estimated that the care of chronic wounds in the United States costs 6-15 billion U.S. dollars annually. 6 The annual wound care costs in Denmark, a country with similar demographics to that of Finland, are estimated to be around 100 million euros.7 From the perspective of patients, community, and health-care resources, a new, safe, clinically-and cost-effective method for the treatment of chronic wounds would be undoubtedly welcome. TRANSLATIONAL RELEVANCEOur multidisciplinary research group in Finland has investigated the properties of Norway spruce (Picea abies) resin in the treatment of acute-and chronic-, either infected or noninfected, wounds for more than 10 years now. 2,[8][9][10][11][12][13][14][15][16][17] As a result of this comprehensive translational research program, we have succeeded in showing through basic, clinical, and applied research...

In-feed resin acids reduce matrix metalloproteinase activity in the ileal mucosa of healthy broilers without inducing major effects on the gut microbiota

“…Resins derived from coniferous trees are phytochemicals that were used since ancient times in Asian and Scandinavian traditional human medicine. These resin-based products are mainly used for treating wounds, sores, pressure ulcers and a variety of other skin problems [20–22]. Recent scientific research has confirmed the efficacy of these compounds, both in human clinical trials as well as in animal models and in vitro [20, 23–26].…”

Norway Spruce Balm: Phytochemical Composition and Ability to Enhance Re-epithelialization In Vitro

“…They were identified as p-coumaric acid (1), caffeic acid (2), and ferulic acid (3). Sub-fraction 2 consisted mostly of pinoresinol (4), which was isolated by preparative TLC. Sub-fraction 5 contained the DHAA derivatives 7α,15-dihydroxy-DHAA and 7β,15-dihydroxy-DHAA, which were isolated by flash chromatography.…”

“…The resinous excretion of Norway spruce (Picea abies (L.) H. Karst., Pinaceae) [3] has a long-standing history in the treatment of skin ulcers and infected wounds [4]. Lipophilic preparations using butter or swine lard as ointment base were and still are known as an effective cure for acute and chronic wounds.…”

“…In this study, the balm was subjected to fractionated extraction and further purified employing flash chromatography, HPLC-PDA-ELSD, preparative and analytical TLC. Hydroxycinnamic acids (1)(2)(3), the lignan pinoresinol (4), four hydroxylated derivatives of dehydroabietic acid (DHAA) (5)(6)(7)(8), and dehydroabietic acid (9) were isolated. Their structures were elucidated by LC-MS, 1D-and 2D-NMR.…”

1,6-Dehydropinidine Is an Abundant Compound in Picea abies (Pinaceae) Sprouts and 1,6-Dehydropinidine Fraction Shows Antibacterial Activity against Streptococcus equi Subsp. equi

“…Recently, there here has been increasing interest in the secondary chemistry of P. sylvestris and P. abies as a source of bioactive compounds [ 1 ]. Specifically, the wood extractives of these species have shown to have antibacterial properties against methicillin-resistant Staphylococcus aureus and Escherichia coli [ 2 ] and P. abies resin-based salve has been proven to be clinically effective for the treatment of chronic wounds [ 3 ]. The defensive chemistry of coniferous species consists of all three major secondary chemistry groups—phenolics (e.g., acetophenones, lignans, stilbenes, flavonoids, phenolic acids and proanthocyanidins), terpenes (e.g., monoterpenes and resin acids) and alkaloids (piperidines) but the bioactive compounds responsible for antimicrobial properties have been assumed to be phenolic and terpene compounds [ 1 ].…”