An overview of the therapeutic potential of regenerative medicine in cutaneous wound healing

Abstract

The global burden of disease associated with wounds is an increasingly significant public health concern. Current treatments are often expensive, time-consuming and limited in their efficacy in chronic wounds. The challenge of overcoming current barriers associated with wound care requires innovative management techniques. Regenerative medicine is an emerging field of research that focuses on the repair, replacement or regeneration of cells, tissues or organs to restore impaired function. This article provides an overview of the pathophysiology of wound healing and reviews the latest evidence on the application of the principal components of regenerative medicine (growth factors, stem cell transplantation, biomaterials and tissue engineering) as therapeutic targets. Improved knowledge and understanding of the pathophysiology of wound healing has pointed to new therapeutic targets. Regenerative medicine has the potential to underpin the design of specific target therapies in acute and chronic wound healing. This personalised approach could eventually reduce the burden of disease associated with wound healing. Further evidence is required in the form of large animal studies and clinical trials to assess long-term efficacy and safety of these new treatments.

Keywords: Biomaterials; Growth factors; Regenerative medicine; Stem cells; Tissue engineering; Wound healing.

Figure 1

An overview of acute wound healing and therapeutic targets for stem cells, growth factors and biomaterials. Injury to skin triggers an immediate haemostatic response, which results in fibrin clot formation and growth factor release. Acute inflammatory cells, platelets and endothelial cells are active during the inflammatory and proliferative phases of healing whereby they secrete growth factors to promote collagen deposition, vascularisation and chemotaxis either directly or through paracrine effects on other cells, such as dermal fibroblasts. In the mature stages of wound healing, dermal fibroblast and myofibroblasts cause wound contraction and scar maturation. Stem cells and growth factors have been shown to promote wound healing through activity on immune cells, promoting angiogenesis and extracellular matrix deposition as well as reepithelialisation. Biomaterials have shown value in accelerating angiogenesis, regulating the wound environment as a dressing or used alone or with stem cells to promote reepithelialisation. M, macrophage; N, neutrophil; F, Fibroblast; P, platelet; RBC, red blood cells; EGF, epidermal growth factor; FGF, fibroblast growth factor; PDGF, platelet‐derived growth factor; VEGF, vascular endothelial growth factor; TGFβ, transforming growth factor beta.

Figure 2

Therapeutic applications of regenerative medicine in wound healing. The key components of regenerative medicine (stem cells, biomaterials and growth factors) can be used to target different stages of wound healing, such as angiogenesis, immune modulation, cell proliferation and extracellular matrix (ECM), deposition in order to induce repair. Tissue engineering may combine the use of stem cells, biomaterials and growth factors to generate replacement tissue for repairing non‐healing chronic wounds.