The Potential of Fish Oil Components and Manuka Honey in Tackling Chronic Wound Treatment

Abstract

Chronic wounds are becoming an increasing burden on healthcare services, as they have extended healing times and are susceptible to infection, with many failing to heal, which can lead ultimately to amputation. Due to the additional rise in antimicrobial resistance and emergence of difficult-to-treat Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. (ESKAPE pathogens), novel treatments will soon be required asides from traditional antibiotics. Many natural substances have been identified as having the potential to aid in both preventing infection and increasing the speed of wound closure processes. Manuka honey is already in some cases used as a topical treatment in the form of ointments, which in conjunction with dressings and fish skin grafts are an existing US Food and Drug Administration-approved treatment option. These existing treatment options indicate that fatty acids from fish oil and manuka honey are well tolerated by the body, and if the active components of the treatments were better understood, they could make valuable additions to topical treatment options. This review considers two prominent natural substances with established manufacturing and global distribution-marine based fatty acids (including their metabolites) and manuka honey-their function as antimicrobials and how they can aid in wound repair, two important aspects leading to resolution of chronic wounds.

Keywords: ESKAPE; biofilm; docosahexaenoic acid; eicosapentaenoic acid; manuka honey; resolvins; wound.

Figure 1

Pathways demonstrating the starting materials of (A) eicosapentaenoic acid (EPA) and (B) docosahexaenoic acid (DHA) and their intermediates in synthesising resolvins.

Figure 2

An online search using PubMed for published articles whose titles contain either docosahexaenoic acid, eicosapentaenoic acid, or resolvin based on the year published, showing the increase in published research since the 1980s. Due to other chemicals using similar abbreviations, search terms were restricted to full names only. Data correct as of May 2024.

Figure 3

Summary of the ways in which the different components of honey are thought to exhibit antimicrobial effects on bacteria [73,77,78,79,80,81].