Cited by 6Wound Healing and TreatmentsBacterial biofilms and quorum sensingImmune Response and Inflammation

The DOI matches its Crossref record; 130 of the 131 references it cites were found in a registry or an index; none of the 70 sources its claims cite is checked for support yet.

Nutritional Immunity in Wound Infection: Unveiling the Role of Dietary Elements in Host–Pathogen Interaction

Open access
Chen, Chaoming, Hu, Xuanfan, He, Da, He, Xuemei, Shen, Lan·2025·Food Science & Nutrition

Abstract

Nutritional immunity is an essential defense process by which the host restricts the supply of critical micronutrients to invading pathogens, thus hindering their survival and growth. During wound infections, this mechanism is instrumental in determining the course of host–pathogen interactions. This article discusses the pathophysiology of wound infection, beginning with the classification of wounds as acute and chronic wounds, and emphasizes how compromised epithelial barriers and chronic inflammation provide a niche for microbial colonization. The host immune response during the healing of wounds is tightly regulated, with inflammatory mediators, neutrophil infiltration, macrophage polarization, and eventual tissue regeneration. However, in the case of normal pathogens like Staphylococcus aureus , Pseudomonas aeruginosa , and Escherichia coli , they exploit the microenvironment within the wound for accessing necessary nutrients while avoiding immune detection. The premise for this is nutritional immunity, where the host withholds metals like iron, zinc, manganese, and copper from access to prevent nutrient delivery to pathogens. Pathogens retaliate by generating siderophores, transporters, and metallophores to enable nutrient capture. In addition, clinical use of metal‐chelating intelligent dressings, ionophore‐antibiotic hybrids, and metal modulation technologies has improved our capability to control infection via nutritional routes. At the same time, immunonutrition with such nutrients as omega‐3 fatty acids, arginine, glutamine, nucleotides, and antioxidant vitamins C and E has been demonstrated to have promise in promoting wound healing and maintaining immune resistance after surgery. This review emphasizes the necessity of targeting micronutrient pathways and incorporating nutritional immunity in wound care regimes for better clinical outcomes and prevention of infection‐related complications.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review argues that nutritional immunity—host sequestration of iron, zinc, manganese, and copper—is central to wound infection outcomes, while pathogens counter with siderophores, transporters, and metallophores. It also reviews immunonutrition and metal-modulating dressings as potential adjuncts, but notes limited standardized evidence.

Key findings

  • The host restricts micronutrients through transferrin, lactoferrin, ferritin, hepcidin, calprotectin, ZIP8, and Nramp1, while pathogens such as *S. aureus* and *P. aeruginosa* use siderophores (pyoverdine, pyochelin, staphyloferrins), heme acquisition, ZnuABC, MntABC/MntH, and staphylopine to acquire metals.
  • Wound infections are a major burden: surgical site infections alone contributed as much as 20% of all nosocomial infections, and common pathogens include *S. aureus* (including MRSA), *P. aeruginosa*, *E. coli*, and *E. faecalis*; biofilms, virulence factors, and intracellular persistence drive chronicity.
  • Clinical strategies include metal-modulating smart dressings and immunonutrition with omega-3 fatty acids, arginine, glutamine, nucleotides, and vitamins C and E. Reported outcomes include preoperative immunonutrition reducing infection complications by almost 50% versus control in a meta-analysis of seven RCTs, and a gastrectomy cohort showing 34% shorter hospital stay and 70.1% fewer infection complications.
  • Glutamine evidence is mixed: a 502-patient Scottish trial found no significant effect on infection or mortality with 20.2 g/day parenteral glutamine, and the 1223-patient REDOX trial linked glutamine supplementation to higher mortality without other clinical benefits.

Methods

  • Narrative review based on searches of Google Scholar, PubMed, Scopus, and Web of Science for peer-reviewed English-language publications from January 2000 to December 2024, with selected pre-2000 seminal works.
  • Search terms included micronutrients, nutrients, nutritional immunity, wound infection, wound healing, iron sequestration, manganese, copper, and zinc.
  • The paper synthesizes pathophysiology, host–pathogen competition for iron, zinc, manganese, and copper, and clinical/therapeutic implications, including tables and figures; no new primary data are presented.

Limitations

  • Stated: lack of good, detailed data hinders standardized micronutrient supplementation regimes; no validated wound-specific nutritional immunity panels exist; measurement approaches vary widely, producing heterogeneous outcomes.
  • Stated: most available studies on dietary therapies and wound healing use cross-sectional designs, so they cannot document changes over time or prove causality; prospective cohorts and RCTs are needed.
  • Evident from the text: as a narrative review, it synthesizes heterogeneous studies and does not systematically appraise evidence quality; conclusions about immunonutrition are constrained by differences in study scale, outcome measures, and combined nutrient interventions.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/fsn3.70854

Cites

130 of 130 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

FIGURE 1 A contrast of the recuperation of acute and chronic wounds. Unlike chronic wounds, which are characterized by poor epithelialization and continuous swelling, acute wounds have structured immunological and vascular reactions. Source: Li et al. (2022).
FIGURE 1 A contrast of the recuperation of acute and chronic wounds. Unlike chronic wounds, which are characterized by poor epithelialization and continuous swelling, acute wounds have structured immunological and vascular reactions. Source: Li et al. (2022).CC BY · PubMed Central
FIGURE 2 Stages of the recuperation process of wounds. In order to regain tissue integrity, the process consists of four overlapping steps: hemostasis, swelling, proliferation, and remodeling with distinct cellular activity. This figure was generated by using biorender.
FIGURE 2 Stages of the recuperation process of wounds. In order to regain tissue integrity, the process consists of four overlapping steps: hemostasis, swelling, proliferation, and remodeling with distinct cellular activity. This figure was generated by using biorender.CC BY · PubMed Central
FIGURE 3 Cellular and molecular reactions occur during the various stages of the healing process. With a focus on vital immune cells, fibroblasts, and collagen buildup responsible for tissue regeneration, the image illustrates the inflammatory, proliferative, and restructuring steps. Source: Jakovija and Chtanova (2023).
FIGURE 3 Cellular and molecular reactions occur during the various stages of the healing process. With a focus on vital immune cells, fibroblasts, and collagen buildup responsible for tissue regeneration, the image illustrates the inflammatory, proliferative, and restructuring steps. Source: Jakovija and Chtanova (2023).CC BY · PubMed Central
FIGURE 4 Host and pathogen mechanisms for iron sequestration. The host restricts bacterial utilization of iron by using transporters (like Nramp1) and metal‐binding proteins (including transferrin, lactoferrin, ferritin, and calprotectin), whereas pathogens exhibit siderophores and receptors to navigate around these protections. This figure was generated by utilizing biorender.
FIGURE 4 Host and pathogen mechanisms for iron sequestration. The host restricts bacterial utilization of iron by using transporters (like Nramp1) and metal‐binding proteins (including transferrin, lactoferrin, ferritin, and calprotectin), whereas pathogens exhibit siderophores and receptors to navigate around these protections. This figure was generated by utilizing biorender.CC BY · PubMed Central
FIGURE 5 Multipurpose smart wound dressings that incorporate curative and detecting properties. Aspects of sophisticated dressings that can change pH (A), conduct electricity (B), and regulate temperature wirelessly (C). This figure was created by using biorender.
FIGURE 5 Multipurpose smart wound dressings that incorporate curative and detecting properties. Aspects of sophisticated dressings that can change pH (A), conduct electricity (B), and regulate temperature wirelessly (C). This figure was created by using biorender.CC BY · PubMed Central

Verification

Claims the paper makes

31 No basis given · 23 Check pending · 17 No full text of the sources · 17 Not checked yet · 12 Own interpretation · 6 Sources not found

Verify all 43 references — free account
  • Probably not a substantial claim. 23
  • It may state two separate claims as one. 41
57 of 57
  • The paper relies on this without support.

    Pathogens generate siderophores, transporters, and metallophores to capture nutrients in wounds.

    “Pathogens retaliate by generating siderophores, transporters, and metallophores to enable nutrient capture.”
  • The paper relies on this without support.

    Clinical use of metal-chelating intelligent dressings, ionophore-antibiotic hybrids, and metal modulation technologies has improved the capability to control infection via nutritional routes.

    “In addition, clinical use of metal‐chelating intelligent dressings, ionophore‐antibiotic hybrids, and metal modulation technologies has improved our capability to control infection via nutritional routes.”
  • The paper relies on this without support.

    Antibiotic resistance has made wound infection more formidable, with conventional therapies not being able to clear infections.

    “In addition, antibiotic resistance has made the problem more formidable, with conventional therapies not being able to clear infections, and alternative and integrative treatments that enhance host defense mechanisms with specific targeting of microbial growth becoming the need.”
  • The paper relies on this without support.

    All life depends on transition metals, which invasive microbial pathogens must obtain in order to proliferate within the host and spread infection.

    “All life depends on transition metals, which invasive microbial pathogens must obtain in order to proliferate within the host and spread infection.”
  • The paper relies on this without support.

    During infection, both pathogen and host must have access to iron for their cells to survive and proliferate.

    “For their cells to survive and proliferate during an infection, the pathogen and the host must continue to have access to iron.”
  • The paper relies on this without support.

    Findings on perioperative immunonutrition in surgical and critically ill patients are relevant to wound infection and wound healing.

    “it can be concluded that immunonutrition is essential for reducing immunosuppression and inflammation brought on by surgery, which may shorten hospital stays and prevent infectious complications.”
  • The paper relies on this without support.

    Metal sequestration mechanisms at the host-pathogen interface apply to wound infections.

    “The host restricts bacterial utilization of iron by using transporters (like Nramp1) and metal‐binding proteins (including transferrin, lactoferrin, ferritin, and calprotectin), whereas pathogens exhibit siderophores and receptors to navigate around these protections.”
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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

2 of 2

Citations

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Metadata

Authors
Chen, C., Hu, X., He, D., He, X., & Shen, L.
Affiliations
  • Critical Care Center Southern Central Hospital of Yunnan Province (The First People's Hospital of Honghe State) Gejiu Yunnan China
  • Ultrasonography Lab Southern Central Hospital of Yunnan Province (The First People's Hospital of Honghe State) Gejiu Yunnan China
  • Infectious Disease Southern Central Hospital of Yunnan Province (The First People's Hospital of Honghe State) Gejiu Yunnan China
  • Nephrology Department Southern Central Hospital of Yunnan Province (The First People's Hospital of Honghe State) Gejiu Yunnan China
Corresponding author
Shen, Lan
Venue
Food Science & Nutrition
Publisher
Wiley
Published
2025-09
Volume
13
Issue
9
Pages
e70854-e70854
ISSN
2048-7177 (ISSN-L)
OpenAlex
W4413930458
Cited by
6
References
131
Citations by year
2026: 6
FWCI
1.10
Type
journal article
Language
en
Open access
Locations
  • Food Science & Nutrition (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
Funders
  • Kunming Medical University
  • Yunnan Provincial Science and Technology Department
  • Qingdao University
Topics
  • Health Sciences › Medicine › Surgery › Wound Healing and Treatments
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bacterial biofilms and quorum sensing
  • Life Sciences › Immunology and Microbiology › Immunology › Immune Response and Inflammation
Keywords
nutritional immunity, wound infection, host-pathogen interaction, siderophores, metal chelation, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, chronic wounds, acute wounds, immunonutrition, omega-3 fatty acids, L-arginine, glutamine, wound healing, chronic inflammation

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