Immunology of Wound Healing
Open accessAbstract
PURPOSE OF REVIEW: Chronic wounds are a tremendous burden on the healthcare system and lead to significant patient morbidity and mortality. Normal cutaneous wound healing occurs through an intricate and delicate interplay between the immune system, keratinocytes, and dermal cells. Each cell type contributes signals that drive the normal phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This paper reviews how various immunological cell types and signaling molecules influence the way wounds develop, persist, and heal. RECENT FINDINGS: Concurrent with the achievement of hemostasis, neutrophils are the first cells to migrate to the wound bed, brought in by pro-inflammatory signals including IL-8. Their apoptosis and engulfment by macrophages (efferocytosis) provides a key signal to the local immune milieu, including macrophages, to transition to an anti-inflammatory, pro-repair state, where angiogenesis occurs and granulation tissue is laid down. Myofibroblasts, activated through contractile forces and signaling molecules, then drive remodeling, where granulation tissue becomes scar. Unchecked inflammation at this stage can result in abnormal scar formation. SUMMARY: Although the derangement of immune signals at any stage can result in impaired wound healing, recent research has shown that the key transition point lies between the inflammatory and the proliferative phases. This review summarizes the events that facilitate this transition and discusses how this process can be disrupted, leading to chronic, non-healing wounds.
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Written from the paper’s full text.
TL;DR
This review summarizes immune mechanisms across hemostasis, inflammation, proliferation, and remodeling, arguing that the critical transition from the inflammatory to the proliferative phase often fails in chronic wounds. It highlights neutrophil apoptosis/efferocytosis and macrophage polarization as key drivers of repair.
Key findings
- Chronic wounds in the USA afflict approximately 6.5 million individuals and cost the healthcare system over 25 billion dollars annually; their mortality effect has been reported as comparable to cancer.
- Normal wound healing is divided into hemostasis (minutes to hours), inflammation (days 1–3), proliferation and repair (days 4–21), and remodeling (days 21–365); the key inflammatory-to-proliferative transition occurs around days 2–5 and often fails in chronic wounds.
- Neutrophils are early responders recruited by IL-8/CXCL8; their apoptosis and macrophage engulfment (efferocytosis) signal a shift to anti-inflammatory, pro-repair macrophages. Persistent neutrophils, NETs, proteases/MMPs, reactive oxygen species, and elevated CXCL8 contribute to chronic, non-healing wounds.
- Anti-inflammatory macrophages promote angiogenesis, granulation tissue, and re-epithelialization via VEGF, TGF-β, PDGF, EGF, KGF, and other signals; impaired pro- to anti-inflammatory macrophage transition—seen with iron overload, hyperglycemia, and hypoxia—stalls healing. Mature scars regain only 80% of initial tensile strength.
Methods
- Narrative review of the literature; no primary data, sample, or statistical analysis are reported.
- Synthesizes immune cell and signaling pathways across the four phases of wound healing, focusing on the inflammatory-to-proliferative transition and chronic wounds.
- Draws on cited animal models, in vitro studies, and human wound observations; no systematic search or meta-analysis is described.
Limitations
- The paper states no limitations.
- Evident from the text: it is a narrative review without systematic search, inclusion criteria, or quality appraisal.
- Evident from the text: many mechanistic conclusions rely on mouse models and in vitro findings, with limited direct human chronic wound data; no original experiments or quantitative synthesis are presented.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 81 cited sources checked · 0 supported · 0 flagged
- Premisecitation
In impaired models of wound healing such as diabetes, where infection risk is higher, neutrophils are clearly required.
“In impaired models of wound healing, such as diabetes, where infection risk is higher, neutrophils are clearly required [28].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [28] Wilgus TA, Roy S, McDaniel JC. Neutrophils and wound repair: positive actions and negative reactions. Adv Wound Care. 2013;2(7):379–88. https://doi.org/10.1089/wound.2012.0383 . source
Not checked in the free run.
- Rests on an assumption: Findings from mouse models of wound healing can be generalized to human wound healing and chronic wounds.
- Premisecitation
Neutrophil influx into a wound is mediated by chemical signals including IL-8/CXCL8.
“Their influx is mediated by a number of chemical signals, including IL-8, or CXCL8, as mentioned above, and neutrophils have over 30 different receptors that mitigate their migration and activation response [24].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [24] Futosi K, Fodor S, Mocsai A. Neutrophil cell surface receptors and their intracellular signal transduction pathways. Int Immunopharmacol. 2013;17(3):638–50. https://doi.org/10.1016/j.intimp.2013.06.034 . source
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- Premisecitation
Normal wound healing can generally be broken down into four overlapping but distinct steps: hemostasis, inflammation, proliferation and repair, and wound remodeling.
“normal wound healing can generally be broken down into four over-lapping but distinct steps (Fig. 1). These steps include hemostasis (minutes to hours after injury), inflammation (days 1–3), proliferation and repair (days 4–21), and lastly, wound remodeling (days 21–365) [8, 9].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [8] Morton LM, Phillips TJ. Wound healing and treating wounds: differential diagnosis and evaluation of chronic wounds. J Am Acad Dermatol. 2016;74(4):589–605; quiz −6. https://doi.org/10.1016/j.jaad.2015.08.068 . source
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- cites [9] Reinke JM, Sorg H. Wound repair and regeneration. Eur Surg Res. 2012;49(1):35–43. https://doi.org/10.1159/000339613 . source
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- Premisecitation
Chronic wounds demonstrate significantly increased levels of the potent neutrophil chemoattractant CXCL8.
“chronic wounds demonstrate significantly increased levels of the potent neutrophil chemoattractant, CXCL8 [58].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [58] Fivenson DP, Faria DT, Nickoloff BJ, Poverini PJ, Kunkel S, Burdick M, et al. Chemokine and inflammatory cytokine changes during chronic wound healing. Wound Repair Regen. 1997;5(4):310–22. https://doi.org/10.1046/j.1524-475X.1997.50405.x . source
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- Premisereasoning
Platelet activation releases growth factors such as PDGF and immune mediators responsible for activation of the immune system and transition to the inflammatory phase.
“Platelet activation not only results in hemostasis, but also in the release of growth factors such as platelet-derived growth factor (PDGF) as well as immune mediators that are responsible for activation of the immune system and transition to the inflammatory phase of wound healing.”
Quote in the paperNot a substantial claim
- Premisecitation
In non-aged, non-impaired mouse models, neutrophil depletion does not negatively affect wound healing as profoundly as macrophage deletion.
“mouse models of wound healing have shown that in non-aged, non-impaired models, neutrophil depletion does not negatively affect wound healing as profoundly as macrophage deletion [25–27].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [25] Leibovich SJ, Ross R. The role of the macrophage in wound repair. A study with hydrocortisone and antimacrophage serum. Am J Pathol. 1975;78(1):71–100.
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- cites [26] Pinhal-Enfield G, Ramanathan M, Hasko G, Vogel SN, Salzman AL, Boons GJ, et al. An angiogenic switch in macrophages involving synergy between Toll-like receptors 2, 4, 7, and 9 and adenosine A(2A) receptors. Am J Pathol. 2003;163(2):711–21. https://doi.org/10.1016/s0002-9440(10)63698-x . source
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- cites [27] Simpson DM, Ross R. The neutrophilic leukocyte in wound repair a study with antineutrophil serum. J Clin Invest. 1972;51(8):2009–23. https://doi.org/10.1172/jci107007 . source
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- Rests on an assumption: Findings from mouse models of wound healing can be generalized to human wound healing and chronic wounds.
- Interpretationnone given
Chronic wounds fail to shift from the inflammatory to the proliferative phase of wound healing.
“New research has illustrated that chronic wounds fail to shift from the inflammatory to the proliferative phase of wound healing”
Quote in the paperSubstantial claim - Interpretationnone given
The key transition point in wound healing lies between the inflammatory and the proliferative phases.
“recent research has shown that the key transition point lies between the inflammatory and the proliferative phases.”
- Also stated in: § Conclusions · plain
“Recent research has shown that the key transition point in wound healing lies between the inflammatory and the proliferative phases.”
Quote in the paperNot a substantial claim - Also stated in: § Conclusions · plain
- Premisecitation
The immune system plays a substantial role in wound repair mechanisms.
“the immune system has been found to play a substantial role due to its impact on several repair mechanisms [6, 7].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [6] MA S, MJ N. The innate immune system in acute and chronic wounds. Adv Wound Care. 2016;5(2):65–78. https://doi.org/10.1089/wound.2014.0608 . source
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- cites [7] Strbo N, Yin N, Stojadinovic O. Innate and adaptive immune responses in wound epithelialization. Adv Wound Care. 2014;3(7):492–501. https://doi.org/10.1089/wound.2012.0435 . source
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- Premisenone given
Myofibroblasts, activated through contractile forces and signaling molecules, drive remodeling, where granulation tissue becomes scar.
“Myofibroblasts, activated through contractile forces and signaling molecules, then drive remodeling, where granulation tissue becomes scar.”
Quote in the paperNot a substantial claim - Interpretationreasoning
The sustained and inappropriate presence of neutrophils at the site of injury is a major contributing factor in non-healing wounds.
“In sum, the sustained and inappropriate presence of neutrophils at the site of injury is a major contributing factor in non-healing wounds.”
Quote in the paperSubstantial claim - Premisecitation
Apoptosis and engulfment of neutrophils by macrophages provides a key signal to the local immune milieu to transition to an anti-inflammatory, pro-repair state.
“Their apoptosis and engulfment by macrophages (efferocytosis) provides a key signal to the local immune milieu, including macrophages, to transition to an anti-inflammatory, pro-repair state”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [47] Fadok VA, Bratton DL, Konowal A, Freed PW, Westcott JY, Henson PM. Macrophages that have ingested apoptotic cells in vitro inhibit proinflammatory cytokine production through autocrine/paracrine mechanisms involving TGF-beta, PGE2, and PAF. J Clin Invest. 1998;101(4):890–8. https://doi.org/10.1172/jci1112 . source
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- cites [48] Serhan CN, Chiang N, Van Dyke TE. Resolving inflammation: dual anti-inflammatory and pro-resolution lipid mediators. Nat Rev Immunol. 2008;8(5):349–61. https://doi.org/10.1038/nri2294 . source
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- cites [49] Widgerow AD. Cellular resolution of inflammation—catabasis. Wound Repair Regen. 2012;20(1):2–7. https://doi.org/10.1111/j.1524-475X.2011.00754.x . source
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- Premisecitation
Derangement of immune signals at any stage can result in impaired wound healing.
“Although the derangement of immune signals at any stage can result in impaired wound healing, recent research has shown that the key transition point lies between the inflammatory and the proliferative phases.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [10••]
Not checked in the free run.
- Premisenone given
Persistence of neutrophils is associated with delayed wound healing and chronic wounds.
“their persistence, as will be discussed in detail below, has been associated with delayed wound healing and chronic wounds.”
Quote in the paperNot a substantial claim - Premisenone given
Unchecked inflammation at the remodeling stage can result in abnormal scar formation.
“Unchecked inflammation at this stage can result in abnormal scar formation.”
Quote in the paperSubstantial claim - Premisecitation
In physiologic wound repair, neutrophil apoptosis followed by local macrophage uptake of apoptotic neutrophils triggers a transition out of the inflammatory phase.
“In physiologic wound repair, neutrophils undergo apoptosis after carrying out their various functions at the site of injury. Local macrophage uptake of apoptotic neutrophils then triggers a transition out of inflammatory phase [47–49].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [47] Fadok VA, Bratton DL, Konowal A, Freed PW, Westcott JY, Henson PM. Macrophages that have ingested apoptotic cells in vitro inhibit proinflammatory cytokine production through autocrine/paracrine mechanisms involving TGF-beta, PGE2, and PAF. J Clin Invest. 1998;101(4):890–8. https://doi.org/10.1172/jci1112 . source
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- cites [48] Serhan CN, Chiang N, Van Dyke TE. Resolving inflammation: dual anti-inflammatory and pro-resolution lipid mediators. Nat Rev Immunol. 2008;8(5):349–61. https://doi.org/10.1038/nri2294 . source
Not checked in the free run.
- cites [49] Widgerow AD. Cellular resolution of inflammation—catabasis. Wound Repair Regen. 2012;20(1):2–7. https://doi.org/10.1111/j.1524-475X.2011.00754.x . source
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- Premisecitation
Hemostasis is achieved within the first minutes to hours of injury through a series of serine protease events designed to prevent blood loss.
“The initial events following injury are designed to achieve hemostasis within the first minutes to hours of injury based on a series of serine protease events designed to prevent blood loss [11].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [11] Smith SA, Travers RJ, Morrissey JH. How it all starts: initiation of the clotting cascade. Crit Rev Biochem Mol Biol. 2015;50(4):326–36. https://doi.org/10.3109/10409238.2015.1050550 . source
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- Premisecitation
Neutrophils can eliminate organisms residing in the extracellular environment through the deployment of neutrophil extracellular traps (NETs).
“More recent evidence indicates that neutrophils can also eliminate organisms residing in the extracellular environment through the deployment of neutrophil extracellular traps (NETs).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [41] Papayannopoulos V, Zychlinsky A. NETs: a new strategy for using old weapons. Trends Immunol. 2009;30(11):513–21. https://doi.org/10.1016/j.it.2009.07.011 . source
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- cites [42] Brinkmann V, Reichard U, Goosmann C, Fauler B, Uhlemann Y, Weiss DS, et al. Neutrophil extracellular traps kill bacteria. Science. 2004;303(5663):1532–5. https://doi.org/10.1126/science.1092385 . source
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- Premisecitation
Neutrophils defend against wound infection by phagocytosing pathogens and killing them through release of reactive oxygen species, proteases, or antimicrobial proteins.
“neutrophils defend against wound infection by phagocytosing pathogens then killing them through release of reactive oxygen species, proteases, or antimicrobial proteins [28].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [28] Wilgus TA, Roy S, McDaniel JC. Neutrophils and wound repair: positive actions and negative reactions. Adv Wound Care. 2013;2(7):379–88. https://doi.org/10.1089/wound.2012.0383 . source
Not checked in the free run.
- Premisereasoning
Prolonged presence of neutrophils and their associated inflammatory mediators in the wound milieu contributes to the formation and persistence of chronic wounds.
“Many studies suggest that the prolonged presence of neutrophils and their associated inflammatory mediators in the wound milieu contributes to the formation and persistence of chronic wounds.”
Quote in the paperSubstantial claim - Premisecitation
The remodeling phase is largely driven by myofibroblasts.
“This remodeling phase is largely driven by myofibroblasts, which develop from fibroblasts in response to both mechanical tension and TGF-β signaling and are responsible for contraction of the wound [94].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [94] Yannas IV, Tzeranis DS, So PTC. Regeneration of injured skin and peripheral nerves requires control of wound contraction, not scar formation. Wound Repair Regen. 2017;25(2):177–91. https://doi.org/10.1111/wrr.12516 . source
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- Premisecitation
In a mouse model of iron overload, local wound macrophages persisted in a pro-inflammatory state with excess production of iNOS, IL-12, TNF-α, and free radicals, leading to impaired wound healing.
“in a mouse model of iron overload, local wound macrophages persisted in a pro-inflammatory state with excess production of inducible nitric oxide synthase (iNOS), IL-12, and TNF-α, in addition to free radicals, leading to impaired wound healing [81].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [81] Sindrilaru A, Peters T, Wieschalka S, Baican C, Baican A, Peter H, et al. An unrestrained proinflammatory M1 macrophage population induced by iron impairs wound healing in humans and mice. J Clin Investig. 2011;121(3):985–97. https://doi.org/10.1172/jci44490 . source
Not checked in the free run.
- Rests on an assumption: Findings from mouse models of wound healing can be generalized to human wound healing and chronic wounds.
- Premisecitation
Myofibroblast-induced fibrosis can be over-activated by Th2-derived cytokines IL-4 and IL-13.
“Recent evidence indicates that myofibroblast-induced fibrosis can be over-activated, not only in the setting of signaling through TGF-β, but also in the setting of Th2-derived cytokines IL-4 and IL-13; Th1 cytokines, such as IFN-γ, attenuate excessive scar formation [100, 101].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [100] Wynn TA. Fibrotic disease and the T(H)1/T(H)2 paradigm. Nat Rev Immunol. 2004;4(8):583–94. https://doi.org/10.1038/nri1412 . source
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- cites [101] Hinz B. The role of myofibroblasts in wound healing. Curr Res Transl Med. 2016;64(4):171–7. https://doi.org/10.1016/j.retram.2016.09.003 . source
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- Premisecitation
Myofibroblast-induced fibrosis can be over-activated by signaling through TGF-β.
“Recent evidence indicates that myofibroblast-induced fibrosis can be over-activated, not only in the setting of signaling through TGF-β, but also in the setting of Th2-derived cytokines IL-4 and IL-13; Th1 cytokines, such as IFN-γ, attenuate excessive scar formation [100, 101].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [100] Wynn TA. Fibrotic disease and the T(H)1/T(H)2 paradigm. Nat Rev Immunol. 2004;4(8):583–94. https://doi.org/10.1038/nri1412 . source
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- cites [101] Hinz B. The role of myofibroblasts in wound healing. Curr Res Transl Med. 2016;64(4):171–7. https://doi.org/10.1016/j.retram.2016.09.003 . source
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- Premisecitation
Myofibroblasts contribute to remodeling by releasing MMPs that degrade collagen laid down during granulation tissue formation.
“In addition to contraction of wound beds and generation of collagen, myofibroblasts contribute to remodeling by release of MMPs that degrade collagen laid down during granulation tissue formation [96, 97].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [96] Darby IA, Laverdet B, Bonte F, Desmouliere A. Fibroblasts and myofibroblasts in wound healing. Clin Cosmet Investig Dermatol. 2014;7:301–11. https://doi.org/10.2147/ccid.s50046 . source
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- cites [97] Van De Water L, Varney S, Tomasek JJ. Mechanoregulation of the myofibroblast in wound contraction, scarring, and fibrosis: opportunities for new therapeutic intervention. Adv Wound Care. 2013;2(4):122–41. https://doi.org/10.1089/wound.2012.0393 . source
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- Premisecitation
Myofibroblasts are responsible for contraction of the wound.
“This remodeling phase is largely driven by myofibroblasts, which develop from fibroblasts in response to both mechanical tension and TGF-β signaling and are responsible for contraction of the wound [94].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [94] Yannas IV, Tzeranis DS, So PTC. Regeneration of injured skin and peripheral nerves requires control of wound contraction, not scar formation. Wound Repair Regen. 2017;25(2):177–91. https://doi.org/10.1111/wrr.12516 . source
Not checked in the free run.
- Premisecitation
Myofibroblasts express smooth muscle actin (SMA).
“Myofibroblasts express smooth muscle actin (SMA), which is responsible for generating the contractile force attributed to this cell type [94, 95].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [94] Yannas IV, Tzeranis DS, So PTC. Regeneration of injured skin and peripheral nerves requires control of wound contraction, not scar formation. Wound Repair Regen. 2017;25(2):177–91. https://doi.org/10.1111/wrr.12516 . source
Not checked in the free run.
- cites [95] Hinz B, Phan SH, Thannickal VJ, Prunotto M, Desmouliere A, Varga J, et al. Recent developments in myofibroblast biology: paradigms for connective tissue remodeling. Am J Pathol. 2012;180(4):1340–55. https://doi.org/10.1016/j.ajpath.2012.02.004 . source
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- Premisecitation
The differentiation of myofibroblasts into fat cells is dependent upon neogenic hair follicles, which lead to BMP signaling and activation of adipocyte transcription factors.
“This process is dependent upon neogenic hair follicles, which lead to bone morphogenic protein (BMP) signaling and activation of adipocyte transcription factors [98••].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 98••
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- Premisecitation
Hypertrophic scars tend to arise in areas of high tension.
“Hypertrophic scars arise within 1–2 months of injury, and tend to arise in areas of high tension.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [99] Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011;17(1–2):113–25. https://doi.org/10.2119/molmed.2009.00153 . source
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- Premisecitation
Normally, myofibroblasts coordinate the breakdown of granulation tissue and its replacement with long-lasting type I collagen.
“Normally, myofibroblasts carefully coordinate the breakdown of granulation tissue and replacement with long-lasting type I collagen [100].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [100] Wynn TA. Fibrotic disease and the T(H)1/T(H)2 paradigm. Nat Rev Immunol. 2004;4(8):583–94. https://doi.org/10.1038/nri1412 . source
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- Interpretationnone given
Cutaneous wound healing occurs through an interplay between the immune system, keratinocytes, and dermal cells such as platelets, fibroblasts, and myofibroblasts.
“Cutaneous wound healing occurs through an intricate and delicate interplay between the immune system, keratinocytes, and dermal cells such as platelets, fibroblasts, and myofibroblasts.”
Quote in the paperSubstantial claim - Premisecitation
Efferocytosis of apoptotic neutrophils induces macrophages to transition from a pro-inflammatory phenotype to an anti-inflammatory phenotype.
“Macrophages in the wound site are responsible for phagocytosis of apoptotic neutrophils, a process known as efferocytosis [73••]. This action itself induces macrophages to transition from a pro-inflammatory phenotype, to an anti-inflammatory phenotype”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [73••]
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- cites [47] Fadok VA, Bratton DL, Konowal A, Freed PW, Westcott JY, Henson PM. Macrophages that have ingested apoptotic cells in vitro inhibit proinflammatory cytokine production through autocrine/paracrine mechanisms involving TGF-beta, PGE2, and PAF. J Clin Invest. 1998;101(4):890–8. https://doi.org/10.1172/jci1112 . source
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- Premisecitation
Keloid scars can occur at any point post-injury.
“Keloid scars can occur at any point post-injury, do not tend to occur in areas of high tension, and may grow beyond the borders of the initial scar [99].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [99] Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011;17(1–2):113–25. https://doi.org/10.2119/molmed.2009.00153 . source
Not checked in the free run.
- Premisecitation
In macrophage-deficient models, angiogenesis is impaired.
“in macrophage-deficient models, angiogenesis is impaired [85].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [85] Fantin A, Vieira JM, Gestri G, Denti L, Schwarz Q, Prykhozhij S, et al. Tissue macrophages act as cellular chaperones for vascular anastomosis downstream of VEGF-mediated endothelial tip cell induction. Blood. 2010;116(5):829–40. https://doi.org/10.1182/blood-2009-12-257832 . source
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- Rests on an assumption: Findings from mouse models of wound healing can be generalized to human wound healing and chronic wounds.
- Premisecitation
Macrophages from patients with chronic, non-healing wounds have been shown to have higher levels of iron based on Prussian blue staining.
“Macrophages from patients with chronic, non-healing, wounds have been shown to have higher levels of iron, based on Prussian blue staining [82, 83].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [82] Zamboni P, Izzo M, Tognazzo S, Carandina S, De Palma M, Catozzi L, et al. The overlapping of local iron overload and HFE mutation in venous leg ulcer pathogenesis. Free Radic Biol Med. 2006;40(10):1869–73. https://doi.org/10.1016/j.freeradbiomed.2006.01.026 . source
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- cites [83] Zamboni P, Tognazzo S, Izzo M, Pancaldi F, Scapoli GL, Liboni A, et al. Hemochromatosis C282Y gene mutation increases the risk of venous leg ulceration. J Vasc Surg. 2005;42(2):309–14. https://doi.org/10.1016/j.jvs.2005.04.003 . source
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- Premisecitation
DAMPs and PAMPs, as well as interferon-γ released from natural killer cells, polarize macrophages into a pro-inflammatory phenotype.
“DAMPs and PAMPs (released from necrotic tissue and pathogens, respectively), as well as interferon-γ [(IFN-γ), released from natural killer cells] polarize macrophages into a pro-inflammatory phenotype [64].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [64] Adams DO. Molecular interactions in macrophage activation. Immunol Today. 1989;10(2):33–5. https://doi.org/10.1016/0167-5699(89)90298-3 . source
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- Interpretationcitation
Transitioning from a pro-inflammatory macrophage-dominant wound to an anti-inflammatory macrophage-dominant milieu is essential in resolving inflammation and preparing the wound for effective repair.
“Transitioning from a pro-inflammatory macrophage-dominant wound to an anti-inflammatory macrophage-dominant milieu is essential in resolving inflammation and preparing the wound for effective repair [72].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [72] Mosser DM, Edwards JP. Exploring the full spectrum of macrophage activation. Nat Rev Immunol. 2008;8(12):958–69. https://doi.org/10.1038/nri2448 . source
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- Premisecitation
Iron overload, commonly seen in the skin in the setting of venous stasis, is a signal known to prolong the presence of pro-inflammatory macrophages.
“Certain signals are known to prolong the presence of pro-inflammatory macrophages, including iron overload, which is commonly seen in the skin in the setting of venous stasis [81, 82].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [81] Sindrilaru A, Peters T, Wieschalka S, Baican C, Baican A, Peter H, et al. An unrestrained proinflammatory M1 macrophage population induced by iron impairs wound healing in humans and mice. J Clin Investig. 2011;121(3):985–97. https://doi.org/10.1172/jci44490 . source
Not checked in the free run.
- cites [82] Zamboni P, Izzo M, Tognazzo S, Carandina S, De Palma M, Catozzi L, et al. The overlapping of local iron overload and HFE mutation in venous leg ulcer pathogenesis. Free Radic Biol Med. 2006;40(10):1869–73. https://doi.org/10.1016/j.freeradbiomed.2006.01.026 . source
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- Premisecitation
Wound bed myofibroblasts may further differentiate into fat cells, replenishing subcutaneous adipose tissue.
“However, exciting new research indicates that these wound bed myofibroblasts may further differentiate into fat cells, replenishing subcutaneous adipose tissue.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 98••
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- Premisecitation
SMA is responsible for generating the contractile force attributed to myofibroblasts.
“Myofibroblasts express smooth muscle actin (SMA), which is responsible for generating the contractile force attributed to this cell type [94, 95].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [94] Yannas IV, Tzeranis DS, So PTC. Regeneration of injured skin and peripheral nerves requires control of wound contraction, not scar formation. Wound Repair Regen. 2017;25(2):177–91. https://doi.org/10.1111/wrr.12516 . source
Not checked in the free run.
- cites [95] Hinz B, Phan SH, Thannickal VJ, Prunotto M, Desmouliere A, Varga J, et al. Recent developments in myofibroblast biology: paradigms for connective tissue remodeling. Am J Pathol. 2012;180(4):1340–55. https://doi.org/10.1016/j.ajpath.2012.02.004 . source
Not checked in the free run.
- Interpretationreasoning
Each cell type contributes proteins and molecular signals that transition the cycle through the normal phases of wound healing (hemostasis, inflammatory, proliferative, and remodeling).
“Each cell type contributes proteins and molecular signals that transition the cycle through the normal phases of wound healing, including the hemostasis, inflammatory, proliferative, and remodeling phases.”
Quote in the paperSubstantial claim - Premisecitation
Myofibroblasts develop from fibroblasts in response to mechanical tension and TGF-β signaling.
“This remodeling phase is largely driven by myofibroblasts, which develop from fibroblasts in response to both mechanical tension and TGF-β signaling and are responsible for contraction of the wound [94].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [94] Yannas IV, Tzeranis DS, So PTC. Regeneration of injured skin and peripheral nerves requires control of wound contraction, not scar formation. Wound Repair Regen. 2017;25(2):177–91. https://doi.org/10.1111/wrr.12516 . source
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- Premisecitation
In vitro studies have shown that blocking signaling of IL-10 in fibroblasts may decrease keloid scar formation.
“A role for these therapies in cutaneous fibrosis remains to be explored, though in vitro studies have shown that blocking signaling of the related cytokine IL-10 in fibroblasts may decrease keloid scar formation [102].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [102] Shi J, Li J, Guan H, Cai W, Bai X, Fang X, et al. Anti-fibrotic actions of interleukin-10 against hypertrophic scarring by activation of PI3K/AKT and STAT3 signaling pathways in scar-forming fibroblasts. PLoS One. 2014;9(5):e98228. https://doi.org/10.1371/journal.pone.0098228 . source
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- Premisecitation
Angiogenesis occurs in a two-step process: vessel sprouting, followed by vessel anastomosis.
“New blood vessel formation, referred to as angiogenesis, occurs in a two-step process: vessel sprouting, followed by vessel anastomosis [85].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [85] Fantin A, Vieira JM, Gestri G, Denti L, Schwarz Q, Prykhozhij S, et al. Tissue macrophages act as cellular chaperones for vascular anastomosis downstream of VEGF-mediated endothelial tip cell induction. Blood. 2010;116(5):829–40. https://doi.org/10.1182/blood-2009-12-257832 . source
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- Premisecitation
Keratinocytes activate fibroblasts in a feedback loop through the production of fibronectin, tenascin C, and laminin 332.
“Keratinocytes themselves further activate fibroblasts in a feedback loop through the production of fibronectin, tenascin C, and laminin 332 (Fig. 2) [93].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [93] Iorio V, Troughton LD, Hamill KJ. Laminins: roles and utility in wound repair. Adv Wound Care. 2015;4(4):250–63. https://doi.org/10.1089/wound.2014.0533 . source
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- Premisecitation
Re-epithelialization is initiated by EGF, KGF, and TGF-α, which are produced by platelets, keratinocytes, and activated pro-repair, anti-inflammatory macrophages.
“Re-epithelialization is initiated by epidermal growth factor (EGF), keratinocyte growth factor (KGF), and transforming growth factor-α (TGF-α), which are produced by platelets, keratinocytes, and activated pro-repair, anti-inflammatory macrophages [92].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [92] Schultz G, Rotatori DS, Clark W. EGF and TGF-alpha in wound healing and repair. J Cell Biochem. 1991;45(4):346–52. https://doi.org/10.1002/jcb.240450407 . source
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- Premisecitation
Hypertrophic scars arise within 1-2 months of injury.
“Hypertrophic scars arise within 1–2 months of injury, and tend to arise in areas of high tension.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [99] Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011;17(1–2):113–25. https://doi.org/10.2119/molmed.2009.00153 . source
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- Premisecitation
Keloid scars may grow beyond the borders of the initial scar.
“Keloid scars can occur at any point post-injury, do not tend to occur in areas of high tension, and may grow beyond the borders of the initial scar [99].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [99] Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011;17(1–2):113–25. https://doi.org/10.2119/molmed.2009.00153 . source
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- Premisecitation
Th1 cytokines, such as IFN-γ, attenuate excessive scar formation.
“Recent evidence indicates that myofibroblast-induced fibrosis can be over-activated, not only in the setting of signaling through TGF-β, but also in the setting of Th2-derived cytokines IL-4 and IL-13; Th1 cytokines, such as IFN-γ, attenuate excessive scar formation [100, 101].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [100] Wynn TA. Fibrotic disease and the T(H)1/T(H)2 paradigm. Nat Rev Immunol. 2004;4(8):583–94. https://doi.org/10.1038/nri1412 . source
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- cites [101] Hinz B. The role of myofibroblasts in wound healing. Curr Res Transl Med. 2016;64(4):171–7. https://doi.org/10.1016/j.retram.2016.09.003 . source
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- Premisecitation
Keloid scars do not tend to occur in areas of high tension.
“Keloid scars can occur at any point post-injury, do not tend to occur in areas of high tension, and may grow beyond the borders of the initial scar [99].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [99] Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011;17(1–2):113–25. https://doi.org/10.2119/molmed.2009.00153 . source
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- Interpretationreasoning
Alteration of normal signals at any stage can result in impaired wound healing, with non-healing wounds or excessive scar formation.
“Alteration of normal signals at any stage can result in impaired wound healing, with non-healing wounds or excessive scar formation, at great cost to both patients and the healthcare system.”
Quote in the paperSubstantial claim
- May combine two claims. 15
May combine two claims.
PremisecitationNeutrophils are the first cells to migrate to the wound bed, brought in by pro-inflammatory signals including IL-8.
“Concurrent with the achievement of hemostasis, neutrophils are the first cells to migrate to the wound bed, brought in by pro-inflammatory signals including IL-8.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [31] Baggiolini M, Loetscher P, Moser B. Interleukin-8 and the chemokine family. Int J Immunopharmacol. 1995;17(2):103–8. source
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May combine two claims.
PremisecitationNeutrophils are the most abundant inflammatory cells to infiltrate a new wound and function mainly to remove debris and prevent infection.
“Neutrophils represent the most abundant inflammatory cells to infiltrate a new wound and function mainly to remove debris and prevent infection [22, 23].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [22] Engelhardt E, Toksoy A, Goebeler M, Debus S, Brocker EB, Gillitzer R. Chemokines IL-8, GROalpha, MCP-1, IP-10, and Mig are sequentially and differentially expressed during phase-specific infiltration of leukocyte subsets in human wound healing. Am J Pathol. 1998;153(6):1849–60. source
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- cites [23] de Oliveira S, Rosowski EE, Huttenlocher A. Neutrophil migration in infection and wound repair: going forward in reverse. Nat Rev Immunol. 2016;16(6):378–91. https://doi.org/10.1038/nri.2016.49 . source
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May combine two claims.
PremisecitationNETs are detected in excess in diabetic foot wounds and delay healing, and inhibition of NETosis and NET function in mouse models of delayed wound healing improves outcomes.
“NETs have also been detected in excess in diabetic foot wounds and have been shown to delay healing, and inhibition of NETosis and NET function in mouse models of delayed wound healing improves outcomes [59•].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [59•]
Not checked in the free run.
- Rests on an assumption: Findings from mouse models of wound healing can be generalized to human wound healing and chronic wounds.
May combine two claims.
PremisecitationMacrophages play a critical role in wound healing, including in angiogenesis, fibroplasia, cell proliferation, and transition out of the inflammatory phase.
“Macrophages play a critical role in wound healing, and their roles in angiogenesis, fibroplasia, cell proliferation, and transition out of the inflammatory phase is clear (Fig. 2) [25–27, 60].”
Quote in the paperNot a substantial claim0 of 4 sources checked- cites [25] Leibovich SJ, Ross R. The role of the macrophage in wound repair. A study with hydrocortisone and antimacrophage serum. Am J Pathol. 1975;78(1):71–100.
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- cites [26] Pinhal-Enfield G, Ramanathan M, Hasko G, Vogel SN, Salzman AL, Boons GJ, et al. An angiogenic switch in macrophages involving synergy between Toll-like receptors 2, 4, 7, and 9 and adenosine A(2A) receptors. Am J Pathol. 2003;163(2):711–21. https://doi.org/10.1016/s0002-9440(10)63698-x . source
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- cites [27] Simpson DM, Ross R. The neutrophilic leukocyte in wound repair a study with antineutrophil serum. J Clin Invest. 1972;51(8):2009–23. https://doi.org/10.1172/jci107007 . source
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- cites [60] Koh TJ, DiPietro LA. Inflammation and wound healing: the role of the macrophage. Expert Rev Mol Med. 2011;13:e23. https://doi.org/10.1017/s1462399411001943 . source
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May combine two claims.
PremisecitationThe inflammatory phase overlaps considerably with initial hemostasis and occurs during the first 72 h after tissue injury.
“The inflammatory phase overlaps considerably with initial hemostasis, occurring during the first 72 h after tissue injury [16].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [16] Eming SA, Martin P, Tomic-Canic M. Wound repair and regeneration: mechanisms, signaling, and translation. Sci Transl Med. 2014;6(265):265sr6. https://doi.org/10.1126/scitranslmed.3009337 . source
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May combine two claims.
PremisecitationHistamine released by the activated complement cascade causes capillary dilation and leakage, accelerating migration of inflammatory cells and full transition to the inflammatory phase.
“After hemostasis is achieved, histamine released by the activated complement cascade causes capillary dilation and leakage, accelerating migration of inflammatory cells into the wound bed and full transition to the inflammatory phase of wound healing [15].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] Sinno H, Prakash S. Complements and the wound healing cascade: an updated review. Plast Surg Int. 2013;2013:146764–7. https://doi.org/10.1155/2013/146764 . source
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PremisecitationNeutrophil-derived proteases such as elastase and matrix metalloproteinases can degrade healthy extracellular matrix, and increased levels of these proteases have been repeatedly detected in chronic wounds.
“neutrophil-derived proteases, such as elastase and matrix metalloproteinases (MMPs), can degrade healthy extracellular matrix (ECM), and increased levels of these proteases have been repeatedly detected in chronic wounds [52–56].”
Quote in the paperSubstantial claim0 of 5 sources checked- cites [52] Briggaman RA, Schechter NM, Fraki J, Lazarus GS. Degradation of the epidermal-dermal junction by proteolytic enzymes from human skin and human polymorphonuclear leukocytes. J Exp Med. 1984;160(4):1027–42. source
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- cites [53] Grinnell F, Zhu M. Fibronectin degradation in chronic wounds depends on the relative levels of elastase, alpha1-proteinase inhibitor, and alpha2-macroglobulin. J Invest Dermatol. 1996;106(2):335–41. source
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- cites [54] Herrick S, Ashcroft G, Ireland G, Horan M, McCollum C, Ferguson M. Up-regulation of elastase in acute wounds of healthy aged humans and chronic venous leg ulcers are associated with matrix degradation. Lab Invest. 1997;77(3):281–8.
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- cites [55] Nwomeh BC, Liang HX, Cohen IK, Yager DR. MMP-8 is the predominant collagenase in healing wounds and nonhealing ulcers. J Surg Res. 1999;81(2):189–95. https://doi.org/10.1006/jsre.1998.5495 . source
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- cites [56] Pirila E, Korpi JT, Korkiamaki T, Jahkola T, Gutierrez-Fernandez A, Lopez-Otin C, et al. Collagenase-2 (MMP-8) and matrilysin-2 (MMP-26) expression in human wounds of different etiologies. Wound Repair Regen. 2007;15(1):47–57. https://doi.org/10.1111/j.1524-475X.2006.00184.x . source
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May combine two claims.
PremisecitationPlatelet degranulation releases inflammatory mediators including IL-8/CXCL8, IL-1α, IL-1β, IL-6, and TNF-α, and activates the complement cascade.
“Platelet degranulation also leads to the release of inflammatory mediators such as interleukin (IL)-8, or CXCL8 (a potent neutrophil chemoattractant), in addition to IL-1α, IL-1β, IL-6, and tumor necrosis factor (TNF)-α, and activates the complement cascade [9, 14].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [9] Reinke JM, Sorg H. Wound repair and regeneration. Eur Surg Res. 2012;49(1):35–43. https://doi.org/10.1159/000339613 . source
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- cites [14] Bjork J, Hugli TE, Smedegard G. Microvascular effects of anaphylatoxins C3a and C5a. J Immunol. 1985;134(2):1115–9. source
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May combine two claims.
PremisecitationDysregulation of hemostasis, inflammation, proliferation, or remodeling can result in delayed wound healing and the potential to form chronic ulcers and/or excessive scarring.
“Dysregulation of any of these events can result in delayed wound healing and the potential to form chronic ulcers and/or excessive scarring [10••].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [10••]
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PremisecitationAnti-inflammatory, pro-repair macrophages produce VEGF, which promotes vessel sprouting, and express two transmembrane proteins that promote vascular anastomosis.
“Not only do anti-inflammatory, pro-repair macrophages produce VEGF, which promotes vessel sprouting, they also express two transmembrane proteins that have been shown to promote vascular anastomosis [80, 85, 86].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [80] Brancato SK, Albina JE. Wound macrophages as key regulators of repair: origin, phenotype, and function. Am J Pathol. 2011;178(1):19–25. https://doi.org/10.1016/j.ajpath.2010.08.003 . source
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- cites [85] Fantin A, Vieira JM, Gestri G, Denti L, Schwarz Q, Prykhozhij S, et al. Tissue macrophages act as cellular chaperones for vascular anastomosis downstream of VEGF-mediated endothelial tip cell induction. Blood. 2010;116(5):829–40. https://doi.org/10.1182/blood-2009-12-257832 . source
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- cites [86] Affolter M, Zeller R, Caussinus E. Tissue remodelling through branching morphogenesis. Nat Rev Mol Cell Biol. 2009;10:831–42. https://doi.org/10.1038/nrm2797 . source
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May combine two claims.
PremisecitationWounds without IL-6 lack an appropriate inflammatory response and demonstrate stunted angiogenesis, collagen accumulation, and re-epithelialization.
“Wounds without IL-6 lack an appropriate inflammatory response and demonstrate stunted angiogenesis, collagen accumulation, and re-epithelialization [89].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [89] Lin ZQ, Kondo T, Ishida Y, Takayasu T, Mukaida N. Essential involvement of IL-6 in the skin wound-healing process as evidenced by delayed wound healing in IL-6-deficient mice. J Leukoc Biol. 2003;73(6):713–21. source
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May combine two claims.
InterpretationcitationWhen the transition from a pro-inflammatory to an anti-inflammatory macrophage phenotype is impaired, wound healing stalls in the inflammatory phase and a chronic wound results.
“When the transition from a pro- to an anti-inflammatory macrophage phenotype is impaired, wound healing stalls in the inflammatory phase and a chronic wound results [10••].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [10••]
Not checked in the free run.
May combine two claims.
Premisenone givenHyperglycemia in diabetes, hypoxia in arterial or venous insufficiency, or secondary infection likely also contribute to the persistence of pro-inflammatory macrophages.
“Additional signals, such as hyperglycemia in the setting of diabetes, hypoxia in the setting of arterial or venous insufficiency, or secondary infection likely also contribute to the persistence of pro-inflammatory macrophages.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningIf wounds fail to transition from the inflammatory phase, pro-inflammatory macrophages persist and non-healing wounds develop.
“If wounds fail to transition from the inflammatory phase, pro-inflammatory macrophages persist and non-healing wounds develop.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationnone givenNumerous signals are responsible for the transition between the inflammatory and proliferative phases, most notably the apoptosis and phagocytosis of wound-bed resident neutrophils (efferocytosis).
“Numerous signals are responsible for the transition, most notably the apoptosis and phagocytosis of wound-bed resident neutrophils (efferocytosis).”
Quote in the paperNot a substantial claim
The paper relies on this without support.
Findings from mouse models of wound healing can be generalized to human wound healing and chronic wounds.
“mouse models of wound healing have shown that in non-aged, non-impaired models, neutrophil depletion does not negatively affect wound healing as profoundly as macrophage deletion [25–27].”
“in a mouse model of iron overload, local wound macrophages persisted in a pro-inflammatory state with excess production of inducible nitric oxide synthase (iNOS), IL-12, and TNF-α, in addition to free radicals, leading to impaired wound healing [81].”
“inhibition of NETosis and NET function in mouse models of delayed wound healing improves outcomes [59•].”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
These cells are known to be irreplaceable partners in a successful wound healing.
“Indeed, these cells are known to be irreplaceable partners in a successful wound healing70.”
From Platelets induce increased estrogen production through NF-κB and TGF-β1 signaling pathways in endometriotic stromal cells (2020) · cites this paper as [70]
The absence or over-abundance of any of these cell types would derail the normal healing process, leading healing astray and causing pathological healing such as fibrosis.
“The absence or over-abundance of any of these cell types would derail the normal healing process, leading healing astray and causing pathological healing such as fibrosis70.”
From Platelets induce increased estrogen production through NF-κB and TGF-β1 signaling pathways in endometriotic stromal cells (2020) · cites this paper as [70]
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“Furthermore, this leads to the formation of a fibrin clot, referred to as an eschar, which acts as a plug for the wound, preventing blood loss, providing a scaffold for incoming immune cells, serving as a reservoir for cytokines and growth factors during the early stages of repair, and offering protection against bact…”
BackgroundInfluentialCannabinoid Signaling in the Skin: Therapeutic Potential of the “C(ut)annabinoid” System
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Anti-inflammation biomaterial platforms for chronic wound healing
Xu, Z., Liang, B., Tian, J., & Wu, J. (2021) · Biomaterials Science · doi:10.1039/d1bm00637a · Cited by 151 · see citing works
Mohsin, F., Javaid, S., Tariq, M., & Mustafa, M. (2024) · International Immunopharmacology · doi:10.1016/j.intimp.2024.112713 · Cited by 153 · see citing works
Heras, K. L., García-Orue, I., Rancan, F., Igartúa, M., Santos‐Vizcaíno, E., & Hernández, R. M. (2024) · Advanced Drug Delivery Reviews · doi:10.1016/j.addr.2024.115342 · Cited by 142 · see citing works
Bacteria and Antibiotics in Wound Healing
Caldwell, M. D. (2020) · Surgical Clinics of North America · doi:10.1016/j.suc.2020.05.007 · Cited by 136 · see citing works
Chittasupho, C., Manthaisong, A., Okonogi, S., Tadtong, S., & Samee, W. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms23010142 · Cited by 131 · see citing works
“The inflammation occurs where white blood cells such as phagocytic cells, neutrophils and macrophages migrate to the injured site [5].”
BackgroundApplication of stem cells in regeneration medicine
Jin, Y. H., Li, S., Yu, Q., Chen, T., & Liu, D. (2023) · MedComm · doi:10.1002/mco2.291 · Cited by 131 · see citing works
Healing Mechanisms in Cutaneous Wounds: Tipping the Balance
Singer, A. J. (2021) · Tissue Engineering Part B Reviews · doi:10.1089/ten.teb.2021.0114 · Cited by 133 · see citing works
“For more on the role of the immune response in wound healing, see the recent reviews by CañedoDorantes and Cañedo-Ayala and Ellis et al.(45,60) Compared with reparative healing, the inflammatory response in regenerative healing is attenuated.”
BackgroundWound healing and microbiome, an unexpected relationship
Canchy, L., Kérob, D., Demessant‐Flavigny, A., & Amici, J. M. (2023) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.18854 · Cited by 131 · see citing works
“Moreover, excessive inf lammation is commonly associated with chronicity as it further delays the complete transition to the proliferative phase.(9,10) Besides, it can provide an ideal environment for bacterial infiltration and proliferation, increasing the risk of persistent infection.”
BackgroundDiban, F., Lodovico, S. D., Fermo, P. D., et al. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24021004 · Cited by 122 · see citing works
Hydrogel-Based Skin Regeneration
Arabpour, Z., Abedi, F., Salehi, M., et al. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25041982 · Cited by 120 · see citing works
“These stages involve the interaction of various cell types and matrix components, including hemostasis, inflammation, proliferation, and remodeling, as illustrated in Figure 1 [11].”
BackgroundEpigenetic regulation of macrophage polarization in wound healing
Chen, C., Liu, T., Tang, Y., Luo, G., Liang, G., & He, W. (2023) · Burns & Trauma · doi:10.1093/burnst/tkac057 · Cited by 123 · see citing works
“At an early stage of wound healing, a proinflammatory reaction is conducive to anti-infection activity in injured tissue and a late pro-healing response is beneficial to wound repair [9].”
BackgroundXing, C., Zhu, H., Dou, X., Gao, L., Baddi, S., Zou, Y., Zhao, C., Peng, Y., Fang, Y., & Feng, C. (2023) · ACS Nano · doi:10.1021/acsnano.2c10039 · Cited by 120 · see citing works
Distinct inflammatory and wound healing responses to complex caudal fin injuries of larval zebrafish
Miskolci, V., Squirrell, J. M., Rindy, J., Vincent, W. J. B., Sauer, J., Gibson, A. L. F., Eliceiri, K. W., & Anna Huttenlocher, A. (2019) · eLife · doi:10.7554/elife.45976 · Cited by 114 · see citing works
“We evaluated three aspects of these injuries (Figure 1A), representing key stages of wound healing – new tissue formation, inflammation and remodeling (Ellis et al., 2018).”
MethodBeneficial Effects of Green Tea EGCG on Skin Wound Healing: A Comprehensive Review
Xu, F.-W., Lv, Y.-L., Zhong, Y., Xue, Y., Wang, Y., Zhang, L., Hu, X. M., & Tan, W. (2021) · Molecules · doi:10.3390/molecules26206123 · Cited by 123 · see citing works
“The skin wound healing process has four sequential and overlapping stages, including hemostasis, inflammation, proliferation and tissue remodeling [52], which involves various types of cells (e.”
BackgroundInfluentialPalani, N., Vijayakumar, P., Monisha, P., Ayyadurai, S., & Rajadesingu, S. (2024) · Journal of Nanobiotechnology · doi:10.1186/s12951-024-02491-8 · Cited by 125 · see citing works
Rejuvenation of three germ layers tissues by exchanging old blood plasma with saline-albumin
Mehdipour, M., Skinner, C. M., Wong, N., Lieb, M., Liu, C., Etienne, J., Kato, C., KIPROV, D. D., Conboy, M. J., & Conboy, I. M. (2020) · Aging · doi:10.18632/aging.103418 · Cited by 113 · see citing works
“Immune regulators promote better surveillance and wound clearance in multiple tissues [75, 76].”
BackgroundČoma, M., Fröhlichová, L., Urban, L., Zajíček, R., Urban, T., Szabó, P., Novak, S., Fetissov, V., Dvořánková, B., Smetana, K., et al. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22020897 · Cited by 121 · see citing works
Bacteriophages for Chronic Wound Treatment: From Traditional to Novel Delivery Systems
Pinto, A. M., Cerqueira, M. Â., Bañobre‐López, M., Pastrana, L. M., & Sillankorva, S. (2020) · Viruses · doi:10.3390/v12020235 · Cited by 115 · see citing works
“Fibroblasts that acquire contractile properties can contract the wound edges and the migration and proliferation of keratinocytes, which are responsible for the closure of the lesion [17,27].”
BackgroundInfluentialBacterial Cellulose as a Versatile Biomaterial for Wound Dressing Application
de Amorim, J. D. P., da Silva, C. J. G., de Medeiros, A. D. M., et al. (2022) · Molecules · doi:10.3390/molecules27175580 · Cited by 108 · see citing works
Harrell, C. R., Markovic, B. S., Fellabaum, C., Arsenijevic, N., Djonov, V., & Volarevic, V. (2020) · BioFactors · doi:10.1002/biof.1587 · Cited by 106 · see citing works
“inflammatory M1 macrophages and neutrophils in IFN-γ, IL-17, and IL-22-dependent manner, creating an “autocrine inflammatory loop” that results in a persistent inflammation within the nonhealing wounds.(25) Vander Beken and colleagues recently demonstrated that within the ATP-binding cassette Subfamily B Member 5 (ABC…”
BackgroundLiu, B., Fu, R., Duan, Z., Zhu, C., Deng, J., & Fan, D. (2022) · Composites Part B Engineering · doi:10.1016/j.compositesb.2022.109804 · Cited by 102 · see citing works
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Kalasin, S., Sangnuang, P., & Surareungchai, W. (2022) · Analytical Chemistry · doi:10.1021/acs.analchem.2c00782 · Cited by 102 · see citing works
Flynn, K., Mahmoud, N. N., Sharifi, S., Gould, L. J., & Mahmoudi, M. (2023) · ACS Pharmacology & Translational Science · doi:10.1021/acsptsci.3c00030 · Cited by 101 · see citing works
Applications of Nanosized-Lipid-Based Drug Delivery Systems in Wound Care
Matei, A.-M., Căruntu, C., Tampa, M. Ş., Georgescu, S. R., Matei, C., Constantin, M. M., Constantin, T. V., Călina, D. C., Ciubotaru, D. A., Bădărău, I. A., et al. (2021) · Applied Sciences · doi:10.3390/app11114915 · Cited by 94 · see citing works
“It involves activation of the immune system’s cellular components, the coagulation cascade, and the inflammatory pathways, leading to a massive remodeling of all skin compartments [1,2].”
BackgroundMacrophage Phenotypes in Normal and Diabetic Wound Healing and Therapeutic Interventions
Sadoun, H. A. (2022) · Cells · doi:10.3390/cells11152430 · Cited by 95 · see citing works
“C3b mediates bacterial opsonization, and this further stimulates neutrophil recruitment to the wound site [1,16,17] (Figure 1).”
BackgroundKeratinocyte-Macrophage Crosstalk by the Nrf2/Ccl2/EGF Signaling Axis Orchestrates Tissue Repair
VILLARREAL-PONCE, A. P., Tiruneh, M. W., Lee, J., Guerrero‐Juarez, C. F., Kuhn, J. F., David, J. A., Dammeyer, K. L., Kell, R. M., Kwong, J., Rabbani, P. S., et al. (2020) · Cell Reports · doi:10.1016/j.celrep.2020.108417 · Cited by 88 · see citing works
“Granulation tissue formation describes an essential component of wound repair that encompasses the production of new connective tissue and blood vessels within the wound bed (Ellis et al., 2018).”
BackgroundZhao, Y., & Jalili, S. (2022) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2022.02.114 · Cited by 85 · see citing works
Multifunctional lipid-based nanoparticles for wound healing and antibacterial applications: A review
Motsoene, F., Abrahamse, H., & Kumar, S. S. D. (2023) · Advances in Colloid and Interface Science · doi:10.1016/j.cis.2023.103002 · Cited by 85 · see citing works
Myofibroblast progeny in wound biology and wound healing studies
Monika, P., Waiker, P. V., Chandraprabha, M. N., Rangarajan, A., & Murthy, K. N. C. (2021) · Wound Repair and Regeneration · doi:10.1111/wrr.12937 · Cited by 88 · see citing works
“hospitalization, loss of mobility, compromising quality of life, requirement of support and sometime increase the risk of nosocomial infection causing burden to health care workers and other patients visiting hospital.(2) Considering the number of diabetic patients, accidents and other events associated with wound, th…”
BackgroundCerium oxide nanoparticles in wound care: a review of mechanisms and therapeutic applications
Chen, S., Wang, Y., Bao, S., Li, Y., Fu, X., Yu, Y., Lyu, H., Pang, H., Guo, S., Zhang, H., et al. (2024) · Frontiers in Bioengineering and Biotechnology · doi:10.3389/fbioe.2024.1404651 · Cited by 84 · see citing works
“These factors play a catalytic role in the wound healing cascade by activating neutrophils, and subsequently macrophages, endothelial cells and fi broblasts (Ellis et al., 2018).”
BackgroundAn Update on Molecular Mechanisms of Scarring—A Narrative Review
Kohlhauser, M., Mayrhofer, M., Kamolz, L., & Smolle, C. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms252111579 · Cited by 89 · see citing works
“These cells in turn not only lead to expression of cytokines but also chemokines, which subsequently attract inflammatory cells [6,21,22].”
BackgroundAdvanced Wound Diagnostics: Toward Transforming Wound Care into Precision Medicine
Weigelt, M. A., Lev‐Tov, H. A., Tomic‐Canic, M., Lee, W. D., Williams, R., Strasfeld, D. B., Kirsner, R. S., & Herman, I. M. (2021) · Advances in Wound Care · doi:10.1089/wound.2020.1319 · Cited by 82 · see citing works
“77,78 MMP-2, neutrophil elastase, and CG have highest activity at pH 7–8, which fits in with our understanding of the increased protease activity seen in chronic wounds.”
Recent advancements in bioadhesive self-healing hydrogels for effective chronic wound care
Nezhad‐Mokhtari, P., Hasany, M., Kohestanian, M., Dolatshahi‐Pirouz, A., Milani, M., & Mehrali, M. (2024) · Advances in Colloid and Interface Science · doi:10.1016/j.cis.2024.103306 · Cited by 86 · see citing works
Khalili‐Tanha, G., Radisky, E. S., Radisky, D. C., & Shoari, A. (2025) · Journal of Translational Medicine · doi:10.1186/s12967-025-06447-w · Cited by 90 · see citing works
“Following injury, platelets create a provisional clot containing fibrinogen and fibronectin, and inflammatory cells clear debris, setting the stage for epithelial cells to migrate over the wound bed [2, 112].”
The role of the host—Neutrophil biology
Chapple, I. L. C., Hirschfeld, J., Kantarci, A., Wilensky, A., & Shapira, L. (2023) · Periodontology 2000 · doi:10.1111/prd.12490 · Cited by 83 · see citing works
Enhancing wound healing dressing development through interdisciplinary collaboration
Hawthorne, B., Simmons, J. K., Stuart, B., Tung, R., Zamierowski, D. S., & Mellott, A. J. (2021) · Journal of Biomedical Materials Research Part B Applied Biomaterials · doi:10.1002/jbm.b.34861 · Cited by 80 · see citing works
“as well as secrete proinflammatory cytokines and chemokines that increase the number of natural killer cells, helper T cells, and macrophages at the site of injury.(13) Some macrophages will differentiate into antiinflammatory and pro-regenerative M2 macrophages.”
BackgroundInfluentialdel Olmo, J. A., Pérez‐Álvarez, L., Sáez‐Martínez, V., Cid, S. B., Ruiz‐Rubio, L., Pérez-González, R., Vilas‐Vilela, J. L., & Alonso, J. M. (2022) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2022.01.193 · Cited by 78 · see citing works
Cutaneous Wound Healing: A Review about Innate Immune Response and Current Therapeutic Applications
Adib, Y., Bensussan, A., & Michel, L. (2022) · Mediators of Inflammation · doi:10.1155/2022/5344085 · Cited by 81 · see citing works
“Different signals can induce the activation of resident innate cells and the recruitment of circulating inflammatory cells into the wound site; they include the release of alarmins, also known as damage-associated molecular patterns or DAMPs by damaged host cells (e.g., uric acid, DNA, RNA, and extracellular matrix co…”
BackgroundInfluentialHybrid-Based Wound Dressings: Combination of Synthetic and Biopolymers
Aderibigbe, B. A. (2022) · Polymers · doi:10.3390/polym14183806 · Cited by 78 · see citing works
“In this phase, neutrophils and monocyte infiltration in the wound bed prevent the invasion of microbes, foreign debris, and tissue damage [27,28].”
BackgroundTumors vs. Chronic Wounds: An Immune Cell's Perspective
Hua, Y., & Bergers, G. (2019) · Frontiers in Immunology · doi:10.3389/fimmu.2019.02178 · Cited by 76 · see citing works
“During this inflammation period, neutrophils secrete reactive oxygen species (ROS), nitric oxide (NO), and antimicrobial proteins (AMPs) and deploy web-like extracellular traps (NETs) in order to phagocytose and kill contaminating microorganisms (12, 13).”
BackgroundBacterial cellulose/chitosan composite materials for biomedical applications
Liu, K., Wang, Y., Liu, W., et al. (2024) · Chemical Engineering Journal · doi:10.1016/j.cej.2024.153014 · Cited by 75 · see citing works
MSCs and their exosomes: a rapidly evolving approach in the context of cutaneous wounds therapy
Marofi, F., Alexandrovna, K. I., Margiana, R., Bahramali, M., Suksatan, W., Abdelbasset, W. K., Chupradit, S., Nasimi, M., & Maashi, M. S. (2021) · Stem Cell Research & Therapy · doi:10.1186/s13287-021-02662-6 · Cited by 78 · see citing works
“The inflammatory phase, as the second step of wound healing, concentrates on deteriorating bacteria and eliminating debris, thereby providing the wound bed for the establishment of new tissue [27, 28].”
BackgroundQin, X., He, J., Wang, X., Wang, J., Yang, R., & Chen, X. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1256687 · Cited by 79 · see citing works
Biofilms and Chronic Wounds: Pathogenesis and Treatment Options
Shen, A., Taha, M. R., Ghannoum, M. A., & Tyring, S. K. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14217784 · Cited by 92 · see citing works
“After this, proliferation begins where granulation tissue forms and the keratinocytes undergo epithelialization [30,31].”
Tang, Q., Chen, C., Jiang, Y., et al. (2020) · Journal of Materials Chemistry B · doi:10.1039/d0tb00726a · Cited by 73 · see citing works
Current Progress and Outlook of Nano-Based Hydrogel Dressings for Wound Healing
Zhang, X., Wei, P., Yang, Z., Liu, Y., Yang, K., Cheng, Y., Yao, H., & Zhang, Z. (2022) · Pharmaceutics · doi:10.3390/pharmaceutics15010068 · Cited by 74 · see citing works
Constantino, V. R. L., Figueiredo, M. P., Magri, V. R., Eulálio, D., Cunha, V. R. R., Alcântara, A. C. S., & Perotti, G. F. (2023) · Pharmaceutics · doi:10.3390/pharmaceutics15020413 · Cited by 73 · see citing works
Stimuli-responsive hydrogels for skin wound healing and regeneration
Xin, H., Maruf, D. S. A. A., Akin-Ige, F., & Amin, S. (2024) · Emergent Materials · doi:10.1007/s42247-024-00930-8 · Cited by 74 · see citing works
“Granula - tion tissues are also converted to scar at this stage [ 41, 51].”
Tyavambiza, C., Meyer, M., & Meyer, S. (2022) · Bioengineering · doi:10.3390/bioengineering9110712 · Cited by 72 · see citing works
Yang, Y., Suo, D., Xu, T., Zhao, S., Xu, X., Bei, H., Wong, K. K. Y., Li, Q., Zheng, Z., Li, B., et al. (2024) · Science Advances · doi:10.1126/sciadv.ado9479 · Cited by 70 · see citing works
“During hemostasis, the activated platelets could secrete immune mediators (e.g., IL-8 and transforming growth factor– β ) to recruit immune cells (e.g., macrophages) and, thus, to evoke the immune response ( 53 ).”
Applications of mesenchymal stem cell-exosome components in wound infection healing: new insights
Fakouri, A., Razavi, Z.-S., Mohammed, A. T., Hussein, A. H. A., Afkhami, H., & Hooshiar, M. H. (2024) · Burns & Trauma · doi:10.1093/burnst/tkae021 · Cited by 69 · see citing works
“During the advanced phases of wound healing, it has been observed that effector cells undergo apoptosis, collagen III is replaced by collagen I, matrix metalloprotease degradation occurs and the synthesis of other ECM proteins takes place [146].”
BackgroundImmunomodulatory Properties of Host Defence Peptides in Skin Wound Healing
Petkovic, M., Mouritzen, M. V., Mojsoska, B., & Jenssen, H. (2021) · Biomolecules · doi:10.3390/biom11070952 · Cited by 68 · see citing works
“Hemostasis involves various protease cascades leading to the formation of a fibrin cloth to prevent blood loss and seal the wound [61].”
BackgroundDirect and Indirect Roles of Macrophages in Hypertrophic Scar Formation
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Wójcik, M., Kazimierczak, P., Benko, A., Pałka, K., Vivcharenko, V., & Przekora, A. (2021) · Materials Science and Engineering C · doi:10.1016/j.msec.2021.112068 · Cited by 66 · see citing works
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Clinically relevant experimental rodent models of diabetic foot ulcer
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3D scaffolds in the treatment of diabetic foot ulcers: New trends vs conventional approaches
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Skin γδ T Cells and Their Function in Wound Healing
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Skin immunity in wound healing and cancer
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“After sterilizing the wound, neutrophils initiate an apoptotic celldeath pathway which leads to efferocytosis by macrophages (53).”
BackgroundMetal-organic framework-based dressings: Application and opportunities in wound healing
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Eosinophils in wound healing and epithelial remodeling: Is coagulation a missing link?
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“Nonheal-ing wounds in patients with DM negatively a ff ect the quality of life, mortality, and morbidity, and hence, pose a critical clinical challenge and impose an economic burden worldwide [3].”
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A Photo‐Responsive Hollow Manganese/Carbon Hybrid Nanosphere for Wound Disinfection and Healing
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- Authors
- Ellis, S., Lin, E. J., & Tartar, D.
- Affiliations
- University of California, Davis (US)
- Corresponding author
- Tartar, Danielle
- ORCID
- Tartar, Danielle
- Venue
- Current Dermatology Reports
- Published
- 2018-09-28
- Volume
- 7
- Issue
- 4
- Pages
- 350-358
- ISSN
- 2162-4933 (ISSN-L)
- PMC
- PMC6244748
- OpenAlex
- W2892642834
- Semantic Scholar
- 2db5782e12aeaff45400ab4236b744f21a3178e0
- Cited by
- 625
- References
- 105
- Citations by year
- 2026: 65 · 2025: 114 · 2024: 109 · 2023: 90 · 2022: 96 · 2021: 86 · 2020: 44 · 2019: 21
- FWCI
- 4.74
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Current Dermatology Reports (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Rehabilitation › Wound Healing and Treatments
- Health Sciences › Medicine › Dermatology › Dermatologic Treatments and Research
- Health Sciences › Medicine › Hepatology › Liver physiology and pathology
- Keywords
- wound healing, chronic wounds, skin wound healing, neutrophils, efferocytosis, macrophages, interleukin-8, inflammation, angiogenesis, granulation tissue, myofibroblasts, scar formation, keratinocytes, dermal cells, immune signaling
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