Biology and Biomarkers for Wound Healing

Abstract

Background: As the population grows older, the incidence and prevalence of conditions that lead to a predisposition for poor wound healing also increase. Ultimately, this increase in nonhealing wounds has led to significant morbidity and mortality with subsequent huge economic ramifications. Therefore, understanding specific molecular mechanisms underlying aberrant wound healing is of great importance. It has and will continue to be the leading pathway to the discovery of therapeutic targets, as well as diagnostic molecular biomarkers. Biomarkers may help identify and stratify subsets of nonhealing patients for whom biomarker-guided approaches may aid in healing.

Methods: A series of literature searches were performed using Medline, PubMed, Cochrane Library, and Internet searches.

Results: Currently, biomarkers are being identified using biomaterials sourced locally from human wounds and/or systemically using high-throughput "omics" modalities (genomic, proteomic, lipidomic, and metabolomic analysis). In this review, we highlight the current status of clinically applicable biomarkers and propose multiple steps in validation and implementation spectrum, including those measured in tissue specimens, for example, β-catenin and c-myc, wound fluid, matrix metalloproteinases and interleukins, swabs, wound microbiota, and serum, for example, procalcitonin and matrix metalloproteinases.

Conclusions: Identification of numerous potential biomarkers using different avenues of sample collection and molecular approaches is currently underway. A focus on simplicity and consistent implementation of these biomarkers, as well as an emphasis on efficacious follow-up therapeutics, is necessary for transition of this technology to clinically feasible point-of-care applications.

Conflict of interest statement

Authors declare no conflict of interest.

Figures

Figure 1. The future

The flow chart shows potential use of various types of biomarkers to personalize treatment approach in patients with chronic wounds.

Figure 2. The long road of discovery and development of biomarkers

Steps in development of biomarker start from biomarker discovery, development of specific assay to be used in clinic and a final biomarker validation in multicenter clinical trials before it becomes available for use as a guiding tool by physicians in clinics.

Figure 3. Biomarker-based guidance to debridement

Possible use of biomarkers as an indicator for a debridement margin e.g. how far wound care practitioner should debride a chronic wound.