Amniotic membrane induces epithelialization in massive posttraumatic wounds

Abstract

Large-surface or deep wounds often become senescent in the inflammatory or proliferation stages and cannot progress to reepithelialization. This failure makes intervention necessary to provide the final sealing epithelial layer. The best current treatment is autologous skin graft, although there are other choices such as allogenic or autologous skin substitutes and synthetic dressings. Amniotic membrane (AM) is a tissue of interest as a biological dressing due to its biological properties and immunologic characteristics. It has low immunogenicity and beneficial reepithelialization effects, with antiinflammatory, antifibrotic, antimicrobial, and nontumorigenic properties. These properties are related to its capacity to synthesize and release cytokines and growth factors. We report the use of AM as a wound dressing in two patients with large and deep traumatic wounds. Negative pressure wound therapy followed by AM application was capable of restoring skin integrity avoiding the need for skin graft reconstruction. AM induced the formation of a well-structured epidermis. To understand this effect, we designed some assays on human keratinocyte-derived HaCaT cells. AM treatment of HaCaT induced ERK1/2 and SAP/JNK kinases phosphorylation and c-jun expression, a gene critical for keratinocytes migration; however, it did not affect cell cycle distribution. These data suggest that AM substantially modifies the behavior of keratinocytes in chronic wounds, thereby allowing effective reepithelialization.

Grafting with Cryopreserved Amniotic Membrane versus Conservative Wound Care in Treatment of Pressure Ulcers: A Randomized Clinical Trial

“…Different cytokines such as angiopoietin-2, epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), heparin binding epidermal growth factor (HB-EGF), HGF, TGFβ, plateletderived growth factor BB (PDGF-BB), placental growth factor (PlGF), and VEGF have been detected in dehydrated human amnion/chorion membrane. These factors might enhance the epithelial cell proliferation [18,19,[51][52][53]. No HLA matching is necessary for AM transplantation.…”

Antimikrobinės atsparumas. Naujos antimikrobinės medžiagos lėtinėms trofinėms opoms gydyti

“…According to many authors, the lysis of grafts at autodermoplasty on ready-to-plastic granulation is most often associ-ated with the microbial colonization of wounds [1,3,14,15]. Therefore, the current selection is not only a means effective against pathogenic microorganisms, but also a method of treating postoperative wounds after autodermoplasty.…”

Newborn Stem Cells: Identity, Function, and Clinical Potential

“…-199 medium) to heal large leg wounds in two female patients. While not producing statistical proof of amnion efficacy for wound healing, the amnion did reduce "heat, desiccation, and protein loss" and was easily applied [Insausti et al, 2010]. On a cellular level, histological analysis suggested that the amnion membrane aided reepilthelization and angiogenesis, but also increased fibrosis.…”

“…On a cellular level, histological analysis suggested that the amnion membrane aided reepilthelization and angiogenesis, but also increased fibrosis. At the molecular level, amnion treatment resulted in increased c-Jun expression (an important marker of keratinocyte migration and wound repair) at the leading edge of keratinocyte growth [Insausti et al, 2010]. However, despite these initial successes, there have not been any major multicenter clinical trials using amnion for the treatment of cutaneous wounds, including diabetesinduced leg/foot ulcers.…”

“…There is much evidence that both amnion soluble factors and stem cells are useful for accelerating wound repair. Amnion secretes growth factors, such as epidermal growth factor (EGF), basic fibroblastic growth factor (bFGF), and keratinocyte growth factor (KGF) [Insausti et al, 2010], all of which should encourage reepithelization of cutaneous wounds. Interestingly, some of these factors, such as EGF and FGF, have been reported in keratinocyte and dermal fibroblast differentiation media for MSCs.…”