Venous leg ulcers – the search for a prognostic indicator

Abstract

Disordered cell function within chronic wounds generates many parameters that can be measured to differentiate between healing and non healing status. Theoretically, these may form the basis of a wound assessment system to define disease severity and response to treatment. In a review of tissue, wound exudate and microbiology studies of venous leg ulcers, we identify many such parameters that are associated with healing status. These include cytokines, proteases and their inhibitors, senescence markers, oxidative stress markers and microbiological status defined by culture. Some of these, such as protease level in wound exudate, have been proposed as prognostic indicators of healing status and many more could be considered potential markers to incorporate into a wound assessment system. However, no published data are available that validate known wound components to accurately reflect wound progression on a single patient basis. Rather than further characterisation of the expression of known wound biomarkers, the development of an accurate and objective test for prediction of chronic wound outcome requires identification of an appropriate combination of novel molecules that vary coordinately with healing status.

Panbacterial real-time PCR to evaluate bacterial burden in chronic wounds treated with Cutimed™ Sorbact™

“…A recent review enumerates several potential biomarkers (cytokines, proteases and their inhibitors, senescence markers, oxidative stress, microbiological status, etc. ), but concludes that no available data reflect wound progression or regression [22]. Our study indicates that panbacterial real-time PCR might fill this need.…”

Neutrophil activity in chronic venous leg ulcers—A target for therapy?

“…Several advisory panels assigned the task of creating evidence‐based guidelines for treating chronic wounds such as CVLUs have recognized that a growing body of evidence supports a relationship between high wound fluid protease levels and nonhealing wounds . Some have endorsed using protease levels as biochemical markers to guide treatment . However, because clinical observations alone cannot detect high protease activity in the microenvironment of CVLUs, a simple diagnostic tool to quantify protease levels within the wound would help clinicians determine if appropriate management strategies designed to dampen excessive protease activity are indicated.…”

Preparation, Characterization and Activity of a Peptide-Cellulosic Aerogel Protease Sensor from Cotton

“…However, chronic wounds have elevated levels of MMPs (0.1–0.2 U/mL) and HNE (0.02–0.1 U/mL) protease depending on the type of chronic wound (diabetic, venous pressure and arterial ulcers) [34]. These proteases at elevated concentrations are biomarkers for chronic wound treatment with protease sequestrant dressings [35,36,37]. Therefore, the use of nanocellulosic aerogels (NA) as the transducer surface attached to a fluorescent peptide substrate, such as succinyl-alanine-proline-alanine-4-amino-7-methyl-coumarin (Suc-Ala-Pro-Ala-AMC) or succinyl-alanine-alanine-proline-valine-4-amino-7-methyl-coumarin (Suc-Ala-Ala-Pro-Val-AMC) [38], which has selectivity for HNE, not only offers specificity, but also offers a way to detect HNE in chronic wound fluid.…”