Level 4

Science of wound care

This simple overview from the website of Cell magazine, is their view on important domains in life sciences. It is actually also a nice map for wound care science. Linking wound care science to these apparent important scientific fields (if not Cell would have used a different selection) makes a nice exercise.

The good news is that wound care science can make good use of the developments in insight and technology in all of these fields. The bad news is it is rarely done.

Landmark cell reviews

Let’s walk through each domain

Aging; the future cornerstone of wound care science is aging. Even casual observers will notice that most “wound owners” are older people. However, the influence of age on wound healing is not clear. The field of inflammaging and its mathematical modelling is really promising.

Cancer; although not interesting at first sight, but if we see cancer as regeneration gone wrong the idea changes. Cancer also provides us with processes playing a role in tissue generation.

Cell biology; it reveals the way each cell and groups of cells function and behave. Even though we know the players in the wound-healing process we do not know how they behave in a more complex wound or in a stressed environment. Here we have to find the difference in wound healing in a healthy young animal and a compromised human. Bridging that gap is still a challenge.

Immunology; our immune system is evolutionary slightly younger than tissue repair yet plays an important role in keeping us healthy by removing all that is unwanted. It’s role in wound care is not simply to remove bacteria, but actually, it has a complex regulatory role. However, it is not functioning flawlessly and, therefore, is either may be a symptom or a cause of a non-healing wound.

Neuroscience; apart from the obvious in relation to pain, I have to confess I am a bit lost, suggestions? Nevertheless, I am sure the nerve system plays a role in regulating wound healing.

Noncoding RNA’s, this field is now not relevant for wound healing. Not because it does not play a role but because it will be discovered for wound care in approx 5 years from now.

Metabolism is the counterpart of anatomy and describes the processes in wound healing. Metabolic issues are at the heart of wound healing. Any problem in anatomy or physiology will, in the end, influence cell metabolism which leads to an alteration in function, proliferation and eventually apoptosis.

Transcription and epigenetics; We are already looking into the genomics of wound healing, if only by linking telomere length to wound incidence. And epigenetic-wise I am looking forward to the first articles describing how DNA methylation alters metabolic pathways in chronic wounds.

Signaling; we have not yet seen the end of the research on growth factors and other signals regulating tissue regeneration. especially the relation between a growth factor and its role in different stages of wound healing.

Stem cells; wound healing and regeneration depends on forming new tissue. These can be formed by either simple division of epidermal cells or have to be formed by proliferating one cell-type to another or by bringing in new (stem) cells to the wound bed.

Development; this field will, together with stem cel research learn us why and how each specific cell and function ends up at the right spot in the new tissue. It may also learn us where this process can derail.

Microbiology; the role of microbes in the living body is rapidly becoming more complex. They are not all bad. Lessons from the gut are to be taken to the wound. We may one day discover that the speed of wound healing depends on what is living in your wound.


When finished I cannot help but ask myself: what would the grid for wound care science look like?

The following blocks may be interesting
Anatomy and physiology; classic medical subjects too often overlooked in wound care

Systems biology; which seems to hold more promises for wound healing

Genetics; straight hereditary research may provide some insights and help us discover more genes involved in wound healing.

Mathematical modelling; in the next decade the science of life will be overtaken by mathematical models to find correlations we would not have found otherwise.

All in all a nice exercise (that is, for me) of linking wound care to science.

Let’s end with a citation:

In der lebendigen Natur geschieht nichts, was nicht in einerVerbindung mit dem Ganzen steheund wenn uns dieErfahrungen nur isoliert erscheinenwenn wir die Versuchenur als isolierte Fakta anzusehen habenso wird dadurchnicht gesagtdaß sie isoliert seien, es ist nur die Frage: wiefinden wir die Verbindung dieser PhänomenedieserBegebenheiten?

            Johann Wolfgang von Goethe

(Very free translation: all living things are connected, if you do not see the connection between isolated facts, you may have to look harder)

Level 2

Everything you always wanted to know about biofilms but …

The question: “Is there a biofilm in the wound?” reveals it is still hard to understand biofilms for wound care professionals.

To ask this simple question is uncovering a knowledge gap.

There is no such thing as A biofilm. Her are two thoughts which may enlighten you.

  1. most microbes are able to produce biofilms.
  2. If a biofilm will increase their chance of survival they will produce one, if it does not they will not.

This immediately implies that every imaginable combination of species and numbers of each species will have an influence on the biofilm.

This also implies no two biofilms are the same, stay the same or that there is only one biofilm in the wound. There will be deep tissue biofilms and superficial biofilms. The whole combination of microbes and biofilms may be more comparable to a city than a glass house. Its appearance will depend on the size of the city and the number of different inhabitants and their needs.

Luckily even biofilms will have to follow some natural or mathematical rules and therefore the number of clinical relevant biofilms may be not infinite.

Not all biofilms are bad either. As we know, every nine out of ten cells in your body are not really you. There are biofilms in the intestine which are essential for a proper functioning body. They are so important the appendix functions as a special reservoir for spare biofilms in the case something goes wrong.

In the wound it is very well imaginable that a biofilm has a ECM like function. So presumably not all biofilms are bad.

So in the end, the question is not if there is a biofilm in the wound, the question is if there is a (good or bad) clinical relevant microbiome in the wound.

For more information: Elisabeth Bik has a nice blog on biofilms and the microbiome. Here you may find this nice example of biofilm dynamics.


Level 3

PAD and the DFU

Thanks to David Armstrong for sharing