Level 0 Level 3

Peeking at the neighbours… translating findings in other fields to wound care.

To close a wound new tissue has to be formed guided and shaped. Let’s have a look at how adjacent fields of life-sciences handle the issue. One of the problems of new tissue is you need specific cell types at the wound site. This means that cells have to be transported to the wound bed, they have to multiply and/or have to change function, proliferate.

In heart regeneration they have the same issue, how to regrow damaged tissue. But cardiologists have an extra problem, we can do without a significant portion of tissue, as long as it is not heart tissue or another vital piece of human hardware! They can not wait for nature to do its thing. Therefore, they targeted this subject by means of in vivo cardiac reprogramming. This is also called transdifferentiation, or direct reprogramming. It is a potentially compelling regenerative strategy where reprogramming factors are delivered directly to the damaged organ or tissue to induce regeneration in vivo. Wouldn’t that be nice for wound care?

Why heart regeneration? To grow new tissue the body needs to develop the “tissue-infrastructure” to support regeneration, this means neoangiogenesis. That is where the cardiologists come in. They know how to get from an endothelial cell to a capillary. So even if the subject is not similar, there are things to learn.

Another, much overlooked, piece of infrastructure is innervation. Damaged nerves have a negative impact on wound healing, so new nerves also have to be formed. Luckily even skin fibroblasts theoretically can morph into neurons. So here the same applies.

But even if you are able to produce tissue infrastructure at the wound site we still need some kind of information to get the right tissue at the right place. What phenomena guide the architecture of the new tissue? The obvious targets are of course other cells and growth factors. But we tend to overlook that a cell actually has dimensions so it cannot fit in every part of the tissue. There are also not many “open spots” in a wound, it is actually quite a crowded place. This can mean not only cells and growth factors play a role. Also extracellular matrix plays a role it also determines the available space which not only guides cells in where to go, but the cell also gets information on how to change its role in the tissue.

In adjacent fields like cardiology and neurology, we may learn how to influence the formation of new tissue beyond a generic level. Some day we may be able to steer the formation of vessels and nerves.

So a lot of exiting developments in adjacent fields of life sciences. Of course the usual warning, a heart is is not a wound. Plus, even in these fields, they have the level 0 and 1 problem. What you see in a young lab animal might be a very different thing in a real patient.

Nevertheless, keep watching; you never know what you learn.

Refs: and its original article and