Immunology of Wound Healing
Immunology of Wound Healing
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DOI：
10.1007/s13671-018-0234-9
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发表时间：
2018-12-01
影响因子：
1.6
通讯作者：
Tartar, Danielle
中科院分区：
文献类型：
--
作者：
Ellis, Samantha;Lin, Elaine J.;Tartar, Danielle
综述目的慢性创面是医疗保健系统的巨大负担，并导致显著的患者发病率和死亡率。正常的皮肤伤口愈合是通过免疫系统、角质形成细胞和真皮细胞之间复杂而微妙的相互作用进行的。每种细胞类型都贡献了驱动伤口愈合的正常阶段的信号：止血、炎症、增殖和重塑。本文综述了各种免疫细胞类型和信号分子如何影响伤口的发展、持续和愈合。最近的研究发现，在止血的同时，中性粒细胞是第一批迁移到伤口床上的细胞，由包括IL-8在内的促炎信号带来。它们的凋亡和被巨噬细胞吞噬(泡泡吞噬)为包括巨噬细胞在内的局部免疫环境提供了一个关键信号，使其过渡到抗炎、促进修复的状态，在这种状态下，血管生成和肉芽组织形成。肌肉成纤维细胞通过收缩力量和信号分子激活，然后驱动重塑，肉芽组织形成疤痕。尽管在任何阶段免疫信号的紊乱都会导致伤口愈合受损，但最近的研究表明，关键的转折点位于炎症和增殖期之间。这篇综述总结了促进这一转变的事件，并讨论了这一过程如何被破坏，导致慢性、不可愈合的伤口。
Purpose of Review Chronic wounds are a tremendous burden on the healthcare system and lead to significant patient morbidity and mortality. Normal cutaneous wound healing occurs through an intricate and delicate interplay between the immune system, keratinocytes, and dermal cells. Each cell type contributes signals that drive the normal phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This paper reviews how various immunological cell types and signaling molecules influence the way wounds develop, persist, and heal.Recent Findings Concurrent with the achievement of hemostasis, neutrophils are the first cells to migrate to the wound bed, brought in by pro-inflammatory signals including IL-8. Their apoptosis and engulfment by macrophages (efferocytosis) provides a key signal to the local immune milieu, including macrophages, to transition to an anti-inflammatory, pro-repair state, where angiogenesis occurs and granulation tissue is laid down. Myofibroblasts, activated through contractile forces and signaling molecules, then drive remodeling, where granulation tissue becomes scar. Unchecked inflammation at this stage can result in abnormal scar formation.Summary Although the derangement of immune signals at any stage can result in impaired wound healing, recent research has shown that the key transition point lies between the inflammatory and the proliferative phases. This review summarizes the events that facilitate this transition and discusses how this process can be disrupted, leading to chronic, non-healing wounds.