Table 1.
Clinically relevant biological markers to be targeted to reverse the status of chronic wounds.
| Biomarker | Characteristics in chronic wound | Method of analysis | Possible solutions |
|---|---|---|---|
| Protein levels | A decrease in total protein content | Bradford protein assay | Increase dietary protein intake |
| Proteinase levels | Elevated metalloproteinases levels, especially MMP 2, 7 and 9 | Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS PAGE), Human MMP diagnosis kit | Increase the levels of tissue inhibitors of MMPs |
| Tissue bacterial levels | High tissue levels of a diverse range of bacteria. Bacteria release enzymes that reduce growth factors and produce MMPs that degrade the extracellular matrix. Increased inflammatory response is observed | Microbiological tests | Levels of bacterial counts can be decreased by continuous removal of the exudates, thus reducing inflammation |
| Genes | Significant differences in the expression of a diverse collection of genes (can be up regulated or down regulated) | Real-Time quantitative reverse Transcription Polymerase Chain Reaction (qRT PCR), Microarray | Target specific genes for regulation using natural or synthetic products |
| Growth factors | Reduction in growth factor levels necessary for healing | Enzyme-linked immunosorbent assay (ELISA) | Increase fibroblast production and proliferation which in turn release necessary growth factors |
| Cytokine levels | Increased proinflammatory cytokine levels | Column chromatography | Vitamin D treatment and elemental diet can reduce the proinflammatory cytokine levels |
| pH | Rate of wound healing was found to be lower at elevated alkaline pH as compared to wounds having pH close to neutral | Glass top electrode | Lowering the pH to more acidic environment using pH modulating topical agents |
| Hypoxia | Partial Oxygen Pressure of <30 mmHg. It impedes fibroblast proliferation and collagen production affecting wound healing by allowing certain negative entities, such as bacteria, to flourish. | Pulse oximeter, laser doppler flow, skin perfusion pressure and ankle brachial index | Vacuum-assisted closure (negative pressure wound therapy), Compression bandages or compression garments |
| Poor nutrition | Wounds are characterized by prolonged inflammatory phase of healing. Decreased fibroblast formation is observed as long as the patient remains in a catabolic state due to poor nutrition. | Nutrition analysis and analysis of daily food intake | Improving patient's diet by providing nutritious food intake or dietary supplements |