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Complements and the Wound Healing Cascade: An Updated Review

DOI: 10.1155/2013/146764

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Abstract:

Wound healing is a complex pathway of regulated reactions and cellular infiltrates. The mechanisms at play have been thoroughly studied but there is much still to learn. The health care system in the USA alone spends on average 9 billion dollars annually on treating of wounds. To help reduce patient morbidity and mortality related to abnormal or prolonged skin healing, an updated review and understanding of wound healing is essential. Recent works have helped shape the multistep process in wound healing and introduced various growth factors that can augment this process. The complement cascade has been shown to have a role in inflammation and has only recently been shown to augment wound healing. In this review, we have outlined the biology of wound healing and discussed the use of growth factors and the role of complements in this intricate pathway. 1. Introduction From birth to old age, skin has the vital role of regulating fluid balance, infection control, and thermogenesis. Disruption of this regenerating protective layer can be devastating to the patient and society. More than 2 million burn cases [1] and 7 million chronic skin ulcers caused by pressure, arterial or venous insufficiency, and diabetes mellitus each year in the United States alone are affected by abnormal wound healing [2]. This translates to annual costs of $9 billion in attempt to reduce the major disability and consequent death of such severe skin injury [3]. To help reduce patient morbidity and mortality related to abnormal or prolonged skin healing, an understanding of wound healing is essential. Recent works have helped shape the multistep process in wound healing and introduced various growth factors that can augment this process. The complement cascade has been shown to have a role in inflammation and has only recently been shown to augment wound healing (Figure 3). In this work, we will review the biology of wound healing and discuss the use of growth factors and the role of complements in this intricate pathway. 2. Wound Healing Normal wound healing is a dynamic series of events involving the coordinated interaction of blood cells, proteins, proteases, growth factors, and extracellular matrix components. The wound healing process can be divided into three phases: (1) inflammatory phase; (2) proliferative phase; and (3) maturational phase. Although different predominant cells characterize these phases at differing times, a considerable amount of overlap can occur (Figure 1). Figure 1: Cytokines and complements involved in inflammation. The three phases of wound healing are

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