scholarly journals Experiences of Bromelain-Based Enzymatic Debridement (Nexobrid) in Burn Patients: A Clinical Report

2021 ◽  
Vol 17 (3) ◽  
pp. 207-212
Author(s):  
Hong Sil Joo ◽  
Joo Hoen Choi

Early debridement (i.e., eschar removal) is regarded as a cornerstone for treating burn wounds. Although surgical debridement is the standard method for complete removal of eschars, it has inefficiencies such as blood loss, heat loss, and poor selectivity, the latter of which means that both viable and necrotic tissue are affected. To make up for the shortcomings, various alternative techniques have been developed. Nexobrid, a mixture of proteolytic enzymes with high bromelain content, has emerged as a viable option in recent years due to its selectivity and efficiency. This product enables dissolving eschar without sacrificing viable or healthy tissue, preserving the potential for spontaneous epithelialization, which accelerates wound healing and leads to better aesthetic outcomes in burn wounds. Herein, we present our experience with proteolytic enzyme debridement using Nexobrid.

Burns ◽  
2021 ◽  
Author(s):  
Karel E.Y. Claes ◽  
Sarah Amar ◽  
Henk Hoeksema ◽  
Kornhaber Rachel ◽  
Alette de Jong ◽  
...  

mBio ◽  
2017 ◽  
Vol 8 (2) ◽  
Author(s):  
Jake Everett ◽  
Keith Turner ◽  
Qiuxian Cai ◽  
Vernita Gordon ◽  
Marvin Whiteley ◽  
...  

ABSTRACT Environmental conditions affect bacterial behavior and can greatly influence the course of an infection. However, the environmental cues that elicit bacterial responses in specific infection sites are relatively unknown. Pseudomonas aeruginosa is ubiquitous in nature and typically innocuous. However, it is also one of the most prevalent causes of fatal sepsis in burn wound patients. The aim of this study was to determine the impact of environmental factors, specifically the availability of arginine, on the pathogenesis of P. aeruginosa in burn wound infections. Comparison of burned versus noninjured tissue revealed that l-arginine (l-Arg) was significantly depleted in burn wounds as a consequence of elevated arginase produced by myeloid-derived suppressor cells. We also observed that l-Arg was a potent chemoattractant for P. aeruginosa, and while low concentrations of l-Arg increased P. aeruginosa’s swimming motility, high concentrations resulted in diminished swimming. Based on these observations, we tested whether the administration of exogenous l-Arg into the burn wound could attenuate the virulence of P. aeruginosa in thermally injured mice. Administration of l-Arg resulted in decreased P. aeruginosa spread and sepsis and increased animal survival. Taken together, these data demonstrate that the availability of environmental arginine greatly influences the virulence of P. aeruginosa in vivo and may represent a promising phenotype-modulating tool for future therapeutic avenues. IMPORTANCE Despite our growing understanding of the pathophysiology of burn wounds and the evolution of techniques and practices to manage infections, sepsis remains a significant medical concern for burn patients. P. aeruginosa continues to be a leader among all causes of bacteremic infections due to its tendency to cause complications in immunocompromised patients and its ubiquitous presence in the hospital setting. With the unforgiving emergence of multidrug-resistant strains, it is critical that alternative strategies to control or prevent septic infections in burn patients be developed in parallel with novel antimicrobial agents. In this study, we observed that administration of l-Arg significantly reduced bacterial spread and sepsis in burned mice infected with P. aeruginosa. Given the safety of l-Arg in high doses and its potential wound-healing benefits, this conditionally essential amino acid may represent a useful tool to modulate bacterial behavior in vivo and prevent sepsis in burn patients. IMPORTANCE Despite our growing understanding of the pathophysiology of burn wounds and the evolution of techniques and practices to manage infections, sepsis remains a significant medical concern for burn patients. P. aeruginosa continues to be a leader among all causes of bacteremic infections due to its tendency to cause complications in immunocompromised patients and its ubiquitous presence in the hospital setting. With the unforgiving emergence of multidrug-resistant strains, it is critical that alternative strategies to control or prevent septic infections in burn patients be developed in parallel with novel antimicrobial agents. In this study, we observed that administration of l-Arg significantly reduced bacterial spread and sepsis in burned mice infected with P. aeruginosa. Given the safety of l-Arg in high doses and its potential wound-healing benefits, this conditionally essential amino acid may represent a useful tool to modulate bacterial behavior in vivo and prevent sepsis in burn patients.


2021 ◽  
Vol 28 (10) ◽  
pp. 1376-1380
Author(s):  
Saeeda Nabat ul Hassan ◽  
Khushbu Farva ◽  
Ghulam Asghar Bhutta

Objective: To study prevalence of various gram negative bacteria in infected burn wounds among stable burn patients reporting to out-patient department on follow-ups. Study Design: Cross Sectional study. Setting: Department of Pathology, Sahara Medical College Narowal. Period: January to June 2020. Material & Methods: Patients with burn wounds with clinical signs and symptoms of infection but vitally stable, wound less than one month old involving < 20% body surface, reporting to out-patient door of study institution on follow-ups were enrolled into the study. Swabs of infected wounds were taken and sent for bacterial culture and sensitivity to the pathology department of the institution, where micro flora were isolated and their antibiotic susceptibility pattern was determined using standard techniques. Consent was taken from patients before including them in study. Results: Total 210 cases were studied. Gram negative bacteria were isolated from 190 cases, out of them 30% were oxidase positive ad 70% were oxidase negative. Most common organism isolated was Pseudomonas Aeruginosa (30%), followed by Proteus Sps. (25.3%) and Entero bacter Sps. (15.8%) etc. Conclusion: Among gram negative bacteria pseudomonas is a major isolated organism from infected burn wounds having high susceptibility to imipenem and cefepime.


Burns ◽  
2010 ◽  
Vol 36 (3) ◽  
pp. 352-355 ◽  
Author(s):  
Farhad Hafezi ◽  
Hamid Elmi Rad ◽  
Bijan Naghibzadeh ◽  
AmirHossein Nouhi ◽  
Ghazal Naghibzadeh

Cells ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 2545
Author(s):  
Josefine Lin Henriksen ◽  
Nana Brandborg Sørensen ◽  
Trine Fink ◽  
Vladimir Zachar ◽  
Simone Riis Porsborg

Treatment of severe burn wounds presents a daunting medical challenge, and novel approaches promoting healing and reducing scarring are highly desirable. The application of mesenchymal stem/stromal cells (MSCs) has been suggested as a novel treatment. In this paper, we present systematic reviews of pre-clinical and clinical studies of MSC therapy for second- or third-degree thermal burn wounds. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, the PubMed and Embase databases were searched, and interventional studies of MSC therapy using rodent models (21 studies) or human burn patients (three studies) were included in the pre-clinical and clinical reviews, respectively, where both overall outcome and wound-healing-phase-specific methodologies and effects were assessed. The pre-clinical studies demonstrated a promising effect of the application of MSCs on several wound healing phases. The clinical studies also suggested that the MSC treatment was beneficial, particularly in the remodeling phase. However, the limited number of studies, their lack of homogeneity in study design, relatively high risk of bias, lack of reporting on mode of action (MOA), and discontinuity of evidence restrict the strength of these findings. This comprehensive review presents an overview of available methodologies to assess the MOA of MSC treatment for distinct wound healing phases. Furthermore, it includes a set of recommendations for the design of high-quality clinical studies that can determine the efficacy of MSCs as a therapy for burn wounds.


2020 ◽  
Vol 41 (6) ◽  
pp. 1224-1230 ◽  
Author(s):  
Seyed Hamid Salehi ◽  
Mahnoush Momeni ◽  
Masoud Vahdani ◽  
Mohammad Moradi

Abstract Burns are a significant public health burden worldwide. In addition to those who die, millions remain with life-threatening deformities and disabilities resulting in stigma and rejection. Surgical excision is currently the standard of care for removing necrotic tissues in burn wounds to prepare the wound bed for grafting or enhancing the healing process. However, there is a growing interest on enzymatic debridement as an adjunct therapy in burn wounds. The aim of this study was to investigate clinical trials using debriding agents for burn wound in humans in a systematic review. This was a systematic review of electronic databases including CINAHL, PubMed, Ovid Medline, Web of Science, Google Scholar, and Embase from January 1969 to February 2019. The study protocol was registered in PROSPERO registry. The following keywords were searched: “burn wounds”, “enzymatic debridement”, “papain”, “papain-urea”, “pine apple”, “Bromelain”, “collagenases”, “Nexobrid”, “Debrase”, “Debridase”, “Actinidia deliciosa”, “Sutilains”, “Debrace”, “piruvat acid”. Those studies fulfilling the inclusion and exclusion criteria with low score of bias based on Cochrane Bias Tool were reviewed. Sixteen investigations fulfilled our inclusion criteria to be reviewed. Six, seven, and three clinical trials on humans were found regarding collagenase, bromelain, and miscellaneous agents. Collagenase has been reported to be effective in burns below 25% of TBSA, especially in outpatients’ clinics. However, Nexobrid has been shown to be effective in deep burns and decreases the percentage of graft without significant adverse effects. There was not enough evidence supporting the clinical values of Papain, Sutilains, Urea, etc. Surgical excision still remains the standard of care for burn wounds debridement. However, enzymatic debridement, especially Bromelain might help to reduce sessions for surgical debridement or area under graft as an adjunct treatment. Despite the fact, more studies with larger sample sizes and with less conflicts of interest are needed to clearly elucidate the exact role of Bromelain.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 903-903
Author(s):  
Sylwia Borkowska ◽  
Malwina Suszynska ◽  
Katarzyna Mierzejewska ◽  
Marta Budkowska ◽  
Daria Salata ◽  
...  

Abstract Background Hematopoietic stem/progenitor cells (HSPCs) residing in BM are released from their niches and circulate under steady-state conditions at detectable levels in the peripheral blood (PB), and their number increases in response to i) systemic or local inflammation, ii) strenuous exercise, iii) stress, iv) tissue/organ injury, and v) pharmacological agents. All these processes involve activation of the complement cascade (ComC), and while mice deficient in the complement protein C3, which is an upstream component of the ComC, are easy mobilizers (Blood 2004; 103:2071), mice deficient in a downstream component of ComC, complement protein 5 (C5), are very poor mobilizers (Leukemia 2009; 23:2052). To explain these observations, it has been suggested that during the mobilization process the C5a cleavage fragment stimulates release of proteolytic enzymes from BM-residing myeloid cells, which attenuates SDF-1–CXCR4 and VLA4–VCAM-1 retention signals in BM niches. In addition, C5a generated in BM sinusoids is a potent chemoattractant for granulocytes and monocytes, which, as the first cells egressing from the BM, play an important role in permeabilization of the BM–PB barrier and thus facilitate the subsequent egress of HSPCs. It is also known that activation of ComC is based on stepwise activation of the cascade of proteolytic pro-enzymes, and thus the lack of upstream C3 should theoretically affect generation of C5 convertase, which is a proteolytic enzyme activating a downstream component of ComC (C5). However, surprisingly, C3–/– mice are easy mobilizers (Blood 2004; 103:2071). Hypothesis To explain how C5 can be activated during the mobilization process even when C3 is missing, we hypothesized that other proteases that are products of the activated coagulation cascade (CoaC) and fibrynolytic cascade (FibC) compensate for the lack of proteolytic activity of ComC-derived C5 convertase. Materials and Methods In our experiments 2-month-old C3-deficient mice (C3–/–) and normal wild type (WT) littermates were mobilized for 6 days by G-CSF in the presence or absence of selected CoaC and FibC inhibitors such as refludan (a direct inhibitor of thrombin) and tranexamic acid (an inhibitor of plasminogen activation). Following mobilization, we measured in PB i) the total number of white blood cells (WBC), ii) the number of circulating clonogenic CFU-GM, and iii) the number of Sca-1+c-kit+lineage– (SKL) cells. In parallel, we measured the activation of C5 by measuring the level of C5a and evaluated activation of CoaC by measuring prothrombin (PT) and activated partial thromboplastin times (APTT) as well as thrombin/antithrombin (TAT) and plasmin/antiplasmin (PAP) complexes. Results We observed that G-CSF-induced mobilization of HSPCs was significantly reduced in easy-mobilizing C3–/– mice if the mice were treated during mobilization with refludan (a CoaC inhibitor) or tranexamic acid (an FibC inhibitor). This reduction correlated with significant inhibition of C5 activation/cleavage. More importantly, we also noticed that inhibitors of CoaC and FibC had a negative effect on mobilization of HSPCs in normal WT animals. The activation of ComC, CoaC, and FibC in mice mobilized with G-CSF was confirmed by an increase in C5a level (Figure 1A) and by measuring PT and APTT time (Figure 1B) as well as TAT and PAP complexes (Figure 1C). Conclusions The data presented in this work demonstrate, for the first time, the existence of crosstalk between all three evolutionarily ancient proteolytic enzyme cascades, ComC, CoaC, and FibC, in the mobilization process of HSPCs. These results also confirm that C5, which plays an important role in egress of HSPCs from the BM, can be activated/cleaved during mobilization not only by ComC-generated C5 convertase but in addition by proteolytic enzymes of CoaC and FibC. Our observations of crosstalk between ComC, CoaC, and FibC may lead to the development of more efficient mobilization strategies in poor mobilizers. Furthermore, since it is known that all these cascades are activated in all the situations in which HSPCs are mobilized from BM into PB (e.g., infections, tissue/organ damage, or strenuous exercise) and show a circadian rhythm of activation due to a drop in blood pH during deep sleep at night, they are involved both in stress-induced as well as in circadian changes in HSPC trafficking in PB. Disclosures: No relevant conflicts of interest to declare.


1968 ◽  
Vol 35 (3) ◽  
pp. 385-393 ◽  
Author(s):  
H. S. Juffs ◽  
A. C. Hayward ◽  
H. W. Doelle

SummaryA study was made of the formation of the extracellular proteolytic enzymes during the growth cycle of several species ofPseudomonascultivated under different conditions of temperature and nutrition. Proteolytic activity was not proportional to growth. Expressed per unit of cell dry weight, the proteolytic activity showed a peak in the early logarithmic phase which was greater in cultures grown at 3 than at 28°C. Proteolytic enzyme was not formed in the absence of organic nitrogen. Of 16 organisms studied,Pseudomonas aeruginosaATCC 10145 was the most prolific producer of proteolytic enzyme.


2013 ◽  
Vol 69 (2) ◽  
pp. 144-150 ◽  
Author(s):  
Vijay Langer ◽  
P.S. Bhandari ◽  
S. Rajagopalan ◽  
M.K. Mukherjee

2019 ◽  
Vol 2 ◽  
pp. 26-32 ◽  
Author(s):  
Mykola Kukhtyn ◽  
Khrystyna Kravcheniuk ◽  
Ludmila Beyko ◽  
Yulia Horiuk ◽  
Oleksandr Skliar ◽  
...  

Microbial films formation on the dairy equipment creates a serious problem, because they are difficult to eliminate by washing and disinfecting means that results in contaminating dairy products by microorganisms. The aim of the work was to study the influence of Savinase®Evity 16L proteolytic enzyme on the process of destructing biofilms, formed by Staphylococcus aureus on stainless steel with different surface roughness. It has been established, that surface roughness of stainless steel influences the process of Savinase®Evity 16L enzyme penetration in a hollow and prevents the destruction of the biofilm matrix, created by Staphylococcus aureus. It has been revealed, that after the influence of a proteolytic enzyme on Staphylococcus aureus biofilms, created on steel with roughness 0,16±0,018 mcm, the density decreased in 4,0 times (р≤0,05), comparing with a condition before processing. At roughness 0,63±0,087 mcm the density of formed biofilms decreased at the effect of Savinase®Evity 16L in 3,3times (р≤0,05) and the biofilm was characterized as a weak one. At the same time at stainless steel surfaces with roughness 2,68–0,95mcm, the density of biofilms decreased in 2,3–2,1times (р≤0,05), comparing with a condition before processing, and they were characterized as ones of the middle density. It has been also revealed, that the degradation intensity of biofilms under the influence of Savinase®Evity 16L enzyme at roughness 2,68–0,95 mcm was 1,7–1,9 times (р≤0,05) lower than at the surface with roughness 0,16±0,018 mcm. So, the revealed degradation features of a biofilm, created by Staphylococcus aureus at surfaces of stainless steel of different roughness at the influence of Savinase®Evity 16L proteolytic enzyme give a possibility to substantiate the addition of proteolytic enzymes to the composition of washing means for dairy production. It is also offered to process the surface to the roughness no more than 0,63 mcm for producing food steel for raising the effectiveness of biofilms destruction by enzymes and for the sanitary processing.


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