Law, Wai Tak. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 107-123). / Abstracts in English and Chinese. / Abstract --- p.i / 摘要 --- p.iv / Acknowledgements --- p.vi / Publications --- p.viii / Table of Contents --- p.ix / Chapter Chapter 1 --- Introduction / Chapter 1.1 --- Wound healing --- p.1 / Chapter 1.1.1 --- Physiology of wound healing --- p.1 / Chapter 1.1.2 --- Three phases of wound healing --- p.3 / Chapter 1.1.3 --- Angiogenesis in wound healing --- p.10 / Chapter 1.2 --- Delayed wound healing --- p.11 / Chapter 1.2.1 --- Chronic ulcers --- p.11 / Chapter 1.2.2 --- Examples of ulcers --- p.12 / Chapter 1.3 --- Traditional Chinese medicine (TCM) --- p.16 / Chapter 1.3.1 --- Principles of TCM --- p.16 / Chapter 1.3.2 --- TCM and chronic ulcers --- p.16 / Chapter 1.4 --- Objectives of study --- p.19 / Chapter Chapter 2 --- Materials and Methods --- p.21 / Chapter 2.1 --- Selection of traditional Chinese herbs --- p.21 / Chapter 2.2 --- Authentication of TCM --- p.22 / Chapter 2.3 --- Preparation of TCM --- p.23 / Chapter 2.4 --- In vitro studies on the effects of TCM on wound healing --- p.23 / Chapter 2.4.1 --- Angiogenesis study by using human umbilical vein endothelial cell (HUVEC) --- p.25 / Chapter 2.4.2 --- Granulation study by using human fibroblast cell line (CRL) --- p.32 / Chapter 2.4.3 --- Preparation of cell culture conditions --- p.35 / Chapter 2.5 --- In vivo study on the effects of TCM on wound healing by using diabetic mice --- p.38 / Chapter 2.5.1 --- Diabetic mice model --- p.38 / Chapter 2.5.2 --- Diabetic mice wound induction --- p.41 / Chapter 2.5.3 --- "Measurement of body weight, blood glucose level and ulcer area" --- p.43 / Chapter Chapter 3 --- Results / Chapter 3.1 --- The percentage yield of each herbs --- p.48 / Chapter 3.2 --- pH value of all the effective treatment concentration --- p.49 / Chapter 3.3 --- Selection of traditional Chinese herbs --- p.53 / Chapter 3.4 --- Effect of selected TCM on the proliferation of HUVEC --- p.55 / Chapter 3.5 --- Effect of selected TCM on the migration of HUVEC --- p.61 / Chapter 3.6 --- Effect of selected TCM on the proliferation of CRL --- p.63 / Chapter 3.7 --- "Effect of Radix Rehmanniae (selected TCM) on the change in body weight, blood glucose level and ulcer area" --- p.66 / Chapter Chapter 4 --- Discussions --- p.75 / Chapter Chapter 5 --- How does my study contribute towards the modernisation of Chinese medicine? --- p.100 / References --- p.107 / Appendix --- p.124

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Thesis (M.Sc.(Medical Sciences)) -- University of Limpopo, 2022 / Background: Wound infections continue to be problematic in clinical practice where empiric treatment of infections is a routine, with non-healing wounds being a burden to the health care system. A gap has been noted between antimicrobial resistance and demographic factors as an existing relationship. This necessitates an investigation of patterns of isolates and susceptibility profiles of microorganisms in wounds to modify the preventative and therapeutic strategies against the resistant strains leading to the stall of wound healing, which could aid in empiric treatment. Objective: The aim of this study was to determine the antimicrobial patterns and their associated demographic determinants in bacteria isolated from patients with non healing wounds at Pietersburg and Mankweng Hospitals, Limpopo Province. Methods: The study was conducted using antimicrobial susceptibility data collected from National Health Laboratory Service through Academic Affairs and Research Management System for the period 2016-2020. A total of 797 Antimicrobial Susceptibility Test results were analysed using Statistical Package for Social Sciences version 27.0. The susceptibility rates for the bacterial isolates by age and gender were calculated. The mean percentages for sensitivity and resistance were also calculated. Pearson’s Chi-square test was used to compare age and gender with drug susceptibility. A p-value of ≤ 0.05 was considered significant. Results: Of the 797 patient Antimicrobial Susceptibility Test results, 372 (46.7%) were males and 425 (53.3%) females, with mean age of 31.42 ± 21.75 years. The most common isolates were, Klebsiella pneumoniae (23%), Pseudomonas aeruginosa (21.7%), Escherichia coli (16%) and Proteus mirabilis (13.5%). Highest percentage of resistance to any antibiotic was amoxicillin, ampicillin (85.15%) then trimethoprim sulfamethoxazole (60.85%), amoxicillin ampicillin (49.1%), tigecycline (46.35%), cefepime (32.7%), gentamycin (25.4%), ciprofloxacin (22.5%), colistin (17.6%), and meropenem (12.3%). Furthermore, the general view of the study is no statistically clinical significance on the effect of age and gender on bacterial resistance although statistical significance was noted on age the resistance Acinetobacter baumannii vi (p=0.018), and gender on K. pneumoniae (p=0.015), P. mirabilis (p=0.024). Major resistance to A. baumannii, K. pneumoniae and P. mirabilis were from female patients. Conclusions: The most effective antibiotics were meropenem, colistin, and ciprofloxacin. The highest number of isolates were K. pneumoniae, E. coli, P. aeruginosa, P. mirabilis and A. baumannii with the most effective antibiotics gentamycin, meropenem, ciprofloxacin, and cefepime. Although the general view of the study is that no statistically clinical significance was noted on the effect of age and gender on bacterial resistance, it is important to note the significant observation that there was an observed relation of age to amoxicillin-clavulanic acid and Ciprofloxacin and gender to amoxicillin ampicillin. As such, there is insufficient evidence that supports the effect of age and gender on antimicrobial susceptibility. The study suggests caution against the use of amoxicillin ampicillin in the treatment of wound infections as it confers low levels of efficacy and high resistance and ultimately the call to revise minimum inhibitory concentrations and critical concentrations of all less effective drugs to increase their efficacy. / National Research Foundation (NRF)

Pyruvate kinase M2 (PKM2) is a glycolytic enzyme expressed in highly proliferating cells. Studies of PKM2 have been focused on its function of promoting cell proliferation in cancer cells. Our laboratory previously discovered that extracellular PKM2 released from cancer cells promoted angiogenesis by activating endothelial cell proliferation and migration. PKM2 activated endothelial cells through integrin αvβ3. Angiogenesis and myofibroblast differentiation are key processes during wound healing. In this dissertation, I demonstrate that extracellular PKM2 released from activated neutrophils promotes angiogenesis and myofibroblast differentiation during wound healing. PKM2 activates dermal fibroblasts through integrin αvβ3 and PI3K signaling pathway. I also claim that extracellular PKM2 plays a role during liver fibrosis. PKM2 protects hepatic stellate cells from apoptosis by activating the survival signaling pathway.

Fibrosis of vital organs remains one of the leading causes of death in the developed world, where it occurs predominantly in soft tissues (liver, lung, kidney, heart) through fibroblast proliferation and deposition of extracellular matrix (ECM). In the process of fibrosis, remodeling and deposition of ECM results in stiffening of cellular microenvironment; cells also respond to these changes in the stiffness through engagement of their cytoskeleton and signaling via cell-ECM contacts. Thus, understanding to what extent the stiffness of the cellular microenvironment changes as a consequence of fibrotic progression, and how cells respond to this change, is critical. In this thesis, we quantitatively measured stiffness of the lung parenchyma and its changes during fibrosis. We find that the average stiffness increases by approximately 10-fold. We then investigated how changes in ECM rigidity affect the cytoskeletal phenotype of lung fibroblasts. We find a complex relation between expression of the glycoprotein Thy-1 (CD90) and ECM rigidity-dependent cytoskeletal phenotype (i.e. “mechanotransduction”). Finally, we investigate a mechanism for the regulation of rigidity sensing by Thy-1 and its involvement in intracellular signaling through cell-ECM contacts. Taken together, this work helps define in vivo parameters critical to the fibrogenesis program and to define unique cellular phenotypes that may respond or contribute to mechanical homeostasis in fibrotic diseases.

Despite the ongoing political debate regarding the legality of medical marijuana, clinical investigations of the therapeutic use of cannabinoids are now more prevalent than at any time in history. Cannabinoids have been shown to have analgesic, anti-spasmodic, anticonvulsant, anti-tremor, anti-psychotic, anti-inflammatory, anti-oxidant, anti-emetic and appetite-stimulant properties. There are mainly two well-known cannabinoid receptors, CB1 and CB2, located in the central (CB1) and peripheral (CB2) nervous systems as well as the immune system. More recently, endocannabinoids (ligands) and their receptors have also been found in the skeleton which appear as the main body system and physiologically regulated by CB2. This study aimed to examine the effect of both CB1 and CB2 receptor stimulation on wound closure response of MG-63 osteoblast bone cell monolayers using different treatments with cannabinoid such as Winn55,212-2, URB602 and HU308. Also, cell adhesion, cell proliferation and cell length was investigated. The study also aimed to examine the effect of HU308 treatments in combination with TGF-β3 (transforming growth factor beta -3) on wound healing, cell adhesion and extracellular matrix up regulation (collagen type I, fibronectin and protien S-100A6) as well as other biological factors such as secretion of matrix metalloproteinase (MMP-2) and nitric oxide (NO). Finally, this study investigated HU308/TGF-β3 combination treatment on the regulation of extracellular matrix (collagen type I, fibronectin and protien S-100A6) in a 3D multilayer system of MG-63 osteoblast bone cells. Wound healing assays of MG-63 monolayers revealed accelerated wound repair as well as increased cell proliferation mainly regulated through CB2 receptors, and that treatments with HU308 and HU308/TGF-β3 achieved minimum closure timings compared with control groups (P<0.05). Our finding suggested that proliferation rate with 500nM HU308 was significantly higher than control and TGF-β3/HU308 combination groups (P<0.05). Interestingly, percentage of wound remained open after 15 hours for combination groups was 17.6%±1.32 whereas treatment with 500nM HU308 had 20%±2.25 indicating that the combination groups took the lead throughout wound healing. It was also observed that bridge formation in all treatment groups was taking place between 15 to 20 hour periods whereas within control treatments bridge formation started to take place after 25 hours. Cell surface attachment was examined via the trypsinization assay in which the time taken to trypsinize cells from the surface provided a means of assessing the strength of attachment. The results indicated that higher concentrations of HU308 (2μM), induced significant force of cell attachment compared with control and concentrations of 500nM and 1μM (P<0.05). However, groups treated with TGF-β3 and combination HU308/TGF-β3 indicated reduced cell surface attachment compared with control groups, indicating enhanced cell migration. Immunofluorescence staining as well as Elisa based semi-quantification technique indicated that both collagen type I and fibronectin were unregulated using higher concentrations of HU308 with decreased cell proliferation compared to lower concentrations. Nevertheless, protein S-100A6 was up-regulated in treatments with HU308, TGF-β3 and their combination HU308/TGF-β3 (P<0.05), indicating the positive role of these treatments in promoting cell differentiation. MMP-2 levels in the current study were also shown to be concentration-dependent, i.e. higher concentrations of HU308 significantly reduced MMP-2 secretion leading to decreased cell migration, while HU308/TGF-β3 combination treatment increased MMP-2 levels, indicating an increase in cell migration. The current study also examined levels of nitric oxide synthesis in relation to different treatments with HU308, TGF-β3 and HU308/TGF-β3 combination. It was found that nitric oxide up-regulation influences rate of MG-63 osteoblast wound healing in a concentration dependent manner. Lastly, UpCell culture dishes proved to have efficacy in obtaining a multilayer model of MG-63 osteoblast system in-vitro through changes in cell morphology. It was also found that treatments with HU308, TGF-β3 and HU308/TGF-β3 combination influenced collagen type I, fibronecton and protein S-100A6 secretion. These findings supported the earlier Elisa based semi-quantification results obtained for monolayer cultures.

Tissue engineered scaffolds were constructed to mimic the native extracellular matrix (ECM) and promote cell migration of keratinocytes and fibroblasts. Electrospinning technology was used to fabricate these nano-scale matrices that consist of varying compositions and fiber diameters. The purpose of this study was to examine how average fiber diameter and scaffold composition regulate cell migration. Odyssey infrared scanning evaluated this on a macroscopic level, whereas confocal microscopy focused on a more microscopic approach. The expression of proteases released into the culture media was also examined. The results from this study suggest that fiber diameter increases as a function of electrospinning starting concentration. Altering the composition by adding a basement membrane-like material, Matrigel, does not statistically affect the average fiber diameter. Fibroblast migration is greater on collagen scaffolds than gelatin scaffolds based on surface area measurements. Confocal images illustrate a distinct cell polarity and various cell morphologies of fibroblasts on electrospun collagen scaffolds. Cell-matrix interactions are more prominent on intermediate to large scale fibers. However, cell-cell contacts are more prevalent at the smallest fiber diameters, suggesting that this scaffold acts like or as a two-dimensional surface. The expression of matrix metalloproteases (MMPs), specifically MMP-2 and MMP-9, by fibroblasts during in vivo cell migration assays, suggests that the greatest amount of matrix remodeling is at the two extremes of fiber diameters.

Normal wound healing is a complex process that occurs in overlapping phases and depends upon interactions of the patient, environment and a large number of cells, growth factors, cytokines, chemokines, and other biochemical mediators. Psychological stress has been shown to adversely affect the normal wound healing process through its impact on cellular immunity. Cellular immunity impacts wound healing through the production and regulation of many of the above biochemical mediators of wound healing. The purpose of this pilot study was to examine the relationships among pre- and post-operative psychological stress experienced by women who were undergoing either immediate or delayed breast reconstruction following mastectomy for breast cancer and influence of that stress on wound healing, specifically the biochemical mediators of wound healing in the local wound environment. An integration of Lazarus and Folkman’s cognitive appraisal model of stress and coping and the psychoneuroimmunology model proposed by McCain, Gray, Walter and Robins (2005) served as the theoretical framework for the research. A descriptive non-experimental design was used, with samples collected over time to describe biochemical patterns in surgical wounds of women undergoing autologous breast reconstruction. Biochemical data were collected preoperatively, as well as at 24, 48, 72 and 96 hours postoperatively. Psychological stress instruments were administered pre-operatively and 48 hours post-operatively. Although subjects overall displayed low levels of psychological stress, meaningful wound fluid biochemical mediator patterns were detected. This study adds to our knowledge concerning wound fluid chemical mediators present in the local wound environment over time.

Bone morphogenetic proteins (BMPs) and their receptors (BMPRs) coordinate tissue development and postnatal remodelling by regulating proliferation, differentiation and apoptosis. However, their role in wound healing remains unclear. To study this, transgenic mice overexpressing Smad1 (K14-caSmad1) or the BMP antagonist Noggin (K14-Noggin) were utilised, together with human and mouse ex vivo wound healing models and in vitro keratinocyte culture. In wild-type mice, transcripts for Bmpr-1A, Bmpr-II, Bmp ligands and Smad proteins were decreased following tissue injury, whilst Bmpr-1B expression was up-regulated. Furthermore, immunohistochemistry revealed a down-regulation of BMPR-1A in hair follicles adjacent to the wound in murine skin, whilst in murine and human wounds, BMPR-1B and phospho-Smad-1/5/8 expression was pronounced in the wound epithelial tongue. K14-caSmad1 mice displayed retarded wound healing, associated with reduced keratinocyte proliferation and increased apoptosis, whilst K14-Noggin mice exhibited accelerated wound healing. Furthermore, microarray analysis of K14-caSmad1 epidermis revealed decreased expression of distinct cytoskeletal and cell motility-associated genes including wound-associated keratins (Krt16, Krt17) and Myo5a versus controls. Human and mouse keratinocyte proliferation and migration were suppressed by BMP-4/7 both in vitro and ex vivo, whilst they were stimulated by Noggin. Additionally, K14-caSmad1 keratinocytes showed retarded migration compared to controls when studied in vitro. Furthermore, Bmpr-1B silencing accelerated migration and was associated with increased expression of Krt16, Krt17 and Myo5a versus controls. Thus, this study demonstrates that BMPs inhibit proliferation, migration and cytoskeletal re-organization in epidermal keratinocytes during wound healing, and raises a possibility that BMP antagonists may be used for the future management of chronic wounds.

The extracellular matrix (ECM) offers a protective shelter for cells and provides signaling paths important for cell to cell communication. ECM consists of basement membranes (BM) and interstitial matrix. BMs provide mechanical support for parenchymal cells, influence cell proliferation, survival, migration and differentiation. They are also important for tissue integrity. Laminins (LM) are the major non-collagenous component of BMs. Cell-ECM interactions, mediated by receptors, are indispensable during embryonic development, wound healing, remodeling and homeostasis of tissues. The integrins are the major cell-adhesion receptors. The expression of alpha11 integrin chain in the cornea is of great interest, as it is part of the alpha11beta1 integrin receptor for collagen type I, the predominant component of the corneal stroma. The aims were to thoroughly characterize the ECM in the developing and adult human eye, with particular focus on the cornea, LM and alpha11 integrin chains, and to examine alpha11 integrin chain in an animal model of corneal wound healing and remodeling. Human fetal eyes, 9-20 weeks of gestation (wg), and adult human corneas with different diagnosis were treated for immunohistochemistry with specific antibodies against LM and alpha11 integrin chains. Normal and knockout (ko) mice were treated with laser surgery to create a deep wound in the corneal stroma. The wound healing process was followed at different time points. The cellular source of alpha11 integrin chain was studied in cell cultures. In the fetal eyes, the BM of the corneal epithelium, the Descemet’s membrane (DM) and the Bruch’s membrane each had their specific combinations of LM chains and time line of development, whereas the lens capsule and the internal limiting membrane showed constant LM chain patterns. The epithelial BMs of normal and diseased adult corneas contained similar LM chains. The normal morphology of the epithelial BM was altered in the different diseases, particularly when scarring was present. In the scarred keratoconus corneas there were excessive LM chains. The majority of keratoconus corneas also expressed extra LM chains in the DM. At 10-17 wg alpha11 integrin chain was present in the human corneal stroma, especially in the anterior portion, but it was scarce at 20 wg, in normal adult corneas and in Fuchs’ endothelial dystrophy. In contrast, it was increased in the anterior portion of the stroma in keratoconus corneas with scarring. Alpha11 integrin ko mice had a defective healing with subsequent thinner corneas. Alpha11 integrin expression correlated to the presence of alpha-smooth muscle actin in vivo as well as in vitro. The distinct spatial and temporal patterns of distribution for alpha11 integrin and each of the LM chains suggest that they play an important role in human ocular differentiation. The selectively affected LM composition and the novel expression of alpha11 integrin chain in scarred keratoconus corneas as well as the pathologic healing in ko mice, indicate that alpha11 integrin and LM chains also play an important role in the process of corneal healing, remodeling and scarring and might participate in the pathogenesis of corneal disease. This knowledge is of practical importance for future topical therapeutic agents capable of modulating the corneal wound healing processes.