慢性伤口不愈合机制的新假说.pdf

Wound Repair and Regeneration PERSPECTIVE ARTICLE Why chronic wounds will not heal: a novel hypothesis Thomas Bjarnsholt, PhD1; Klaus Kirketerp-Mller, MD2; Peter ?strup Jensen, PhD3; Kit G. Madsen, MSc4; Richard Phipps, PhD1; Karen Krogfelt, PhD5; Niels Hiby, Dr. Med3; Michael Givskov, Dr. Techn1 1. Bioscience and Technology, Bldg 227 BioCentrum, Technical University of Denmark, Lyngby, Denmark, 2. Copenhagen Wound Healing Center, Bispebjerg Hospital, Bispebjerg, Denmark, 3. Department of Clinical Microbiology,University hospital of Copenhagen, Denmark, 4. AdvanDx A/S, Vedback, Denmark, and 5. State Serum Institute, Copenhagen, Denmark Reprint requests: ABSTRACT Dr. Michael Givskov, Bioscience and Technology, Bldg 227 BioCentrum, The present paper presents a hypothesis aimed at explaining why venous leg Technical University of Denmark, DK-2800 ulcers, pressure ulcers, and diabetic foot ulcers develop into a chronic state. We Lyngby, Denmark. propose that the lack of proper wound healing is at least in part caused by inef?- Tel: 145 cient eradication of infecting, opportunistic pathogens, a situation reminiscent of Email: immg@pop.dtu.dk chronic Pseudomonas aeruginosa infections found in patients suffering from cys- tic ?brosis (CF). We have analyzed sections from chronic wounds by ?uorescence Manuscript received: September 19, 2006 in situ hybridization and found distinct microcolonies—the basal structures of Accepted in ?nal form: May 9, 2007 bacterial bio?lms. Several researchers have previously reported that another im- portant hallmark of bio?lm formation is development of increased tolerance to DOI:10.1111/j.1524-475X.2007.00283.x various antimicrobial measures and treatments. Furthermore, the immune re- sponse