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Preparing the soil: Adjusting the metabolic health of patients with chronic wounds and musculoskeletal diseases

L. D. da Fonseca,G. Santos,G. Azzini,Tomás Mosaner,Daniel de Moraes Ferreira Jorge,Alex Pontes de Macedo,S. Huber,Pablo Sobreiro,Ignácio Dallo,Madhan Jeyaraman,P. Everts,Annu Navani,José Fábio Lana

Published 2024 in International Wound Journal

ABSTRACT

In recent years, systemic inflammation has emerged as a pivotal player in the development and progression of various degenerative diseases. This complex, chronic inflammatory state, often undetected, can have far‐reaching consequences for the body's physiology. At the molecular level, markers such as C‐reactive protein, cytokines and other inflammatory mediators serve as indicators of systemic inflammation and often act as predictors of numerous musculoskeletal diseases and even certain forms of cancer. The concept of ‘meta‐inflammation’, specifically referring to metabolically triggered inflammation, allows healthcare professionals to understand inflammatory responses in patients with metabolic syndrome. Driven by nutrient excess and the expansion of adipose tissue, meta‐inflammation is closely associated with insulin resistance, further propagating the metabolic dysfunction observed in many Western societies. Wound persistence, on the other hand, exacerbates the detrimental effects of prolonged inflammation at the local level. Acute inflammation is a beneficial and essential process for wound healing and infection control. However, when inflammation fails to resolve, it can impede the healing process, leading to chronic wounds, excessive scarring and even the activation of fibrotic pathways. This approach significantly reduces the efficacy of regenerative biological therapies. Our review focuses on the vital role of proteins, vitamins and minerals in collagen synthesis and cell proliferation for tissue healing. We also examine hormonal influences on regeneration, noting the negative effects of imbalances, and emphasize glucose regulation's importance in creating a stable environment for chronic wound healing.

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