Biological solutions activated by cold plasma at atmospheric pressure: A new therapeutic approach for skin wound healing

Abstract

Chronic wounds are a major public health problem, and nearly 35 % of them do not heal with conventional treatments. The direct application of cold plasmas at atmospheric pressure, partially ionized gases, is an emerging technology with a range of potential biomedical applications, including the improvement of wound healing. A new method that is easier to implement has been developed: the use of biological solutions exposed to cold plasmas at atmospheric pressure, known as plasma-activated media (PAM). Numerous preclinical studies and in vitro models indicate that PAM treatments facilitate wound healing by promoting the migration of cell types such as keratinocytes, fibroblasts and mesenchymal stem/stromal cells, stimulating angiogenesis, and inhibiting bacterial proliferation, all of which are critical to this vital process. PAM treatments modulate the inflammatory response, induce the expression of growth factors and matrix metalloproteinases, reduce cellular adhesion, promote cytoskeletal modifications and activate several biochemical pathways involved in the wound healing process, possibly through the action of plasma-generated reactive oxygen and nitrogen species. Some studies have shown that PAM may have applications in the treatment of other skin conditions either by reducing the production of pro-inflammatory cytokines or by inducing apoptosis of tumor cells. PAM treatments therefore represent a promising new therapy for the management of dermatological conditions, particularly for chronic skin and mucosal wounds. Wound healing is a physiological process characterized by a precise sequence of events necessary for restoring the skin barrier integrity, including bacterial clearance, re-epithelialization, angiogenesis, tissue remodeling and resolution of inflammation. Chronic wounds are skin lesions that do not progress through the various events and often remain in an inflammatory phase, preventing epithelial cells from closing the epidermis and exposing it to the risk of infection. The increasing prevalence of chronic wounds as population ages and the resulting rise in healthcare costs is a major public health challenge. Several studies have shown that biological solutions activated with cold atmospheric pressure plasma, a partially ionized gas leading to the production of various reactive oxygen and nitrogen species (RONS) and ions, have beneficial effects on wound healing, making them a potential new therapeutic approach. • Biological solutions activated by cold plasma at atmospheric pressure (PAM) are a promising therapy for the treatment of chronic wounds. • PAM treatments inhibit bacterial proliferation and stimulate both angiogenesis and cell migration. • PAM seems to act through reactive oxygen and nitrogen species.

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