Persistent inflammation, chronic non-healing ulcers and excessive scarring with stubborn inflammatory reactions are characteristic of wound-healing disorders in the skin. Standard treatment at present entails the surgical removal of diseased tissue followed by reconstructive plastic surgery to close the wound or long-term treatment with various wound dressings.
Increased healthcare costs, an economic impact on the labour market and, above all, greatly reduced quality of life among patients, are the social implications of aberrant wound healing.
The inflammatory process associated with wound healing is crucial in ensuring adequate wound closure. The phospholipids and surfactant proteins contained in the surfactant regulate the activity of alveolar macrophages in the lungs, thereby reducing inflammatory reactions. Based on this concept, Professor Ursula Mirastschijski, a specialist in plastic and aesthetic surgery at Bremen University Hospital, has examined whether the commercially available bovine surfactant Alveofact® can positively influence wound healing and scarring if applied topically.
The various in vitro and in vivo models studied by Prof. Mirastschijski revealed that the topically applied pulmonary surfactant Alveofact® has a positive effect on wound healing. These findings ( https://www.nature.com/articles/s41598-020-59394-5 ) were confirmed by a phase I randomised clinical trial in humans: owing to the pro-migratory and anti-inflammatory activity of the pulmonary surfactant Alveofact®, local inflammation was reduced and wound healing accelerated. Wound re-epithelialisation was achieved more rapidly in the Alveofact® group than in the control group.
The natural ingredients of the pulmonary surfactant were recently found to accelerate and promote wound healing in the lungs in the presence of pulmonary diseases by reducing the alveolar surface tension and influencing the inflammatory reaction. However, the fact that the anti-inflammatory and antibacterial effect of pulmonary surfactant also influences wound closure in human skin is a new and hitherto unpublished observation from in vivo studies.
Another notable finding from the study published in Nature magazine is that the biological pulmonary surfactant Alveofact® can down-regulate the inflammatory reaction in the epithelial cells of the skin despite the absence of anti-inflammatory hydrophilic surfactant proteins SP-A and SP-D. Consequently, the anti-inflammatory properties of pulmonary surfactant in the epithelial cells of the lungs can therefore be applied to the epithelial cells of the skin.
In summary, it can be stated that the topically applied pulmonary surfactant Alveofact® can have an anti-inflammatory, pro-migratory and anti-fibrotic effect on wound healing in human skin. By treating skin wounds with the pulmonary surfactant Alveofact®, wound closure was significantly accelerated, and local inflammation mitigated. At the same time, application of Alveofact® to human skin proved to be safe and tolerable and therefore does not give rise to safety concerns in clinical use. Topical use of the pulmonary surfactant Alveofact® is a promising, innovative method of pharmacological treatment for normal and aberrant wound healing in human skin as a means of preventing excessive scarring. Further developments and studies in the future will reveal whether this promising therapeutic strategy can also establish itself as a standard approach in surgery and dermatology.