麻省理工大学：《生物材料——组织交互作用》教学讲义（英文版）WOUND HEALING Roots of the Tissue Response

Massachusetts Institute of Technology Harvard Medical School Brigham and women's Hospital VA Boston Healthcare System 279J3.96J/BE441/HST522J UNIT CELL PROCESSES ASSOCIATED WITH WOUND HEALING LV. Yannas, Ph. D and M. Spector, Ph. D

Massachusetts Institute of Technology Massachusetts Institute of Technology Harvard Medical School Harvard Medical School Brigham and Wo Brigham and Women’s Hospital men’s Hospital VA Boston Healthcare System VA Boston Healthcare System 2.79J/3.96J/BE.441/HST522J 2.79J/3.96J/BE.441/HST522J UNIT CELL PROCESSES ASSOCIATED UNIT CELL PROCESSES ASSOCIATED WITH WOUND HEALING WITH WOUND HEALING I.V. Yannas, Ph.D. and M. Spector, Ph.D. I.V. Yannas, Ph.D. and M. Spector, Ph.D

WOUND HEALING Roots of the Tissue response Resolution Slight Injur 4 Tissue Categories Connective Tissue Nonvascularized Inflammation Epitheli tissue (Vascularized tissue Nerve No Healing Muscle Healing Process Regeneration Repair(scar) cT bone CT cartilas ge Ep: epidermis Nerve Muscle: smooth Muscle: cardiac skel spontaneous

WOUND HEALING WOUND HEALING Roots of the Tissue Response Roots of the Tissue Response Injury Inflammation Inflammation (Vascularized tissue) (Vascularized tissue) Healing Healing Process Process Regeneration* Regeneration* Repair (Scar) Repair (Scar) CT: bone CT: bone CT: cartilage CT: cartilage Ep: epidermis : epidermis Nerve Muscle: smooth Muscle: smooth Muscle: cardiac, Muscle: cardiac, skel . 4 Tissu 4 Tissu e Categories Categories Connective Tissue nnective Tissue Epithelium Epithelium Nerve Muscle *spontaneous *spontaneous Resolution Resolution Slight No Healing No Healing Nonvascularized Nonvascularized tissue

RESPONSE TO IMPLANTS WOUND HEALING flury Vascular Response Inflammation Tissue of labile Tissue of and stable cells Permanent cells Framework framework Scar Intact Destroyed Regeneration Scar

RESPONSE TO IMPLANTS: RESPONSE TO IMPLANTS: WOUND HEALING WOUND HEALING Injury Vascular Response Vascular Response Inflammation Inflammation Tissue of Labile Tissue of Labile Tissue of Tissue of and Stable Cells and Stable Cells Permanent Cells Permanent Cells Framework Framework Framework Framework Scar Intact Destroyed Intact Destroyed Regeneration Scar Regeneration Scar

RESPONSE TO IMPLANTS WOUND HEALING Surgical Implantation Inc, time Vascular response Acute Clotting Inflammation Phagocytosis Granulation Neovascularization New Collagen Synthesis Tissue Tissue of labile and stable cells Tissue of permanent cells Implant movement FrameworkFramework scarring Intact Destroved (fibrous encapsulation; synovium) R egen scarring Chronic Inflammation (incorp. (fibrous encapsulation of implant) synovium hronic inflammation

RESPONSE TO IMPLANTS: RESPONSE TO IMPLANTS: WOUND HEALING WOUND HEALING Surgical Implantation Surgical Implantation Vascular Response Vascular Response Clotting Clotting Phagocytosis Phagocytosis Neovascularization Neovascularization New Collagen Synthesis New Collagen Synthesis Tissue of Labile and Stable Cells Tissue of Labile and Stable Cells Tissue of Permanent Cells Tissue of Permanent Cells Framework Framework Framework Framework Scarring Scarring Intact Destroyed Intact Destroyed (fibrous encapsulation; (fibrous encapsulation; synovium) synovium) Regen. Scarring Scarring Chronic Inflammation Chronic Inflammation (incorp. (fibrous encapsulation; (fibrous encapsulation; of implant) of implant) synovium) synovium) Chronic Inflammation Chronic Inflammation Acute Inflammation Inflammation Granulation Granulation Tissue Imp lant Movement ant Movement Inc. time Inc. time

UNIT CELL PROCESSES Regulator UCP Cell Matrix Product t Regulator Connective ECM Mitosis Tissue! Adhesion ynthesis Epithelia Protein Migration Muscle Collagen Contraction Nerve Biomaterial Endocytosis Integrin Exocytosis

UNIT CELL PROCESSES UNIT CELL PROCESSES Cell + Matrix Product + Regulator Cell + Matrix Product + Regulator Regulator Regulator Mitosis Mitosis Synthesis Synthesis Migration Migration Contraction Contraction Endocytosis Endocytosis Exocytosis Exocytosis UCP Connective Connective Tissue Epithelia Epithelia Muscle Nerve ECM Adhesion Adhesion Protein Protein Collagen Collagen Biomaterial Biomaterial Integrin Integrin

UNIT CELL PROCESSES VASCULAR RESPONSE Contraction Endothelial Cell Basal Lamina- Leakage Reg

UNIT CELL PROCESSES UNIT CELL PROCESSES VASCULAR RESPONSE VASCULAR RESPONSE Endothelial Cell Endothelial Cell + Basal Lamina Basal Lamina Leakage Leakage + Reg. Contraction Contraction

UNIT CELL PROCESSES VASCULAR RESPONSE (circulation) Exocytosis Platelet+ serum→Reg Seratonin circulation) Exocytosis Basophil+ serum→Reg PAF (tissue) Exocytosis Mast cell+ECM→Reg Seratonin Histamine Contraction Endothelial Cell Basal Lamina- Leakage Reg

UNIT CELL PROCESSES UNIT CELL PROCESSES VASCULAR RESPONSE VASCULAR RESPONSE Endothelial Cell Endothelial Cell + Basal Lamina Basal Lamina Leakage Leakage + Reg. Contraction Contraction Platelet + serum Reg. Platelet + serum Reg. Exocytosis Exocytosis Basophil Basophil + serum Reg. + serum Reg. Exocytosis Exocytosis Mast Cell + ECM Reg. Mast Cell + ECM Reg. Exocytosis Exocytosis Seratonin Seratonin Histamine Histamine PAF Seratonin Seratonin (circulation) (circulation) (circulation) (circulation) (tissue) (tissue)

UNIT CELL PROCESSES VASCULAR RESPONSE Exocytosis Platelet+ serum→Reg Seratonin Exocytosis Basophil+ serum→>Reg, PAF ExocytOSIs Mast cell+ECM→Reg Seratonin Histamine Contraction Endothelial Cell Basal Lamina- Leakage Reg Histamine Contraction Smooth Muscle t Basal Lamina- Vasoconstrict

UNIT CELL PROCESSES UNIT CELL PROCESSES VASCULAR RESPONSE VASCULAR RESPONSE Endothelial Cell Endothelial Cell + Basal Lamina Basal Lamina Leakage Leakage + Reg. Contraction Contraction Smooth Muscle Smooth Muscle + Basal Lamina Basal Lamina Vasoconstrict Vasoconstrict . Contraction Contraction Platelet + serum Reg. Platelet + serum Reg. Exocytosis Exocytosis Basophil Basophil + serum Reg. + serum Reg. Exocytosis Exocytosis Mast Cell + ECM Reg. Mast Cell + ECM Reg. Exocytosis Exocytosis Histamine Histamine Cell Seratonin Seratonin Histamine Histamine PAF Seratonin Seratonin

UNIT CELL PROCESSES CLOTTING Exocytosis Platelet Collagen Coagulation factors Fibrin polymerization

UNIT CELL PROCESSES UNIT CELL PROCESSES CLOTTING CLOTTING Platelet + Collagen Platelet + Collagen Coaguation Coaguation factors factors Exocytosis Exocytosis Fibrin polymerization Fibrin polymerization

UNIT CELL PROCESSES CLOTTING Exocytosis Platelet Collagen Coagulation factors Fibrin polymerization PAF (In Circulation) Exocytosis Basophil+serm→Reg PAF (In Tissue) Exocytosis Mast cell+ECM→Reg

UNIT CELL PROCESSES UNIT CELL PROCESSES CLOTTING CLOTTING Platelet + Collagen Platelet + Collagen Coaguation Coaguation factors factors Exocytosis Exocytosis Basophil Basophil + serum Reg. + serum Reg. Exocytosis Exocytosis Mast Cell + ECM Reg. Mast Cell + ECM Reg. Exocytosis Exocytosis Fibrin polymerization Fibrin polymerization PAF PAF (In Circulation) (In Circulation) (In Tissue) (In Tissue)