Next, the proliferative or tissue formation phase involves proliferation of a number of cell types to form a provisional connective tissue matrix, new blood vessels, and epithelial closure. The inflammatory phase is induced by pro-inflammatory mediators released by injured tissues, and is critical for controlling infection, clearing necrotic debris, and induction of the wound healing process ( Zhang and Mosser, 2008 Koh and DiPietro, 2011 Eming et al., 2017). Immediately following injury, platelet aggregation is important to achieve coagulation and hemostasis in the wound. Skin wound healing involves distinct but overlapping phases of hemostasis, inflammation, proliferation, and remodeling ( Eming et al., 2014). The review also highlights the possible links between altered bone marrow myelopoiesis and increased Mo production as well as extrinsic and intrinsic factors that drive wound macrophage dysregulation leading to impaired wound healing in diabetes. ![]() The current brief review describes the origin, heterogeneity and function of wound Mϕ during normal skin wound healing followed by discussion of how dysregulated wound Mϕ numbers and phenotype are associated with impaired diabetic wound healing. In addition, an impaired transition of diabetic wound Mϕ from “pro-inflammatory” to “pro-healing” phenotypes driven by the local wound environment as well as intrinsic changes in bone marrow Mo is also thought to be partly responsible for impaired diabetic wound healing. Increased production of bone marrow Mo caused by alterations of hematopoietic stem and progenitor cell (HSPC) niche and epigenetic modifications of HSPCs likely contributes to the enhanced number of wound Mϕ in diabetes. Although skin wound Mϕ originate both from tissue resident Mϕ and infiltrating bone marrow-derived Mo, the latter play dominant roles during the inflammatory phase of wound repair. Monocytes (Mo) and macrophages (Mϕ) play important roles in normal skin wound healing, and dysregulation of wound Mo/Mϕ leads to impaired wound healing in diabetes.
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