Effectiveness of Exosome-Enriched Hydrogel Dressing in Accelerating Burn Wound Healing

Abstract

Background: Thermal injuries to the skin cause intense inflammation and delayed healing, leading to considerable challenges in the field of advanced wound healing. Stem cell-derived extracellular vesicles (EVs) have strong paracrine capacities to guide cell behaviour throughout wound healing in the cutis. Hypothesis: Exosomes enriched-hydrogels can repair tissue, reduce systemic inflammation and promote re-epithelialization in partial thickness thermal burn wounds when compared to the use of standard hydrogel therapy. Methods: This double blind, parallel group randomized controlled trial involved 60 patients suffering from acute partial thickness thermal burn in 6 months study in central Punjab. The participants were randomly assigned (1:1) to either the exosome-enriched hydrogel dressing (n=30) or the identical hydrogel dressing (n=30) applied at intervals of 48 hours for 4 weeks. The percent of total epithelialization at week 4 was a primary outcome. Secondary outcomes were: Visual Analog Scale (VAS) pain score, serum C-reactive protein (CRP) level, and Vancouver Scar Scale score. A total of 55 subjects were included in the final analysis (28 intervention, 27 control). Results: At 4 weeks, the intervention group demonstrated a significantly higher mean complete epithelialization rate compared to controls (91.2\% \pm 5.8\% vs. 71.8\% \pm 7.3\%; mean difference: 19.4\%, 95\% CI: 14.2\% to 24.6\%; p < 0.001). There was a significant time \times group interaction for wound closure as indicated by repeated-measures ANOVA (F(1, 53) = 112.45, p < 0.001). Patients treated with exosome hydrogels experienced significantly greater reductions in VAS pain scores (1.8 \pm 0.7 vs. 3.9 \pm 0.9; p < 0.001), lower serum CRP levels (6.2 \pm 1.8\text{ mg/L} vs. 14.5 \pm 3.1\text{ mg/L}; p < 0.001), and lower scar scale ratings (2.4 \pm 0.8 vs. 4.8 \pm 1.1; p < 0.001).  In conclusion, exosome-enriched hydrogel dressings can efficiently promote re-epithelialization and minimize early inflammation and tissue scarring in PTBI, and this cell-free regenerative strategy is very promising