Abstract
Over the past few decades, there has been a resurgence in the clinical use of honey as a topical wound treatment. A plethora of in vitro and in vivo evidence supports this resurgence, demonstrating that honey debrides wounds, kills bacteria, penetrates biofilm, lowers wound pH, reduces chronic inflammation, and promotes fibroblast infiltration, among other beneficial qualities. Given these results, it is clear that honey has a potential role in the field of tissue engineering and regeneration. Researchers have incorporated honey into tissue engineering templates, including electrospun meshes, cryogels, and hydrogels, with varying degrees of success. This review details the current state of the field, including challenges which have yet to be overcome, and makes recommendations for the direction of future research in order to develop effective tissue regeneration therapies.
Highlights
Honey has been used as a wound treatment by indigenous cultures around the globe for thousands of years
This study found that the active components of the honey diffused through established biofilm matrices of all bacterial types and killed bacteria in a dose-dependent manner, with minimum concentrations between 6 and 12% of Manuka honey and 12 to 25% of Norwegian Forest honey killing biofilm-embedded bacteria depending on the bacterial type
Alandejani et al demonstrated the effectiveness of Manuka honey and Sidr honey, another methylglyoxal-containing variety, against biofilms of methicillin-resistant S. aureus (MRSA), methicillin-susceptible S. aureus (MSSA), and P. aeruginosa
Summary
Honey has been used as a wound treatment by indigenous cultures around the globe for thousands of years. The lower pH of honey (3.5–4) reduces protease activity, increases oxygen release from hemoglobin, and stimulates the activity of macrophages and fibroblasts, while the hydrogen peroxide content sterilizes the wound and stimulates vascular endothelial growth factor (VEGF) production [7] Invertase, another enzyme from the bee crop, slowly divides sucrose into glucose and fructose, increasing the strength of the osmotic potential. Methylglyoxal crosslinks glucose oxidase, destroying its enzymatic activity and eliminating the hydrogen peroxide content in Manuka honey [35] These studies utilized mechanistic controls of methyglyoxal alone or added to non-methylglyoxal-containing honeys to isolate the effect of the methylglyoxal on the other honey components. If a more comprehensive review of the mechanisms of honey that contribute to wound healing is desired, the authors suggest “Honey: a potent agent for wound healing?” by Lusby et al or “The evidence and the rationale for the use of honey as a wound dressing” by Molan [39,40]
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