Wound Healing Properties of Pomegranate

Abstract

Pomegranate is rich in bioactive compounds such as anthocyanidins, proanthocyanidins, hydrolysable and non-hydrolysable tannins, flavanones, isoflavones, flavanols, flavones, phenolic acids and hydroxy-benzoic acids, with antioxidant, anti-microbial, anti-inflammatory, anti-biofilm, anti-quorum sensing and immunomodulatory properties. Wound healing is a complex process and at the same time in the wound aria is possible to exist microbes, biofilm, reactive oxygen radicals, and to occur quorum sensing, oxidative stress, inflammation, infection, while tissue repair functions are also taking place. Pomegranate through its’ various bioactivities is getting involved in various biochemical paths and functions during wound healing process and contribute thus by all these ways into healing process. Pomegranate juice, plant parts extracts and phytochemicals treatment accelerate wound healing process, increases wound contraction, reduces healing period, manages pain, enhances DNA, protein, hydroxyproline and collagen production, stimulates synthesis of type-1 procollagen and fibroblasts production and migration, leads to excellent epithelialization, neovascularization and granulation tissue organization. In diabetic patients, pomegranate treatment upregulates the levels of VEGF, EGF and TGF-β1 enhancing wound healing. Moreover, pomegranate reduces microbes count that may lead to infection, inhibits biofilm formation and attenuates preformed biofilms, inhibits quorum sensing and swimming motility that contribute to biofilm formation downregulating the expression of specific bacteria related to swimming motility and quorum sensing. As a strong antioxidant, immunomodulatory and anti-inflammatory agent, pomegranate inhibits oxidative stress, downregulates NOS activity and NO production, inhibits the endothelial activation of genes which predispose to oxidation sensitivity, increases the levels of the antioxidant enzymes glutathione, glutathione peroxidase and catalase, reduces immune cells’ count and stimulates keratinocytes proliferation that play a key role in immune defense against infection. Is important to be mentioned that pomegranate treated effectively acute and chronic wounds such as surgical, incision, excision, burn, oral lichen planus, gingival, aphthous stomatitis, diabetic wounds and gastric ulcers giving results better or comparable to commercial medicines without any adverse effects, while antibiotics and corticosteroids cause side effects that may be severe. These results indicate that pomegranate could possibly be considered as an alternative, safe, multifunctional, wound healing agent.