title: Anaerobic cocci populating the deep tissues of chronic wounds impair cellular wound healing responses in vitro.
abstract: BACKGROUND
  Anaerobic cocci are estimated to be present in the deep tissues of over 50% of chronic skin wounds. While the part they play in the chronicity of these wounds is uninvestigated, anaerobic cocci have previously been shown to be involved in other chronic inflammatory human conditions.
  
  
  METHODS
  In this study the anaerobic microflora of the deep tissues of 18 patients with refractory chronic venous leg ulcers (mean age 80.3 years; mean duration > 24 months) was characterized using strict anaerobic culture conditions. The effect of the anaerobic organisms isolated from these tissues on extracellular matrix (ECM) proteolysis and cellular wound healing responses was studied using in vitro models.
  
  
  RESULTS
  Anaerobic organisms were present in the deep tissues of 14 of 18 wounds and were principally Peptostreptococcus spp. The effects of three Peptostreptococcus spp. isolated from these wounds (P. magnus, P. vaginalis and P. asaccharolyticus) on cellular wound healing responses were compared with those of two pathogenic organisms also isolated from these wounds (Pseudomonas aeruginosa and Citrobacter diversus). While the direct ECM proteolytic activity exhibited by the Peptostreptococcus spp. was limited, they did significantly inhibit both fibroblast and keratinocyte proliferation, but only at high concentrations. However, at lower concentrations peptostreptococcal supernatants profoundly inhibited keratinocyte wound repopulation and endothelial tubule formation. The magnitude of these effects varied between strains and they were distinct from those demonstrated by Pseudomonas aeruginosa and Citrobacter diversus.
  
  
  CONCLUSIONS
  These studies confirm the importance of anaerobic organisms in chronic wounds and demonstrate an indirect, strain-specific mechanism by which these microorganisms may play a part in mediating the chronicity of these wounds.
authors.affiliation: Department of Oral Surgery, Dental School, University of Wales College of Medicine, Cardiff, CF14 4XY, UK.
authors.forename: P
authors.initials: P
authors.lastname: Stephens
authors.forename: I B
authors.initials: IB
authors.lastname: Wall
authors.forename: M J
authors.initials: MJ
authors.lastname: Wilson
authors.forename: K E
authors.initials: KE
authors.lastname: Hill
authors.forename: C E
authors.initials: CE
authors.lastname: Davies
authors.forename: C M
authors.initials: CM
authors.lastname: Hill
authors.forename: K G
authors.initials: KG
authors.lastname: Harding
authors.forename: D W
authors.initials: DW
authors.lastname: Thomas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002455:Cell Division; D002478:Cells, Cultured; D002908:Chronic Disease; D041041:Citrobacter koseri / Q000472:pathogenicity; D004727:Endothelium / Q000502:physiology; D005347:Fibroblasts / Q000502:physiology; D006801:Humans; D006868:Hydrolysis; D015603:Keratinocytes / Q000502:physiology; D007871:Leg Ulcer / Q000382:microbiology* / Q000503:physiopathology; D010462:Peptostreptococcus / Q000201:enzymology / Q000472:pathogenicity*; D011550:Pseudomonas aeruginosa / Q000472:pathogenicity; D014945:Wound Healing / Q000502:physiology*