ARTICLE REFERENCE

ROLE OF REACTIVE OXYGEN

SPECIES (ROS) ON ACUTE WOUND
By:
Akhlis Mufid Auliya G99172028
Karla Monica Praenta G991905031
Maulidi Izzati G991903034
Consulant:
dr. AMRU SUNGKAR, Sp.B, Sp.BP-
RE(K)
Plastic Surgery Station Dr. Moewardi Hospital
Period: 28 October -03 Nopember 2019
BACKGROUND
Cells from the reaction of wound healing
will produce Reactive Oxygen Species
(ROS) that can have beneficial effect of the
tissue by induces Vascular Endothelial
Groth Factor (VEGF) and gives bacteriacid
effect.
Otherwise, excessive product of ROS can
cause tissue damage and also interfere the
reaction of wound healing.
ACUTE WOUND
Wounds are a disorder of normal condition
of the skin
When a wound arises, several effects will
appear:
1. Loss of all or part of organ function
2. Sympathetic stress response
3. Bleeding and blood clots
4. Bacterial contamination
5. Cell death

Occurs suddenly rather than over time

WOUND HEALING
The wound healing phase can be divided into 3
interrelated and overlapping stages:

Hemostasis and Inflammatory

Phase

Proliferation Phase

Remodeling Phase
WOUND HEALING

Complications of the wound

healing
ROS (REACTIVE OXYGEN
SPECIES )
Reactive oxygen species (ROS) are defined as
chemically reactive oxygen radicals as well as non-
radical derivatives of oxygen. The varying range of
reactivity each reactive oxygen species exhibits is
crucial to its impact at the molecular level. Their
significance in the development of many
cardiovascular diseases is well known, but they also
have beneficial roles in cells. Developing a balance
between the overproduction of ROS and its utilization
is important in maintaining healthy redox processes
within the cells.
TARGETS OF ROS
 SOURCES OF ROS
The sources of ROS :

Intracellular

Extracellular
SOURCES OF ROS
 ROLE OF ROS
Role of ROS : The ROS plays the double role of being
the inevitable by-product of aerobic metabolism on one
hand and serving as a marker during stressful conditions
on the other hand

Reactive oxygen species (ROS) have been given a

considerable amount of scrutiny due to the disease states
that they have been linked to, such as aging, cancer, and
atherosclerosis. The body requires a balance in its ROS
levels for homeostasis. If the level of ROS exceeds that
which the body can handle, then oxidative stress occurs.
On the other hand, if the level is too low, reductive stresses
occur and can also cause pathologies ranging from cancer
to cardiomyopathy
REACTIVE OXYGEN
SPECIES (ROS) AND
WOUNDS
ROS which produced by oxidative stress have
an important role in inducing tissue factor
(TF)-mRNA.
TF that produced in case of tissue damage will
initiate extrinsic coagulation pathway,
thrombin will produced it after that.
ROS will induced TF-mRNA and rising
procoagulation activity surface of TF in
trombogenic sickle of damaged blood vessel.
ROS also affecting platelet and collagen
rising.
The activity and aggregation of these
platelet is an important thing in the
process of coagulation that could release
growth factors and cytokines and starts
the wound healing process.
The activated platelet then will potentiate
the coagulation with releasing ROS and
RNS and the expression of TF.
Some growth factors will be released by
platelet, leukosit and fibroblast and are
responsible for the activity of neutrophil,
monosit in the wounded area and will start the
angiogenesis and reepithelization.
TGF that released by fibroblast and lekosit will
inducing the cells to produced more cytokines
like TNF-α, IL-1b and PDGF that will potentiate
the inflammation response process.
PDGF will activate the Neutrophyl Factor kB
(NF-kB) transcription factor and macrophage
chemoattractant protein-1 for the inflammation
process.
ROS also help in the process of
reepithelization with activating collagenase
expression and mediating EGF signaling.
H2O2 activating Activator Protein - 1 (AP-1)
and then will induced collagenase expression
(MMP-1).
Collagenase help in extracellular matrix
degradation that help in cells migration of the
wound.
One or two day after the injury, keratinocyte
will proliferate to support the wound healing.
H2O2 also responsible as the signal to
epidermal growth factor (EGF) in rising the
keratinocyte proliferation.
Acute hypoxia and ROS are important
stimulators in the process of
angiogenesis.
Both of them inducing macrophages,
fibroblasts, endotel cells and
keratinocytes to produce VEGF but the
hypoxia is chronic will have negative
effect for neurovascularization.
Angiogenesis and matrix deposition after
injury, will look like a granulation tissue
that has new vascularization and FGF-2
also vascular endothelial growth factor
(VEGF) that released on wound area that
inducing the angiogenesis and rising
FGF-2 affinity of receptors and this
induction is did by ROS.
Matrix will produced by molecules that
produced by fibroblast and will support
the production of granulation tissue.
This matrix next will be replaced by cross-
linked collagen that synthesized by fibroblast
and will induced the production of collagen I,
III, IV and all the cross linked process.
When fibroblast producing and changing the
matrix with lots of collagens, some of the
fibroblast will changed into myofibroblasts and
help in wound contraction and ROS has a role
on the change of fibroblast to myofibroblasts.
The contraction wound will help in
reepithelization process so it will faster the
healing process.
CONCLUSION
Reactive Oxygen Species (ROS) is
a reactive radical that has a
beneficial effect and detrimental
effects if excessive and plays a role
in the process of wound healing
through the mechanism of
inflammation, angiogenesis and
matrix formation in the wound
healing process.
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