For our Wound Research Voices feature in February, we are pleased to share a short summary of a PhD thesis by Julian Rembe, University Hospital Düsseldorf, Germany. The title of the thesis is Breakdown, Identification and Observation of the Micro-Environment in Acute and Chronic Wounds (Wound-BIOME Project).

Lay Person Summary

Chronic wounds do not simply heal more slowly than acute wounds; they exist in a fundamentally altered biological state. Instead of progressing through the normal phases of healing, they remain trapped in a cycle of persistent inflammation, tissue breakdown, and impaired regeneration. 

This PhD project aimed to improve the understanding of the wound micro-environment by analysing biological signals directly obtained from human wounds. Using standardized wound swabbing as a minimally invasive sampling method, wound exudate from patients with acute wounds and various chronic wound entities was analysed. The focus was on inflammatory mediators, immune responses, tissue remodelling processes, and microbial influences. 

By identifying molecular patterns that distinguish healing from non-healing wounds, this work contributes to the development of objective, biology-driven wound diagnostics and supports a shift toward more personalized wound care strategies. 

Methodology

This doctoral research initiated the multicentre Wound-BIOME project and followed a translational, patient-based approach. Standardized wound swabs were used to sample the wound micro-environment repeatedly and non-invasively. Samples from acute wounds and different chronic wound types were analysed using proteomic profiling (LC-MS/MS) and multiplex immunoassays to characterize inflammatory signalling, immune activity, matrix remodelling, and regenerative pathways. 

Additional feasibility analyses included microRNA sequencing and metagenomic microbiome profiling. Molecular data were integrated with clinical parameters such as wound type, infection status, and healing outcome. Advanced bioinformatics and statistical methods were applied to identify biologically and clinically relevant patterns. 

Conclusions & Key Messages (Clinical Relevance) 

The project demonstrates that chronic wounds are characterized by a distinct and dysregulated wound micro-environment, dominated by persistent inflammation and excessive tissue breakdown. 

Key findings include: 

• Clear molecular differences between acute and chronic wounds, as well as between healing and non-healing wounds, 

• Identification of immunomarker ratios (e.g. IL-1β/IL-1RA and CXCL8/CXCL10) with potential relevance for assessing healing status, infection, and regenerative stage, 

• Validation of wound swabbing as a feasible and reliable diagnostic tool for repeated, non-invasive monitoring of the wound micro-environment. 
  
  

From a clinical perspective, these findings support moving beyond purely visual wound assessment toward biomarker-guided, individualized wound management, enabling more targeted therapeutic decisions and improved monitoring of treatment response. 

Publications 

1. Rembe JD et al. Assessment and Monitoring of the Wound Micro-Environment in Chronic Wounds Using Standardized Wound Swabbing for Individualized Diagnostics and Targeted Interventions. Biomedicines, 2024. https://doi.org/10.3390/biomedicines12102187  
2. Rembe JD et al. “Diagnostics beyond bacteria” – Wound swabs for biomolecular disease pattern analysis in chronic wounds. Gefässchirurgie, 2024 [german]. https://doi.org/10.1007/s00772-024-01122-8  
3. Rembe JD, Stürmer EK. Biomarkers in wound healing and wound treatment. 
   Gefässchirurgie, 2023 [german]. https://doi.org/10.1007/s00772-022-00968-0  
4. Rembe JD et al. Immunomarker profiling in human chronic wound swabs reveals IL-1β/IL-1RA and CXCL8/CXCL10 ratios as potential biomarkers for wound healing and infection status. Journal of Translational Medicine, 2025. https://doi.org/10.1186/s12967-025-06417-2  
5. Rembe JD et al. Proteomic patterns in chronic wound healing: unveiling molecular insights for diagnostic and therapeutic strategies. Journal of Investigative Dermatology, submitted.