We are searching for the """"""""control points"""""""" of the healing and scarring process with the object of enhancing retarded repair in acutely injured patients, and, more importantly, to prevent excessive scarring and subsequent disability due to trauma, arthritis, arteriosclerosis, and other diseases of pathologic deposition of connective tissue. We have isolated several control points: 1) between coagulation, and angiogenesis and inflammation, 2) between macrophages and angiogenesis and fibroplasia, 3) between local lactoacidosis and collagen synthesis, and 4) between the circulation and the oxygen supply. Means of enhancing the chemical messages as well as blocking them are also being investigated. Immune contributions to normal repair are being studied in this regard since immune-stimulated cells also seem to excite scar formation. The inflammatory cells, the new vessels, and fiber-producing cells together create a specific environment, and we are investigating how this environment enhances signal reception of response. The inflammatory process, so important in inducing repair, is also responsible for resistance to infection, and the same environment which seems to support the healing response has properties which seem to reduce resistance to infection. Fortunately, our work shows that it is possible to create environmental conditions which enhance resistance to infection and still support the healing process.
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