**Author details**

The potential therapy has been further investigated in a model of hypertrophic scarring, where it was found that application of Flii antibodies resulted in less fibrosis by reducing the number of myofibroblasts within the wound [84]. Further investigation into the use of neutralising antibodies to dampen inflammation and reduce fibrosis in human burns patients is clearly warranted.

New therapies are also being developed to resolve post burn inflammation quickly and lead to better healing outcomes. Lipid mediators, such as the resolvins and lipoxins, which stimulate the resolution of the inflammatory phase, have become of particular interest in recent years [11]. Resolvin D2 has recently been found to restore burn neutrophil directionality and can reduce neutrophil numbers and minimise secondary necrosis in burns [85, 86]. The use of phototherapy has been shown to significantly reduce the number of immune cells within a rat burn wound, increasing angiogenesis and collagen deposition [87] and may herald a new area of research for the development of devices to treat burn wounds. Novel biomaterials are also being investigated in the treatment of burn injuries, not only to provide a provisional matrix or augment skin grafting, but are also being assessed for their ability to modulate the immune response [88]. Fibrin-based hydrogels delivered into pig burn wounds prevented contracture but also reduced immune cells within the hydrogel as well as reducing neutrophil and macrophage numbers within the in the surrounding granulation tissue on day 7 post burn [89]. It is expected that future therapies will aim to provide the dual roles of enhancing healing

outcomes whilst preventing the excessive systemic inflammatory effects post burn.

Recent studies have revealed some difficulties in predicting and assessing the efficacy of therapies in treating burn wounds. For example, the drugs Atorvastatin and Losartan, originally developed to lower cholesterol levels, showed promise in reducing fibrosis and inflammation in a number of conditions. However, when applied to partial and full thickness burn wounds, it was found that whilst Atrovastatin improved healing of full thickness burns, Losartan was detrimental, but found to be beneficial when applied to partial thickness burns [90]. This highlights the complexities of the immune response and progression through the healing cascade in burn injury and demands that careful consideration be paid during the development of any new therapy to the specific use of a treatment. Moreover, it is not yet known if dampening the immune response by any of these approaches would result in a heightened risk of infection. Therefore investigations into the effect of local versus systemic delivery methods, a thorough understanding of the dose-response effect and confounding effects due to the severity of the injury itself, combined with a careful evaluation of timing of treatments is required. Nevertheless, research into methods, which modulate the immune response, to avoid the complications of a dysregulated immune response and the formation of excess scarring and fibrosis following severe burns remains of critical importance for the future developments of

*6.2.4. Enhancement of the resolution of the inflammatory response*

50 Hot Topics in Burn Injuries

**7. Considerations and conclusions**

new therapeutic approaches for the treatment of burns.

Xanthe L. Strudwick and Allison J. Cowin\*

\*Address all correspondence to: allison.cowin@unisa.edu.au

Regenerative Medicine, Future Industries Institute, University of South Australia, Adelaide, South Australia, Australia

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**Section 4**

**Treatment of Burn Injury**
