Engineering Niches for Skin and Wound Healing

Optimization of wound healing has been a major goal of medical care throughout history. A myriad of devices, dressings, and therapies have been developed to control the local wound environment, facilitate timely healing, and modulate scar. Despite this, chronic wounds remain a major health burden, scarless wound healing is an aspirational goal, and hypertrophic and keloid scar formation are unpredictable and difficult to treat. Stem cells play a vital role in both wound healing and normal skin homeostasis, prompting their application to wounds and local tissues in efforts to optimize wound healing. However, significant barriers to their use remain, in the form of variable results, regulatory hurdles, expense, poor user-friendliness, and limited cell survival. Stem cell niche engineering is an emerging modality that seeks to facilitate stem cell recruitment, aid the effectiveness of exogenous stem cells, and ultimately result in the reestablishment of stable stem cell populations in support of wound healing and normal skin homeostasis. We examine the stem cell niches of the skin during normal homeostasis and wound healing, explore niche engineering approaches, and identify how these approaches may help address important unmet clinical needs and thereby optimize wound care.