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Significance: The treatment and care of patients with skin wounds are a major healthcare expenditure. Burn wounds, iatrogenic surgical wounds, venous stasis dermatitis ulcers, diabetic lower limb ulcers, pressure ulcers, and skin wounds from peripheral neuropathies are largely treated with only supportive care. Despite a great deal of research into using growth factors as therapeutic agents, to date, the field has been disappointing. The only biologic agent that is Federal Drug Administration (FDA) approved for promoting skin wound healing is recombinant platelet-derived growth factor (PDGF-BB), but its modest efficacy and expense limit its use clinically. Recent Advances: Acute hypoxia induced by the clotting of dermal blood vessels during the wounding of skin is a major stress factor that leads to the re-programming of basal keratinocytes to initiate re-epithelialization. The laterally migrating keratinocytes secrete extracellular heat shock protein 90 alpha. Heat shock protein 90 alpha (hsp90α) engages low-density lipoprotein receptor-related protein-1 (LRP-1) cellular receptors and works as an autocrine factor to stimulate keratinocyte migration (re-epithelialization) and as a paracrine factor to stimulate the migration of dermal fibroblasts (fibroplasia) and microvascular endothelial cells (neo-vascularization). Hypoxia-triggered extracellular heat shock protein 90 alpha acts as the master regulator of initial skin wound healing. Critical Issues: It is not yet known how the engagement of hsp90α with the LRP-1 receptor leads to increased motility of keratinocytes, fibroblasts, or microvascular endothelial cells. Understanding the sequence of how an acute skin wound via hypoxic stress leads to cellular events that ultimately induce accelerated wound closure provides numerous targets for new wound-healing therapeutic agents. Future Directions: Developing data for an investigational new drug (IND) application to the FDA for a Phase I study using hsp90α in human skin wounds. Identifying the cellular signaling mechanisms by which hsp90α enhances skin cell migration, leading to accelerated wound closure.

Keratinocyte Migration and a Hypothetical New Role for Extracellular Heat Shock Protein 90 Alpha in Orchestrating Skin Wound Healing