Publication:

Protease sink vs. direct inhibition: mechanistic insights and clinical evidence for MMP-targeted dressings in hard-to-heal wounds

Chronic wounds are characterised by excessive matrix metalloproteinase (MMP) activity and impaired remodelling of the extracellular matrix (ECM). Dressing marketed as MMP inhibitors aims to restore protease balance, but their mechanism and clinical efficacy differ. This review bridges the mechanistic and clinical perspectives by comparing collagen and oxidized recombinant cellulose (ORC) matrixes (protease inhibitors) with TLC-NOSF (technology lipids with nano-oligosaccharide factor). Collagen-based creams act passively as a protease sink, as a binding medium for MMPs and as an inflammatory mediator, but their clinical effectiveness is inconsistent, with most randomised studies not showing any significant improvement in complete healing. In contrast, TLC-NOSF directly inhibits MMP-2 and MMP-9, stabilises growth factors and consistently improves wound sealing and area reduction in high-quality blinded clinical trials. Mechanism of action predicts clinical outcome: passive binding to protease (collagen) provides modest, variable benefits, while active, specific inhibition (TLC-NOSF) is correlated with reproducible efficacy and support from guidelines. Mechanistic-clinical integration underlines the importance of selection of dressings based on biological plausibility as well as experimental evidence.