ROLE OF PROTEINS

IN TISSUE HEALING
BY: Margarita Damas
 WHAT ARE PROTEINS
Proteins are large, complex molecules that play many critical
roles in the body. They do most of the work in cells and are

required for the structure, function, and regulation of the

body’s tissues and organs.

Proteins are made up of hundreds or thousands of smaller

units called amino acids, which are attached to one another

in long chains.
There are 20 different types of amino acids that can be

combined to make a protein.

The sequence of amino acids determines each protein’s

unique 3-dimensional structure and its specific function.

Amino acids are coded by combinations of three DNA building

blocks (nucleotides), determined by the sequence of genes.

 ESSENTIAL AMINO ACIDS
Essential amino acids cannot be produced by the body. Consequently, they

must come from food.

The 9 essential amino acids are: histidine, isoleucine, leucine, lysine,

methionine, phenylalanine, threonine, tryptophan, and valine.

TYPES OF

AMINO ACIDS NON-ESSENTIAL AMINO ACIDS

Non-essential means that our bodies can make the amino acid, even though

we don't get it from the food we eat.

Non-essential amino acids include: alanine, arginine, asparagine, aspartic

Amino acids are classified into three groups: acid, cysteine, glutamic acid, glutamine, glycine, proline, serine, and

ESSENTIAL AMINO ACIDS tyrosine.

NON-ESSENTIAL AMINO ACIDS

CONDITIONAL AMINO ACIDS
CONDITIONAL AMINO ACIDS
Conditional amino acids are usually non-essential, except in times of
illness and stress.
Conditional amino acids include: arginine, cysteine, glutamine, tyrosine,

glycine, ornithine, proline, and serine.

PROTEIN HYDROLYSATES
The hydrolysis of protein results in the production of a range of

peptides. The nature of the peptides produced depends on the method

and duration of the hydrolytic process, and the conditions (for example,

temperature, pH) under which the hydrolysis is performed.

During hydrolysis, as a result of the cleavage of peptide bonds, proteins

are broken down into peptides of different sizes and free amino acids

but typically contain mostly di and tripeptides.

The more rapid availability of amino acids and the presence of

biologically active peptides have resulted in protein hydrolysates being

used as therapeutic substances and incorporated into clinical nutrition

products, such as geriatric dietary supplements, weight-control

andtherapeutic diets, or for clinical treatments in patients with

digestion or absorption disorders, or malnutrition associated with

cancer, trauma and burns

WHERE CAN WE FIND THEM
Some food sources of dietary protein include:
lean meats – beef, lamb, veal, pork, kangaroo
poultry – chicken, turkey, duck, emu, goose, bush birds
fish and seafood – fish, prawns, crab, lobster, mussels, oysters, scallops, clams
eggs
dairy products – milk, yoghurt (especially Greek yoghurt), cheese (especially cottage cheese)
nuts (including nut pastes) and seeds – almonds, pine nuts, walnuts, macadamias, hazelnuts,

cashews, pumpkin seeds, sesame seeds, sunflower seeds

legumes and beans – all beans, lentils, chickpeas, split peas, tofu.
Some grain and cereal-based products are also sources of protein, but are generally not as high in

protein as meat and meat-alternative products.

PROTEINS AND TISSUE DAMAGE
Protein is a major structural and functional

component of tissue and dietary sources

supply essential amino acids which are

necessary for protein synthesis.

Changes in protein turnover following

tissue damage are critical to tissue repair

and advancing knowledge of dietary protein

requirements has emphasised the need for

increased protein intake during tissue

repair.
TISSUE REPAIR
Tissue repair involves four phases:
HAEMOSTASIS INFLAMMATION REPAIR REMODELLING

An adequate protein intake has three important roles in this

process:
1. Promoting wound healing
2. Maintenance of tissue integrity
3. Speeding convalescence
Indeed, while an adequate protein intake is essential for rapid

wound healing and recovery, an inadequate protein intake can delay

wound healing and reduce the integrity of the repaired tissue.

PROCESS OF THE PROTEINS IN TISSUE HEALING
Following moderate to severe injury, protein depletion

occurs due to an increased metabolic loss of N (due to loss

of actual tissue, blood or exudates from the damaged area,

loss due to excessive protein catabolism which follows injury

or infection, and disuse or reflex atrophy).

By counteracting the negative N balance

that occurs after injury, supplementation

that can increase protein intake and

enhance protein synthesis may be useful.

For this reason there has been considerable

interest in the use of nutritional

interventions to promote tissue repair, in

particular the use of protein hydrolysates.

EFFECT ON POST-SURGICAL RECOVERY
Surgical trauma leads to an increase in whole-body protein degradation,

with the extent depending on the severity of the insult. These changes in

whole-body protein turnover result in a period of negative N balance.

Due to the importance of protein nutrition in tissue repair, high-protein

diets have been shown to accelerate the rate of tissue regeneration and

increase tensile strength of the wound.

 TYPES OF CYTOKINES AND CELLS INVOLVED
Platelets release growth factors and adhesive proteins that stimulate the inflammatory

response and induce cell migration into the wound using the provisional matrix as a

substrate.
Wound cleaning is carried out by neutrophils, which solubilize debris, and monocytes,

which differentiate into macrophages and phagocytose debris.

Macrophages also release growth factors and cytokines to activate subsequent events.
Fibroblasts enter the wound site to replace the provisional matrix with granulation

tissue composed of fibronectin and collagen. As endothelial cells revascularize the

damaged area, fibroblasts differentiate into myofibroblasts and contract the matrix to

bring the margins of the wound together.

TYPES OF CYTOKINES AND CELLS INVOLVED
The ECM proteins fibrin, fibronectin and collagen contribute to the

structural integrity of the matrix during the phases of tissue repair.

The fibrin, fibronectin provisional matrix acts as a framework for cell adhesion and

migration.
This matrix is ​replaced with fibronectin rich granulation tissue, which provides a

vascularized network for subsequent deposition of collagen.

Finally, the architecture of the new tissue is remodeled as collagen fibrils are

bundled and crosslinked.

Matricellular proteins including the galectins, osteopontin, SPARC, tenascins,

thrombospondins, vitronectin, and perhaps others that share several distinguishing

features.
They are expressed at high levels during development but not in the normal adult
and are upregulated at sites of tissue remodeling.
PROTEINS AND INFECTION
Nutrition and infection interact with each other in a synergistic

vicious cycle, leading to an adverse nutritional status and

increased susceptibility to infection. Infectious episodes result in

hypermetabolism and a negative nitrogen balance which is

modulated by hormones, cytokines and other proinflammatory

mediators, and is compounded by a reduced food intake. The

extent of the negative nitrogen balance varies with the type of

infection and its duration.

Infections need to be treated appropriately, with nutrition as an

adjunct to the treatment.

Prior undernutrition could also impair the body's response to

infection, although the weight of the evidence would suggest that

this happens more particularly in edematous undernutrition.

In general, the amount of extra protein that would appear to be

needed is of the order of 20-25 per cent of the recommended

intake, for most infections. In acute infections, this is particularly

relevant during the convalescence period.

SUMMARY OF THE IMPORTANCE OF

PROTEINS IN TISSUE HEALING

1. Proteins are esential to wound healing, to the maintenance of tisue integrity; and
from present indications, to expeditious convalescence. Protein deficiency endangers

al three.
2. A patient can become protein deficient as a result of inadequate intake and increased

nitrogen output or a combination of these two factors.

3. The ceiling of nitrogen intake in natural food is naturally low and consequently

natural food is often inadequate to replenish the increased protein loss in disease and

injury.
4. Studies on cases of burns and postoperative of surgeries suggest that convalescence

can be shortened, strength and weight conserved by ful caloric and nitrogen

replacement immediately postoperatively; and that there may be a critical range of

nitrogen intake for each disease category.

5. The protein hydrolysates, by raising the ceiling level of nitrogen intake, are

indispensable in many disease conditions and can be used with greater elasticity than

natural food.
 REFERENCES
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repair. Nutrition Research Reviews. 2011;24(2):191-197.

2. Midwood K, Williams L, Schwarzbauer J. Tissue repair and

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Journal of Biochemistry & Cell Biology. 2004;36(6):1031-

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3. Tui C (1945) The value of protein and its chemical

components (amino acids) in surgical repair. Bull N Y 24.

Acad Med 21, 631 – 655.

4. Kurpad A. V. (2006). The requirements of protein & amino

acid during acute & chronic infections. The Indian journal

of medical research, 124(2), 129–148.