MSCs and their secreted EVs have proven efficacy in slowing down the course of the disease. have shown paracrine beneficial effects, regulating inflammation, modifying the fibroblast activation and production of collagen and promoting neovascularization and re-epithelialization. This review explains the effects of MSCs and their derived products in each step of the wound repair process. As well, it reviews the pre-clinical and clinical use of MSCs to benefit in skin wound healing in diabetic associated wounds and in pathophysiological fibrosis. strong class=”kwd-title” Keywords: wound healing, regeneration, scar, MSC, mesenchymal stem/stromal cells, fibrosis, inflammation, angiogenesis, extracellular matrix 1. Introduction During tissue damage there is a usual response to injury that involves several actions of overlapping events, called wound healing . Wound healing is usually a dynamic process and many cellular players and structures are involved in the process. These cellular and molecular events are highly coordinated and controlled. For effective tissue repair and restoration of tissue function, there is a need for alteration of actin cytoskeleton as well as secretion of extracellular matrix (ECM) proteins and integrin receptors . Scarring is usually a way to heal an injury when fibrous tissue replaces the damaged tissue, but on the other side regeneration can happen when the injured tissue is usually replaced by renewing and rebuilding itself. In humans and other mammals, almost all tissues are prone to heal by forming a scar, and very few tissues are able to regenerate. The wound repair process has several phases: (1) homeostasis/coagulation, (2) inflammatory cell recruitment, (3) proliferative phase and (4) maturation phase [1,2,3]. In the first step, platelets and the activation of the coagulation cascade are the main players, and fibrin strands adhere in the first seconds; there is a formation of thrombus or a clot, and platelets are trapped in the wound area. The inflammatory phase is triggered by the recruitment of inflammatory cells into the wound site, which will try to eliminate the damaged cells, the pathogens of the wound area. The leukocytes recruited into this sitefirst the Avermectin B1 neutrophils, Avermectin B1 then the monocytes, followed by otherssecrete growth factors, Pou5f1 enzymes and chemokines that produce swelling, heat, redness and pain  (Physique 1). If this stage is usually prolonged, and an excessive number of activated cells are recruited at the injured site, then the inflammation will not help the wound healing process. In the proliferative phase, the main objective is to cover and fill the wound; the margins from the wound begin contracting by fibroblasts that are differentiated and triggered into myofibroblasts. Afterward, the re-epithelialization procedure starts; this stage is activated by extracellular matrix (ECM) deposition, of collagen [5 mainly,6,7,8]. Finally, through the maturation Avermectin B1 stage, the collagen materials reorganize from collagen type III to type I, as well as the cells remodels, getting power and versatility by advertising epithelialization and neovascularization [9 gradually,10,11,12]. Open up in another window Shape one time lapse of cells recruited right into a wound. Through the 1st stage, neutrophils and platelets are recruited, and monocytes are recruited and infiltrate the cells and differentiate into macrophages; resident macrophages can proliferate. Altogether, this qualified prospects result in fibrocyte recruitment and fibroblast proliferation as well as the posterior transformation to myofibroblasts. Additional cells such as for example lymphocytesmainly T cellsare recruited in low amounts in the past due stages also. This figure will not display the NK, dendritic cells and mast cells; their amounts are really low generally, however they can play a significant part on the procedure still. The failing from the wound healing up process isn’t realized totally, as well as the abnormal formation of the wound is connected with a continuing localized inflammation  highly. There are several risks factors, such as for example age, malnutrition, attacks, smoking, radiation or medications, associated with incorrect wound recovery. Unresolved long-lasting swelling favors skin damage over regeneration, as well as the control of the inflammatory response at first stages might become crucial for regeneration [4,14,15]; as stated previously, in mammals, skin damage is the regular process to solve injury. Resolving inflammation can be connected not merely towards the innate disease fighting capability, the adaptive disease fighting capability plays a significant role along the way  also. The regenerative procedure can be controlled from the manifestation of many proteins and chemoattractants extremely, the recruitment of many immune system cells at different period factors and in varied cell numbers, as well as the activation from the angiogenic and regenerative pathways [17,18] (Shape 1). ECM redesigning is vital for appropriate wound healing, as well as the rules of activity of the matrix metalloproteinases (MMPs) and cells inhibitors (TIMPs) can be meticulously.