Immunomodulatory properties of medicinal maggots Lucilia sericata in wound healing process

The healing properties of medicinal maggots (larval stage of Lucilia sericata) are widely used in the chirurgical debridement of non-healing wounds including diabetic foot ulcers, venous and pressure ulcers, where classical approaches have failed. Several kinds of wounds are prone to complications coming out of a specific wound bed environment. There are multi-resistant bacterial species present, their pathogenic impact is multiplied by their ability to form a biofilm. Moreover, immunological events in chronic wounds differ from those in acute wounds. Non-healing wounds are cycled in the early inflammation phase with increased levels of inflammation attributes like inflammation cytokines and matrix metalloproteinases produced by inflammation phase cells. Application of larval therapy promotes progress in the healing process to the next stages involving tissue granulation and re-epithelisation. Larval debridement is an effective method of cleaning the wound of cell debris, necrotic tissue and bacterial load. This happens in a mechanical and biological manner, but the whole complex mechanism of the maggot healing activity is still not fully elucidated. Centuries of clinical practice brings noticeable proof of the maggots' beneficial effect in wound healing management. This long history led to the investigation of the bioactive components of the larval body and its extracts in vitro. We introduce a review which describes the immunomodulation impact of maggot body components on the cellular and molecular levels of the wound healing process.