Opportunities and Risks of Biofunctionalization of Implants with Extracellular Matrix Protein 1 to Support Skin and Bone Healing

Extracellular matrix protein1 (ECM1) plays a crucial role in the activation of latent transforming growth factorbeta (TGFβ). Active TGFβ governs key phases of tissue repair including inflammation, fibroblast activation, angiogenesis, and matrix remodeling. Dysregulation of TGFβ signaling is a hallmark of chronic wounds, excessive scar formation, and fracture non-union. As a protein of the extracellular matrix, ECM1 offers ideal conditions for the biofunctionalization of implants. Its mode of action has been studied mainly in fibrosis models, where TGFβ acts as driver of the disease. Controlled knock-out or over-expression of ECM1 either promoted or improved fibrosis development. In this review, we discuss how the findings can be applied to the biofunctionalization of implants to support the healing of skin and bone.