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Özdemir Sipahioğlu Ü, Boyraz Özkavak S. Evaluation of neuropathy in epidermal growth factor administered patients diagnosed with diabetic foot. J Tissue Viability 2024:S0965-206X(24)00144-X. [PMID: 39396885 DOI: 10.1016/j.jtv.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 08/02/2024] [Accepted: 09/21/2024] [Indexed: 10/15/2024]
Abstract
AIM This study was conducted to evaluate the effect of epidermal growth factor administered to patients diagnosed with diabetic foot on neuropathy. Secondarily, the effect of EGF on foot ulcer and neuropathic pain has also been evaluated. MATERIALS AND METHODS The study is an analytical type study with a single-group pretest-posttest quasi-experimental design. It was conducted with 30 patients diagnosed with Type 1 and Type 2 Diabetes who applied to the wound care unit and cardiovascular surgery outpatient clinic at Pamukkale University Hospitals between March 2021 and November 2022. By not using the sampling method, all patients who received EGF in the units were reached. Data were collected by "structured patient information form", "SINBAD classification", and "LANSS pain scale." Data were obtained as a "pretest" before the administration of epidermal growth factor (EGF), and as a "posttest" applied one month after the completion of EGF administration. Data were analyzed with Wilcoxon, Mann-Whitney U, Kruskal-Wallis H, Spearman's Rank Correlation, Mc Nemar, and Chi-Square Tests. FINDINGS It was observed that the average age of individuals with diabetic foot ulcer was 60.1 ± 12.9, 40 % were obese/morbidly obese, 83.3 % were male, and 43.3 % were treated with insulin + oral antidiabetic. It was determined that the number of years with diabetes was 17.37 ± 10.93 years, and the duration of diabetic foot ulcer was 218.83 ± 279.04 days. 46.7 % of the participants were determined to have a previous foot wound, and 33.3 % had a history of amputation in the past. Neuropathy was present in 100 % of the participants in the pre-test, while it was found to be 56.7 % in the post-test. The participants with neuropathy were observed to have a significantly higher SINBAD classification and LANSS pain scale scores: (p = 0,01; p = .00). HbA1c, SINBAD, and LANSS scores decreased significantly after EGF (p = 0,00; p = .01; p = .01). EGF administration was observed to have a statistically significant positive effect on neuropathy (p < .01). RESULTS EGF administration was observed to have a positive effect on the healing of foot ulcers, the reduction of neuropathic pain, and on neuropathy in patients diagnosed with diabetic foot.
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Berlanga-Acosta J, Garcia-Ojalvo A, Guillen-Nieto G, Ayala-Avila M. Endogenous Biological Drivers in Diabetic Lower Limb Wounds Recurrence: Hypothetical Reflections. Int J Mol Sci 2023; 24:10170. [PMID: 37373317 DOI: 10.3390/ijms241210170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
An impaired healing response underlies diabetic foot wound chronicity, frequently translating to amputation, disability, and mortality. Diabetics suffer from underappreciated episodes of post-epithelization ulcer recurrence. Recurrence epidemiological data are alarmingly high, so the ulcer is considered in "remission" and not healed from the time it remains epithelialized. Recurrence may result from the combined effects of behavioral and endogenous biological factors. Although the damaging role of behavioral, clinical predisposing factors is undebatable, it still remains elusive in the identification of endogenous biological culprits that may prime the residual scar tissue for recurrence. Furthermore, the event of ulcer recurrence still waits for the identification of a molecular predictor. We propose that ulcer recurrence is deeply impinged by chronic hyperglycemia and its downstream biological effectors, which originate epigenetic drivers that enforce abnormal pathologic phenotypes to dermal fibroblasts and keratinocytes as memory cells. Hyperglycemia-derived cytotoxic reactants accumulate and modify dermal proteins, reduce scar tissue mechanical tolerance, and disrupt fibroblast-secretory activity. Accordingly, the combination of epigenetic and local and systemic cytotoxic signalers induce the onset of "at-risk phenotypes" such as premature skin cell aging, dysmetabolism, inflammatory, pro-degradative, and oxidative programs that may ultimately converge to scar cell demise. Post-epithelialization recurrence rate data are missing in clinical studies of reputed ulcer healing therapies during follow-up periods. Intra-ulcer infiltration of epidermal growth factor exhibits the most consistent remission data with the lowest recurrences during 12-month follow-up. Recurrence data should be regarded as a valuable clinical endpoint during the investigational period for each emergent healing candidate.
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Affiliation(s)
- Jorge Berlanga-Acosta
- Tissue Repair, Wound Healing and Cytoprotection Research Group, Biomedical Research Direction, Center for Genetic Engineering and Biotechnology, Playa, Havana 10600, Cuba
| | - Ariana Garcia-Ojalvo
- Tissue Repair, Wound Healing and Cytoprotection Research Group, Biomedical Research Direction, Center for Genetic Engineering and Biotechnology, Playa, Havana 10600, Cuba
| | - Gerardo Guillen-Nieto
- Tissue Repair, Wound Healing and Cytoprotection Research Group, Biomedical Research Direction, Center for Genetic Engineering and Biotechnology, Playa, Havana 10600, Cuba
| | - Marta Ayala-Avila
- Tissue Repair, Wound Healing and Cytoprotection Research Group, Biomedical Research Direction, Center for Genetic Engineering and Biotechnology, Playa, Havana 10600, Cuba
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Shakhakarmi K, Seo JE, Lamichhane S, Thapa C, Lee S. EGF, a veteran of wound healing: highlights on its mode of action, clinical applications with focus on wound treatment, and recent drug delivery strategies. Arch Pharm Res 2023; 46:299-322. [PMID: 36928481 DOI: 10.1007/s12272-023-01444-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
Epidermal growth factor (EGF) has been used in wound management and regenerative medicine since the late 1980s. It has been widely utilized for a long time and still is because of its excellent tolerability and efficacy. EGF has many applications in tissue engineering, cancer therapy, lung diseases, gastric ulcers, and wound healing. Nevertheless, its in vivo and during storage stability is a primary concern. This review focuses on the topical use of EGF, especially in chronic wound healing, the emerging use of biomaterials to deliver it, and future research possibilities. To successfully deliver EGF to wounds, a delivery system that is proteolytically resistant and stable over the long term is required. Biomaterials are an area of interest for the development of such systems. These systems may be used in non-healing wounds such as diabetic foot ulcers, pressure ulcers, and burns. In these pathologies, EGF can reduce the risk of amputation of the lower extremities, as it accelerates the wound healing process. Furthermore, appropriate delivery system would also stabilize and control the EGF release profile in a wound. Several in vitro and in vivo studies have already proven the efficacy of such systems in the above-mentioned types of wounds. Moreover, several formulations such as ointments and intralesional injections are already available on the market. However, these products are still problematic in terms of inadequate diffusion of EGF, low bioavailability storage conditions, and shelf-life. This review discusses the nano formulations comprising biomaterials infused with EGF which could be a promising delivery system for chronic wound healing in the future.
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Affiliation(s)
| | - Jo-Eun Seo
- College of Pharmacy, Keimyung University, Daegu, 704-701, Republic of Korea
| | | | - Chhitij Thapa
- College of Pharmacy, Keimyung University, Daegu, 704-701, Republic of Korea
| | - Sangkil Lee
- College of Pharmacy, Keimyung University, Daegu, 704-701, Republic of Korea.
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Miller-Kobisher B, Suárez-Vega DV, Velazco de Maldonado GJ. Epidermal Growth Factor in Aesthetics and Regenerative Medicine: Systematic Review. J Cutan Aesthet Surg 2021; 14:137-146. [PMID: 34566354 PMCID: PMC8423211 DOI: 10.4103/jcas.jcas_25_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Epidermal Growth Factor (rhEGF) is a promising skin antiaging agent that successfully promotes skin wound repair, and it has been investigated in the past decade for these purposes. However, there are no updated systematic reviews, in English or English, that support the efficacy of rhEGF as a regenerative skin treatment or systematic reviews that compile the uses of rhEGF as facial aesthetic therapy and regenerative medicine. Aim: To describe the current state of facial aesthetic and regenerative medicine treatments in which rhEGF has been effectively used. Materials and Methods: An exhaustive search was carried out in “Medline” (via “PubMed”), “Cochrane,” “Bireme” through the Virtual Health Library (VHL), “Elsevier” via “Science Direct,” “Springer,” “SciELo,” “ResearchGate,” and Google Scholar. Studies related to the use of rhEGF in addressing skin disorders or skin aging are included. Results: Overall, 49 articles were found, which described the use of rhEGF for skin regeneration and restructuring. Efficacy in the regeneration of skin wounds was verified through the intradermal and topical application of formulations with rhEGF. Most clinical trials in aesthetics point to an effective inversion of skin aging. However, uncontrolled or randomized trials abound, so that does not represent enough evidence to establish its efficiency. There are transient adverse effects for both cases. Conclusion: The rhEGF considers an effective therapeutic alternative for patients with recalcitrant skin wounds and skin aging, as it is a potent and specific mitogenic factor for the skin.
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Affiliation(s)
| | - Dubraska V Suárez-Vega
- Department of Investigation, Dental Research Center, University of Los Andes (ULA), Mérida, Venezuela
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Uzun E, Güney A, Gönen ZB, Özkul Y, Kafadar İH, Günay M, Mutlu M. Intralesional allogeneic adipose-derived stem cells application in chronic diabetic foot ulcer: Phase I/2 safety study. Foot Ankle Surg 2021; 27:636-642. [PMID: 32826167 DOI: 10.1016/j.fas.2020.08.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/30/2020] [Accepted: 08/05/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Impaired wound healing is a major cause of morbidity in diabetic patients by causing chronic ulcers. This study aimed to investigate the safety and outcomes after intralesional allogeneic adipose-derived mesenchymal stem cells injection in chronic diabetic foot ulcers. METHODS Twenty patients (12 male and eight female) were involved in the study. We randomized the patients into two groups of 10 patients each. The study group was treated with allogeneic adipose-derived mesenchymal stem cells injection with standard diabetic wound care. The control group received only standard diabetic wound care. Patient demographics, wound characteristics, wound closure time, amputation rates and clinical scores were evaluated. RESULTS The mean age was 57.3 ± 6.6 years. The mean follow-up duration was 48.0 (range, 26-50) months. Wound closure was achieved in 17 of 20 lesions (study group, 9 lesions; control group, 8 lesions; respectively). The mean time to wound closure was 31.0 ± 10.7 (range, 22-55) days in the study group, 54.8 + 15.0 (range, 30-78) days in the control group (p = 0.002). In three patients, minor amputations were performed (one patient in study group; two patients in the control group, p = 0.531). There was a significant difference between groups in terms of postoperative Short Form 36- physical functioning (p = 0.017) and Short Form 36-general health (p = 0.010). CONCLUSION Allogeneic adipose-derived mesenchymal stem cells injection was found to be a safe and effective method with a positive contribution to wound-healing time in the treatment of chronic diabetic foot ulcers.
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Affiliation(s)
- Erdal Uzun
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - Ahmet Güney
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - Zeynep Burçin Gönen
- Oral and Maxillofacial Surgery, Genome and Stem Cell Center, Erciyes University, Kayseri, Turkey.
| | - Yusuf Özkul
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - İbrahim Halil Kafadar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - Mahmut Günay
- Department of Orthopedics and Traumatology, Kanuni Training and Research Hospital, Trabzon, Turkey.
| | - Mahmut Mutlu
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
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Çetinkaya ÖA, Çelik SU, Erzincan MB, Hazır B, Uncu H. Intralesional epidermal growth factor application is a potential therapeutic strategy to improve diabetic foot ulcer healing and prevent amputation. Turk J Surg 2020; 36:15-22. [PMID: 32637871 DOI: 10.5578/turkjsurg.4541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/27/2019] [Indexed: 12/25/2022]
Abstract
Objectives This study aimed to investigate the efficacy of intralesional epidermal growth factor (EGF) in preventing the extremity from a major amputation and its effects on wound healing in chronic diabetic foot ulcers (DFUs). Material and Methods Thirty-three patients with DFUs were treated with intralesional EGF application between January 2013 and January 2017. The first endpoint was to determine the prevention rate of major amputation within 12 months following treatment. The second endpoints were the recovery of ulcer surface area with ≥ 50% granulation following two months and the healing of ulcer surface area with ≥ 75% granulation following six months after the first application of EGF. Results After three patients were excluded because of major side effects in the remaining 30 patients (48 DFUs), granulation rate of ≥ 50% was achieved in 24 (37 DFUs) patients, and not achieved in 6 (11 DFUs) patients eight weeks following the EGF application. A granulation rate of ≥ 75% was achieved in 21 (31 DFUs) patients after six months. At 12 months following the treatment, one major and seven minor amputations were performed, a total of 10 DFUs in five patients were not healed, and the DFUs in 17 patients completely recovered. Conclusion Intralesional EGF application has positive results in addition to good foot care in DFUs, and promising results can be obtained by protecting the extremity from amputation by using it in patients whose vascular intervention methods are not appropriate and have DFUs that do not heal with conventional wound care treatments.
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Affiliation(s)
- Ömer Arda Çetinkaya
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Süleyman Utku Çelik
- Clinic of General Surgery, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Miraç Barış Erzincan
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Barış Hazır
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Hakan Uncu
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
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Lam KC, Marshall AN, Snyder Valier AR. Patient-Reported Outcome Measures in Sports Medicine: A Concise Resource for Clinicians and Researchers. J Athl Train 2020; 55:390-408. [PMID: 32031883 DOI: 10.4085/1062-6050-171-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the importance of assessing patient outcomes during patient care, current evidence suggests relatively limited use of patient-reported outcome measures (PROMs) by athletic trainers (ATs). Major barriers to PROM use include lack of knowledge, navigating the intricate process of assessing a wide variety of PROMs, and selecting the most appropriate PROM to use for care. A concise resource for ATs to consult when selecting and implementing PROMs may help facilitate the use of PROMs in athletic health care. OBJECTIVE To review the instrument essentials and clinical utility of PROMs used by ATs. METHODS We studied 11 lower extremity region-specific, 10 upper extremity region-specific, 6 generic, and 3 single-item PROMs based on the endorsement of at least 10% of ATs who use PROMs, as reported in a recent investigation of PROM use in athletic training. A literature search was conducted for each included PROM that focused on identifying and extracting components of the instrument essentials (ie, instrument development, reliability, validity, responsiveness and interpretability, and precision) and clinical utility (ie, acceptability, feasibility, and appropriateness). Through independent review and group consensus, we also classified each PROM question by International Classification of Functioning, Disability and Health domain and health-related quality-of-life dimensions. KEY FINDINGS The PROMs contained in this report generally possessed appropriate instrument essentials and clinical utility. Moreover, the PROMs generally emphasized body structure and function as well as the physical functioning of the patient. Athletic trainers aiming to assess patients via a whole-person approach may benefit from combining different PROMs for use in patient care to ensure broader attention to disablement health domains and health-related quality-of-life dimensions.
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Affiliation(s)
| | - Ashley N Marshall
- Dr Marshall is now in the Department of Health and Exercise Science, Appalachian State University, Boone, NC
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