Folic acid may be a potential addition to diabetic foot ulcer treatment - a hypothesis

Nanotherapeutic potential of antibacterial folic acid-functionalized nanoceria for wound-healing applications

Aim: The functionalization and characterization of antibacterial nanoceria with folic acid (FA) and elucidation of their in vivo wound healing application. Materials & methods: Functionalization of nanoceria were done with FA using a chemical method and their antibacterial activity, cellular biocompatibility and in vivo wound healing application were evaluated. Results: The functionalization of nanoceria with FA was done with 10 to 20 nm size and -20.1 mV zeta potential. The nanoformulation showed a bacteriostatic effect along with biocompatibility to different cell lines; 0.1% w/v spray of FA-nanoceria demonstrated excellent wound healing capacity within 14 days in a Wister rat model. Conclusion: The antioxidant and reactive oxygen species scavenging activity of the FA-nanoceria make it a promising therapeutic agent as a unique spray formulation in wound healing applications.

Was hat die Ernährung mit der Wundheilung zu tun?

Bei einer Störung im Ablauf der Wundheilung kann es zu einem verzögerten oder fehlenden Wundverschluss kommen. Als ein möglicher Störfaktor gilt die Ernährung. Man muss zwischen quantitativer und qualitativer Mangelernährung unterscheiden. Gerade übergewichtige Patienten leiden oft an einer qualitativen Mangelernährung und Sarkopenie.

Spezifische Erkrankungen machen eine entsprechende diätetische Nahrungsempfehlung notwendig. So findet man bei dialysepflichtigen Patienten, Dekubitus-Patienten und Ulcus cruris-Patienten oft einen Eiweißmangel. Auch niedrige Level an Vitamin C, Zink, Folsäure, Vitamin D oder Spurenelementen können die Wundheilung negativ beeinflussen.

Größere prospektive Studien sollten klären, ob eine Substitution dieser Mangelzustände den gewünschten positiven Effekt auf die Wundheilung hat. Es erscheint aber sinnvoll, eine ausgewogene Ernährung und an die individuellen Ernährungsgewohnheiten angepasste Verbesserung der Aufnahme von Vitaminen, Spurenelementen und Eiweißen anzustreben.

Modulation of MCP-1, TGF-β1, and α-SMA Expressions in Granulation Tissue of Cutaneous Wounds Treated with Local Vitamin B Complex: An Experimental Study

Vitamin B complex can modulate the inflammatory response and activate wound healing. However, the action mechanisms involved in this process are still unclear. The aim of this study was to evaluate the effects of vitamin B complex on the modulation of monocyte chemotactic protein (MCP)-1, transforming growth factor (TGF)-β1, and α-smooth muscle actin (α-SMA) in granulation tissue growth. Cutaneous ulcers on Wistar rats were topically treated with vitamin B complex. MCP-1, TGF-β1, and α-SMA expressions were evaluated 24, 72, and 168 h after the treatment. Inflammatory cells were counted and collagen fibril staining was performed. After 24 h, more mononuclear cells (p ≤ 0.01) and a higher MCP-1 (p ≤ 0.05) and TGF-β1 (p ≤ 0.01) expression were observed. After 72 h, the number of fibroblasts and mononuclear cells (p ≤ 0.05) was elevated. After 168 h, an increased number of fibroblasts, myofibroblasts, and blood vessels (p ≤ 0.01) as well as a strong intensity of collagen fibril staining were seen. At that point, the cells presented a higher TGF-β1 expression (p ≤ 0.05), and the size of the ulcer area was decreased (p ≤ 0.01). We can conclude that vitamin B complex may stimulate a positive modulation of MCP-1, TGF-β1, and α-SMA expressions in granulation tissue of cutaneous ulcers.

Diabetic foot ulcers: evaluation and management

Diabetic foot ulcers (DFUs) are a common complication of diabetes and present a significant health risk to patients, as well as impose a large economic burden. Evaluation for contributory factors that may impact general health or healing, such as hyperglycemia, peripheral artery disease, neuropathy, and nutritional status, is of the utmost importance. Management of DFUs requires involvement of a multidisciplinary team and a standardized approach to patient care. Standard therapy for DFUs includes offloading and debridement. Assessment and control of infection are critical, including determining the severity of the infection, which may drive therapeutic approaches. For recalcitrant ulcers, adjuvant therapies are used to hasten the healing process, and newer therapies are under investigation.

Intervention with vitamins in patients with nonproliferative diabetic retinopathy: a pilot study

Background

The purpose of this study was to determine whether a combination of vitamins B6, B9, and B12 is an effective intervention for reducing the signs and symptoms of nonproliferative diabetic retinopathy.

Methods

Ten subjects with type 2 diabetes mellitus (n = 20 eyes) with clinically diagnosed mild to moderate nonproliferative diabetic retinopathy were recruited from a private practice ophthalmology clinic for this open-label, uncontrolled, prospective six-month study. Metanx® vitamin tablets (containing 3 mg L-methylfolate calcium, 35 mg pyridoxal-5′-phosphate, and 2 mg methylcobalamin) were administered at a dosage of two tablets daily. Primary outcome indicators were the percent change in mean retinal sensitivity threshold measured by macular microperimetry and the percent change in mean central retinal thickness measured by spectral-domain optical coherence tomography.

Results

Three subjects were lost to follow-up. In the remaining seven subjects, two of 14 eyes had foveal edema that prevented microperimetry measurements due to poor fixation. The remaining 12 eyes showed a nonlinear improvement in mean threshold retinal sensitivity (P < 0.001). Overall change in mean central retinal thickness in 14 eyes was linear (R² = 0.625; P = 0.034), with a significant reduction between one and six months (P = 0.012).

Conclusion

In this pilot study, the Metanx intervention appeared to have some beneficial effects with respect to reducing retinal edema and increasing light sensitivity in subjects with nonproliferative diabetic retinopathy.