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Dos Santos CM, de Souza Lima da Silveira PR, da Rocha RB, da Silva Sousa FM, Fontenele Alves R, Silva Barros AC, Saura Cardoso V. Adherence to Self-care and Quality of Life of Patients with Diabetic Foot Ulcers Treated with Low-Level Laser Therapy: An Exploratory Study. Adv Skin Wound Care 2024; 37:1-10. [PMID: 39037103 DOI: 10.1097/asw.0000000000000189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To evaluate the quality of life (QoL) of patients with a diabetic foot ulcer undergoing treatment with low-level laser therapy (LLLT) at 904 nm and its association with self-care. METHODS In this randomized, exploratory study, participants were divided into the following four groups: control group (CG) with LLLT placebo, LLLT group 1 (LG1) at 10 J/cm2, LLLT group 2 (LG2) at 8 J/cm2, and LLLT group 3 (LG3) at 4 J/cm2. Participants received light therapy (or placebo) twice a week, for a total of 20 sessions. Researchers assessed participants' QoL using the Short-Form 36 questionnaire. RESULTS Sixty-two participants were included in the analysis (CG = 18, LG1 = 14, LG2 = 17, LG3 = 13). The LG1 group showed a higher proportion of healing, whereas the CG group showed a lower proportion than the other groups. The LG1 group showed a relationship between physical limitations and blood glucose monitoring, pain and foot care, and general health status (GHS) and foot care. The GL2 group showed a relationship between physical limitations and blood glucose monitoring, vitality and foot care, and GHS and diet. CONCLUSIONS Low-level laser therapy had a positive impact on QoL as assessed by the Short-Form 36 questionnaire (functional capacity, vitality, and pain domains), and there was a positive association between QoL and self-care in the LLLT groups (physical limitations, pain, GHS, and vitality domains).
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Affiliation(s)
- Cristiana Maria Dos Santos
- At the Integrated Center of Medical Specialties, Parnaíba, Piauí, Brazil, Cristiana Maria dos Santos, MSc, PT, and Pedro Renan de Souza Lima da Silveira, MSc, PT, are Physical Therapists. Rebeca Barbosa da Rocha, MSc, PT, is Assistant Professor, Delta Parnaíba Federal University, Parnaíba, Piauí, Brazil. Also at the Integrated Center of Medical Specialties, Fernanda Mello da Silva Sousa, MSc, PT, and Rayana Fontenele Alves, MSc, PT, are Physical Therapists. Also at Delta Parnaíba Federal University, Ana Carolina Silva Barros, PT, is Student, and Vinicius Saura Cardoso, PhD, PT, is Associate Professor
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Cai G, Li R, Chai X, Cai X, Zheng K, Wang Y, Fan K, Guo Z, Guo J, Jiang W. Catalase-templated nanozyme-loaded microneedles integrated with polymyxin B for immunoregulation and antibacterial activity in diabetic wounds. J Colloid Interface Sci 2024; 667:529-542. [PMID: 38653074 DOI: 10.1016/j.jcis.2024.04.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
Diabetic wounds are characterized by chronic trauma, with long-term non-healing attributed to persistent inflammation and recurrent bacterial infections. Exacerbation of the inflammatory response is largely due to increased levels of reactive oxygen species (ROS). In this study, catalase (CAT) was used as a biological template to synthesize nanozyme-supported natural enzymes (CAT-Mn(SH)x) using a biomimetic mineralization method. Subsequently, polymyxin B (CAT-Mn(SH)x@PMB) was immobilized on its surface through electrostatic assembly. CAT-Mn(SH)x@PMB demonstrates the ability for slow and sustained release of hydrogen sulfide (H2S). Finally, CAT-Mn(SH)x@PMB loaded microneedles (MNs) substrate were synthesized using polyvinyl alcohol (PVA) and hydroxyethyl methacrylate (HEMA), and named CAT-(MnSH)x@PMB-MNs. It exhibited enhanced enzyme and antioxidant activities, along with effective antibacterial properties. Validation findings indicate that it can up-regulate the level of M2 macrophages and reduce the level of pro-inflammatory cytokine tumor necrosis factor-α (TNF-α). Additionally, it promotes angiogenesis and rapid nerve regeneration, thereby facilitating wound healing through its dual anti-inflammatory and antibacterial effects. Hence,this study introduces a time-space tissue-penetrating and soluble microneedle patch with dual anti-inflammatory and antibacterial effects for the treatment of diabetic wounds.
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Affiliation(s)
- Guoliang Cai
- BGI College and Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China; Center for Precision Medicine, Academy of Medical Sciences. Zhengzhou University, Zhengzhou, Henan, PR China
| | - Ruifeng Li
- Center for Precision Medicine, Academy of Medical Sciences. Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xubin Chai
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing Tiantan Hospital, Beijing 100070, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xiao Cai
- BGI College and Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Kaifeng Zheng
- Center for Precision Medicine, Academy of Medical Sciences. Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yanyan Wang
- Center for Precision Medicine, Academy of Medical Sciences. Zhengzhou University, Zhengzhou, Henan, PR China
| | - Kelong Fan
- CAS Engineering Laboratory for Nanozyme, Key Laboratory of Biomacromolecules (CAS), CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China; Nanozyme Laboratory in Zhongyuan, Henan Academy of Innovations in Medical Science, Zhengzhou, Henan 451163, China
| | - Zhiping Guo
- National Health Commission Key Laboratory of Cardiovascular Regenerative Medicine, Central China Fuwai Hospital of Zhengzhou University, Fuwai Central China Cardiovascular Hospital & Central China Branch of National Center for Cardiovascular Diseases, Zhengzhou, Henan 451464, China.
| | - Jiancheng Guo
- BGI College and Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China; Center for Precision Medicine, Academy of Medical Sciences. Zhengzhou University, Zhengzhou, Henan, PR China.
| | - Wei Jiang
- Center for Precision Medicine, Academy of Medical Sciences. Zhengzhou University, Zhengzhou, Henan, PR China; National Health Commission Key Laboratory of Cardiovascular Regenerative Medicine, Central China Fuwai Hospital of Zhengzhou University, Fuwai Central China Cardiovascular Hospital & Central China Branch of National Center for Cardiovascular Diseases, Zhengzhou, Henan 451464, China; Nanozyme Laboratory in Zhongyuan, Henan Academy of Innovations in Medical Science, Zhengzhou, Henan 451163, China.
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Wang H, Zhen Z, Qin D, Liu Y, Liu Y, Chen X. Effect and mechanism of natural composite hydrogel from fish scale intercellular matrix on diabetic chronic wound repair. Colloids Surf B Biointerfaces 2024; 240:113991. [PMID: 38815311 DOI: 10.1016/j.colsurfb.2024.113991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/09/2024] [Accepted: 05/25/2024] [Indexed: 06/01/2024]
Abstract
Diabetes mellitus is a chronic metabolic disease with prolonged low-grade inflammation and impaired cellular function, leading to poor wound healing. The treatment of diabetic wounds remains challenging due to the complex wound microenvironment. In view of the prominence of fish scales in traditional Chinese medicine and their wide application in modern medicine, we isolated the intercellular components in the scales of sea bass, obtained a natural composite hydrogel, fish scales gel (FSG), and applied it to diabetic chronic wounds. FSG was rich in collagen-like proteins, and possessed low-temperature gelation properties. In vitro, FSG was biocompatible and promoted fibroblast proliferation by approximately 40 %, endothelial cell migration by approximately 20 % and activated the M1 macrophages. In addition, FSG restored the function of fibroblasts and vascular endothelial cells damaged by high glucose. Importantly, FSG normalized the acute inflammatory response to impaired macrophages in a high-glucose microenvironment. Transcriptome analysis implies that this mechanism may involve enhanced cell signaling and cellular communication, improved sensitivity to cytokines, and activation of the TNF signaling pathway. Animal experiments confirmed that FSG significantly improved wound closure by approximately 15 % in diabetic rats, showing similar effects to acute wounds. In conclusion, the regulation of multiple cellular functions by FSG, especially the counterintuitive ability to induce acute inflammation, promoted diabetic wound healing and provides a novel therapeutic strategy for wound repair in diabetic patients.
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Affiliation(s)
- Haonan Wang
- College of Marine Life Science, Sanya Oceanographic Institution, Ocean University of China, Qingdao 266003, China
| | - Zhanghe Zhen
- Institute of Physics, Chinese Academy of Sciences, Beijing 100190, China
| | - Di Qin
- College of Marine Life Science, Sanya Oceanographic Institution, Ocean University of China, Qingdao 266003, China
| | - Yixuan Liu
- College of Marine Life Science, Sanya Oceanographic Institution, Ocean University of China, Qingdao 266003, China
| | - Ya Liu
- College of Marine Life Science, Sanya Oceanographic Institution, Ocean University of China, Qingdao 266003, China
| | - Xiguang Chen
- College of Marine Life Science, Sanya Oceanographic Institution, Ocean University of China, Qingdao 266003, China; Laoshan Laboratory, Qingdao 266237, China.
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Dunlap LJ, Lew E, Gallegos R, Murdoch R, Mulvihill S. Management of Diabetic Foot Ulcers with Two Forefoot Offloading Techniques: Case Series. Adv Skin Wound Care 2024; 37:434-439. [PMID: 39037098 DOI: 10.1097/asw.0000000000000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
ABSTRACT Offloading is a key principle to healing diabetic foot ulcers. Nonremovable knee-high offloading devices are considered the criterion standard for offloading plantar forefoot ulcers. However, patients exhibit a limited tolerance for these devices, which contributes to a lack of use. In this case series describing two patients, the authors share two alternative offloading modalities for the treatment of diabetic plantar forefoot ulcers. One patient was managed using a football offloading dressing, and the other was managed with a modified felted football dressing. The football and modified felted football offloading dressings provide a cost-effective, less time-consuming application and often are a better-tolerated alternative to nonremovable knee-high offloading devices. Clinical findings support further investigation into dressing options tolerated by patients with improved adherence and optimal healing outcomes.
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Affiliation(s)
- Leslie J Dunlap
- In the Department of Orthopaedics and Rehabilitation, Center for Healing in the Lower Extremity, Albuquerque, New Mexico, USA, Leslie J. Dunlap, DMSc, MSPA-C, CWS, is Physician Assistant, University of New Mexico Hospital; and Eric Lew, DPM, FACFAS, is Associate Professor, University of New Mexico Health Sciences Center. In the Department of Rehabilitation Services, University of New Mexico Hospital, Regina Gallegos, MPT, CWS, and Richard Murdoch, PT, CWS, are Physical Therapists and Simone Mulvihill, PTA, is Physical Therapy Assistant
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Zhao Y, Jing L, Ma X, Li Y, Zhang J, Li C, Liu G, Dai J, Cao S. Trends and prospects in nursing care for diabetic foot: A bibliometric analysis from 2003 to 2023. J Tissue Viability 2024:S0965-206X(24)00113-X. [PMID: 39038996 DOI: 10.1016/j.jtv.2024.07.008] [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: 05/03/2024] [Revised: 07/09/2024] [Accepted: 07/18/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUNDS Diabetic foot (DF) is a globally significant concern, with complications like diabetic foot ulcers (DFUs) posing major challenges despite medical advancements. Effective nursing strategies are crucial to preventing DF progression and reducing disability risk. However, nursing research in DF care is fragmented, necessitating a comprehensive bibliometric analysis to identify key trends, influential contributors, and critical research areas. PURPOSE This study explored current trends in nursing methods for DF care and their impact on patient outcomes, utilizing CiteSpace, VOSviewer, and Bibliometrix to identify key contributors, influential countries, and noteworthy topics, aiming to provide valuable insights for healthcare professionals and researchers in the field. METHODS Relevant publications from the Web of Science (WOS) Core Collection Science Citation Index Expanded were retrieved for the period between 2003 and 2023. We included peer-reviewed original articles or reviews related to diabetic foot (DF) and nursing. The following criteria were used for exclusion: ① conference abstracts or corrigendum documents, ② unpublished articles, ③ repeated publications, ④ unrelated articles, ⑤ case reports, and ⑥ qualitative studies. CiteSpace was employed to identify top authors, institutions, countries, keywords, co-cited authors, journals, references, and research trends. VOSviewer was used to generate a network of authors, journals, and references. Bibliometrix was utilized to create maps of cooperating countries and keyword frequency charts, as well as a Sankey diagram illustrating the relationship between authors, keywords, and countries. RESULTS A total of 305 relevant articles were included in this study. The research pertaining to nursing aspects of diabetic foot care exhibited a noticeable upward trend. The analysis in this study revealed that "amputation" held the highest centrality, indicating a critical area of focus in nursing interventions to prevent severe outcomes. "Diabetic foot ulcer" ranked first in terms of citation rate, emphasizing the ongoing challenges in managing DFUs through nursing care. In recent years, there was a shift in focus towards keywords such as "pressure ulcers", "burden", and "chronic wound" highlighting the evolving priorities in nursing research to address complex wound care, patient burden, and long-term management strategies. CONCLUSIONS The current primary research focuses in nursing care for diabetic foot (DF) include wound management, offloading techniques, sensory protection, anti-infective treatment, education and self-management, and multidisciplinary teamwork. Future research should prioritize developing innovative nursing interventions tailored to individual patient needs, integrating advanced technologies like telemedicine and wearable devices for continuous monitoring, and exploring the psychological aspects of DFU management to improve patient adherence and outcomes. Additionally, more longitudinal studies are needed to assess the long-term effectiveness of various nursing strategies on patient quality of life.
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Affiliation(s)
- Yanan Zhao
- School of Nursing, Capital Medical University, Beijing, China
| | - Liwei Jing
- School of Nursing, Capital Medical University, Beijing, China.
| | - Xin Ma
- Department of Othopaedics, Huashan Hospital, Fudan University, Shanghai, China; Shanghai Sixth People's Hospital, Shanghai, China.
| | - Yangxi Li
- China-Japan Friendship Hospital, Beijing, China
| | - Jing Zhang
- School of Nursing, Capital Medical University, Beijing, China
| | - Chenyang Li
- School of Nursing, Capital Medical University, Beijing, China
| | - Guangtian Liu
- College of Nursing and Rehabilitation, North China University of Science and Tchnology, Hebei, China
| | - Jiaqi Dai
- School of Nursing, Capital Medical University, Beijing, China
| | - Shengxuan Cao
- Department of Othopaedics, Huashan Hospital, Fudan University, Shanghai, China
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Wong AYW, Hooi NMF, Yeo BSY, Sultana R, Bee YM, Lee ARYB, Tay SM. Improving Diabetic Wound-Healing Outcomes With Topical Growth Factor Therapies. J Clin Endocrinol Metab 2024; 109:e1642-e1651. [PMID: 38477463 DOI: 10.1210/clinem/dgae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
CONTEXT Diabetes mellitus is associated with morbid complications such as diabetic foot ulcers (DFUs) that may lead to amputations or mortality if not managed adequately. OBJECTIVE New adjunctive interventions to treat diabetic wounds include topical biologics and growth factors. This study aims to evaluate their efficacy in improving wound-healing outcomes and safety. METHODS Comprehensive database searches of MEDLINE via PubMed, EMBASE, and Cochrane were performed from inception to December 2022. Three independent researchers selected the studies. Randomized controlled trials that compared the use of a topical biologic growth factor-containing regimen to other biologics or standard of care (SOC) were included. This review followed PRISMA guidelines. Risk of bias analysis was performed using the Jadad scale. Network meta-analysis was performed. Treatments were grouped into common nodes based on the type of biologic agent. Primary outcomes of interest were healing rate and time to wound closure. Secondary outcomes included wound infection, serious adverse events (AEs), and amputation rate. RESULTS Human umbilical cord (HUC) was associated with the highest cure, followed by recombinant human epidermal growth factor (hEGF). A significantly greater reduction in the time to cure DFUs was seen in HUC, hEGF, and fibroblast growth factor (FGF). There was a significantly lower risk of AEs when platelet-rich plasma (PRP) was administered. CONCLUSION HUC, hEGF, and FGF are promising topical biologics with statistically significant primary outcomes compared to SOC, while PRP is effective in reducing ulcer-related AEs. HUC has been found to be the most effective in terms of cure rate and a reduction in time to cure.
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Affiliation(s)
- Andrew Yew Wei Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Natalie Ming Foong Hooi
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Brian Sheng Yep Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Rehena Sultana
- Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore
| | - Ainsley Ryan Yan Bin Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Sook Muay Tay
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Surgical Intensive Care, Singapore General Hospital, Singapore 169608, Singapore
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Weatherall T, Avsar P, Nugent L, Moore Z, McDermott JH, Sreenan S, Wilson H, McEvoy NL, Derwin R, Chadwick P, Patton D. The impact of machine learning on the prediction of diabetic foot ulcers - A systematic review. J Tissue Viability 2024:S0965-206X(24)00109-8. [PMID: 39019690 DOI: 10.1016/j.jtv.2024.07.004] [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: 01/11/2024] [Revised: 06/24/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Globally, diabetes mellitus poses a significant health challenge as well as the associated complications of diabetes, such as diabetic foot ulcers (DFUs). The early detection of DFUs is important in the healing process and machine learning may be able to help inform clinical staff during the treatment process. METHODS A PRISMA-informed search of the literature was completed via the Cochrane Library and MEDLINE (OVID), EMBASE, CINAHL Plus and Scopus databases for reports published in English and in the last ten years. The primary outcome of interest was the impact of machine learning on the prediction of DFUs. The secondary outcome was the statistical performance measures reported. Data were extracted using a predesigned data extraction tool. Quality appraisal was undertaken using the evidence-based librarianship critical appraisal tool. RESULTS A total of 18 reports met the inclusion criteria. Nine reports proposed models to identify two classes, either healthy skin or a DFU. Nine reports proposed models to predict the progress of DFUs, for example, classing infection versus non-infection, or using wound characteristics to predict healing. A variety of machine learning techniques were proposed. Where reported, sensitivity = 74.53-98 %, accuracy = 64.6-99.32 %, precision = 62.9-99 %, and the F-measure = 52.05-99.0 %. CONCLUSIONS A variety of machine learning models were suggested to successfully classify DFUs from healthy skin, or to inform the prediction of DFUs. The proposed machine learning models may have the potential to inform the clinical practice of managing DFUs and may help to improve outcomes for individuals with DFUs. Future research may benefit from the development of a standard device and algorithm that detects, diagnoses and predicts the progress of DFUs.
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Affiliation(s)
- Teagan Weatherall
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Pinar Avsar
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Linda Nugent
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Medical Sciences, Jeddah, Saudi Arabia.
| | - Zena Moore
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Medical Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia; Lida Institute, Shanghai, China; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; University of Wales, Cardiff, UK; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Southport, Queensland, Australia.
| | - John H McDermott
- Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, Dublin, Ireland.
| | - Seamus Sreenan
- Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, Dublin, Ireland.
| | - Hannah Wilson
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Natalie L McEvoy
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Rosemarie Derwin
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Paul Chadwick
- Birmingham City University, Birmingham, UK; Spectral MD, London, UK.
| | - Declan Patton
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Medical Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia; Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
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Xiao X, Zhao F, DuBois DB, Liu Q, Zhang YL, Yao Q, Zhang GJ, Chen S. Nanozymes for the Therapeutic Treatment of Diabetic Foot Ulcers. ACS Biomater Sci Eng 2024; 10:4195-4226. [PMID: 38752382 DOI: 10.1021/acsbiomaterials.4c00470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Diabetic foot ulcers (DFU) are chronic, refractory wounds caused by diabetic neuropathy, vascular disease, and bacterial infection, and have become one of the most serious and persistent complications of diabetes mellitus because of their high incidence and difficulty in healing. Its malignancy results from a complex microenvironment that includes a series of unfriendly physiological states secondary to hyperglycemia, such as recurrent infections, excessive oxidative stress, persistent inflammation, and ischemia and hypoxia. However, current common clinical treatments, such as antibiotic therapy, insulin therapy, surgical debridement, and conventional wound dressings all have drawbacks, and suboptimal outcomes exacerbate the financial and physical burdens of diabetic patients. Therefore, development of new, effective and affordable treatments for DFU represents a top priority to improve the quality of life of diabetic patients. In recent years, nanozymes-based diabetic wound therapy systems have been attracting extensive interest by integrating the unique advantages of nanomaterials and natural enzymes. Compared with natural enzymes, nanozymes possess more stable catalytic activity, lower production cost and greater maneuverability. Remarkably, many nanozymes possess multienzyme activities that can cascade multiple enzyme-catalyzed reactions simultaneously throughout the recovery process of DFU. Additionally, their favorable photothermal-acoustic properties can be exploited for further enhancement of the therapeutic effects. In this review we first describe the characteristic pathological microenvironment of DFU, then discuss the therapeutic mechanisms and applications of nanozymes in DFU healing, and finally, highlight the challenges and perspectives of nanozyme development for DFU treatment.
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Affiliation(s)
- Xueqian Xiao
- School of Laboratory Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, China
| | - Fei Zhao
- Institute of Hematology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei 430065, China
| | - Davida Briana DuBois
- Department of Chemistry and Biochemistry, University of California, 1156 High Street, Santa Cruz, California 95064, United States
| | - Qiming Liu
- Department of Chemistry and Biochemistry, University of California, 1156 High Street, Santa Cruz, California 95064, United States
| | - Yu Lin Zhang
- School of Laboratory Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, China
- Hubei Shizhen Laboratory, Wuhan, Hubei 430065, China
| | - Qunfeng Yao
- School of Laboratory Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, China
- Hubei Shizhen Laboratory, Wuhan, Hubei 430065, China
| | - Guo-Jun Zhang
- School of Laboratory Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, China
- Hubei Shizhen Laboratory, Wuhan, Hubei 430065, China
| | - Shaowei Chen
- Department of Chemistry and Biochemistry, University of California, 1156 High Street, Santa Cruz, California 95064, United States
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Yadav JP, Verma A, Pathak P, Dwivedi AR, Singh AK, Kumar P, Khalilullah H, Jaremko M, Emwas AH, Patel DK. Phytoconstituents as modulators of NF-κB signalling: Investigating therapeutic potential for diabetic wound healing. Biomed Pharmacother 2024; 177:117058. [PMID: 38968797 DOI: 10.1016/j.biopha.2024.117058] [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: 04/15/2024] [Revised: 06/14/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024] Open
Abstract
The NF-κB pathway plays a pivotal role in impeding the diabetic wound healing process, contributing to prolonged inflammation, diminished angiogenesis, and reduced proliferation. In contrast to modern synthetic therapies, naturally occurring phytoconstituents are well-studied inhibitors of the NF-κB pathway that are now attracting increased attention in the context of diabetic wound healing because of lower toxicity, better safety and efficacy, and cost-effectiveness. This study explores recent research on phytoconstituent-based therapies and delve into their action mechanisms targeting the NF-κB pathway and potential for assisting effective healing of diabetic wounds. For this purpose, we have carried out surveys of recent literature and analyzed studies from prominent databases such as Science Direct, Scopus, PubMed, Google Scholar, EMBASE, and Web of Science. The classification of phytoconstituents into various categorie such as: alkaloids, triterpenoids, phenolics, polyphenols, flavonoids, monoterpene glycosides, naphthoquinones and tocopherols. Noteworthy phytoconstituents, including Neferine, Plumbagin, Boswellic acid, Genistein, Luteolin, Kirenol, Rutin, Vicenin-2, Gamma-tocopherol, Icariin, Resveratrol, Mangiferin, Betulinic acid, Berberine, Syringic acid, Gallocatechin, Curcumin, Loureirin-A, Loureirin-B, Lupeol, Paeoniflorin, and Puerarin emerge from these studies as promising agents for diabetic wound healing through the inhibition of the NF-κB pathway. Extensive research on various phytoconstituents has revealed how they modulate signalling pathways, including NF-κB, studies that demonstrate the potential for development of therapeutic phytoconstituents to assist healing of chronic diabetic wounds.
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Affiliation(s)
- Jagat Pal Yadav
- Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India; Pharmacology Research Laboratory, Faculty of Pharmaceutical Sciences, Rama University, Kanpur 209217, India; Bioorganic and Medicinal Chemistry Research Laboratory, Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India.
| | - Amita Verma
- Bioorganic and Medicinal Chemistry Research Laboratory, Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India
| | - Prateek Pathak
- Department of Pharmaceutical Analysis, Quality Assurance and Pharmaceutical Chemistry, GITAM School of Pharmacy, GITAM (Deemed to be University), Hyderabad Campus, 502329, India
| | - Ashish R Dwivedi
- Department of Pharmaceutical Analysis, Quality Assurance and Pharmaceutical Chemistry, GITAM School of Pharmacy, GITAM (Deemed to be University), Hyderabad Campus, 502329, India
| | - Ankit Kumar Singh
- Bioorganic and Medicinal Chemistry Research Laboratory, Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India; Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Ghudda, Bathinda 151401, India
| | - Pradeep Kumar
- Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Ghudda, Bathinda 151401, India
| | - Habibullah Khalilullah
- Department of Pharmaceutical Chemistry and Pharmacognosy, Unaizah College of Pharmacy, Qassim University, Unayzah 51911, Saudi Arabia
| | - Mariusz Jaremko
- Smart-Health Initiative (SHI) and Red Sea Research Center (RSRC), Division of Biological and Environmental Sciences and Engineering (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal, 23955-6900, Saudi Arabia
| | - Abdul-Hamid Emwas
- Core Labs, King Abdullah University of Science and Technology (KAUST), Thuwal, 23955-6900, Saudi Arabia
| | - Dinesh Kumar Patel
- Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India.
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10
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Cazzell SM, Caporusso J, Vayser D, Davis RD, Alvarez OM, Sabolinski ML. Dehydrated Amnion Chorion Membrane versus standard of care for diabetic foot ulcers: a randomised controlled trial. J Wound Care 2024; 33:S4-S14. [PMID: 38973638 DOI: 10.12968/jowc.2024.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
OBJECTIVE Diabetic foot ulcers (DFUs) continue to challenge wound care practitioners. This prospective, multicentre, randomised controlled trial (RCT) evaluated the effectiveness of a dehydrated Amnion Chorion Membrane (dACM) (Organogenesis Inc., US) versus standard of care (SoC) alone in complex DFUs in a challenging patient population. METHOD Subjects with a DFU extending into dermis, subcutaneous tissue, tendon, capsule, bone or joint were enrolled in a 12-week trial. They were allocated equally to two treatment groups: dACM (plus SoC); or SoC alone. The primary endpoint was frequency of wound closure determined by a Cox analysis that adjusted for duration and wound area. Kaplan-Meier analysis was used to determine median time to complete wound closure (CWC). RESULTS The cohort comprised 218 patients, and these were split equally between the two treatment groups with 109 patients in each. A Cox analysis showed that the estimated frequency of wound closure for the dACM plus SoC group was statistically superior to the SoC alone group at week 4 (12% versus 8%), week 6 (22% versus 11%), week 8 (31% versus 21%), week 10 (42% versus 27%) and week 12 (50% versus 35%), respectively (p=0.04). The computed hazard ratio (1.48 (confidence interval: 0.95, 2.29) showed a 48% greater probability of wound closure in favour of the dACM group. Median time to wound closure for dACM-treated ulcers was 84 days compared to 'not achieved' in the SoC-treated group (i.e., ≥50% of SoC-treated DFUs failed to heal by week 12; p=0.04). CONCLUSION In an adequately powered DFU RCT, dACM increased the frequency, decreased the median time, and improved the probability of CWC when compared with SoC alone. dACM demonstrated beneficial effects in DFUs in a complex patient population. DECLARATION OF INTEREST This study was funded by Organogenesis Inc., US. JC serves as a consultant and speaker for Organogenesis. RDD serves as a speaker for Organogenesis. OMA and MLS serve as consultants for Organogenesis. The authors have no other conflicts of interest to declare.
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Affiliation(s)
| | | | | | | | - Oscar M Alvarez
- Department of Surgery, Division of Plastic Surgery, Rutgers NJMS, Newark, NJ, US
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11
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Bang FS, Leeberg V, Ding M, Dreyer CH. The effect of VEGF stimulation in diabetic foot ulcers: A systematic review. Wound Repair Regen 2024; 32:384-392. [PMID: 38494793 DOI: 10.1111/wrr.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
Diabetic foot ulcers are a common and severe complication of diabetes mellitus, and a risk factor for amputation. Because of the vessel insufficiency in diabetic foot ulcers (DFU), vascular endothelial growth factor (VEGF) that simulates angiogenesis is of interest to promote wound healing. This systematic review evaluates the last 16 years of in-vivo studies with VEGF stimulation as a treatment for DFU, developed based on the last published systematic article. A total of 961 articles were identified through databases in two phases. 947 articles were excluded by exclusion criteria, and four articles met our inclusion criteria and were included. The effects of VEGF on wound healing were analysed in all four studies. In three studies, the VEGF-treated wounds showed statistically faster healing than those not treated with VEGF. In one study, the VEGF-treated wounds revealed a positive trend toward faster healing. Furthermore, all four studies were in favor of using VEGF, but concluded that further research is needed. These studies showed a positive trend towards faster healing and was safe when using VEGF topically on humans. Furthermore, viral particles of VEGF seem to have a systematic effect when a dose exceeding 5.0 × 109 vp pr wound. Future research in using VEGF on DFU should focus on VEGF's relevant dosage, release rate, and specific mechanism. This review inspires further research, and a consistent study design is prerequisite such that results are more homogenic and comparable. Much effort is needed to translate the results into our clinical practice.
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Affiliation(s)
- Frederik S Bang
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Veronica Leeberg
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ming Ding
- Department of Orthopaedic Surgery and Traumatology, CORI-Centre for Orthopaedic Research and Innovation, Slagelse Hospital, Slagelse, Denmark
| | - Chris H Dreyer
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopaedic Surgery and Traumatology, CORI-Centre for Orthopaedic Research and Innovation, Slagelse Hospital, Slagelse, Denmark
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12
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Padula WV, Ramanathan S, Cohen BG, Rogan G, Armstrong DG. Comparative Effectiveness of Placental Allografts in the Treatment of Diabetic Lower Extremity Ulcers and Venous Leg Ulcers in U.S. Medicare Beneficiaries: A Retrospective Observational Cohort Study Using Real-World Evidence. Adv Wound Care (New Rochelle) 2024; 13:350-362. [PMID: 38588554 DOI: 10.1089/wound.2023.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Objective: To compare the effectiveness of cellular tissue products (CTP) versus standard care in U.S. Medicare beneficiaries with diabetic lower extremity ulcers (DLEUs) or venous leg ulcers (VLUs). Approach: We performed a retrospective cohort study using real-world evidence from U.S. Medicare claims for DLEUs or VLUs between 2016 and 2020. There were three cohorts evaluated: viable cryopreserved placental membrane (vCPM) or viable lyopreserved placental membrane (vLPM); other CTP; and standard care. Claims were collapsed into episodes of care. Univariate and bivariate statistics were used to examine the frequency distribution of demographics and clinical variables. Multivariable zero-inflated binomial regressions were used to evaluate mortality and recurrence trends. Logistic regression compared three adverse outcomes (AOs): amputation; 1-year mortality; and wound recurrence. Results: There were 333,362 DLEU episodes among 261,101 beneficiaries, and 122,012 VLU episodes among 80,415 beneficiaries. DLEU treatment with vLPM was associated with reduced 1-year mortality (-26%), reduced recurrence (-91%), and reduced AOs (-71%). VLU treatment with vCPM or vLPM was associated with reduced 1-year mortality (-23%), reduced recurrence (-80%), and 66.77% reduction in AOs. These allografts were also associated with a 49% and 73% reduced risk of recurrence in DLEU and VLU, respectively, compared with other CTPs. Finally, vCPM or vLPM were associated with noninferior prevention of AOs related to amputation, mortality, and recurrence (95% CI: 0.69-1.14). Conclusions: DLEUs and VLUs treated with vCPM and vLPM allografts are associated with lowered 1-year mortality, wound recurrence, and AOs in DLEUs and VLUs compared with standard care. Decision makers weighing coverage of placental allografts should consider these added short- and long-term clinical benefits relative to costly management and high mortality of Medicare's most frequent wounds.
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Affiliation(s)
- William V Padula
- Department of Pharmaceutical & Health Economics, Alfred E. Mann School of Pharmacy & Pharmaceutical Sciences, University of Southern California, Los Angeles, California, USA
- The Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
- Stage Analytics, Suwanee, Georgia, USA
| | | | | | | | - David G Armstrong
- The Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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13
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Wang YB, Lv Y, Li GY, Zheng JT, Jiang QX, Wei R. Clinical comprehensive treatment protocol for managing diabetic foot ulcers: A retrospective cohort study. World J Clin Cases 2024; 12:2976-2982. [PMID: 38898850 PMCID: PMC11185408 DOI: 10.12998/wjcc.v12.i17.2976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFUs) are a common complication of diabetes, often leading to severe infections, amputations, and reduced quality of life. The current standard treatment protocols for DFUs have limitations in promoting efficient wound healing and preventing complications. A comprehensive treatment approach targeting multiple aspects of wound care may offer improved outcomes for patients with DFUs. The hypothesis of this study is that a comprehensive treatment protocol for DFUs will result in faster wound healing, reduced amputation rates, and improved overall patient outcomes compared to standard treatment protocols. AIM To compare the efficacy and safety of a comprehensive treatment protocol for DFUs with those of the standard treatment protocol. METHODS This retrospective study included 62 patients with DFUs, enrolled between January 2022 and January 2024, randomly assigned to the experimental (n = 32) or control (n = 30) group. The experimental group received a comprehensive treatment comprising blood circulation improvement, debridement, vacuum sealing drainage, recombinant human epidermal growth factor and anti-inflammatory dressing, and skin grafting. The control group received standard treatment, which included wound cleaning and dressing, antibiotics administration, and surgical debridement or amputation, if necessary. Time taken to reduce the white blood cell count, number of dressing changes, wound healing rate and time, and amputation rate were assessed. RESULTS The experimental group exhibited significantly better outcomes than those of the control group in terms of the wound healing rate, wound healing time, and amputation rate. Additionally, the comprehensive treatment protocol was safe and well tolerated by the patients. CONCLUSION Comprehensive treatment for DFUs is more effective than standard treatment, promoting granulation tissue growth, shortening hospitalization time, reducing pain and amputation rate, improving wound healing, and enhancing quality of life.
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Affiliation(s)
- Yan-Bin Wang
- Department of Vascular Surgery, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China
| | - Yan Lv
- First Department of General Surgery, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China
| | - Guang-Yu Li
- Department of Vascular Surgery, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China
| | - Ji-Ting Zheng
- Department of Vascular Surgery, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China
| | - Qing-Xin Jiang
- First Department of General Surgery, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China
| | - Ran Wei
- First Department of General Surgery, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China
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14
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Tseng SL, Kang L, Li ZJ, Wang LQ, Li ZM, Li TH, Xiang JY, Huang JZ, Yu NZ, Long X. Adipose-derived stem cells in diabetic foot care: Bridging clinical trials and practical application. World J Diabetes 2024; 15:1162-1177. [PMID: 38983804 PMCID: PMC11229965 DOI: 10.4239/wjd.v15.i6.1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/03/2024] [Accepted: 04/19/2024] [Indexed: 06/11/2024] Open
Abstract
Diabetic foot ulcers (DFUs) pose a critical medical challenge, significantly im-pairing the quality of life of patients. Adipose-derived stem cells (ADSCs) have been identified as a promising therapeutic approach for improving wound healing in DFUs. Despite extensive exploration of the mechanical aspects of ADSC therapy against DFU, its clinical applications remain elusive. In this review, we aimed to bridge this gap by evaluating the use and advancements of ADSCs in the clinical management of DFUs. The review begins with a discussion of the classification and clinical management of diabetic foot conditions. It then discusses the current landscape of clinical trials, focusing on their geographic distribution, reported efficacy, safety profiles, treatment timing, administration techniques, and dosing considerations. Finally, the review discusses the preclinical strategies to enhance ADSC efficacy. This review shows that many trials exhibit biases in study design, unclear inclusion criteria, and intervention protocols. In conclusion, this review underscores the potential of ADSCs in DFU treatment and emphasizes the critical need for further research and refinement of therapeutic approaches, with a focus on improving the quality of future clinical trials to enhance treatment outcomes and advance the field of diabetic wound care.
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Affiliation(s)
- Song-Lu Tseng
- Department of Plastic and Reconstructive Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Lin Kang
- Biomedical Engineering Facility, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Beijing, Beijing 100021, China
| | - Zhu-Jun Li
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Li-Quan Wang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zi-Ming Li
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Tian-Hao Li
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jie-Yu Xiang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jiu-Zuo Huang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Nan-Ze Yu
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao Long
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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15
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Tan L, Qu J, Wang J. Development of novel lysosome-related signatures and their potential target drugs based on bulk RNA-seq and scRNA-seq for diabetic foot ulcers. Hum Genomics 2024; 18:62. [PMID: 38862997 PMCID: PMC11165785 DOI: 10.1186/s40246-024-00629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFU) is the most serious complication of diabetes mellitus, which has become a global health problem due to its high morbidity and disability rates and the poor efficacy of conventional treatments. Thus, it is urgent to identify novel molecular targets to improve the prognosis and reduce disability rate in DFU patients. RESULTS In the present study, bulk RNA-seq and scRNA-seq associated with DFU were downloaded from the GEO database. We identified 1393 DFU-related DEGs by differential analysis and WGCNA analysis together, and GO/KEGG analysis showed that these genes were associated with lysosomal and immune/inflammatory responses. Immediately thereafter, we identified CLU, RABGEF1 and ENPEP as DLGs for DFU using three machine learning algorithms (Randomforest, SVM-RFE and LASSO) and validated their diagnostic performance in a validation cohort independent of this study. Subsequently, we constructed a novel artificial neural network model for molecular diagnosis of DFU based on DLGs, and the diagnostic performance in the training and validation cohorts was sound. In single-cell sequencing, the heterogeneous expression of DLGs also provided favorable evidence for them to be potential diagnostic targets. In addition, the results of immune infiltration analysis showed that the abundance of mainstream immune cells, including B/T cells, was down-regulated in DFUs and significantly correlated with the expression of DLGs. Finally, we found latamoxef, parthenolide, meclofenoxate, and lomustine to be promising anti-DFU drugs by targeting DLGs. CONCLUSIONS CLU, RABGEF1 and ENPEP can be used as novel lysosomal molecular signatures of DFU, and by targeting them, latamoxef, parthenolide, meclofenoxate and lomustine were identified as promising anti-DFU drugs. The present study provides new perspectives for the diagnosis and treatment of DFU and for improving the prognosis of DFU patients.
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Affiliation(s)
- Longhai Tan
- Department of Dermatology, Tianjin Beichen Hospital, Tianjin, 300400, China.
| | - Junjun Qu
- Zhu Xianyi Memorial Hospital of Tianjin Medical University, Tianjin, 300134, China
| | - Junxia Wang
- Department of Dermatology, Tianjin Beichen Hospital, Tianjin, 300400, China
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16
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Tang W, Du X, Wu Z, Nie Z, Yu C, Gao Y. circ-Erbb2ip from adipose-derived mesenchymal stem cell-derived exosomes promotes wound healing in diabetic mice by inducing the miR-670-5p/Nrf1 axis. Cell Signal 2024; 121:111245. [PMID: 38849105 DOI: 10.1016/j.cellsig.2024.111245] [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: 10/10/2023] [Revised: 03/16/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND To investigate the mechanism of exosomes (Exo) secretion by hypoxic pretreated adipose-derived mesenchymal stem cells (ADSCs) promoting skin wound healing in diabetic (DM) mice. METHODS High-throughput sequencing was used to investigate abnormal expression of circRNA in hypoxic pretreatment ADSCs exosome (HExo) and ADSCs exosome (Exo). Bioinformatics analysis and luciferase reporting analysis were used to clarify the interacted relationship among circRNA, miRNA and mRNA. EPCs cells were employ to analysis the ROS, inflammatory cytokines expression, angiogenic differentiation function under hypoxic condition by using immunofluorescence, ELISA detection and tube forming experiment. DM ulceration mice model were constructed and the therapeutic effect of Exo were detected using immunohistochemistry, immunofluorescence. RESULTS The result show that HExo have more treatment effect than Exo in promotes cutaneous wound healing of DM mice. High-throughput sequencing found that circ-Erbb2ip play a role in HExo mediated tissues repair. Downregulation circ-Erbb2ip decreased the therapeutic effect of HExo to wound healing in diabetic mice. Bioinformatics analysis and luciferase reporting analysis confirmed that both miR-670-5p and Nrf1 were downstream targets of circ-Erbb2ip. Downregulation of Nrf1 or overexpression of miR-670-5p reversed the protective effect of circ-Erbb2ip to EPCs after exposure to high glucose microenvironment. Upregulation circ-Erbb2ip increased the therapeutic effect of Exo to wound healing in diabetic mice by increased angiogenesis and decreased ROS, inflammatory cytokines expression. CONCLUSION In conclusion, ADSC-Exos containing circ-Erbb2ip promotes wound healing by targeting miR-670-5p/Nrf1 pathway, and their effects in promoting soft tissue wound healing warrant further study.
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Affiliation(s)
- Wenbo Tang
- The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China; The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, China
| | - Xiaoying Du
- The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China; The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, China
| | - Zifu Wu
- The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, China
| | - Zhonglin Nie
- The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, China
| | - Chaowen Yu
- The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, China.
| | - Yong Gao
- The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China; The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, China.
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17
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Yunir E, Adesta FEA, Rizka A, Tarigan TJE. Correlation between initial serum 25-hydroxyvitamin D and granulation growth in diabetic foot ulcers. J Wound Care 2024; 33:clii-clix. [PMID: 38850545 DOI: 10.12968/jowc.2021.0243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
OBJECTIVE To determine the correlation between initial serum 25-hydroxyvitamin D (25(OH)D) levels with granulation growth in diabetic foot ulcers (DFUs) after 21 days of treatment. METHOD This cohort study involved patients with type 2 diabetes who had a DFU treated at hospital. Blood samples were taken from patients on admission. The chemiluminescent immunoassay technique was used to measure 25(OH)D levels. Granulation tissue growth was analysed by comparing the photographs from the initial treatment to day 21 of treatment. RESULTS The median value of 25(OH)D levels at initial treatment was 8 ng/ml. The result showed no correlation between 25(OH)D levels and the granulation growth in DFUs (p=0.86). CONCLUSION The initial serum 25(OH)D level was not correlated with the growth of granulation tissue in DFUs.
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Affiliation(s)
- Em Yunir
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Fajar Englando Alan Adesta
- Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Aulia Rizka
- Division of Geriatric, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Tri Juli Edi Tarigan
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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18
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Zhao H, Wu Y, Xie Y, Li Y, Chen C, Li C, Yang F, Zhang D, Wang Y, Yuan J. Hydrogel dressings for diabetic foot ulcer: A systematic review and meta-analysis. Diabetes Obes Metab 2024; 26:2305-2317. [PMID: 38465784 DOI: 10.1111/dom.15544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/12/2024]
Abstract
AIM To investigate the differences in utility between conventional dressings and hydrogel dressings for the treatment of diabetic foot ulcer (DFU). METHODS The PubMed, Embase, Cochrane Library, CNKI, VIP and Wanfang databases were systematically searched up to 21 January 2023. Fixed/random-effect models were used to calculate the odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) for the effect size analysis, with heterogeneity determined by I2 statistics. Subgroup analyses of different classes of hydrogel were also conducted. RESULTS A total of 15 randomized controlled trials with 872 patients were eligible for the present analysis. Compared with conventional dressings, hydrogel dressings significantly improved the healing rate (OR 4.09, 95% CI 2.83 to 5.91), shortened the healing time (MD -11.38, 95% CI -13.11 to -9.66), enhanced granulation formation (MD -3.60, 95% CI -4.21 to -3.00) and epithelial formation (MD -2.82, 95% CI -3.19 to -2.46), and reduced the incidence of bacterial infection (OR 0.10, 95% CI 0.05 to 0.18). CONCLUSION The meta-analysis showed that hydrogel dressings are more effective in treating DFU compared with conventional dressings.
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Affiliation(s)
- Hongjiao Zhao
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao, China
| | - You Wu
- Institute of Neuroregeneration and Neurorehabilitation, Qingdao University, Qingdao, China
| | - Yuchen Xie
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Yanfei Li
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Chen Chen
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Chanjuan Li
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Fangzheng Yang
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Deteng Zhang
- Institute of Neuroregeneration and Neurorehabilitation, Qingdao University, Qingdao, China
| | - Yaqin Wang
- School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qingdao, China
- Laboratory of Nephrology and Department of Nephrology, Qingdao Municipal Hospital, Qingdao, China
| | - Junhua Yuan
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao, China
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Patel P, Dongre S, Patel A, Patel G. Evaluating a promising methylcellulose hydrogel for enhanced diabetic foot ulcer therapy through comprehensive preclinical studies. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2024; 35:1421-1438. [PMID: 38536671 DOI: 10.1080/09205063.2024.2333068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/15/2024] [Indexed: 06/04/2024]
Abstract
The present research focuses on formulating and evaluating hydrogels modified with crosslinking agents using methylcellulose to treat diabetic foot ulcers (DFU). Methylcellulose hydrogels are prepared and characterized for their crosslinking capacity through FTIR and degradation studies. The optimized hydrogel is further assessed for viscosity, gel strength, contact angle, in-vitro biodegradation, water-vapor transmission rate, anti-bacterial activity, and in-vivo efficacy. The results demonstrate that the developed hydrogel exhibits promising properties for DFU treatment, including increased wound healing percentage, improved ulcer morphology, reduced levels of proinflammatory cytokines, and enhanced tissue characteristics. These findings suggest that the novel hydrogel composition could serve as a viable alternative to existing dressings for DFU management.
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Affiliation(s)
- Priya Patel
- Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology, Changa, Gujarat, India
| | - Sanika Dongre
- Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology, Changa, Gujarat, India
| | - Alkesh Patel
- Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology, Changa, Gujarat, India
| | - Gayatri Patel
- Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology, Changa, Gujarat, India
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20
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Sun M, Tian Y, Liu J, Yan Y, Zhang X, Xiao C, Jiang R. Proanthocyanidins-based tandem dynamic covalent cross-linking hydrogel for diabetic wound healing. Int J Biol Macromol 2024; 272:132741. [PMID: 38825292 DOI: 10.1016/j.ijbiomac.2024.132741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/04/2024]
Abstract
Wound healing in diabetic patients presents significant challenges in clinical wound care due to high oxidative stress, excessive inflammation, and a microenvironment prone to infection. In this study, we successfully developed a multifunctional tandem dynamic covalently cross-linked hydrogel dressing aimed at diabetic wound healing. This hydrogel was constructed using cyanoacetic acid functionalized dextran (Dex-CA), 2-formylbenzoylboric acid (2-FPBA) and natural oligomeric proanthocyanidins (OPC), catalyzed by histidine. The resulting Dex-CA/OPC/2-FPBA (DPOPC) hydrogel can be dissolved triggered by cysteine, thereby achieving "controllable and non-irritating" dressing change. Furthermore, the incorporation of OPC as a hydrogel building block endowed the hydrogel with antioxidant and anti-inflammatory properties. The cross-linked network of the DPOPC hydrogel circumvents the burst release of OPC, enhancing its biosafety. In vivo studies demonstrated that the DPOPC hydrogel significantly accelerated the wound healing process in diabetic mice compared to a commercial hydrogel, achieving an impressive wound closure rate of 98 % by day 14. The DPOPC hydrogel effectively balanced the disrupted inflammatory state during the healing process. This dynamic hydrogel based on natural polyphenols is expected to be an ideal candidate for dressings intended for chronic wounds.
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Affiliation(s)
- Minghui Sun
- Department of Dermatology China-Japan Union Hospital of Jilin University, Changchun 130033, PR China; Key Laboratory of Polymer Ecomaterials, Jilin Biomedical Polymers Engineering Laboratory, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, PR China
| | - Yongchang Tian
- Key Laboratory of Polymer Ecomaterials, Jilin Biomedical Polymers Engineering Laboratory, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, PR China; Department of Chemistry, Northeast Normal University, Changchun 130024, PR China
| | - Jiaying Liu
- Key Laboratory of Polymer Ecomaterials, Jilin Biomedical Polymers Engineering Laboratory, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, PR China
| | - Yu Yan
- Key Laboratory of Polymer Ecomaterials, Jilin Biomedical Polymers Engineering Laboratory, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, PR China
| | - Xiaonong Zhang
- Key Laboratory of Polymer Ecomaterials, Jilin Biomedical Polymers Engineering Laboratory, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, PR China.
| | - Chunsheng Xiao
- Key Laboratory of Polymer Ecomaterials, Jilin Biomedical Polymers Engineering Laboratory, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, PR China
| | - Rihua Jiang
- Department of Dermatology China-Japan Union Hospital of Jilin University, Changchun 130033, PR China.
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Li N, Lu X, Yang Y, Ning S, Tian Y, Zhou M, Wang Z, Wang L, Zang J. Calcium Peroxide-Based Hydrogel Patch with Sustainable Oxygenation for Diabetic Wound Healing. Adv Healthc Mater 2024; 13:e2303314. [PMID: 38558386 DOI: 10.1002/adhm.202303314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/24/2024] [Indexed: 04/04/2024]
Abstract
Nonhealing diabetic wounds are predominantly attributed to the inhibition of angiogenesis, re-epithelialization, and extracellular matrix (ECM) synthesis caused by hypoxia. Although oxygen therapy has demonstrated efficacy in promoting healing, its therapeutic impact remains suboptimal due to unsustainable oxygenation. Here, this work proposes an oxygen-releasing hydrogel patch embedded with polyethylene glycol-modified calcium peroxide microparticles, which sustainably releases oxygen for 7 days without requiring any supplementary conditions. The released oxygen effectively promotes cell migration and angiogenesis under hypoxic conditions as validated in vitro. The in vivo tests in diabetic mice models show that the sustainably released oxygen significantly facilitates the synthesis of ECM, induces angiogenesis, and decreases the expression of inflammatory cytokines, achieving a diabetic wound healing rate of 84.2% on day 7, outperforming the existing oxygen-releasing approaches. Moreover, the proposed hydrogel patch is designed with porous, soft, antibacterial, biodegradable, and storage stability for 15 days. The proposed hydrogel patch is expected to be promising in clinics treating diabetic wounds.
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Affiliation(s)
- Na Li
- School of Integrated Circuits, Huazhong University of Science and Technology, Wuhan, 430074, China
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Xiaohuan Lu
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yueying Yang
- School of Integrated Circuits, Huazhong University of Science and Technology, Wuhan, 430074, China
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Shan Ning
- School of Integrated Circuits, Huazhong University of Science and Technology, Wuhan, 430074, China
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Ye Tian
- School of Integrated Circuits, Huazhong University of Science and Technology, Wuhan, 430074, China
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Mengyuan Zhou
- School of Integrated Circuits, Huazhong University of Science and Technology, Wuhan, 430074, China
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Zheng Wang
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lin Wang
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jianfeng Zang
- School of Integrated Circuits, Huazhong University of Science and Technology, Wuhan, 430074, China
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
- The State Key Laboratory of Intelligent Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
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Hettinger G, Mitra N, Thom SR, Margolis DJ. An Improved Clinical and Genetics-Based Prediction Model for Diabetic Foot Ulcer Healing. Adv Wound Care (New Rochelle) 2024; 13:281-290. [PMID: 38258807 DOI: 10.1089/wound.2023.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
Objective: The goal of this investigation was to use comprehensive prediction modeling tools and available genetic information to try to improve upon the performance of simple clinical models in predicting whether a diabetic foot ulcer (DFU) will heal. Approach: We utilized a cohort study (n = 206) that included clinical factors, measurements of circulating endothelial precursor cells (CEPCs), and fine sequencing of the NOS1AP gene. We derived and selected relevant predictive features from this patient-level information using statistical and machine learning techniques. We then developed prognostic models using machine learning approaches and assessed predictive performance. The presentation is consistent with TRIPOD requirements. Results: Models using baseline clinical and CEPC data had an area under the receiver operating characteristic curve (AUC) of 0.73 (0.66-0.80). Models using only single nucleotide polymorphisms (SNPs) of the NOS1AP gene had an AUC of 0.67 (95% confidence interval, CI: [0.59-0.75]). However, models incorporating baseline and SNP information resulted in improved AUC (0.80, 95% CI [0.73-0.87]). Innovation: We provide a rigorous analysis demonstrating the predictive potential of genetic information in DFU healing. In this process, we present a framework for using advanced statistical and bioinformatics techniques for creating superior prognostic models and identify potentially predictive SNPs for future research. Conclusion: We have developed a new benchmark for which future predictive models can be compared against. Such models will enable wound care experts to more accurately predict whether a patient will heal and aid clinical trialists in designing studies to evaluate therapies for subjects likely or unlikely to heal.
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Affiliation(s)
- Gary Hettinger
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Stephen R Thom
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David J Margolis
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Chin BZ, Lee P, Sia CH, Hong CC. Diabetic foot ulcer is associated with cardiovascular-related mortality and morbidity - a systematic review and meta-analysis of 8062 patients. Endocrine 2024; 84:852-863. [PMID: 38280983 DOI: 10.1007/s12020-024-03696-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/10/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVES To conduct a systematic review and meta-analysis of prevalence of cardiovascular-related morbidity and mortality in patients with diabetic foot ulcers (DFU), as well as compare risks of cardiovascular-related morbidity and mortality between diabetic patients with and without DFU. METHODS A systematic search was conducted on Medline, Embase, and Cochrane databases for randomized controlled trials and observational studies which explored the association between DFU and cardiovascular-related morbidity & mortality, or compared differences in hazard ratios of cardiovascular diseases between diabetics with and without DFU. Frequentist, pairwise meta-analysis was performed on studies with two comparator arms, whereas single-arm studies reporting pooled incidences of cardiovascular-related mortality and morbidity were calculated based on exact binomial distributions. A random-effect meta-analysis model was used with heterogenicity of studies assessed using I2, τ2, and χ2 statistics. RESULTS 10 studies were identified and included in the systematic review & meta-analysis of 8602 patients. DFU was consistently found to have significant association with cardiovascular-related morbidity and mortality, with pooled prevalences of all cause cardiovascular-related morbidity (37.1%), IHD (44.7%), CHF (25.1%), CAD (11.7%), and CVA (10.9%), and all cause cardiovascular-related mortality (14.6%), fatal IHD (6.2%), fatal CHF (3.67%), fatal CAD (7.92%), and fatal CVA (1.99%). Diabetic patients with DFU were found to have significantly increased risk of IHD (RR 1.25), CVA (RR 2.03), and all-cause cardiovascular-related mortality (RR 2.59) compared to those without DFU. CONCLUSIONS The presence of DFU is associated with major adverse cardiac events. The alarming rates of cardiovascular-related morbidity and mortality in DFU patients highlight its potential role as a marker of cardiovascular complications and should prompt early clinical investigation and management.
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Affiliation(s)
- Brian Zhaojie Chin
- Department of Orthopaedic Surgery, National University Health System, Level 11 Tower Block, 1E, Lower Kent Ridge Road, Singapore, 119228, Singapore
| | - Peng Lee
- Department of Orthopaedic Surgery, National University Health System, Level 11 Tower Block, 1E, Lower Kent Ridge Road, Singapore, 119228, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, NUHS Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Choon Chiet Hong
- Department of Orthopaedic Surgery, National University Health System, Level 11 Tower Block, 1E, Lower Kent Ridge Road, Singapore, 119228, Singapore.
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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Sanpinit S, Chokpaisarn J, Na-Phatthalung P, Sotthibandhu DS, Yincharoen K, Wetchakul P, Limsuwan S, Chusri S. Effectiveness of Ya-Samarn-Phlae in diabetic wound healing: Evidence from in vitro studies and a multicenter randomized controlled clinical trial. JOURNAL OF ETHNOPHARMACOLOGY 2024; 326:117929. [PMID: 38373661 DOI: 10.1016/j.jep.2024.117929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/29/2023] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Ya-Samarn-Phlae (YaSP) has traditionally been widely used in southern Thailand for treating chronic and infected wounds, including diabetic foot ulcers. However, there are only a limited number of clinical studies supporting the use of this polyherbal formulation. Therefore, the present work aims to provide clinical evidence to support the application of YaSP, prepared according to a standardized traditional procedure (T-YaSP). Additionally, its potential chemical markers and wound healing-related biological activities were examined. MATERIALS AND METHODS The in vitro wound healing-related biological activities of YaSP ethanol extract and T-YaSP, including antibacterial activity against Staphylococcus epidermidis, inhibition and eradication of staphylococcal biofilm, anti-inflammatory effects, and enhancement of human dermal fibroblast migration in scratch wounds, were examined using well-established protocols. The chemical profiles of the ethanol extract of YaSP and T-YaSP were compared, and with promising chemical markers, arecoline, alpha-mangostin, and curcumin were selected and quantified using the HPLC method. A prospective, multicenter, randomized, controlled, parallel-group study was conducted over 12 weeks to evaluate the efficacy of the YaSP solution as an adjunct therapy, combined with standard wound care, for diabetic ulcers compared to standard treatment. RESULTS The YaSP extract reduces NO production and can scavenge NO radicals in LPS-induced RAW 264.7 macrophage cells. Additionally, in a scratch assay, this extract and one of its herbal components, Curcuma longa, enhance the migration of human dermal fibroblasts. T-YaSP, containing 2.412 ± 0.002 mg/g of arecoline, 2.399 ± 0.005 mg/g of curcumin, and 0.017 ± 0.000 mg/g of α-mangostin, has shown the ability to inhibit the development and eradicate the mature biofilm of S. epidermidis. The use of T-YaSP as an adjunct therapy led to a significantly higher proportion of patients achieving healing within six weeks compared to the standard treatment group (36%/9 patients vs. 4%/1 patient; p = 0.013). After 12 weeks, 19 out of 25 patients in the T-YaSP group experienced complete healing, whereas only four patients in the standard treatment group achieved complete wound healing (76% in the T-YaSP group vs. 16% in the control group; p < 0.001). CONCLUSION The results presented here represent the first randomized controlled trial to demonstrate the effectiveness of the traditional polyherbal solution, T-YaSP, which exhibits a wide range of wound healing-related activities. Utilizing T-YaSP as an adjunctive treatment resulted in a significant improvement in the number of type 2 diabetic patients achieving complete healing. However, to explore and utilize YaSP further, conducting a double-blind, randomized controlled trial with a larger population is necessary.
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Affiliation(s)
- Sineenart Sanpinit
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, 80160, Thailand
| | - Julalak Chokpaisarn
- Faculty of Traditional Thai Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand
| | - Pinanong Na-Phatthalung
- The Second Affiliated Hospital, The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Cancer Center, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | | | - Kanyatorn Yincharoen
- Department of Thai Traditional Medicine, Faculty of Science and Technology, Rajamangala University of Technology Srivijaya (RMUTSV), Thung Song, Nakhon Si Thammarat, 80110, Thailand
| | - Palika Wetchakul
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, 80160, Thailand
| | - Surasak Limsuwan
- Faculty of Traditional Thai Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand
| | - Sasitorn Chusri
- School of Health Science and Biomedical Technology Research Group for Vulnerable Populations, MaeFah Luang University, Chiang Rai, 57100, Thailand.
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25
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Chang SC, Lin CW, Chen JC, Wu YH, Chen SG, Huang YY, Cheng NC, Cazzell SM, Chen HH, Huang KF, Tung KY, Huang HL, Perng CK, Shi B, Liu C, Ma Y, Cao Y, Li Y, Xue Y, Gao F, Cao Y, Yan L, Li Q, Armstrong DG, Ning G. Effects of ON101 for Hard-to-Heal Diabetic Foot Ulcers in A Randomized Phase III Trial: A Post hoc Analysis. Adv Wound Care (New Rochelle) 2024. [PMID: 38780901 DOI: 10.1089/wound.2023.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE Hard-to-heal diabetic foot ulcers (DFUs) are associated with higher mortality rates and an increased medical burden for patients. ON101, a new topical cream, exhibited better healing efficacy than the control dressing in a Phase III trial. In this post-hoc analysis, we further identify whether ON101 can improve the healing of ulcers with hard-to-heal risk factors in this cohort of DFU patients. APPROACH To compare the efficacy of ON101 with absorbent dressing among various hard-to-heal wounds in patients with DFU, a post hoc analysis of a randomized phase III trial included 276 DFU patients was performed by subgrouping those patients based on ulcer depth, location, size, duration, and patients' glycated hemoglobin (HbA1c) levels and body mass index (BMI). RESULTS In the full analysis set, the proportion of patients achieving healing was 61.7% in the ON101 group and 37.0% in the comparator (P =0.0001). In sub-group analysis according to risk factors, ON101 demonstrated superior healing capacity on Wagner grade 2 ulcers (P < 0.0001); plantar ulcers (P = 0.0016), ulcers size ≥5 cm² (P = 0.0122), ulcers duration ≥3 months (P = 0.0043); for patients with HbA1c ≥9% (P = 0.0285); and patients with BMI ≥25 (P = 0.0005). INNOVATION ON101, a novel therapeutic drug, can modulate the functions of macrophages and demonstrate superior healing rates to conventional absorbent dressing in patients with hard-to-heal DFUs. CONCLUSIONS The results of this post hoc study suggest that ON101 is a better therapeutic option than conventional dressing used in treatment for DFU patients with higher HbA1c, BMI, or ulcers with complex conditions such as longer duration, deeper wounds, larger size, and plantar location.
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Affiliation(s)
- Shun-Cheng Chang
- Taipei Medical University Shuang Ho Hospital Ministry of Health and Welfare, New Taipei City, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Department of Surgery, Taipei, Taiwan;
| | | | - Jui-Ching Chen
- Oneness Biotech Company Limited, Department of Medical Science, Taipei, Taiwan;
| | - Yi-Hsin Wu
- Oneness Biotech Company Limited, Taipei, Taiwan;
| | - Shyi-Gen Chen
- Tri-Service General Hospital, Division of Plastic and Reconstructive Surgery, Taipei, Taiwan
- National Defense Medical Center, Taipei, Taiwan;
| | - Yu-Yao Huang
- Chang Gung Memorial Hospital Linkou, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taoyuan City, Taiwan
- Chang Gung University College of Medicine, Taoyuan City, Taiwan;
| | - Nai-Chen Cheng
- National Taiwan University Hospital and College of Medicine, Division of Plastic Surgery, Department of Surgery, Taipei, Taiwan;
| | - Shawn M Cazzell
- Limb Preservation Platform, Inc., Fresno, California, United States;
| | - Hsin-Han Chen
- China Medical University Hospital, Plastic and Reconstruction Surgery, Taichung, Taiwan;
| | - Kuo-Feng Huang
- Chi Mei Medical Center, Division of Plastic Surgery, Department of Surgery, Tainan, Taiwan;
| | - Kwang-Yi Tung
- Mackay Memorial Hospital, Division of Plastic Surgery, Department of Surgery, Taipei, Taiwan;
| | - Hsuan-Li Huang
- Taipei Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, Division of Cardiology, New Taipei City, Taiwan
- School of Post-baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan;
| | - Cherng-Kang Perng
- Taipei Veterans General Hospital, Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei, Taiwan
- National Yang Ming Chiao Tung University School of Medicine, Department of Surgery, Taipei, Taiwan
- Chang Bing Show Chwan Memorial Hospital, Department of Surgery, Lukang, Taiwan;
| | - Bimin Shi
- First Affiliated Hospital of Soochow University, Department of Endocrinology, Suzhou, Jiangsu, China;
| | - Chang Liu
- Affiliated Hospital of Jiangsu University, Department of Burn and Plastic Surgery, Zhenjiang, Jiangsu, China;
| | - Yujin Ma
- Henan University of Science and Technology Affiliated First Hospital, Department of Endocrinology, Luoyang, Henan, China;
| | - Yemin Cao
- Shanghai Traditional Chinese Medicine Integrated Hospital, Department of Vascular Anomalies, Shanghai, China;
| | - Yanbing Li
- Sun Yat-sen University First Affiliated Hospital, Department of Endocrinology and Metabolism, Guangzhou, Guangdong, China;
| | - Yaoming Xue
- Southern Medical University Nanfang Hospital, Department of Endocrinology and Metabolism, Guangzhou, Guangdong, China;
| | - Fang Gao
- Southern Medical University Nanfang Hospital, Department of Endocrinology and Metabolism, Guangzhou, Guangdong, China;
| | - Ying Cao
- Southern Medical University Nanfang Hospital, Department of Endocrinology and Metabolism, Guangzhou, Guangdong, China;
| | - Li Yan
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Department of Endocrinology, Guangdong Province, China;
| | - Qiu Li
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Department of Endocrinology,, Jinan, Shandong, China;
| | - David G Armstrong
- University of Southern California Keck School of Medicine, Department of Surgery, Los Angeles, California, United States;
| | - Guang Ning
- Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Department of Endocrine and Metabolic Diseases, Shanghai, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics,Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;
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Jiang X, Li A, Hao W, Yang C, Wang H, Deng W. Limb salvage and systemic management of gouty tophi: Case series. Medicine (Baltimore) 2024; 103:e38137. [PMID: 38758848 PMCID: PMC11098208 DOI: 10.1097/md.0000000000038137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/15/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Gout is a chronic disease characterized by deposition of monosodium urate crystals. Tophi develop in some individuals with untreated or uncontrolled gout, which leads to ulcerations, cosmetic problems, mechanical obstruction of joint movement, joint damage and musculoskeletal disability. Currently, the treatment of gouty tophi is controversial and challenging. Both surgical and internal medical treatments have limitations and require further exploration in clinical practice. PATIENT CONCERNS In Case 1, we treated a patient with severe infection of diabetic foot ulcers with concomitant multiple gouty tophi in the same limb. A systematic management strategy was formulated to close the wound and save the limb. The ulcers healed successfully after half a year. In Case 2, a giant gouty tophi located in the first metatarsophalangeal joint of the left foot was removed by surgical treatment and vancomycin-loaded bone cement implantation. In Case 3, we present a case of gouty tophi that was resolved by standardized systemic medical management. DIAGNOSIS Three patients were all diagnosed with gout accompanied by gouty deposition, although there were other different comorbidities. INTERVENTIONS In case 1, we used debridement to gradually remove gouty tophi. In case 2, the giant gouty tophi was removed by surgical operation. In case 3, the gouty tophi disappeared after standardized treatment with medicine, diet and lifestyle management. OUTCOMES Three patients underwent different treatment therapies to remove gouty tophi based on their specific conditions. LESSONS We explored effective interventions for tophi in gout by surgical or other interventions in combination with pharmacotherapy.
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Affiliation(s)
- Xiaoyan Jiang
- Department of Endocrinology and Metabolism, Diabetic Foot Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Anxin Li
- Department of Endocrinology and Metabolism, Diabetic Foot Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Wei Hao
- Department of Endocrinology and Metabolism, Diabetic Foot Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Cheng Yang
- Department of Endocrinology and Metabolism, Diabetic Foot Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Hongyan Wang
- Department of Endocrinology and Metabolism, Diabetic Foot Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Wuquan Deng
- Department of Endocrinology and Metabolism, Diabetic Foot Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
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Jaberifard F, Almajidi YQ, Arsalani N, Ghorbani M. A self-healing crosslinked-xanthan gum/soy protein based film containing halloysite nanotube and propolis with antibacterial and antioxidant activity for wound healing. Int J Pharm 2024; 656:124073. [PMID: 38569977 DOI: 10.1016/j.ijpharm.2024.124073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/30/2024] [Accepted: 03/30/2024] [Indexed: 04/05/2024]
Abstract
Traumatic multidrug-resistant bacterial infections are the most threat to wound healing. Lower extremity wounds under diabetic conditions display a significant delay during the healing process. To overcome these challenges, the utilization of protein-based nanocomposite dressings is crucial in implementing a successful regenerative medicine approach. These dressings hold significant potential as polymer scaffolds, allowing them to mimic the properties of the extracellular matrix (ECM). So, the objective of this study was to develop a nanocomposite film using dialdehyde-xanthan gum/soy protein isolate incorporated with propolis (PP) and halloysite nanotubes (HNTs) (DXG-SPI/PP/HNTs). In this protein-polysaccharide hybrid system, the self-healing capability was demonstrated through Schiff bonds, providing a favorable environment for cell encapsulation in the field of tissue engineering. To improve the properties of the DXG-SPI film, the incorporation of polyphenols found in PP, particularly flavonoids, is proposed. The synthesized films were subjected to investigations regarding degradation, degree of swelling, and mechanical characteristics. Additionally, halloysite nanotubes (HNTs) were introduced into the DXG-SPI/PP nanocomposite films as a reinforcing filler with varying concentrations of 3 %, 5 %, and 7 % by weight. The scanning electron microscope (SEM) analysis confirmed the proper embedding and dispersion of HNTs onto the DXG-SPI/PP nanocomposite films, leading to functional interfacial interactions. The structure and crystallinity of the synthesized nanocomposite films were characterized using Fourier Transform Infrared Spectrometry (FTIR) and X-ray diffraction (XRD), respectively. Moreover, the developed DXG-SPI/PP/HNTs nanocomposite films significantly improved cell growth of NIH-3T3 fibroblast cells in the presence of PP and HNTs, indicating their cytocompatibility. The antibacterial activity of the nanocomposite was evaluated against Escherichia coli (E. Coli) and Staphylococcus aureus (S. Aureus), which are commonly associated with wound infections. Overall, our findings suggest that the synthesis of DXG-SPI/PP/HNTs nanocomposite scaffolds holds great promise as a clinically relevant biomaterial and exhibits strong potential for numerous challenging biomedical applications.
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Affiliation(s)
- Farnaz Jaberifard
- Polymer Research Laboratory, Department of Organic and Biochemistry, Faculty of Chemistry, University of Tabriz, Tabriz, Iran; Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yasir Q Almajidi
- Baghdad College of Medical Sciences-Department of Pharmacy, Baghdad, Iraq
| | - Nasser Arsalani
- Polymer Research Laboratory, Department of Organic and Biochemistry, Faculty of Chemistry, University of Tabriz, Tabriz, Iran.
| | - Marjan Ghorbani
- Iran Polymer and Petrochemical Institute, PO Box:14965/115, Tehran, Iran; Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Bajuri MY, Nordin A. Activated carbon cloth versus silver-based dressings in a population with diabetic foot ulcer: a randomised controlled trial. J Wound Care 2024; 33:298-303. [PMID: 38683771 DOI: 10.12968/jowc.2024.33.5.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Activated carbon cloth (ACC), known as Zorflex dressing, has emerged as an innovative approach in managing bacterial infection in diabetic foot ulcer (DFU) treatment. This pilot study was undertaken to determine the efficacy of Zorflex ACC dressing (Chemviron Carbon Cloth Division, UK) compared to standard silver-based dressing on DFUs. METHOD An open label, comparative, randomised controlled trial enrolling patients who attended the diabetic foot clinic was conducted between August 2022 and August 2023. The primary endpoint was a difference of 20% in wound area reduction with the ACC dressing compared to silver-based dressing within eight weeks. The secondary endpoints were proportion of complete healing, time to healing and adverse events. RESULTS The cohort comprised 40 patients. The mean wound reduction percentage at 8 weeks for patients in the ACC arm was 85.40±16.00% compared with 65.08±16.36% in the silver-based dressing arm. Complete healing was observed in six of 20 patients in the ACC arm compared to two of 20 in the silver-based dressing arm. CONCLUSION These data suggest that the ACC dressing promotes better ulcer healing in DFU patients than the silver-based dressing.
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Affiliation(s)
- Mohd Yazid Bajuri
- Department of Orthopaedics and Traumatology, Hospital Canselor Tunku Muhriz, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak 56000 Cheras, Malaysia
| | - Abid Nordin
- Department of Orthopaedics and Traumatology, Hospital Canselor Tunku Muhriz, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak 56000 Cheras, Malaysia
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Wu B, Pan W, Luo S, Luo X, Zhao Y, Xiu Q, Zhong M, Wang Z, Liao T, Li N, Liu C, Nie C, Yi G, Lin S, Zou M, Li B, Zheng L. Turmeric-Derived Nanoparticles Functionalized Aerogel Regulates Multicellular Networks to Promote Diabetic Wound Healing. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307630. [PMID: 38441389 PMCID: PMC11095230 DOI: 10.1002/advs.202307630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/27/2023] [Indexed: 05/16/2024]
Abstract
Regulation of excessive inflammation and impaired cell proliferation is crucial for healing diabetic wounds. Although plant-to-mammalian regulation offers effective approaches for chronic wound management, the development of a potent plant-based therapeutic presents challenges. This study aims to validate the efficacy of turmeric-derived nanoparticles (TDNPs) loaded with natural bioactive compounds. TDNPs can alleviate oxidative stress, promote fibroblast proliferation and migration, and reprogram macrophage polarization. Restoration of the fibroblast-macrophage communication network by TDNPs stimulates cellular regeneration, in turn enhancing diabetic wound healing. To address diabetic wound management, TDNPs are loaded in an ultralight-weight, high swelling ratio, breathable aerogel (AG) constructed with cellulose nanofibers and sodium alginate backbones to obtain TDNPs@AG (TAG). TAG features wound shape-customized accessibility, water-adaptable tissue adhesiveness, and capacity for sustained release of TDNPs, exhibiting outstanding performance in facilitating in vivo diabetic wound healing. This study highlights the potential of TDNPs in regenerative medicine and their applicability as a promising solution for wound healing in clinical settings.
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Affiliation(s)
- Bodeng Wu
- Department of Laboratory MedicineNanfang HospitalSouthern Medical UniversityGuangzhou510515China
| | - Weilun Pan
- Department of Laboratory MedicineNanfang HospitalSouthern Medical UniversityGuangzhou510515China
| | - Shihua Luo
- Center for Clinical Laboratory Diagnosis and ResearchAffiliated Hospital of Youjiang Medical University for NationalitiesBaise533000China
- Key Laboratory of Research on Clinical Molecular Diagnosis for High Incidence Diseases in Western Guangxi of Guangxi Higher Education InstitutionsAffiliated Hospital of Youjiang Medical University for NationalitiesBaise533000China
| | - Xiangrong Luo
- Department of Endocrinology and MetabolismNanfang HospitalSouthern Medical UniversityGuangzhou510515China
| | - Yitao Zhao
- Department of Joint Surgery and Sports MedicineThe Third Affiliated Hospital of Southern Medical UniversityGuangzhou510630China
| | - Qi Xiu
- Department of Laboratory MedicineNanfang HospitalSouthern Medical UniversityGuangzhou510515China
| | - Mingzhen Zhong
- Department of Laboratory MedicineNanfang HospitalSouthern Medical UniversityGuangzhou510515China
| | - Zhenxun Wang
- Department of Laboratory MedicineNanfang HospitalSouthern Medical UniversityGuangzhou510515China
| | - Tong Liao
- Department of Laboratory MedicineNanfang HospitalSouthern Medical UniversityGuangzhou510515China
| | - Ningcen Li
- Department of Laboratory MedicineNanfang HospitalSouthern Medical UniversityGuangzhou510515China
| | - Chunchen Liu
- Department of Laboratory MedicineNanfang HospitalSouthern Medical UniversityGuangzhou510515China
| | - Chengtao Nie
- Department of Laboratory MedicineNanfang HospitalSouthern Medical UniversityGuangzhou510515China
| | - Guanghui Yi
- Department of Laboratory MedicineNanfang HospitalSouthern Medical UniversityGuangzhou510515China
| | - Shan Lin
- Department of Laboratory MedicineNanfang HospitalSouthern Medical UniversityGuangzhou510515China
| | - MengChen Zou
- Department of Endocrinology and MetabolismNanfang HospitalSouthern Medical UniversityGuangzhou510515China
| | - Bo Li
- Department of Laboratory MedicineNanfang HospitalSouthern Medical UniversityGuangzhou510515China
| | - Lei Zheng
- Department of Laboratory MedicineNanfang HospitalSouthern Medical UniversityGuangzhou510515China
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Li Z, Qian C, Zheng X, Qi X, Bi J, Wang H, Cao J. Collagen/chitosan/genipin hydrogel loaded with phycocyanin nanoparticles and ND-336 for diabetic wound healing. Int J Biol Macromol 2024; 266:131220. [PMID: 38554920 DOI: 10.1016/j.ijbiomac.2024.131220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
Diabetic wound healing remains a healthcare challenge due to the overexpression of matrix metalloproteinase-9 (MMP-9) and the imbalance between angiogenic factors and vascular inhibitory factors. In this study, we developed a nanocomposite injectable collagen/chitosan hydrogel for the treatment of delayed diabetic wound healing, which can promote cell migration to the wound site (through the addition of phycocyanin) and reduce the expression of MMP-9 (through the use of ND-336) to improve the therapeutic effect of diabetic wound healing. Furthermore, different weight ratios of collagen and chitosan hydrogels were prepared to select the hydrogel with proper mechanical properties. In vitro experiments confirmed that all hydrogels have favorable biocompatibility and hemocompatibility. Notably, Gel 2, with a weight ratio of collagen and chitosan at 25:75, was found to have an excellent capability to facilitate cell migration and in vivo studies further proved that Gel 2 nanocomposite hydrogel had the best ability to improve diabetic wound healing by promoting cell migration and decreasing MMP-9 expression. The collagen/chitosan/genipin hydrogel loaded phycocyanin and ND-336 can be harnessed for non-toxic and efficient treatment of wound healing management of diabetes.
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Affiliation(s)
- Zhiye Li
- School of Pharmacy, Jiangsu University, Zhenjiang 212000, China
| | - Chenyao Qian
- School of Pharmacy, Jiangsu University, Zhenjiang 212000, China
| | - Xiaodan Zheng
- School of Pharmacy, Jiangsu University, Zhenjiang 212000, China
| | - Xueyong Qi
- School of Pharmacy, Jiangsu University, Zhenjiang 212000, China
| | - Jingyue Bi
- School of Pharmacy, Jiangsu University, Zhenjiang 212000, China
| | - Huan Wang
- School of Pharmacy, Jiangsu University, Zhenjiang 212000, China
| | - Jin Cao
- School of Pharmacy, Jiangsu University, Zhenjiang 212000, China.
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Hou Z, Wang T, Wang L, Wang J, Zhang Y, Zhou Q, Zhang Z, Li P, Huang W. Skin-adhesive and self-healing diagnostic wound dressings for diabetic wound healing recording and electrophysiological signal monitoring. MATERIALS HORIZONS 2024; 11:1997-2009. [PMID: 38362709 DOI: 10.1039/d3mh02064a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Performing efficient wound management is essential for infected diabetic wounds due to the complex pathology. Flexible electronics have been recognized as one of the promising solutions for wound management. Herein, a kind of skin-adhesive and self-healing flexible bioelectronic was developed, which could be employed as a diagnostic wound dressing to record diabetic wound healing and monitor electrophysiological signals of the patients. The flexible substrate of diagnostic wound dressings showed excellent tissue adhesive (to various substrates including biological samples), self-healing (fracture strength restores by 96%), and intrinsic antibacterial properties (antibacterial ratio >96% against multidrug-resistant bacteria). The diagnostic wound dressings could record the glucose level (1-30 mM), pH values (4-7), and body temperature (18.8-40.0 °C) around the infected diabetic wounds. Besides, the dressings could help optimize treatment strategies based on electrophysiological signals of patients monitored in real-time. This study contributes to developing flexible bioelectronics for the diagnosis and management of diabetic wounds.
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Affiliation(s)
- Zishuo Hou
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) & Xi'an Institute of Biomedical Materials and Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an, Shaanxi 710072, P. R. China.
- State Key Laboratory for Mechanical Behavior of Materials, Shaanxi International Research Center for Soft Matter, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, P. R. China
| | - Tengjiao Wang
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) & Xi'an Institute of Biomedical Materials and Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an, Shaanxi 710072, P. R. China.
- Chongqing Innovation Center, Northwestern Polytechnical University, Chongqing 401135, P. R. China
- School of Flexible Electronics, Henan Institute of Flexible Electronics (HIFE), Henan University, 379 Mingli Road, Zhengzhou 450046, P. R. China
| | - Lei Wang
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) & Xi'an Institute of Biomedical Materials and Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an, Shaanxi 710072, P. R. China.
| | - Junjie Wang
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) & Xi'an Institute of Biomedical Materials and Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an, Shaanxi 710072, P. R. China.
| | - Yong Zhang
- State Key Laboratory for Mechanical Behavior of Materials, Shaanxi International Research Center for Soft Matter, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, P. R. China
| | - Qian Zhou
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) & Xi'an Institute of Biomedical Materials and Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an, Shaanxi 710072, P. R. China.
| | - Zhengheng Zhang
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) & Xi'an Institute of Biomedical Materials and Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an, Shaanxi 710072, P. R. China.
| | - Peng Li
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) & Xi'an Institute of Biomedical Materials and Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an, Shaanxi 710072, P. R. China.
- School of Flexible Electronics, Henan Institute of Flexible Electronics (HIFE), Henan University, 379 Mingli Road, Zhengzhou 450046, P. R. China
| | - Wei Huang
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) & Xi'an Institute of Biomedical Materials and Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an, Shaanxi 710072, P. R. China.
- School of Flexible Electronics, Henan Institute of Flexible Electronics (HIFE), Henan University, 379 Mingli Road, Zhengzhou 450046, P. R. China
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Xu C, Hu L, Zeng J, Wu A, Deng S, Zhao Z, Geng K, Luo J, Wang L, Zhou X, Huang W, Long Y, Song J, Zheng S, Wu J, Chen Q. Gynura divaricata (L.) DC. promotes diabetic wound healing by activating Nrf2 signaling in diabetic rats. JOURNAL OF ETHNOPHARMACOLOGY 2024; 323:117638. [PMID: 38135237 DOI: 10.1016/j.jep.2023.117638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 12/24/2023]
Abstract
THE ETHNOPHARMACOLOGICAL SIGNIFICANCE Diabetic chronic foot ulcers pose a significant therapeutic challenge as a result of the oxidative stress caused by hyperglycemia. Which impairs angiogenesis and delays wound healing, potentially leading to amputation. Gynura divaricata (L.) DC. (GD), a traditional Chinese herbal medicine with hypoglycemic effects, has been proposed as a potential therapeutic agent for diabetic wound healing. However, the underlying mechanisms of its effects remain unclear. AIM OF THE STUDY In this study, we aimed to reveal the effect and potential mechanisms of GD on accelerating diabetic wound healing in vitro and in vivo. MATERIALS AND METHODS The effects of GD on cell proliferation, apoptosis, reactive oxygen species (ROS) production, migration, mitochondrial membrane potential (MMP), and potential molecular mechanisms were investigated in high glucose (HG) stimulated human umbilical vein endothelial cells (HUVECs) using CCK-8, flow cytometry assay, wound healing assay, immunofluorescence, DCFH-DA staining, JC-1 staining, and Western blot. Full-thickness skin defects were created in STZ-induced diabetic rats, and wound healing rate was tracked by photographing them every day. HE staining, immunohistochemistry, and Western blot were employed to investigate the effect and molecular mechanism of GD on wound healing in diabetic rats. RESULTS GD significantly improved HUVEC survival, decreased apoptosis, lowered ROS production, restored MMP, improved migration ability, and raised VEGF expression. The use of Nrf2-siRNA completely abrogated these effects. Topical application of GD promoted angiogenesis and granulation tissue growth, resulting in faster healing of diabetic wounds. The expression of VEGF, CD31, and VEGFR was elevated in the skin tissue of diabetic rats after GD treatment, which upregulated HO-1, NQO-1, and Bcl-2 expression while downregulating Bax expression via activation of the Nrf2 signaling pathway. CONCLUSION The findings of this study indicate that GD has the potential to serve as a viable alternative treatment for diabetic wounds. This potential arises from its ability to mitigate the negative effects of oxidative stress on angiogenesis, which is regulated by the Nrf2 signaling pathway. The results of our study offer valuable insights into the therapeutic efficacy of GD in the treatment of diabetic wounds, emphasizing the significance of directing interventions towards the Nrf2 signaling pathway to mitigate oxidative stress and facilitate the process of angiogenesis.
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Affiliation(s)
- Caimin Xu
- Department of Endocrinology and Metabolism, The Affiliated Hospital, Southwest Medical University, Luzhou, China; School of Nursing, Southwest Medical University, Luzhou, China; Metabolic Vascular Diseases Key Laboratory of Sichuan Province, Southwest Medical University
| | - Lixin Hu
- Department of Endocrinology and Metabolism, The Affiliated Hospital, Southwest Medical University, Luzhou, China; School of Nursing, Southwest Medical University, Luzhou, China
| | - Jing Zeng
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Anguo Wu
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Shilong Deng
- Department of Nursing, The Affiliated Hospital, Southwest Medical University, Luzhou, China; Wound Healing Basic Research and Clinical Application Key Laboratory, School of Nursing, Southwest Medical University, LuZhou, China
| | - Zijuan Zhao
- Department of Nursing, The Affiliated Hospital, Southwest Medical University, Luzhou, China; Wound Healing Basic Research and Clinical Application Key Laboratory, School of Nursing, Southwest Medical University, LuZhou, China
| | - Kang Geng
- Department of Endocrinology and Metabolism, The Affiliated Hospital, Southwest Medical University, Luzhou, China
| | - Jiesi Luo
- School of Basic Medicine Sciences, Southwest Medical University, Luzhou, China
| | - Long Wang
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Xiaogang Zhou
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Wei Huang
- Department of Endocrinology and Metabolism, The Affiliated Hospital, Southwest Medical University, Luzhou, China; Metabolic Vascular Diseases Key Laboratory of Sichuan Province, Southwest Medical University
| | - Yang Long
- Department of Endocrinology and Metabolism, The Affiliated Hospital, Southwest Medical University, Luzhou, China; Metabolic Vascular Diseases Key Laboratory of Sichuan Province, Southwest Medical University
| | - Jianying Song
- Department of Endocrinology and Metabolism, The Affiliated Hospital, Southwest Medical University, Luzhou, China; School of Nursing, Southwest Medical University, Luzhou, China
| | - Silin Zheng
- Department of Nursing, The Affiliated Hospital, Southwest Medical University, Luzhou, China
| | - Jianming Wu
- School of Basic Medicine Sciences, Southwest Medical University, Luzhou, China.
| | - Qi Chen
- Department of Endocrinology and Metabolism, The Affiliated Hospital, Southwest Medical University, Luzhou, China; School of Nursing, Southwest Medical University, Luzhou, China; Department of Nursing, The Affiliated Hospital, Southwest Medical University, Luzhou, China; Wound Healing Basic Research and Clinical Application Key Laboratory, School of Nursing, Southwest Medical University, LuZhou, China; Metabolic Vascular Diseases Key Laboratory of Sichuan Province, Southwest Medical University.
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Sun J, Lai YC, Lin YW, Fang CH, Sun JS. Enhancing cutaneous wound healing: A study on the beneficial effects of nano-gelatin scaffold in rat models. Int J Artif Organs 2024; 47:280-289. [PMID: 38624101 DOI: 10.1177/03913988241244661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
The challenges in achieving optimal outcomes for wound healing have persisted for decades, prompting ongoing exploration of interventions and management strategies. This study focuses on assessing the potential benefits of implementing a nano-gelatin scaffold for wound healing. Using a rat skin defect model, full-thickness incisional wounds were created on each side of the thoracic-lumbar regions after anesthesia. The wounds were left un-sutured, with one side covered by a gelatin nano-fibrous membrane and the other left uncovered. Wound size changes were measured on days 1, 4, 7, and 14, and on day 14, rats were sacrificed for tissue sample excision, examined with hematoxylin and eosin, and Masson's trichrome stain. Statistical comparisons were performed. The gelatin nanofibers exhibited a smooth surface with a fiber diameter of 260 ± 40 nm and porous structures with proper interconnectivity. Throughout the 14-day experimental period, significant differences in the percentage of wound closure were observed between the groups. Histological scores were higher in the experiment group, indicating less inflammation but dense and well-aligned collagen fiber formation. A preliminary clinical trial on diabetic ulcers also demonstrated promising results. This study highlights the potential of the nano-collagen fibrous membrane to reduce inflammatory infiltration and enhance fibroblast differentiation into myofibroblasts during the early stages of cutaneous wound healing. The nano-fibrous collagen membrane emerges as a promising candidate for promoting wound healing, with considerable potential for future therapeutic applications.
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Affiliation(s)
- Jason Sun
- Carmel Catholic High School, Mundelein, IL, USA
| | - Yi-Chung Lai
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Wen Lin
- Institute of Biomedical Engineering, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Hsiang Fang
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of Orthopedic Surgery, En Chu Kong Hospital, New Taipei City, Taiwan
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Li Y, Leng Y, Liu Y, Zhong J, Li J, Zhang S, Li Z, Yang K, Kong X, Lao W, Bi C, Zhai A. Advanced multifunctional hydrogels for diabetic foot ulcer healing: Active substances and biological functions. J Diabetes 2024; 16:e13537. [PMID: 38599855 PMCID: PMC11006623 DOI: 10.1111/1753-0407.13537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/26/2023] [Accepted: 01/18/2024] [Indexed: 04/12/2024] Open
Abstract
AIM Hydrogels with excellent biocompatibility and biodegradability can be used as the desirable dressings for the therapy of diabetic foot ulcer (DFU). This review aimed to summarize the biological functions of hydrogels, combining with the pathogenesis of DFU. METHODS The studies in the last 10 years were searched and summarized from the online database PubMed using a combination of keywords such as hydrogel and diabetes. The biological functions of hydrogels and their healing mechanism on DFU were elaborated. RESULTS In this review, hydrogels were classified by their active substances such as drugs, cytokines, photosensitizers, and biomimetic peptide. Based on this, the biological functions of hydrogels were summarized by associating the pathogenesis of DFU, including oxidative stress, chronic inflammation, cell phenotype change, vasculopathy, and infection. This review also pointed out some of the shortcomings of hydrogels in present researches. CONCLUSIONS Hydrogels were classified into carrier hydrogels and self-functioning hydrogels in this review. Besides, the functions and components of existing hydrogels were clarified to provide assistance for future researches and clinical applications.
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Affiliation(s)
- Yuetong Li
- Department of Endocrinology, The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Yuxin Leng
- Department of Critical Care MedicinePeking University Third HospitalBeijingChina
| | - Yang Liu
- Department of Laboratory Medicine, The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Jianhua Zhong
- Department of Endocrinology, The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Jiaxin Li
- Department of Endocrinology, The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Shitong Zhang
- Department of General Practice, The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Zhenlin Li
- Department of Endocrinology, The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Kaming Yang
- Department of Endocrinology, The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Xinyi Kong
- Department of Laboratory Medicine, The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Wanwen Lao
- Department of Endocrinology, The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Changlong Bi
- Department of Endocrinology, The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Aixia Zhai
- Department of Laboratory Medicine, The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
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Xu Y, Geng R, Meng X, Feng Z, Wang X, Zhang G, Bai L. The impact of inflammatory biomarkers on amputation rates in patients with diabetic foot ulcers. Int Wound J 2024; 21:e14827. [PMID: 38522433 PMCID: PMC10961172 DOI: 10.1111/iwj.14827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Diabetic Foot Ulcers (DFUs) are a major complication of diabetes, often leading to amputation. Understanding the relationship between haematological inflammatory markers and the incidence of amputation in DFU patients with infectious complications is crucial for improving management and outcomes. This retrospective study, conducted from May 2020 to October 2022, involved 109 patients with DFUs, categorised into amputation (AM) and non-amputation (NAM) groups. Patients were evaluated for various factors, including demographic data, DFU duration, and blood parameters such as haemoglobin A1c (HbA1c), haemoglobin (Hb), albumin (ALB), white blood cell count (WBC), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), C-reactive protein (CRP), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). Statistical analyses were performed using independent sample t-tests, Mann-Whitney U test and logistic regression. The univariate analysis showed no significant difference in BMI, DM duration or DFU duration between groups. However, significant differences were noted in PCT, Hb, ESR, ALB, HbA1c and WBC levels, and in inflammatory ratios (NLR, PLR and LMR). Multivariate logistic regression identified CRP, NLR and PLR as independent risk factors for amputation. The study highlights CRP, PLR and NLR as key independent risk factors for amputation in patients with DFUs. These easily obtainable markers from routine blood tests can effectively aid in predicting the risk of osteomyelitis and amputation, enhancing clinical decision making and patient care strategies.
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Affiliation(s)
- Yun Xu
- Ward 1, The Department of EndocrinologyThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiChina
| | - Ruina Geng
- Ward 1, The Department of EndocrinologyThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiChina
| | - Xiangyu Meng
- Ward 1, The Department of EndocrinologyThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiChina
| | - Zhipeng Feng
- The Department of General MedicineThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiChina
| | - Xu Wang
- Ward 1, The Department of EndocrinologyThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiChina
| | - Guanying Zhang
- Ward 2, The Department of UrologyThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiChina
| | - Liwei Bai
- Ward 1, The Department of EndocrinologyThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiChina
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Zhang L, Lin Y, Huang X, Zhai Z, Wei R, Mo J, Li J, Lu W. Metabolic dysfunction-associated fatty liver disease in the elderly with diabetic foot ulcers: A longitudinal cohort study. Int Wound J 2024; 21:e14586. [PMID: 38102851 PMCID: PMC10961876 DOI: 10.1111/iwj.14586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
This study aimed to explore the association between metabolic-associated fatty liver disease (MAFLD) and ulcer recurrence risk in patients with diabetic foot ulcers (DFUs) through an ambispective longitudinal cohort. From December 2013 to December 2022, a total of 482 inpatients with DFUs (PEDIS grade 3 and above with a severe infection) were eligible for inclusion in this study. This was an ambispective longitudinal cohort study. All participants were followed up every 6 months for 9 years with a median of 36 months. According to whether having MAFLD or not, all subjects were placed into two groups: non-MAFLD (n = 351) and MAFLD (n = 131). The association between MAFLD and ulcer recurrence in patients with DFUs was then evaluated through multivariate Cox regression analysis, stratified analyses and Kaplan-Meier survival analysis. Throughout the follow-up period, out of 482 subjects with DFUs, 68 had ulcer recurrence (14.1%). Three Cox regression models were established for data analyses. In the model I (unadjusted), MAFLD was significantly associated with the ulcer recurrence rate in patients with DFUs (HR = 1.79; 95% CI = 1.097-2.92; p = 0.02). Model II (adjusted model I with gender and age) (HR = 1.781; 95% CI = 1.09-2.912; p = 0.021) and model III (adjusted model II with CVD, duration of diabetes and Cr.) (HR = 1.743; 95% CI = 1.065-2.855; p = 0.027) also showed that MAFLD was significantly related to the ulcer recurrence risk in patients with DFUs, respectively. Stratified analysis indicated that subjects aged ≥60 had a greater risk of ulcer recurrence in MAFLD than in non-MAFLD (HR = 2.31; 95% CI = 1.268-4.206; p = 0.006). Kaplan-Meier survival curve analysis showed that ulcer recurrence rate had a significant association with MAFLD (log-rank, p = 0.018). This study indicated a close association between ulcer recurrence risk and MAFLD in patients with DFUs, especially in the elderly (aged ≥60). Therefore, special attention should be paid to the elderly with both DFUs and MAFLD because they have a higher ulcer recurrence rate than other general populations in routine clinical practice.
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Affiliation(s)
- Liya Zhang
- Department of EndocrinologyShanxi Yingkang Healthcare General HospitalYunchengPeople's Republic of China
| | - Yuanmei Lin
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical SciencesPeople's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Xiuxian Huang
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical SciencesPeople's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Zhenwei Zhai
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical SciencesPeople's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Rongyan Wei
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical SciencesPeople's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Jiacheng Mo
- Information Network Center of Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Junjun Li
- Dean's Office of Guangxi Academy of Medical SciencesPeople's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Wensheng Lu
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical SciencesPeople's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
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Sang P, Zhao J, Yang H. The efficacy of electroacupuncture in among early diabetic patients with lower limb arteriosclerotic wounds. Int Wound J 2024; 21:e14526. [PMID: 38093499 PMCID: PMC10961040 DOI: 10.1111/iwj.14526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 03/25/2024] Open
Abstract
Diabetic foot ulcers are the prevalent complication of diabetes mellitus, frequently culminating in arteriosclerosis of the lower extremities and consequent development of chronic wounds. The effectiveness of electroacupuncture (EA) as therapeutic intervention for promoting wound healing in this particular group of patients has been comprehensively assessed in this study. A randomized controlled trial involving 380 early diabetic patients with arteriosclerotic lesions of the lower limbs was conducted. Standard wound care plus EA was administered to the treatment group, while standard wound care alone was administered to the control group. The principal outcome assessed was the reduction in lesion size following the 8-week treatment period. Pain scores, recuperation time, and quality of life (QoL) evaluations constituted secondary outcomes. In comparison to the control group, the treatment group exhibited a significantly greater reduction in wound size (p < 0.05). The treatment group exhibited significantly reduced pain scores and significantly higher QoL scores (p < 0.05). The duration of recovery did not vary substantially among the groups (p > 0.05). Electroacupuncture thus appeared to be an effective adjunctive treatment for early diabetic patients with lower limb arteriosclerotic lesions, promoting pain relief and quality of life. Additional investigation is necessary to validate these results and delve into the underlying mechanisms of action.
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Affiliation(s)
- Peng Sang
- Department of AcupunctureHeilongjiang Academy of Chinese Medicine SciencesHarbinHeilongjiangChina
| | - Jiahui Zhao
- Department of AcupunctureHeilongjiang Academy of Chinese Medicine SciencesHarbinHeilongjiangChina
| | - Hui Yang
- Department of AcupunctureHeilongjiang Academy of Chinese Medicine SciencesHarbinHeilongjiangChina
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Zhang N, Liu Y, Yan W, Liu F. The effect of negative pressure wound therapy on the outcome of diabetic foot ulcers: A meta-analysis. Int Wound J 2024; 21:e14886. [PMID: 38651532 PMCID: PMC11036310 DOI: 10.1111/iwj.14886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
Negative pressure injury is one of the auxiliary methods of treating diabetes foot ulcers. It has been shown to be superior to conventional techniques in randomized controlled trials (RCTs). Nevertheless, the results of observational research are still scarce. A systematic review of RCTs and observations was carried out to evaluate the effectiveness and security of negative pressure wound therapy (NPWT) treatment for diabetes foot ulcers. Three English e-databases have been found for NPWT research. The meta-analyses of the comparative studies provided point estimates of results. Intermediate results were given as median and binary values were given in the form of odds ratios (OR). Seventeen trials, 13 RCTs and four randomized, controlled trials were found in the survey. Of these, 831 were treated with NPWT, 834 were treated with standard therapy. A total of 14 studies have been conducted to investigate the influence of NPWT on the healing of diabetic foot ulcers(DFU). In the study, NPWT was shown to speed up the healing of the wound in DFU patients(OR, 2.57; 95% CI, 1.72, 3.85 p < 0.0001). A subgroup analysis showed that NPWT was associated with an acceleration of the wound healing rate in 10 RCT trials (OR, 2.48; 95% CI, 1.58, 3.89 p < 0.001). In the four nRCT trials, NPWT was also shown to speed up the healing of the wound(OR, 2.95; 95% CI, 1.03, 8.42 p = 0.04). In 11 studies, the influence of NPWT on amputations of diabetes mellitus (DM) foot ulcers was investigated. The results showed that NPWT was associated with a reduction in amputations (OR, 0.53; 95% CI, 0.37, 0.74 p = 0.0002).In a subgroup of RCT trials, nine RCT trials showed a reduction in amputations(OR, 0.61; 95% CI, 0.43, 0.87 p = 0.007). In both nRCT trials, NPWT also showed a reduction in amputations (OR, 0.03; 95% CI, 0.00, 0.24 p = 0.001). Generally speaking, NPWT can help to heal the wound and lower the risk of amputations in people with diabetes. The subgroup analysis showed similar results for the RCT and non-RCT trials. NPWT can be used to treat diabetes foot ulcers caused by diabetes.
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Affiliation(s)
- Ning Zhang
- Department of Emergency Hand and Foot Microsurgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yibin Liu
- Department of Emergency Hand and Foot Microsurgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Weiqi Yan
- Department of Emergency Hand and Foot Microsurgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Fei Liu
- Department of Emergency Hand and Foot Microsurgery, General Hospital of Ningxia Medical University, Yinchuan, China
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Hetta HF, Elsaghir A, Sijercic VC, Akhtar MS, Gad SA, Moses A, Zeleke MS, Alanazi FE, Ahmed AK, Ramadan YN. Mesenchymal stem cell therapy in diabetic foot ulcer: An updated comprehensive review. Health Sci Rep 2024; 7:e2036. [PMID: 38650719 PMCID: PMC11033295 DOI: 10.1002/hsr2.2036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/06/2024] [Accepted: 03/19/2024] [Indexed: 04/25/2024] Open
Abstract
Background Diabetes has evolved into a worldwide public health issue. One of the most serious complications of diabetes is diabetic foot ulcer (DFU), which frequently creates a significant financial strain on patients and lowers their quality of life. Up until now, there has been no curative therapy for DFU, only symptomatic relief or an interruption in the disease's progression. Recent studies have focused attention on mesenchymal stem cells (MSCs), which provide innovative and potential treatment candidates for several illnesses as they can differentiate into various cell types. They are mostly extracted from the placenta, adipose tissue, umbilical cord (UC), and bone marrow (BM). Regardless of their origin, they show comparable features and small deviations. Our goal is to investigate MSCs' therapeutic effects, application obstacles, and patient benefit strategies for DFU therapy. Methodology A comprehensive search was conducted using specific keywords relating to DFU, MSCs, and connected topics in the databases of Medline, Scopus, Web of Science, and PubMed. The main focus of the selection criteria was on English-language literature that explored the relationship between DFU, MSCs, and related factors. Results and Discussion Numerous studies are being conducted and have demonstrated that MSCs can induce re-epithelialization and angiogenesis, decrease inflammation, contribute to immunological modulation, and subsequently promote DFU healing, making them a promising approach to treating DFU. This review article provides a general snapshot of DFU (including clinical presentation, risk factors and etiopathogenesis, and conventional treatment) and discusses the clinical progress of MSCs in the management of DFU, taking into consideration the side effects and challenges during the application of MSCs and how to overcome these challenges to achieve maximum benefits. Conclusion The incorporation of MSCs in the management of DFU highlights their potential as a feasible therapeutic strategy. Establishing a comprehensive understanding of the complex relationship between DFU pathophysiology, MSC therapies, and related obstacles is essential for optimizing therapy outcomes and maximizing patient benefits.
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Affiliation(s)
- Helal F. Hetta
- Division of Microbiology, Immunology and Biotechnology, Department of Natural Products and Alternative MedicineFaculty of Pharmacy, University of TabukTabukSaudi Arabia
- Department of Medical Microbiology and ImmunologyFaculty of Medicine, Assiut UniversityAssiutEgypt
| | - Alaa Elsaghir
- Department of Microbiology and ImmunologyFaculty of Pharmacy, Assiut UniversityAssiutEgypt
| | | | | | - Sayed A. Gad
- Faculty of Medicine, Assiut UniversityAssiutEgypt
| | | | - Mahlet S. Zeleke
- Menelik II Medical and Health Science College, Kotebe Metropolitan UniversityAddis AbabaEthiopia
| | - Fawaz E. Alanazi
- Department of Pharmacology and ToxicologyFaculty of Pharmacy, University of TabukTabukSaudi Arabia
| | | | - Yasmin N. Ramadan
- Department of Microbiology and ImmunologyFaculty of Pharmacy, Assiut UniversityAssiutEgypt
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He J, Zhou S, Wang J, Sun B, Ni D, Wu J, Peng X. Anti-inflammatory and anti-oxidative electrospun nanofiber membrane promotes diabetic wound healing via macrophage modulation. J Nanobiotechnology 2024; 22:116. [PMID: 38493156 PMCID: PMC10943854 DOI: 10.1186/s12951-024-02385-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND In the inflammatory milieu of diabetic chronic wounds, macrophages undergo substantial metabolic reprogramming and play a pivotal role in orchestrating immune responses. Itaconic acid, primarily synthesized by inflammatory macrophages as a byproduct in the tricarboxylic acid cycle, has recently gained increasing attention as an immunomodulator. This study aims to assess the immunomodulatory capacity of an itaconic acid derivative, 4-Octyl itaconate (OI), which was covalently conjugated to electrospun nanofibers and investigated through in vitro studies and a full-thickness wound model of diabetic mice. RESULTS OI was feasibly conjugated onto chitosan (CS), which was then grafted to electrospun polycaprolactone/gelatin (PG) nanofibers to obtain P/G-CS-OI membranes. The P/G-CS-OI membrane exhibited good mechanical strength, compliance, and biocompatibility. In addition, the sustained OI release endowed the nanofiber membrane with great antioxidative and anti-inflammatory activities as revealed in in vitro and in vivo studies. Specifically, the P/G-CS-OI membrane activated nuclear factor-erythroid-2-related factor 2 (NRF2) by alkylating Kelch-like ECH-associated protein 1 (KEAP1). This antioxidative response modulates macrophage polarization, leading to mitigated inflammatory responses, enhanced angiogenesis, and recovered re-epithelization, finally contributing to improved healing of mouse diabetic wounds. CONCLUSIONS The P/G-CS-OI nanofiber membrane shows good capacity in macrophage modulation and might be promising for diabetic chronic wound treatment.
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Affiliation(s)
- Jibing He
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China
| | - Shasha Zhou
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, P. R. China
| | - Jiaxing Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China
| | - Binbin Sun
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, P. R. China
| | - Dalong Ni
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China.
| | - Jinglei Wu
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, P. R. China.
| | - Xiaochun Peng
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China.
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Du G, Chen J, Zhu X, Zhu Z. Bioinformatics analysis identifies TGF-β signaling pathway-associated molecular subtypes and gene signature in diabetic foot. iScience 2024; 27:109094. [PMID: 38439964 PMCID: PMC10910239 DOI: 10.1016/j.isci.2024.109094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/08/2023] [Accepted: 01/30/2024] [Indexed: 03/06/2024] Open
Abstract
The role of transforming growth factor β (TGF-β) in inflammation and immune response is established, but the mechanism of TGF-β signaling pathway-related genes (TRGs) in diabetic foot ulcer (DFU) is not fully understood. We aimed to investigate the contribution of TRGs in the identification, molecular categorization, and immune infiltration of DFU through bioinformatics analysis. TGF-β signaling pathway is activated in DFU. 33 TRGs were upregulated. Regression analysis revealed TGFBR1 and TGFB1 as significant differential expression core genes, validated by quantitative real-time PCR. The diagnostic model with core genes had high clinical validity (AUC = 0.909). Core gene expression was associated with immune cell infiltration. A total of 5672 genes showed differential expression in TGF-related patterns, with differences in biological functions and immune infiltration. TGF-β signaling pathway may be critical in DFU development.
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Affiliation(s)
- Guanggang Du
- Department of Burn and Wound Repair, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu 610072, China
| | - Jie Chen
- Department of Burn and Wound Repair, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu 610072, China
| | - Xuezhu Zhu
- Department of Burn and Wound Repair, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu 610072, China
| | - Zongdong Zhu
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu 610072, China
- Department of Orthopaedics, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
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Zheng Y, Yang D, Gao B, Huang S, Tang Y, Wa Q, Dong Y, Yu S, Huang J, Huang S. A DNA-inspired injectable adhesive hydrogel with dual nitric oxide donors to promote angiogenesis for enhanced wound healing. Acta Biomater 2024; 176:128-143. [PMID: 38278340 DOI: 10.1016/j.actbio.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024]
Abstract
Chronic diabetic wounds are a severe complication of diabetes, often leading to high treatment costs and high amputation rates. Numerous studies have revealed that nitric oxide (NO) therapy is a promising option because it favours wound revascularization. Here, base-paired injectable adhesive hydrogels (CAT) were prepared using adenine- and thymine-modified chitosan (CSA and CST). By further introducing S-nitrosoglutathione (GSNO) and binary l-arginine (bArg), we obtained a NO sustained-release hydrogel (CAT/bArg/GSON) that was more suitable for the treatment of chronic wounds. The results showed that the expression of HIF-1α and VEGF was upregulated in the CAT/bArg/GSON group, and improved blood vessel regeneration was observed, indicating an important role of NO. In addition, the research findings revealed that following treatment with the CAT/bArg/GSON hydrogel, the viability of Staphylococcus aureus and Escherichia coli decreased to 14 ± 2 % and 6 ± 1 %, respectively. Moreover, the wound microenvironment was improved, as evidenced by a 60 ± 1 % clearance of DPPH. In particular, histological examination and immunohistochemical staining results showed that wounds treated with CAT/bArg/GSNO exhibited denser neovascularization, faster epithelial tissue regeneration, and thicker collagen deposition. Overall, this study proposes an effective strategy to prepare injectable hydrogel dressings with dual NO donors. The functionality of CAT/bArg/GSON has been thoroughly demonstrated in research on chronic wound vascular regeneration, indicating that CAT/bArg/GSON could be a potential option for promoting chronic wound healing. STATEMENT OF SIGNIFICANCE: This article prepares a chitosan hydrogel utilizing the principle of complementary base pairing, which offers several advantages, including good adhesion, biocompatibility, and flow properties, making it a good material for wound dressings. Loaded GSNO and bArg can steadily release NO and l-arginine through the degradation of the gel. Then, the released l-arginine not only possesses antioxidant properties but can also continue to generate a small amount of NO under the action of NOS. This design achieves a sustained and stable supply of NO at the wound site, maximizing the angiogenesis-promoting and antibacterial effects of NO. More neovascularization and abundant collagen were observed in the regenerated tissues. This study provides an effective repair hydrogel material for diabetic wound.
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Affiliation(s)
- Yongsheng Zheng
- Department of Orthopedics, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, China
| | - Dong Yang
- Department of Orthopedics, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, China
| | - Botao Gao
- Institute of Biological and Medical Engineering, Guangdong Academy of Sciences, Guangzhou 510632, China
| | - Shuai Huang
- Department of Orthopedics, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
| | - Yubo Tang
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Qingde Wa
- Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Yong Dong
- Department of Oncology, The First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan, 523106, China
| | - Shan Yu
- Institute of Biological and Medical Engineering, Guangdong Academy of Sciences, Guangzhou 510632, China
| | - Jun Huang
- Institute of Biological and Medical Engineering, Guangdong Academy of Sciences, Guangzhou 510632, China.
| | - Sheng Huang
- Department of Orthopedics, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, China.
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Rezaei S, Imani R. Highly Absorbent Egg White/Carbomer-940 Hydrofilm as a Potential Diabetic Wound Dressing. Macromol Biosci 2024; 24:e2300353. [PMID: 37939368 DOI: 10.1002/mabi.202300353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/20/2023] [Indexed: 11/10/2023]
Abstract
Diabetic foot ulcer (DFU) is the most critical problem in diabetic patients. Managing exudate in this kind of wound presents significant challenges in clinics. Advanced wound dressings serve as the most effective approach to managing DFU. Herein, a highly absorbent hydrofilm is presented through a combination of egg white (EW) and Carbomer-940, benefiting from the bioactivity of the EW component and superabsorption capacity of Carbomer-940. The crystallinity of samples rises due to the presence of Carbomer-940. Regarding the high water absorption capacity of Carbomer-940, the swelling ratio and water-holding capacity of samples are also improved via its incorporation of up to 1005%. In contrast, the transmission of water vapor and in vitro degradation rate decreases as Carbomer-940 powers the crystallinity of hydrofilms. Carbomer-940 incorporation in the EW structure accelerates protein release during the time, while this acceleration is partially compensated by the crystallization effect. The cell viability assay demonstrates no toxicity as well as high human foreskin fibroblast cell proliferation for the hybrid hydrofilm sample, where the cell migration is positively affected in the presence of the bioactive components extracted from the dressing. Taken together, the optimized hybrid hydrofilm could be suggested as a promising wound dressing for managing DFUs.
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Affiliation(s)
- Soheila Rezaei
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, 1591634311, Iran
| | - Rana Imani
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, 1591634311, Iran
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Su N, Wang J, Zhang H, Jin H, Miao B, Zhao J, Liu X, Li C, Wang X, Yang N. Identification and clinical validation of the role of anoikis-related genes in diabetic foot. Int Wound J 2024; 21:e14771. [PMID: 38468369 PMCID: PMC10928261 DOI: 10.1111/iwj.14771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/28/2024] [Indexed: 03/13/2024] Open
Abstract
This study aims to investigate the role of anoikis-related genes in diabetic foot (DF) by utilizing bioinformatics analysis to identify key genes associated with anoikis in DF. We selected the GEO datasets GSE7014, GSE80178 and GSE68183 for the extraction and analysis of differentially expressed anoikis-related genes (DE-ARGs). GO analysis and KEGG analysis indicated that DE-ARGs in DF were primarily enriched in apoptosis, positive regulation of MAPK cascade, anoikis, focal adhesion and the PI3K-Akt signalling pathway. Based on the LASSO and SVM-RFE algorithms, we identified six characteristic genes. ROC curve analysis revealed that these six characteristic genes had an area under the curve (AUC) greater than 0.7, indicating good diagnostic efficacy. Expression analysis in the validation set revealed downregulation of CALR in DF, consistent with the training set results. GSEA results demonstrated that CALR was mainly enriched in blood vessel morphogenesis, endothelial cell migration, ECM-receptor interaction and focal adhesion. The HPA database revealed that CALR was moderately enriched in endothelial cells, and CALR was found to interact with 63 protein-coding genes. Functional analysis with DAVID suggested that CALR and associated genes were enriched in the phagosome component. CALR shows promise as a potential marker for the development and treatment of DF.
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Affiliation(s)
- Nan Su
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanChina
- School of Medicine, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Jiwei Wang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanChina
- School of Medicine, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Hengrui Zhang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanChina
- School of Medicine, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Haoyong Jin
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanChina
- School of Medicine, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Baojian Miao
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanChina
- School of Medicine, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Jiangli Zhao
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanChina
- School of Medicine, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Xuchen Liu
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanChina
- School of Medicine, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Chao Li
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanChina
- School of Medicine, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Xinyu Wang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanChina
- School of Medicine, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Ning Yang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanChina
- School of Medicine, Cheeloo College of MedicineShandong UniversityJinanChina
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Primous NR, Elvin PT, Carter KV, Andrade HL, La Fontaine J, Shibuya N, Biguetti CC. Bioengineered Skin for Diabetic Foot Ulcers: A Scoping Review. J Clin Med 2024; 13:1221. [PMID: 38592047 PMCID: PMC10932123 DOI: 10.3390/jcm13051221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 04/10/2024] Open
Abstract
Diabetic foot ulcers (DFUs) pose a significant threat to individuals with diabetes mellitus (DM), such as lower limb amputation and severe morbidity. Bioengineered skin substitutes (BSS) are alternatives to traditional interventions for treating DFUs, but their efficacy compared to standard wound care (SWC) or other treatment types, such as allografts, remains unknown. A scoping review of human studies was conducted to identify current approaches in the treatment of DFUs using BSS as compared with other treatment options. Systematic searches in PubMed, Cochrane Library, and Web of Science were conducted to identify comparative studies that enrolled 10 or more patients and evaluated wound healing outcomes (closure, time-to-healing, and area reduction). Database searches isolated articles published from 1 December 2012 to 1 December 2022 and were conducted in accordance with PRISMA-ScR guidelines. The literature search yielded 1312 articles, 24 of which were included for the qualitative analysis. Findings in these studies demonstrated that BSS outperformed SWC in all measured outcomes, suggesting that BSS may be a superior treatment for DFUs. Of the 24 articles, 8 articles compared human amniotic membrane allografts (hAMA) to BSS. Conflicting evidence was observed when comparing BSS and hAMA treatments, highlighting the need for future research.
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Affiliation(s)
- Nathaniel R. Primous
- Department of Podiatric Medicine, Surgery and Biomechanics, School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA; (N.R.P.); (P.T.E.); (H.L.A.); (J.L.F.); (N.S.)
| | - Peter T. Elvin
- Department of Podiatric Medicine, Surgery and Biomechanics, School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA; (N.R.P.); (P.T.E.); (H.L.A.); (J.L.F.); (N.S.)
- Department of Biomedical Engineering, University of Texas at Dallas, Dallas, TX 75080, USA
| | - Kathleen V. Carter
- Library, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA;
| | - Hagner L. Andrade
- Department of Podiatric Medicine, Surgery and Biomechanics, School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA; (N.R.P.); (P.T.E.); (H.L.A.); (J.L.F.); (N.S.)
| | - Javier La Fontaine
- Department of Podiatric Medicine, Surgery and Biomechanics, School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA; (N.R.P.); (P.T.E.); (H.L.A.); (J.L.F.); (N.S.)
| | - Naohiro Shibuya
- Department of Podiatric Medicine, Surgery and Biomechanics, School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA; (N.R.P.); (P.T.E.); (H.L.A.); (J.L.F.); (N.S.)
| | - Claudia C. Biguetti
- Department of Podiatric Medicine, Surgery and Biomechanics, School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA; (N.R.P.); (P.T.E.); (H.L.A.); (J.L.F.); (N.S.)
- Department of Biomedical Engineering, University of Texas at Dallas, Dallas, TX 75080, USA
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Sui L, Xie Q, Jiang HT, Li XD. Effectiveness and safety of dermal matrix used for diabetic foot ulcer: a systematic review and meta-analysis of randomized controlled trials. BMC Endocr Disord 2024; 24:23. [PMID: 38374102 PMCID: PMC10877811 DOI: 10.1186/s12902-024-01550-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFUs) have become a global health concern, which can lead to diabetic foot infection (DFI), lower leg amputation, and even mortality. Though the standard of care (SOC) practices have been recognized as the "gold standard" for DFU care, SOC alone may not be adequate to heal all DFUs and prevent their recurrence. The use of dermal matrix has emerged as an adjuvant treatment to enhance DFU healing. The current study aimed to evaluate the effectiveness and safety of dermal matrix application as an adjuvant treatment to the SOC. METHODS The databases of PubMed, Embase and CENTRAL were independently searched by two authors, with the following key terms: "diabetic foot ulcer", "acellular dermal matrix", "wound healing", and so on. Randomized controlled trials (RCTs) evaluated the efficacy and safety of dermal matrix in the treatment of DFUs were eligible for inclusion. The primary outcomes analyzed included time to complete healing and complete healing rate at the final follow-up, while secondary outcomes included wound area, ulcer recurrence rate, amputation risk and complication risk. Meta-analyses were performed using random-effect or fixed-effect models, based on the heterogeneity test. RESULTS This study included a total of 15 RCTs with a total of 1524 subjects. Of these, 689 patients were treated with SOC alone, while 835 patients received SOC plus dermal matrix. Compared to the SOC group, significantly shorter time (MD = 2.84, 95%CI: 1.37 ~ 4.32, p < 0.001***) was required to achieve complete healing in dermal matrix group. Significantly higher complete healing rate (OR = 0.40, 95%CI: 0.33 ~ 0.49, p < 0.001***) and lower overall (RR = 1.83, 95%CI: 1.15 ~ 2.93, p = 0.011*) and major (RR = 2.64, 95%CI: 1.30 ~ 5.36, p = 0.007**) amputation risks were achieved in dermal matrix group compared to SOC group. No significant difference was found in the wound area, ulcer recurrence rate, and complication risk between the two groups. CONCLUSIONS The application of dermal matrix as an adjuvant therapy in conjunction with SOC effectively improved the healing process of DFUs and reduced the amputation risk when compared to SOC alone. Furthermore, dermal matrix application was well tolerated by the subjects with no added complication risk.
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Affiliation(s)
- Lei Sui
- Department of Hand Foot Surgery, Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi Street, Shuangqiao District, Chengde City, 067000, Hebei Province, China
| | - Qiang Xie
- Department of Hand Foot Surgery, Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi Street, Shuangqiao District, Chengde City, 067000, Hebei Province, China
| | - Hong-Tao Jiang
- Department of Hand Foot Surgery, Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi Street, Shuangqiao District, Chengde City, 067000, Hebei Province, China
| | - Xiao-Dong Li
- Department of Hand Foot Surgery, Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi Street, Shuangqiao District, Chengde City, 067000, Hebei Province, China.
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Wolny D, Štěpánek L, Horáková D, Thomas J, Zapletalová J, Patel MS. Risk Factors for Non-Healing Wounds-A Single-Centre Study. J Clin Med 2024; 13:1003. [PMID: 38398316 PMCID: PMC10889692 DOI: 10.3390/jcm13041003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/28/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Chronic wounds present a significant clinical, social, and economic challenge. This study aimed to objectify the risk factors of healing outcomes and the duration of chronic wounds from various etiologies. Methods: Patients treated for non-healing wounds at the surgical outpatient clinic of the Olomouc Military Hospital were involved. Data from patients treated between 8/2021 and 9/2023 were selected. Patients were mostly treated as outpatients, with microbiological follow-up indicated in cases of advanced signs of inflammation. Results: There were 149 patients who met our selection criteria (the mean age was 64.4 years). Predominant causes of wounds involved diabetes (30.9%), post-trauma (25.5%), pressure ulcers (14.8%), surgical site infections (14.8%), and vascular ulcers (14.1%). Patient outcomes included wound resolution in 77.2% of patients (with a mean healing time of 110.9 days), amputation in 14.1%, and wound-related death in 8.7% of patients. Non-healing cases (amputation/death) were predicted by several local factors including an initial depth greater than 1 cm, wound secretion, inflammatory base, and a maximum wound size. Systemic factors included most strongly clinically manifested atherosclerosis and its risk factors. Of the 110 swabs performed, 103 identified at least 1 bacterial genus. The dominant risk factor for a prolonged healing duration was bacterial infection. Wounds contaminated by Proteus or Pseudomonas had prolonged healing times of 87 days (p = 0.02) and 72 days (p = 0.045), respectively. Conclusions: The early identification of local and systemic risk factors contributes to the successful resolution of chronic wounds and a reduced duration of healing.
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Affiliation(s)
- Daniel Wolny
- Department of Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic; (D.W.); (D.H.); (J.T.); (M.S.P.)
- Department of Surgery, Military Hospital Olomouc, Sušilovo Náměstí 5, 771 11 Olomouc, Czech Republic
| | - Ladislav Štěpánek
- Department of Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic; (D.W.); (D.H.); (J.T.); (M.S.P.)
| | - Dagmar Horáková
- Department of Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic; (D.W.); (D.H.); (J.T.); (M.S.P.)
| | - Janet Thomas
- Department of Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic; (D.W.); (D.H.); (J.T.); (M.S.P.)
| | - Jana Zapletalová
- Department of Biophysics, Faculty of Medicine and Dentistry, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic;
| | - Mihir Sanjay Patel
- Department of Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic; (D.W.); (D.H.); (J.T.); (M.S.P.)
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Tang T, Chen L, Zhang M, Wang C, Du X, Ye S, Li X, Chen H, Hu N. Exosomes derived from BMSCs enhance diabetic wound healing through circ-Snhg11 delivery. Diabetol Metab Syndr 2024; 16:37. [PMID: 38326928 PMCID: PMC10851501 DOI: 10.1186/s13098-023-01210-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/03/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Exosomes (Exos) generated from bone mesenchymal stem cells (BMSCs) are elucidated to enhance cutaneous wound healing in mice models of diabetes mellitus (DM). While underlying mechanisms remain unknown. METHODS Next-generation sequencing (NGS) was used to examine changes in circRNA expression levels following Exo treatment. Luciferase assays were used to determine the interactions between RNAs. Immunofluorescence staining was used to examine reactive oxygen species (ROS) in endothelial progenitor cells (EPCs) cultured in high glucose (HG) conditions. Therapeutic effects regarding Exos were also examined by immunofluorescence. RESULTS We found that Exo treatment enhanced cutaneous wound healing significantly. NGS indicated that circ-Snhg11 was involved in Exo-mediated tissue repairing. Downregulation of circ-Snhg11 decreased Exo-mediated therapy responses during wound healing in diabetic mouse. Our luciferase reporter data confirmed that SLC7A11 and miR-144-3p were circ-Snhg11 downstream targets. miR-144-3p overexpression or SLC7A11 knockdown altered the protective effects of circ-Snhg11 upon EPCs exposed to HG conditions. Upregulation of circ-Snhg11 incremented therapy effects of Exo treatment during wound healing in DM mice through enhanced angiogenesis along with a reduction in GPX4-mediated ferroptosis. CONCLUSIONS circ-Snhg11 in BMSC-Exos enhanced SLC7A11/GPX4-mediated anti-ferroptosis signals via miR-144-3p sponging resulting in enhanced diabetic wound healing and improved angiopoiesis.
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Affiliation(s)
- Tao Tang
- Department of Vascular Surgery, The Affiliated Nanjing Drum Tower Hospital, Nanjing University Medical School, #321 Zhongshan Road, Nanjing, Jiangsu, 210008, China
| | - Linyi Chen
- Department of Ophthalmology, The Fourth Affiliated Hospital of Nanjing Medical University, #298 Nan Pu Road, Nanjing, Jiangsu, 210008, China
| | - Ming Zhang
- Department of Vascular Surgery, The Affiliated Nanjing Drum Tower Hospital, Nanjing University Medical School, #321 Zhongshan Road, Nanjing, Jiangsu, 210008, China
| | - Chuang Wang
- Department of Vascular Surgery, The Affiliated Nanjing Drum Tower Hospital, Nanjing University Medical School, #321 Zhongshan Road, Nanjing, Jiangsu, 210008, China
| | - Xiaolong Du
- Department of Vascular Surgery, The Affiliated Nanjing Drum Tower Hospital, Nanjing University Medical School, #321 Zhongshan Road, Nanjing, Jiangsu, 210008, China
| | - Shenglin Ye
- Department of Vascular Surgery, The Affiliated Nanjing Drum Tower Hospital, Nanjing University Medical School, #321 Zhongshan Road, Nanjing, Jiangsu, 210008, China
| | - Xiaoqiang Li
- Department of Vascular Surgery, The Affiliated Nanjing Drum Tower Hospital, Nanjing University Medical School, #321 Zhongshan Road, Nanjing, Jiangsu, 210008, China.
| | - Hong Chen
- Department of Vascular Surgery, The Affiliated Nanjing Drum Tower Hospital, Nanjing University Medical School, #321 Zhongshan Road, Nanjing, Jiangsu, 210008, China.
| | - Nan Hu
- Department of Vascular Surgery, The Affiliated Nanjing Drum Tower Hospital, Nanjing University Medical School, #321 Zhongshan Road, Nanjing, Jiangsu, 210008, China.
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Browne S, Petit N, Quondamatteo F. Functionalised biomaterials as synthetic extracellular matrices to promote vascularisation and healing of diabetic wounds. Cell Tissue Res 2024; 395:133-145. [PMID: 38051351 DOI: 10.1007/s00441-023-03849-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023]
Abstract
Diabetic foot ulcers (DFU) are a type of chronic wound that constitute one of the most serious and debilitating complications associated with diabetes. The lack of clinically efficacious treatments to treat these recalcitrant wounds can lead to amputations for those worst affected. Biomaterial-based approaches offer great hope in this regard, as they provide a template for cell infiltration and tissue repair. However, there is an additional need to treat the underlying pathophysiology of DFUs, in particular insufficient vascularization of the wound which significantly hampers healing. Thus, the addition of pro-angiogenic moieties to biomaterials is a promising strategy to promote the healing of DFUs and other chronic wounds. In this review, we discuss the potential of biomaterials as treatments for DFU and the approaches that can be taken to functionalise these biomaterials such that they promote vascularisation and wound healing in pre-clinical models.
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Affiliation(s)
- Shane Browne
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, 123, St Stephen's Green, Dublin 2, Dublin, Ireland.
- CÚRAM, Centre for Research in Medical Devices, University of Galway, H91 W2TY, Galway, Ireland.
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin 2, Ireland.
| | - Noémie Petit
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, 123, St Stephen's Green, Dublin 2, Dublin, Ireland
| | - Fabio Quondamatteo
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, 123, St Stephen's Green, Dublin 2, Dublin, Ireland.
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Yadav JP, Singh AK, Grishina M, Pathak P, Verma A, Kumar V, Kumar P, Patel DK. Insights into the mechanisms of diabetic wounds: pathophysiology, molecular targets, and treatment strategies through conventional and alternative therapies. Inflammopharmacology 2024; 32:149-228. [PMID: 38212535 DOI: 10.1007/s10787-023-01407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024]
Abstract
Diabetes mellitus is a prevalent cause of mortality worldwide and can lead to several secondary issues, including DWs, which are caused by hyperglycemia, diabetic neuropathy, anemia, and ischemia. Roughly 15% of diabetic patient's experience complications related to DWs, with 25% at risk of lower limb amputations. A conventional management protocol is currently used for treating diabetic foot syndrome, which involves therapy using various substances, such as bFGF, pDGF, VEGF, EGF, IGF-I, TGF-β, skin substitutes, cytokine stimulators, cytokine inhibitors, MMPs inhibitors, gene and stem cell therapies, ECM, and angiogenesis stimulators. The protocol also includes wound cleaning, laser therapy, antibiotics, skin substitutes, HOTC therapy, and removing dead tissue. It has been observed that treatment with numerous plants and their active constituents, including Globularia Arabica, Rhus coriaria L., Neolamarckia cadamba, Olea europaea, Salvia kronenburgii, Moringa oleifera, Syzygium aromaticum, Combretum molle, and Myrtus communis, has been found to promote wound healing, reduce inflammation, stimulate angiogenesis, and cytokines production, increase growth factors production, promote keratinocyte production, and encourage fibroblast proliferation. These therapies may also reduce the need for amputations. However, there is still limited information on how to prevent and manage DWs, and further research is needed to fully understand the role of alternative treatments in managing complications of DWs. The conventional management protocol for treating diabetic foot syndrome can be expensive and may cause adverse side effects. Alternative therapies, such as medicinal plants and green synthesis of nano-formulations, may provide efficient and affordable treatments for DWs.
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Affiliation(s)
- Jagat Pal Yadav
- Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, 211007, India.
- Pharmacology Research Laboratory, Faculty of Pharmaceutical Sciences, Rama University, Kanpur, 209217, India.
- Bioorganic and Medicinal Chemistry Research Laboratory, Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, 211007, India.
| | - Ankit Kumar Singh
- Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Bathinda, 151401, India
| | - Maria Grishina
- Laboratory of Computational Modeling of Drugs, Higher Medical and Biological School, South Ural State University, Chelyabinsk, 454008, Russia
| | - Prateek Pathak
- Department of Pharmaceutical Analysis, Quality Assurance, and Pharmaceutical Chemistry, School of Pharmacy, GITAM (Deemed to Be University), Hyderabad, 502329, India
| | - Amita Verma
- Bioorganic and Medicinal Chemistry Research Laboratory, Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, 211007, India
| | - Vikas Kumar
- Natural Product Drug Discovery Laboratory, Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, 211007, India
| | - Pradeep Kumar
- Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Bathinda, 151401, India
| | - Dinesh Kumar Patel
- Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, 211007, India.
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