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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] [MESH Headings] [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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Ji W, Li B, Li N, Xing C. Design Strategy of Microneedle Systems for Skin Wound Healing: Based on the Structure of Tips and Therapeutic Methodologies. ACS APPLIED BIO MATERIALS 2024; 7:4254-4269. [PMID: 38863157 DOI: 10.1021/acsabm.4c00532] [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: 06/13/2024]
Abstract
The skin, being the largest organ of the human body, is susceptible to damage resulting in wounds that are vulnerable to pathogenic attacks and fail to provide effective protection for internal tissues. Therefore, it is crucial to expedite wound healing. In recent years, microneedles have garnered significant attention as an innovative drug delivery system owing to their noninvasive and painless administration, simplified application process, precise control over drug release, and versatile loading capabilities. Consequently, they hold immense potential for the treatment of skin wound. This review presents a comprehensive design strategy for the microneedle system in promoting skin wound healing. First, the process of skin wound healing and the characteristics of specific wounds are elucidated. The design strategies for microneedles are subsequently presented and classified based on their structural and therapeutic methodologies. Finally, a succinct recapitulation of the previously discussed points and a prospective analysis are provided.
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Affiliation(s)
- Wenchao Ji
- School of Materials Science and Engineering, Hebei University of Technology, Tianjin 300130, P. R. China
| | - Boying Li
- School of Chemical Engineering, Hebei University of Technology, Tianjin 300130, P. R. China
| | - Ning Li
- College of Pharmaceutical Sciences, Soochow University, Suzhou 215000, P. R. China
| | - Chengfen Xing
- School of Materials Science and Engineering, Hebei University of Technology, Tianjin 300130, P. R. China
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Xie S, Han J, Xie W, Luo G, Shi X, Wang H, Hou H, He X, Hu X, Ji P, Ma N, Tong C. Comparing collagenase and silver sulfadiazine in deep second-degree burn treatment. Arch Dermatol Res 2024; 316:417. [PMID: 38904701 DOI: 10.1007/s00403-024-03007-y] [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: 04/15/2024] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 06/22/2024]
Abstract
The indications for collagenase ointment (CO) and its efficacy are not clearly established in the treatment of second-degree burn wounds. To evaluate the efficacy of CO versus silver sulfadiazine ointment (SSD) in the treatment of second-degree burn wounds. A total of 170 eligible patients with deep second-degree burns, aged 18-65 years, with injuries occurring within 48-96 h, and having a total wound area of less than 30% of the total body surface area were included from 5 centers in China. The primary outcome was the wound healing time, and the secondary outcomes were the clearance time of wound necrotic tissues, wound healing rate, and wound inflammation. The study included 85 patients in SSD group and 84 in CO group in the modified intention-to-treat (mITT) population. The median time of wound healing was comparable in both groups (10 days vs. 10.5 days P = 0.16). The time for wound necrotic tissue removal was significantly shortened by CO compared with SSD (5 vs. 10 days P < 0.01). Wound inflammation, pain, wound healing rate, and scar were compared with SSD (all P-values > 0.05). No adverse events, such as infection or allergic reactions to the drugs and materials used, were reported. Both CO and SSD could heal the burn wounds at 10 days of treatment. However, CO significantly shortened the time of wound necrotic tissue removal by 5 days. Trial Registration: ChiCTR2100046971.
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Affiliation(s)
- Songtao Xie
- Department of Burn and Skin Surgery, First Affiliated Hospital of Air Force Military Medical University, No. 127 Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Juntao Han
- Department of Burn and Skin Surgery, First Affiliated Hospital of Air Force Military Medical University, No. 127 Changle West Road, Xincheng District, Xi'an, 710032, China.
| | | | - Gaoxing Luo
- The First Affiliated Hospital of Army Medical University (Southwest Hospital), Chongqing, China.
| | - Xueqin Shi
- Department of Burn and Skin Surgery, First Affiliated Hospital of Air Force Military Medical University, No. 127 Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Hongtao Wang
- Department of Burn and Skin Surgery, First Affiliated Hospital of Air Force Military Medical University, No. 127 Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Hongyi Hou
- Department of Burn and Skin Surgery, First Affiliated Hospital of Air Force Military Medical University, No. 127 Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Xiang He
- Department of Burn and Skin Surgery, First Affiliated Hospital of Air Force Military Medical University, No. 127 Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Xiaolong Hu
- Department of Burn and Skin Surgery, First Affiliated Hospital of Air Force Military Medical University, No. 127 Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Peng Ji
- Department of Burn and Skin Surgery, First Affiliated Hospital of Air Force Military Medical University, No. 127 Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Ningxia Ma
- Department of Burn and Skin Surgery, First Affiliated Hospital of Air Force Military Medical University, No. 127 Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Cuifang Tong
- Department of Burn and Skin Surgery, First Affiliated Hospital of Air Force Military Medical University, No. 127 Changle West Road, Xincheng District, Xi'an, 710032, China
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Li Y, Song W, Kong L, He Y, Li H. Injectable and Microporous Microgel-Fiber Granular Hydrogel Loaded with Bioglass and siRNA for Promoting Diabetic Wound Healing. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2309599. [PMID: 38054634 DOI: 10.1002/smll.202309599] [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: 11/13/2023] [Revised: 11/23/2023] [Indexed: 12/07/2023]
Abstract
Injectable hydrogels find extensive application in the treatment of diabetic wound healing. However, traditional bulk hydrogels are significantly limited due to their nano-porous structure, which obstructs cell migration and tissue infiltration. Moreover, regulating inflammation and matrix metalloproteinase -9 (MMP-9) expression in diabetic wounds is crucial for enhancing wound healing. This study marks the first instance of introducing an efficient, scalable, and simple method for producing microfiber-gel granules encapsulating bioceramics powders. Utilizing this method, an injectable microporous granular microgel-fiber hydrogel (MFgel) is successfully developed by assembling microgel-fibers made from hyaluronic acid (HA) and sodium alginate (SA) loaded with small interfering RNA (siRNA) and bioglass (BG) particles. Compared to traditional hydrogels (Tgel), MFgel possesses a highly interconnected network with micron-sized pores, demonstrating favorable properties for cell adhesion and penetration in in vitro experiments. Additionally, MFgel exhibits a higher compressive modulus and superior mechanical stability. When implanted subcutaneously in mice, MFgel promotes cellular and tissue infiltration, facilitating cell proliferation. Furthermore, when applied to skin defects in diabetic rats, MFgel not only effectively regulates inflammation and suppresses MMP-9 expression but also enhances angiogenesis and collagen deposition, thereby significantly accelerating diabetic wound healing. Taken together, this hydrogel possesses great potential in diabetic wound healing applications.
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Affiliation(s)
- Ying Li
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China
| | - Wei Song
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Lingzhi Kong
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Yaohua He
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
- Department of Orthopedic Surgery, Jinshan District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China
| | - Haiyan Li
- Chemical and Environment Engineering Department, School of Engineering, RMIT University, 124 La Trobe Street, Melbourne, VIC, 3001, Australia
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Tejeda Ramírez S, Tardáguila-García A, López-Moral M, Sanz-Corbalán I, García-Madrid M, Lázaro-Martínez JL. Randomized Double-blind Cost-effectiveness Comparison of Two 10% Urea Creams in Patients with Diabetic Foot Syndrome. Adv Skin Wound Care 2024; 37:1-7. [PMID: 38648245 DOI: 10.1097/asw.0000000000000141] [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: 04/25/2024]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of two 10% urea creams in patients with diabetic foot syndrome. METHODS This was a prospective, longitudinal, single-center, randomized, double-blind, prospective clinical trial that evaluated the skin quality of 20 feet belonging to 10 patients with diabetic foot syndrome after the application of two 10% urea creams purchased from pharmacies and supermarkets. RESULTS At follow-up, 19 (95%) of the participants' feet showed improved skin quality, irrespective of the cream applied. On visual inspection, participants had a decreased presence of xerosis, hyperkeratosis, and preulcerative signs such as subkeratotic bruising and areas of redness on the dorsum of the toes. At the 3-month follow-up, nine (90%) of the participants stated that they had continued to apply the cream as a method of self-management to prevent complications. CONCLUSIONS Creams containing 10% urea purchased in supermarkets improve foot skin quality in patients with diabetic foot syndrome, regardless of their cost. Based on these findings, the authors recommend creams containing 10% urea as a self-management tool for patients with diabetic foot syndrome.
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Affiliation(s)
- Sol Tejeda Ramírez
- At the Universidad Complutense de Madrid, Spain, Sol Tejeda Ramírez, DPM, PhD, is Predoctoral Researcher; Aroa Tardáguila-García, DPM, PhD, is Full Professor; Mateo López-Moral, DPM, PhD, is Professor; Irene Sanz-Corbalán, DPM, PhD, is Full Professor; Marta García-Madrid, DPM, PhD, is Predoctoral Researcher; and José Luis Lázaro-Martínez, DPM, PhD, is Full Professor. The authors have disclosed no financial relationships related to this article. Submitted March 7, 2023; accepted in revised form June 16, 2023
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Miler I, Rabasovic MD, Askrabic S, Stylianou A, Korac B, Korac A. Short-Term l-arginine Treatment Mitigates Early Damage of Dermal Collagen Induced by Diabetes. Bioengineering (Basel) 2024; 11:407. [PMID: 38671828 PMCID: PMC11048012 DOI: 10.3390/bioengineering11040407] [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: 03/13/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Changes in the structural properties of the skin due to collagen alterations are an important factor in diabetic skin complications. Using a combination of photonic methods as an optic diagnostic tool, we investigated the structural alteration in rat dermal collagen I in diabetes, and after short-term l-arginine treatment. The multiplex approach shows that in the early phase of diabetes, collagen fibers are partially damaged, resulting in the heterogeneity of fibers, e.g., "patchy patterns" of highly ordered/disordered fibers, while l-arginine treatment counteracts to some extent the conformational changes in collagen-induced by diabetes and mitigates the damage. Raman spectroscopy shows intense collagen conformational changes via amides I and II in diabetes, suggesting that diabetes-induced structural changes in collagen originate predominantly from individual collagen molecules rather than supramolecular structures. There is a clear increase in the amounts of newly synthesized proline and hydroxyproline after treatment with l-arginine, reflecting the changed collagen content. This suggests that it might be useful for treating and stopping collagen damage early on in diabetic skin. Our results demonstrate that l-arginine attenuates the early collagen I alteration caused by diabetes and that it could be used to treat and prevent collagen damage in diabetic skin at a very early stage.
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Affiliation(s)
- Irena Miler
- Center for Biosystems, BioSense Institute, University of Novi Sad, Dr Zorana Djindjica 1, 21000 Novi Sad, Serbia;
| | - Mihailo D. Rabasovic
- Institute of Physics Belgrade, National Institute of the Republic of Serbia, University of Belgrade, Pregrevica 118, 11000 Belgrade, Serbia; (S.A.)
| | - Sonja Askrabic
- Institute of Physics Belgrade, National Institute of the Republic of Serbia, University of Belgrade, Pregrevica 118, 11000 Belgrade, Serbia; (S.A.)
| | - Andreas Stylianou
- School of Science, European University Cyprus, 6 Diogenous Str., Egkomi, Nicosia 2404, Cyprus;
| | - Bato Korac
- Institute for Biological Research “Sinisa Stankovic”, National Institute of the Republic of Serbia, University of Belgrade, Bulevar Despota Stefana 142, 11000 Belgrade, Serbia;
| | - Aleksandra Korac
- Center for Electron Microscopy, Faculty of Biology, University of Belgrade, Studentski trg 16, 11000 Belgrade, Serbia
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Beram FM, Ali SN, Mesbahian G, Pashizeh F, Keshvadi M, Mashayekhi F, Khodadadi B, Bashiri Z, Moeinzadeh A, Rezaei N, Namazifard S, Hossein-Khannazer N, Tavakkoli Yaraki M. 3D Printing of Alginate/Chitosan-Based Scaffold Empowered by Tyrosol-Loaded Niosome for Wound Healing Applications: In Vitro and In Vivo Performances. ACS APPLIED BIO MATERIALS 2024; 7:1449-1468. [PMID: 38442406 DOI: 10.1021/acsabm.3c00814] [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: 03/07/2024]
Abstract
This study introduces a tyrosol-loaded niosome integrated into a chitosan-alginate scaffold (Nio-Tyro@CS-AL), employing advanced electrospinning and 3D printing techniques for wound healing applications. The niosomes, measuring 185.40 ± 6.40 nm with a polydispersity index of 0.168 ± 0.012, encapsulated tyrosol with an efficiency of 77.54 ± 1.25%. The scaffold's microsized porous structure (600-900 μm) enhances water absorption, promoting cell adhesion, migration, and proliferation. Mechanical property assessments revealed the scaffold's enhanced resilience, with niosomes increasing the compressive strength, modulus, and strain to failure, indicative of its suitability for wound healing. Controlled tyrosol release was demonstrated in vitro, essential for therapeutic efficacy. The scaffold exhibited significant antibacterial activity against Pseudomonas aeruginosa and Staphylococcus aureus, with substantial biofilm inhibition and downregulation of bacterial genes (ndvb and icab). A wound healing assay highlighted a notable increase in MMP-2 and MMP-9 mRNA expression and the wound closure area (69.35 ± 2.21%) in HFF cells treated with Nio-Tyro@CS-AL. In vivo studies in mice confirmed the scaffold's biocompatibility, showing no significant inflammatory response, hypertrophic scarring, or foreign body reaction. Histological evaluations revealed increased fibroblast and macrophage activity, enhanced re-epithelialization, and angiogenesis in wounds treated with Nio-Tyro@CS-AL, indicating effective tissue integration and repair. Overall, the Nio-Tyro@CS-AL scaffold presents a significant advancement in wound-healing materials, combining antibacterial properties with enhanced tissue regeneration, and holds promising potential for clinical applications in wound management.
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Affiliation(s)
| | - Saba Naeimaei Ali
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin 3419759811, Iran
| | - Ghazal Mesbahian
- School of Pharmacy, International Campus, Tehran University of Medical Sciences, Tehran 1416634793, Iran
| | - Fatemeh Pashizeh
- Department of Immunology, School of Medicine, Shahid Sadoughi University of Medical Science, Yazd 8916188635, Iran
| | | | - Farzaneh Mashayekhi
- Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran 14535, Iran
| | - Behnoosh Khodadadi
- Department of Chemistry, Faculty of Physics and Chemistry, Alzahra University, Tehran 1993891176, Iran
| | - Zahra Bashiri
- Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Tehran 14535, Iran
| | - Alaa Moeinzadeh
- Department of Tissue Engineering and Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran 14535, Iran
| | - Niloufar Rezaei
- Gastroenterology and Liver Diseases Research Center, Research, Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 19839-63113, Iran
| | - Saina Namazifard
- Department of Mechanical and Aerospace Engineering, The University of Texas at Arlington, 500 West First Street, Arlington, Texas 76019, United States
| | - Nikoo Hossein-Khannazer
- Gastroenterology and Liver Diseases Research Center, Research, Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 19839-63113, Iran
| | - Mohammad Tavakkoli Yaraki
- School of Natural Sciences, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales 2109, Australia
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Voza FA, Huerta CT, Le N, Shao H, Ribieras A, Ortiz Y, Atkinson C, Machuca T, Liu ZJ, Velazquez OC. Fibroblasts in Diabetic Foot Ulcers. Int J Mol Sci 2024; 25:2172. [PMID: 38396848 PMCID: PMC10889208 DOI: 10.3390/ijms25042172] [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: 12/15/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Fibroblasts are stromal cells ubiquitously distributed in the body of nearly every organ tissue. These cells were previously considered to be "passive cells", solely responsible for ensuring the turnover of the extracellular matrix (ECM). However, their versatility, including their ability to switch phenotypes in response to tissue injury and dynamic activity in the maintenance of tissue specific homeostasis and integrity have been recently revealed by the innovation of technological tools such as genetically modified mouse models and single cell analysis. These highly plastic and heterogeneous cells equipped with multifaceted functions including the regulation of angiogenesis, inflammation as well as their innate stemness characteristics, play a central role in the delicately regulated process of wound healing. Fibroblast dysregulation underlies many chronic conditions, including cardiovascular diseases, cancer, inflammatory diseases, and diabetes mellitus (DM), which represent the current major causes of morbidity and mortality worldwide. Diabetic foot ulcer (DFU), one of the most severe complications of DM affects 40 to 60 million people. Chronic non-healing DFU wounds expose patients to substantial sequelae including infections, gangrene, amputation, and death. A complete understanding of the pathophysiology of DFU and targeting pathways involved in the dysregulation of fibroblasts are required for the development of innovative new therapeutic treatments, critically needed for these patients.
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Affiliation(s)
- Francesca A. Voza
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.A.V.); (C.T.H.); (H.S.); (A.R.); (Y.O.); (T.M.)
| | - Carlos Theodore Huerta
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.A.V.); (C.T.H.); (H.S.); (A.R.); (Y.O.); (T.M.)
| | - Nga Le
- Vascular Biology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biochemistry & Molecular Biology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Hongwei Shao
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.A.V.); (C.T.H.); (H.S.); (A.R.); (Y.O.); (T.M.)
- Vascular Biology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Antoine Ribieras
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.A.V.); (C.T.H.); (H.S.); (A.R.); (Y.O.); (T.M.)
| | - Yulexi Ortiz
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.A.V.); (C.T.H.); (H.S.); (A.R.); (Y.O.); (T.M.)
- Vascular Biology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Carl Atkinson
- Department of Internal Medicine, Division of Pulmonary Critical Care & Sleep Medicine, University of Florida, Gainesville, FL 32611, USA;
| | - Tiago Machuca
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.A.V.); (C.T.H.); (H.S.); (A.R.); (Y.O.); (T.M.)
| | - Zhao-Jun Liu
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.A.V.); (C.T.H.); (H.S.); (A.R.); (Y.O.); (T.M.)
- Vascular Biology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biochemistry & Molecular Biology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Omaida C. Velazquez
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.A.V.); (C.T.H.); (H.S.); (A.R.); (Y.O.); (T.M.)
- Vascular Biology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biochemistry & Molecular Biology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Ionescu C, Petca A, Dumitrașcu MC, Petca RC, Ionescu (Miron) AI, Șandru F. The Intersection of Dermatological Dilemmas and Endocrinological Complexities: Understanding Necrobiosis Lipoidica-A Comprehensive Review. Biomedicines 2024; 12:337. [PMID: 38397939 PMCID: PMC10887100 DOI: 10.3390/biomedicines12020337] [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: 01/08/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Necrobiosis lipoidica (NL) is a rare granulomatous skin disorder with a predilection for females, often associated with diabetes mellitus (DM). This paper aims to comprehensively review the literature on NL, focusing on its association with DM, thyroid disorders, and the metabolic syndrome. METHODS A systematic search was conducted in English-language literature from inception to October 2023, utilizing PubMed. We identified 530 studies and selected 19 based on clinical significance, statistical support, and relevance to the paper's goals. RESULTS The coexistence of NL and DM is prevalent, with rates ranging from 11% to 65.71%. NL may precede DM diagnosis and a correlation between NL and increased daily insulin requirements has been observed in such patients. NL is suggested as a potential prognostic marker for DM complications; however, recent studies question this association, highlighting the need for further research. Studies in the context of NL and Thyroid Disease indicate a correlation, especially with autoimmune thyroiditis. Regarding NL and Metabolic Syndrome, the prevalence of metabolic syndrome among NL patients is notably higher than in the general population. Additionally, DM patients with ulcerated NL commonly exhibit hypertension or obesity, raising questions about the potential influence of hypertension and obesity on NL ulcerations. CONCLUSION Additional research is required to untangle the complex connections between NL and various comorbidities.
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Affiliation(s)
- Corina Ionescu
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.); (F.Ș.)
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.P.); (M.C.D.)
- Department of Obstetrics and Gynecology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Mihai Cristian Dumitrașcu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.P.); (M.C.D.)
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Răzvan-Cosmin Petca
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 050659 Bucharest, Romania
| | - Andreea Iuliana Ionescu (Miron)
- Department of Oncological Radiotherapy and Medical Imaging, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Medical Oncology, Colțea Clinical Hospital, 030167 Bucharest, Romania
| | - Florica Șandru
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.); (F.Ș.)
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
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10
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Liu M, Wang X, Sun B, Wang H, Mo X, El-Newehy M, Abdulhameed MM, Yao H, Liang C, Wu J. Electrospun membranes chelated by metal magnesium ions enhance pro-angiogenic activity and promote diabetic wound healing. Int J Biol Macromol 2024; 259:129283. [PMID: 38199538 DOI: 10.1016/j.ijbiomac.2024.129283] [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: 10/10/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
Diabetic wounds, resulting from skin atrophy due to localized ischemia and hypoxia in diabetic patients, lead to chronic pathological inflammation and delayed healing. Using electrospinning technology, we developed magnesium ion-chelated nanofiber membranes to explore their efficacy in antibacterial, anti-inflammatory, and angiogenic applications for wound healing. These membranes are flexible and elastic, resembling native skin tissue, and possess good hydrophilicity for comfortable wound bed contact. The mechanical properties of nanofiber membranes are enhanced by the chelation of magnesium ions (Mg2+), which also facilitates a long-term slow release of Mg2+. The cytocompatibility of the nanofibrous membranes is influenced by their Mg2+ content: lower levels encourage the proliferation of fibroblasts, endothelial cells, and macrophages, while higher levels are inhibitory. In a diabetic rat model, magnesium ion-chelated nanofibrous membranes effectively reduced early wound inflammation and notably accelerated wound healing. This study highlights the potential of magnesium ion-chelated nanofiber membranes in treating diabetic wounds.
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Affiliation(s)
- Mingyue Liu
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, Department of Biomedical Engineering, Donghua University, Shanghai 201620, PR China
| | - Xiaoyi Wang
- Core Facility Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, PR China
| | - Binbin Sun
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, Department of Biomedical Engineering, Donghua University, Shanghai 201620, PR China
| | - Hongsheng Wang
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, Department of Biomedical Engineering, Donghua University, Shanghai 201620, PR China
| | - Xiumei Mo
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, Department of Biomedical Engineering, Donghua University, Shanghai 201620, PR China
| | - Mohamed El-Newehy
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Meera Moydeen Abdulhameed
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Haochen Yao
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun 130021, China.
| | - Chao Liang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, PR China.
| | - Jinglei Wu
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, Department of Biomedical Engineering, Donghua University, Shanghai 201620, PR China.
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11
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Panda D, Nayak S. Stem Cell-Based Tissue Engineering Approaches for Diabetic Foot Ulcer: a Review from Mechanism to Clinical Trial. Stem Cell Rev Rep 2024; 20:88-123. [PMID: 37867186 DOI: 10.1007/s12015-023-10640-z] [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] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
Diabetic foot ulcer (DFU) is a complication from incomplete or prolonged wound healing, at times requires amputation, putting substantial health and socioeconomic burden. Wound healing is a dynamic overlapping process that can be regulated by arrays of molecular factors showing redundancy in function. However, dysregulation in the mechanism of angiogenesis, extra cellular matrix (ECM) formation and immune modulation are the major causes for impair wound healing in hyperglycaemic patients. Despite development of wound care research, there is a lack of well-accepted targeted therapy with multidisciplinary approach for DFU treatment. Stem cell therapy holds a promising outcome both in preclinical and clinical trials because of its ability to promote healing via regeneration and specialized tissue differentiation. Among different types of stem cells, regenerative potential of mesenchymal stem cell (MSC) is well demonstrated in both experimental and clinical trial. Still there is a huge knowledge gap among medical practitioners for deciding the best stem cell source, administration route, and safety. This review strengthens the fact that why stem cell therapy is a promising candidate to treat DFU and cited multiple tissue engineering and biomaterial-based approaches for delivering stem cells and their aftermath paracrine events. Based on the pre-clinical and clinical studies, the review tried to come up with optimum stem cell source and delivery route for the treatment of DFU. At last, the review glances on possible direction to enhance therapeutics strategy for the same, including different approaches like: phytocompounds, exosomes, scaffold geometry, cell preconditioning and licensing etc.
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Affiliation(s)
- Debarchan Panda
- Department of Integrative Biology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India
| | - Sunita Nayak
- Department of Integrative Biology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India.
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12
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Kumar S, Bharali A, Sarma H, Kushari S, Gam S, Hazarika I, Prasad SK, Laloo D. Traditional complementary and alternative medicine (TCAM) for diabetic foot ulcer management: A systematic review. J Ayurveda Integr Med 2023; 14:100745. [PMID: 37441954 PMCID: PMC10435959 DOI: 10.1016/j.jaim.2023.100745] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 07/15/2023] Open
Abstract
Diabetic Foot Ulcers (DFUs) are a devastating micro-vascular complication of diabetes with an increased prevalence and incidence and high rate of morbidity and mortality. Since antibiotics are frequently used to treat DFU, managing the condition has proven to be extremely challenging and may eventually lead to the development of antibiotic resistance. Scientists from around the world are working to develop an alternative solution to the problem of drug resistance by exploring complementary and alternative medicines that may be obtained from natural sources. Hence, the review aims to comprehensively report the information on the natural treatments and therapy used to manage DFU. All of the information described in the current study was gathered from electronic scientific resources, including Google Scholar, PubMed, Scopus, Science Direct, and Springer Link. Findings from the current review revealed the pre-clinical and clinical utility of 18 medicinal plants, 1 isolated compound, 7 polyherbal formulations including herbal creams, a few micronutrients including vitamins and minerals, insect products such as propolis, honey and, Maggot debridement therapy for the treatment and management of DFU. Natural therapies possess better efficacy, low cost, and shorter duration of treatment when compared with the conventional treatments; hence, all information made available about them is crucial to alter the direction of treatment. Furthermore, the data presented in this review are up to date on the potential efficacy of natural complementary medicines for alleviating DFU problems in in vitro and in vivo tests, as well as clinical studies.
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Affiliation(s)
- Suman Kumar
- Assam Science and Technology University, Guwahati, 781013, Assam, India; Department of Pharmaceutical Chemistry, Girijananda Chowdhury Institute of Pharmaceutical Science, Girijananda Chowdhury University, Guwahati, 781017, Assam, India
| | - Alakesh Bharali
- Department of Pharmaceutics, Girijananda Chowdhury Institute of Pharmaceutical Science, Girijananda Chowdhury University, Guwahati, 781017, Assam, India
| | - Himangshu Sarma
- Department of Pharmacognosy, NETES Institute of Pharmaceutical Science, Mirza, 781101, Assam, India
| | - Susankar Kushari
- Assam Science and Technology University, Guwahati, 781013, Assam, India; Department of Pharmaceutical Chemistry, Girijananda Chowdhury Institute of Pharmaceutical Science, Girijananda Chowdhury University, Guwahati, 781017, Assam, India
| | - Sameeran Gam
- Department of Pharmacognosy, NETES Institute of Pharmaceutical Science, Mirza, 781101, Assam, India
| | - Iswar Hazarika
- Department of Pharmacology, Girijananda Chowdhury Institute of Pharmaceutical Science, Girijananda Chowdhury University, Guwahati, 781017, Assam, India
| | - Satyendra K Prasad
- Department of Pharmacognosy, R.T.M. Nagpur University, Nagpur, 440033, India
| | - Damiki Laloo
- Assam Science and Technology University, Guwahati, 781013, Assam, India; Phytochemical Research Laboratory, Department of Pharmacognosy, Girijananda Chowdhury Institute of Pharmaceutical Science, Girijananda Chowdhury University, Guwahati, 781017, Assam, India.
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13
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Zheng SY, Wan XX, Kambey PA, Luo Y, Hu XM, Liu YF, Shan JQ, Chen YW, Xiong K. Therapeutic role of growth factors in treating diabetic wound. World J Diabetes 2023; 14:364-395. [PMID: 37122434 PMCID: PMC10130901 DOI: 10.4239/wjd.v14.i4.364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/16/2023] [Accepted: 03/21/2023] [Indexed: 04/12/2023] Open
Abstract
Wounds in diabetic patients, especially diabetic foot ulcers, are more difficult to heal compared with normal wounds and can easily deteriorate, leading to amputation. Common treatments cannot heal diabetic wounds or control their many complications. Growth factors are found to play important roles in regulating complex diabetic wound healing. Different growth factors such as transforming growth factor beta 1, insulin-like growth factor, and vascular endothelial growth factor play different roles in diabetic wound healing. This implies that a therapeutic modality modulating different growth factors to suit wound healing can significantly improve the treatment of diabetic wounds. Further, some current treatments have been shown to promote the healing of diabetic wounds by modulating specific growth factors. The purpose of this study was to discuss the role played by each growth factor in therapeutic approaches so as to stimulate further therapeutic thinking.
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Affiliation(s)
- Shen-Yuan Zheng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha 410013, Hunan Province, China
| | - Xin-Xing Wan
- Department of Endocrinology, Third Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China
| | - Piniel Alphayo Kambey
- Department of Neurobiology and Anatomy, Xuzhou Medical University, Xuzhou 221004, Jiangsu Province, China
| | - Yan Luo
- Clinical Medicine Eight-Year Program, Xiangya School of Medicine, Central South University, Changsha 410013, Hunan Province, China
| | - Xi-Min Hu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha 410013, Hunan Province, China
| | - Yi-Fan Liu
- Clinical Medicine Eight-Year Program, Xiangya School of Medicine, Central South University, Changsha 410013, Hunan Province, China
| | - Jia-Qi Shan
- Clinical Medicine Eight-Year Program, Xiangya School of Medicine, Central South University, Changsha 410013, Hunan Province, China
| | - Yu-Wei Chen
- Clinical Medicine Eight-Year Program, Xiangya School of Medicine, Central South University, Changsha 410013, Hunan Province, China
| | - Kun Xiong
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha 410013, Hunan Province, China
- Key Laboratory of Emergency and Trauma, College of Emergency and Trauma, Hainan Medical University, Haikou 571199, Hainan Province, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410013, Hunan Province, China
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14
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Ili P, Sari F. Egg yolk oil accelerates wound healing in streptozotocin induced diabetic rats. Biotech Histochem 2023; 98:94-111. [PMID: 36040350 DOI: 10.1080/10520295.2022.2115554] [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: 02/07/2023] Open
Abstract
Impaired diabetic wound healing causes foot ulcers. We investigated egg yolk oil for skin wound healing in streptozotocin (STZ) induced diabetic rats. Rats were allocated into three groups of six. Group 1, nondiabetic control group, was treated topically with 2% fusidic acid ointment. Group 2, STZ diabetic control, was treated topically with 2% fusidic acid ointment. Group 3, STZ diabetic group, was treated topically with egg yolk oil. Three days after STZ injection, two full thickness excisional skin wounds were created on the back of each animal. Wound diameter was measured for 14 days and wound contraction was calculated. Re-epithelization time also was determined. Three rats from each group were sacrificed on experimental day 7 and the remaining rats on day 14. Wound samples were examined using hematoxylin and eosin, periodic acid-Schiff, Masson's trichrome, Taenzer-Unna orcein and toluidine blue staining. Expression of endoglin (CD105), epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF) were investigated using immunohistochemistry. Egg yolk oil increased the proliferation of epithelial cells and angiogenesis, and stimulated collagen deposition in the lesion area. Egg yolk oil increased CD105, EGF and VEGF expression in blood vessels, and EGF and VEGF expression in epidermis of the lesions. The predominant fatty acids in egg yolk oil are oleic, palmitic and linoleic, which likely were responsible for the beneficial effects of egg yolk oil on diabetic wound healing. Egg yolk oil appears to be a promising therapeutic agent for healing of diabetic wounds.
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Affiliation(s)
- Pinar Ili
- Department of Medical Services and Techniques, Denizli Vocational School of Health Services, Pamukkale University, Denizli, Turkey
| | - Fikret Sari
- Department of Plant and Animal Production, Tavas Vocational School, Pamukkale University, Denizli, Turkey
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15
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Zhang L, Hu C, Xu W, Wu D, Lei S. Advances in wound repair and regeneration: Systematic comparison of cell free fat extract and platelet rich plasma. Front Chem 2022; 10:1089277. [PMID: 36618858 PMCID: PMC9811168 DOI: 10.3389/fchem.2022.1089277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Previous studies showed Cell free fat extract (CEFFE) and Platelet rich plasma (PRP) could effectively accelerate wound healing. However, the comparative study on curative effect is still lacking. A systematic comparison could provide more theoretical support and laboratory basis for the clinical application of CEFFE and PRP. Objective: To compare the efficacy of CEFFE and PRP in promoting skin wound repair. Methods: CEFFE and PRP were prepared according to the literature. The wound repair related factors were measured and compared. In vitro, the effects of both on cell migration, proliferation and tube formation were compared. In vivo, wound healing rate was measured on the 1st, 3rd, 9th, and 12th days after skin injury and treatment. Then the specimens were cut off for histological analysis. Results: Although the total protein content of PRP was significantly around 19 times higher than that of CEFFE, there was no statistical difference in the content of BDNF, EGF and VEGF between CEFFE and PRP. Even the NT-3 content of CEFFE was just slightly higher than that of PRP. The concentration of b-FGF, HGF and TGF-β and PDGF-BB in PRP is higher than that in CEFFE, but there is only a very small difference between them. In vitro, PRP showed better efficacy than CEFFE in promoting fibroblast proliferation while there was no significant difference in promoting angiogenesis and fibroblast migration. Both PRP and CEFFE could significantly promote wound healing in mice. There was no statistical difference in wound healing between CEFFE and PRP groups in vivo. Immunohistochemical staining of Ki67&CD31 showed that there was no significant difference between PRP and CEFFE groups. Conclusion: The effect of PRP and CEFFE in promoting wound healing was similar. In clinical practice, the acquisition of PRP is relatively more convenient. Containing no cells, CEFFE has the advantage of easier preservation. For patients who have discarded adipose tissue, or contraindications to PRP technology, CEFFE technology may provide a new option for skin wound repair.
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Affiliation(s)
| | | | | | - Dingyu Wu
- *Correspondence: Dingyu Wu, ; Shaorong Lei,
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16
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Kanta J, Zavadakova A, Sticova E, Dubsky M. Fibronectin in hyperglycaemia and its potential use in the treatment of diabetic foot ulcers: A review. Int Wound J 2022; 20:1750-1761. [PMID: 36537075 PMCID: PMC10088845 DOI: 10.1111/iwj.13997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 12/24/2022] Open
Abstract
Metabolism of fibronectin, the protein that plays a key role in the healing of wounds, is changed in the patients with diabetes mellitus. Fibronectin can interact with other proteins and proteoglycans and organise them to form the extracellular matrix, the basis of the granulation tissue in healing wounds. However, diabetic foot ulcers (DFUs) suffer from inadequate deposition of this protein. Degradation prevails over fibronectin synthesis in the proteolytic inflammatory environment in the ulcers. Because of the lack of fibronectin in the wound bed, the assembly of the extracellular matrix and the deposition of the granulation tissue cannot be started. A number of methods have been designed that prevents fibronectin degradation, replace lacking fibronectin or support its formation in non-healing wounds in animal models of diabetes. The aim of this article is to review the metabolism of fibronectin in DFUs and to emphasise that it would be useful to pay more attention to fibronectin matrix assembly in the ulcers when laboratory methods are translated to clinical practice.
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Affiliation(s)
- Jiri Kanta
- Faculty of Medicine Charles University Hradec Kralove Czech Republic
| | - Anna Zavadakova
- Biomedical Center, Faculty of Medicine Charles University Pilsen Czech Republic
| | - Eva Sticova
- Diabetes Center Institute for Clinical and Experimental Medicine Prague Czech Republic
- Third Faculty of Medicine Charles University Prague Czech Republic
| | - Michal Dubsky
- Diabetes Center Institute for Clinical and Experimental Medicine Prague Czech Republic
- First Faculty of Medicine Charles University Prague Czech Republic
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17
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Mazurek Ł, Szudzik M, Rybka M, Konop M. Silk Fibroin Biomaterials and Their Beneficial Role in Skin Wound Healing. Biomolecules 2022; 12:biom12121852. [PMID: 36551280 PMCID: PMC9775069 DOI: 10.3390/biom12121852] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
The skin, acting as the outer protection of the human body, is most vulnerable to injury. Wound healing can often be impaired, leading to chronic, hard-to-heal wounds. For this reason, searching for the most effective dressings that can significantly enhance the wound healing process is necessary. In this regard, silk fibroin, a protein derived from silk fibres that has excellent properties, is noteworthy. Silk fibroin is highly biocompatible and biodegradable. It can easily make various dressings, which can be loaded with additional substances to improve healing. Dressings based on silk fibroin have anti-inflammatory, pro-angiogenic properties and significantly accelerate skin wound healing, even compared to commercially available wound dressings. Animal studies confirm the beneficial influence of silk fibroin in wound healing. Clinical research focusing on fibroin dressings is also promising. These properties make silk fibroin a remarkable natural material for creating innovative, simple, and effective dressings for skin wound healing. In this review, we summarise the application of silk fibroin biomaterials as wound dressings in full-thickness, burn, and diabetic wounds in preclinical and clinical settings.
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18
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Li D, Guo J, Ni X, Sun G, Bao H. The progress and challenges of circRNA for diabetic foot ulcers: A mini-review. Front Endocrinol (Lausanne) 2022; 13:1019935. [PMID: 36531481 PMCID: PMC9747764 DOI: 10.3389/fendo.2022.1019935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
Since the Human Genome Project was successfully completed, humanity has entered a post-genome era, and the second-generation sequencing technology has gradually progressed and become more accurate. Meanwhile, circRNAs plays a crucial role in the regulation of diseases and potential clinical applications has gradually attracted the attention of physicians. However, the mechanisms of circRNAs regulation at the cellular and molecular level of diabetic foot ulcer (DFU) is still not well-understood. With the deepening of research, there have been many recent studies conducted to explore the effect of circRNAs on DFU. In this mini-review, we discuss the potential role of circRNAs as therapeutic targets and diagnostic markers for DFU in order to gain a better understanding of the molecular mechanisms that underlie the development of DFU and to establish a theoretical basis for accurate treatment and effective prevention.
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Affiliation(s)
- Deer Li
- Graduate School, Inner Mongolia Medical University, Hohhot, China
- Department of Traumatology and Orthopedics, Inner Mongolia People’s Hospital, Hohhot, China
| | - Jiaxing Guo
- Department of Joint Surgery, The Second Affiliated Hospital, Inner Mongolia Medical University, Hohhot, China
| | - Xiyu Ni
- Graduate School, Inner Mongolia Medical University, Hohhot, China
- Department of Traumatology and Orthopedics, Inner Mongolia People’s Hospital, Hohhot, China
| | - Guanwen Sun
- Department of Traumatology and Orthopedics, Inner Mongolia People’s Hospital, Hohhot, China
| | - Huhe Bao
- Department of Traumatology and Orthopedics, Inner Mongolia People’s Hospital, Hohhot, China
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19
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Wang T, Fan L, Liu J, Tao Y, Li X, Wang X, Li L. Negative Pressure Wound Therapy Promotes Wound Healing by Inhibiting Inflammation in Diabetic Foot Wounds: A Role for NOD1 Receptor. INT J LOW EXTR WOUND 2022:15347346221131844. [PMID: 36221954 DOI: 10.1177/15347346221131844] [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: 11/16/2022]
Abstract
Aims: Diabetic foot results in frequent amputation and quality-of-life reduction in diabetes population. These lesions are featured by a prolonged and exaggerated inflammation with a significant impairment in local bacterial invasion. Negative pressure wound therapy (NPWT) attenuates hyperinflammation in the healing of diabetic foot wounds, but the potential mechanism of NPWT down-regulated inflammatory reaction still remains elusive. This study aims to explore the inflammatory signaling involved in the effect of NPWT on diabetic ulcer. Methods: Thirty patients with diabetic foot ulceration were divided into NPWT group (treated with NPWT, n = 10), NPWT + FK565 group (treated with NPWT combined with FK565 which is NOD1 receptor ligand, n = 10) and control group (n = 10). After two weeks treatment, samples were harvested and analyzed by histochemistry for infiltration of inflammatory cells, immunofluorescence stain for NOD1, western blotting for NOD1, RIP2 (Receptor interacting protein 2), IL-1β, TAK1 (Transforming growth factor-β-activated kinase1), p65 and real time-PCR for expression of NOD1 and RIP2. Results: NPWT could notably accelerate the diabetic wound healing through alleviating inflammatory reaction. The immunofluorescence analysis results revealed that NOD1 was mainly expressed in the cytoplasm and noticeably decreased after the NPWT treatment. And NPWT obviously decreased both the mRNA and protein level of NOD1 and RIP2. Moreover, The protein expression of IL-1β, TAK1 and p65 in the NPWT-group were significant decreased. Conclusion: NPWT effectively promotes wound healing by suppressing the wound inflammation in diabetic foot, which is mediated at least in part by suppression of NOD1 receptor.
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Affiliation(s)
- Tao Wang
- Department of Vascular Surgery, Qingpu Branch of 92323Zhongshan Hospital, affiliated to Fudan University, Shanghai, China
| | - Longhua Fan
- Department of Vascular Surgery, Qingpu Branch of 92323Zhongshan Hospital, affiliated to Fudan University, Shanghai, China
| | - Jianjun Liu
- Department of Vascular Surgery, Qingpu Branch of 92323Zhongshan Hospital, affiliated to Fudan University, Shanghai, China
| | - Yue Tao
- Department of Vascular Surgery, Qingpu Branch of 92323Zhongshan Hospital, affiliated to Fudan University, Shanghai, China
| | - Xu Li
- Department of Vascular Surgery, Qingpu Branch of 92323Zhongshan Hospital, affiliated to Fudan University, Shanghai, China
| | - Xiaojun Wang
- Department of Vascular Surgery, Qingpu Branch of 92323Zhongshan Hospital, affiliated to Fudan University, Shanghai, China
| | - Limeng Li
- Department of Vascular Surgery, Qingpu Branch of 92323Zhongshan Hospital, affiliated to Fudan University, Shanghai, China
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20
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Chakraborty R, Borah P, Dutta PP, Sen S. Evolving spectrum of diabetic wound: Mechanistic insights and therapeutic targets. World J Diabetes 2022; 13:696-716. [PMID: 36188143 PMCID: PMC9521443 DOI: 10.4239/wjd.v13.i9.696] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/12/2022] [Accepted: 08/18/2022] [Indexed: 02/05/2023] Open
Abstract
Diabetes mellitus is a chronic metabolic disorder resulting in an increased blood glucose level and prolonged hyperglycemia, causes long term health conse-quences. Chronic wound is frequently occurring in diabetes patients due to compromised wound healing capability. Management of wounds in diabetic patients remains a clinical challenge despite many advancements in the field of science and technology. Increasing evidence indicates that alteration of the biochemical milieu resulting from alteration in inflammatory cytokines and matrix metalloproteinase, decrease in fibroblast and keratinocyte functioning, neuropathy, altered leukocyte functioning, infection, etc., plays a significant role in impaired wound healing in diabetic people. Apart from the current pharmacotherapy, different other approaches like the use of conventional drugs, antidiabetic medication, antibiotics, debridement, offloading, platelet-rich plasma, growth factor, oxygen therapy, negative pressure wound therapy, low-level laser, extracorporeal shock wave bioengineered substitute can be considered in the management of diabetic wounds. Drugs/therapeutic strategy that induce angiogenesis and collagen synthesis, inhibition of MMPs, reduction of oxidative stress, controlling hyperglycemia, increase growth factors, regulate inflammatory cytokines, cause NO induction, induce fibroblast and keratinocyte proliferation, control microbial infections are considered important in controlling diabetic wound. Further, medicinal plants and/or phytoconstituents also offer a viable alternative in the treatment of diabetic wound. The focus of the present review is to highlight the molecular and cellular mechanisms, and discuss the drug targets and treatment strategies involved in the diabetic wound.
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Affiliation(s)
- Raja Chakraborty
- Institute of Pharmacy, Assam Don Bosco University, Kamrup 782402, Assam, India
| | - Pobitra Borah
- School of Pharmacy, Graphic Era Hill University, Dehradun 248002, Uttarakhand, India
| | - Partha Pratim Dutta
- Faculty of Pharmaceutical Science, Assam down town University, Guwahati 781026, Assam, India
| | - Saikat Sen
- Faculty of Pharmaceutical Science, Assam down town University, Guwahati 781026, Assam, India
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21
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Lu X, Qin L, Guo M, Geng J, Dong S, Wang K, Xu H, Qu C, Miao J, Liu M. A novel alginate from Sargassum seaweed promotes diabetic wound healing by regulating oxidative stress and angiogenesis. Carbohydr Polym 2022; 289:119437. [PMID: 35483850 DOI: 10.1016/j.carbpol.2022.119437] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/12/2022] [Accepted: 03/29/2022] [Indexed: 01/02/2023]
Abstract
Diabetic skin ulcer is one of the most severe complications in diabetes, however, current therapeutic approaches are not effective enough. Agents modulating oxidative stress, inflammation, and angiogenesis are quite promising for alleviation of diabetic skin ulcers. In this study, a novel Sargassum kjellmanianum-derived polysaccharide (SARP) was prepared. SARP was an alginate with Mw of 45.4 kDa, consisting of 76.56% mannuronic acid, 18.89% guluronic acid, and 4.55% glucuronic acid. SARP could attenuate oxidative stress-induced cell damage via activating nuclear factor erythroid 2-related factor 2 (Nrf2). SARP also promoted the migration and tube formation of HUVECs, which was related to the increased vascular endothelial growth factor (VEGF) expression. In diabetic wound model, SARP (iv, 200 mg/kg) administration increased angiogenesis, alleviated oxidative stress, ameliorated diabetes-related aberrations, and thereby accelerated diabetic wound healing. These findings identified SARP had potential to be developed as a drug candidate for diabetic skin ulcers.
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Affiliation(s)
- Xuxiu Lu
- Key Laboratory of Marine Drugs, Ministry of Education, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China; Laboratory for Marine Drugs and Bioproducts of Qingdao National Laboratory for Marine Science and Technology, Qingdao 266237, China
| | - Ling Qin
- Key Laboratory of Marine Eco-Environmental Science and Technology, First Institute of Oceanography, Ministry of Natural Resource, Qingdao 266061, China
| | - Meng Guo
- Key Laboratory of Marine Drugs, Ministry of Education, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China
| | - Jiajia Geng
- Key Laboratory of Marine Drugs, Ministry of Education, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China
| | - Songtao Dong
- Key Laboratory of Marine Drugs, Ministry of Education, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China
| | - Kai Wang
- Key Laboratory of Marine Drugs, Ministry of Education, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China; Key Laboratory of Marine Eco-Environmental Science and Technology, First Institute of Oceanography, Ministry of Natural Resource, Qingdao 266061, China
| | - Hui Xu
- Key Laboratory of Marine Eco-Environmental Science and Technology, First Institute of Oceanography, Ministry of Natural Resource, Qingdao 266061, China
| | - Changfeng Qu
- Laboratory for Marine Drugs and Bioproducts of Qingdao National Laboratory for Marine Science and Technology, Qingdao 266237, China; Key Laboratory of Marine Eco-Environmental Science and Technology, First Institute of Oceanography, Ministry of Natural Resource, Qingdao 266061, China
| | - Jinlai Miao
- Laboratory for Marine Drugs and Bioproducts of Qingdao National Laboratory for Marine Science and Technology, Qingdao 266237, China; Key Laboratory of Marine Eco-Environmental Science and Technology, First Institute of Oceanography, Ministry of Natural Resource, Qingdao 266061, China; Guangxi Academy of Sciences, Nanning 530007, China..
| | - Ming Liu
- Key Laboratory of Marine Drugs, Ministry of Education, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China; Laboratory for Marine Drugs and Bioproducts of Qingdao National Laboratory for Marine Science and Technology, Qingdao 266237, China.
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22
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Xu H, Wang J, Wu D, Qin D. A hybrid hydrogel encapsulating human umbilical cord mesenchymal stem cells enhances diabetic wound healing. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:60. [PMID: 35849219 PMCID: PMC9293866 DOI: 10.1007/s10856-022-06681-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/19/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND Diabetic wound is a severe complication of diabetes. Stem cell is considered as a promising therapy for diabetic skin wounds. Hydrogel can supply niche for cells adhesion and survival to improve the efficacy of stem cell therapy, but the development of hydrogel with suitable properties remains a great challenge. Thus, our study was conducted to combine an optimized hydrogel with stem cell to improve complex diabetic wound treatment. METHODS This study constructed a hydrogel with low toxicity and adjustable mechanical properties from gelatin methacrylate (GelMA) and chitosan-catechol (Chi-C), and encapsulated human umbilical cord-mesenchymal stem cells (hUMSCs) to repair full-thickness diabetic wound. RESULTS We explored the relationship between mechanical stiffness and cell proliferation and differentiation potency, and found 10% GelMA hydrogel with an optimal stiffness improved hUMSCs adhesion, proliferation, and differentiation potency maintenance in vitro. Assistant with optimized hydrogel encapsulating hUMSCs, diabetic wound healing process was greatly accelerated, including accelerated wound closure, inhibited secretion of inflammatory factors TNF-α and IL-1β, promoted vascular regeneration and collagen deposition after treatment of hUMSCs. CONCLUSIONS The optimized hydrogel encapsulating hUMSCs improved diabetic wound healing, and has a broad implication for the treatment of diabetic complication. Diabetic wound is a severe complication of diabetes. Stem cell is considered as a promising therapy for diabetic skin wounds. Hydrogel can supply niche for cells adhesion and survival to improve the efficacy of stem cell therapy. This study constructed a hydrogel with low toxicity and adjustable mechanical properties from gelatin methacrylate (GelMA) and chitosan-catechol (Chi-C), and encapsulated human umbilical cord-mesenchymal stem cells (hUMSCs) to repair full-thickness diabetic wound. Hydrogel of 10% GelMA with an optimal stiffness improved hUMSCs adhesion, proliferation, and differentiation potency maintenance in vitro. Assistant with optimized hydrogel encapsulating hUMSCs, diabetic wound healing process was greatly accelerated, including accelerated wound closure, inhibited secretion of inflammatory factors TNF-α and IL-1β, promoted vascular regeneration and collagen deposition after treatment of hUMSCs. The study supplies an alternative treatment for diabetic complication. Hydrogel-hUMSCs combined treatment accelerates wound closure in diabetic mice. A. Representative images of wounds during 21-day in vivo experiments. B. Quantification of wound closure rate (%) over 21-day period. C. HE staining of wounds at days 7, 14 and 21. The bar corresponds to 200 μm.
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Affiliation(s)
- Hongjie Xu
- Innovation Centre for Advanced Interdisciplinary Medicine, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510799, China
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, 510663, China
| | - Jingjing Wang
- Department of Neurology, Weihai Central Hospital, Weihai, China
| | - Di Wu
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, 510663, China
| | - Dajiang Qin
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, 510663, China.
- Innovation Centre for Advanced Interdisciplinary Medicine, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510799, China.
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23
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Gong F, Zhang Y, Gao J, Li X, Zhang H, Ma G, Huang Y, Zhang B, Zhao F. Effect of platelet-rich plasma vs standard management for the treatment of diabetic foot ulcer wounds: A meta-analysis. Int Wound J 2022; 20:155-163. [PMID: 35751432 PMCID: PMC9797932 DOI: 10.1111/iwj.13858] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 01/07/2023] Open
Abstract
We performed a meta-analysis to evaluate the effect of platelet-rich plasma vs standard management for the treatment of diabetic foot ulcer wounds. A systematic literature search up to March 2022 was performed and 1435 subjects with diabetic foot ulcer wounds at the baseline of the studies; 723 of them were treated with platelet-rich plasma, and 712 used control. Odds ratio (OR) with 95% confidence intervals (CIs) was calculated to assess the effect of platelet-rich plasma vs standard management for the treatment of diabetic foot ulcer wounds using the dichotomous method with a random or fixed-effect model. The use of autologous platelet-rich plasma resulted in significantly higher complete-healed diabetic foot ulcer wounds compared with control (OR, 1.95; 95% CI, 1.49-2.56, P < 0.001). The use of allogeneic platelet-rich plasma resulted in significantly higher complete-healed diabetic foot ulcer wounds compared with control (OR, 6.19; 95% CI, 2.32-16.56, P < 0.001). The use of autologous and allogeneic platelet-rich plasma resulted in significantly higher complete-healed diabetic foot ulcer wounds compared with control. Though, the analysis of outcomes should be with caution because of the low number of studies in certain comparisons, for example, allogeneic platelet-rich plasma compared with control.
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Affiliation(s)
- Fan Gong
- Department of OrthopedicsPeople's Hospital of Ningxia Hui Autonomous RegionNingxiaChina
| | - Yun Zhang
- Department of OrthopedicsPeople's Hospital of Ningxia Hui Autonomous RegionNingxiaChina
| | - Jian Gao
- Department of OrthopedicsPeople's Hospital of Ningxia Hui Autonomous RegionNingxiaChina
| | - Xiaoliang Li
- Department of OrthopedicsPeople's Hospital of Ningxia Hui Autonomous RegionNingxiaChina
| | - Hanlin Zhang
- Department of OrthopedicsPeople's Hospital of Ningxia Hui Autonomous RegionNingxiaChina
| | - Guoxu Ma
- Department of OrthopedicsPeople's Hospital of Ningxia Hui Autonomous RegionNingxiaChina
| | - Yonglu Huang
- Department of OrthopedicsPeople's Hospital of Ningxia Hui Autonomous RegionNingxiaChina
| | - Bowen Zhang
- Department of OrthopedicsPeople's Hospital of Ningxia Hui Autonomous RegionNingxiaChina
| | - Fei Zhao
- Department of OrthopedicsPeople's Hospital of Ningxia Hui Autonomous RegionNingxiaChina
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24
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Basiri R, Spicer M, Levenson C, Ledermann T, Akhavan N, Arjmandi B. Improving Dietary Intake of Essential Nutrients Can Ameliorate Inflammation in Patients with Diabetic Foot Ulcers. Nutrients 2022; 14:nu14122393. [PMID: 35745123 PMCID: PMC9228459 DOI: 10.3390/nu14122393] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 01/27/2023] Open
Abstract
Diabetic foot ulcers (DFUs) are classified as chronic wounds and are one of the most common complications of diabetes. In chronic wounds, management of inflammation is a key step in treatment. Nutrition plays an important role in managing and controlling inflammation. This study evaluated the effects of nutrition supplementation and education on inflammatory biomarkers in patients with DFUs. Eligible patients with foot ulcers were randomly assigned to either a treatment (n = 15) or control group (n = 14). Both groups received standard care for wound treatment from the clinic; however, the treatment group was also provided with nutritional supplementation and education. Plasma concentrations of inflammatory biomarkers, namely C-reactive protein (CRP), interleukin 6 (IL6), interleukin 10 (IL10), and tristetraprolin (TTP), were evaluated at baseline and every four weeks, until complete wound closure had occurred or up to 12 weeks. The mean plasma concentration of IL6 significantly decreased in the treatment group (p = 0.001). The interaction between time and group was not statistically significant for the mean plasma concentrations of CRP, IL10, and TTP during the 12 weeks of the study. The results of this study showed the positive effects of nutritional intervention on controlling inflammation in DFU patients. More clinical trials with a larger population and longer duration of time are needed to confirm our results.
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Affiliation(s)
- Raedeh Basiri
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL 32306, USA; (M.S.); (N.A.); (B.A.)
- Center for Advancing Exercise and Nutrition Research on Aging, Florida State University, Tallahassee, FL 32306, USA
- Correspondence:
| | - Maria Spicer
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL 32306, USA; (M.S.); (N.A.); (B.A.)
| | - Cathy Levenson
- Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
| | - Thomas Ledermann
- Department of Family and Child Sciences, Florida State University, Tallahassee, FL 32306, USA;
| | - Neda Akhavan
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL 32306, USA; (M.S.); (N.A.); (B.A.)
- Center for Advancing Exercise and Nutrition Research on Aging, Florida State University, Tallahassee, FL 32306, USA
| | - Bahram Arjmandi
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL 32306, USA; (M.S.); (N.A.); (B.A.)
- Center for Advancing Exercise and Nutrition Research on Aging, Florida State University, Tallahassee, FL 32306, USA
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25
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Zizhu Ointment Accelerates Wound-Healing of Diabetic Ulcers through Promoting M2 Macrophage Polarization via Downregulating the Notch4 Signaling Pathway. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:5173836. [PMID: 35619768 PMCID: PMC9129934 DOI: 10.1155/2022/5173836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 11/17/2022]
Abstract
Objective The long-term clinical practice shows that Zizhu ointment (ZZO) is an empirical formula for the treatment of diabetic ulcers (DUs). In this study, we investigated the underlying mechanism of ZZO in the treatment of DU mice. Methods Through streptozotocin induction and high-fat diet, a DU mouse model was established and ZZO was given for treatment. The activation of Notch4 signaling was examined by immunofluorescence staining, RT-PCR, as well as Western blotting. Flow cytometry was performed to detect the counts of F4/80+ cells, M1 and M2 macrophages, as well as the expression of CD11c, CD206, etc. The role of Notch4 in wound healing in diabetic mice was verified by Notch4 inhibitors and agonists. Results Accelerated wound healing and decreased expression levels of Notch4 and its target genes and ligands were observed in diabetic mice treated with ZZO. ZZO promoted M2 macrophage polarization, downregulated the expression of proinflammatory factors, and upregulated the levels of anti-inflammatory factors. The same tendency was observed in diabetic mice after treatment with Notch4 inhibitors. Knockout of Notch4 accelerated the wound healing rate as well. Conclusions ZZO accelerates wound healing of diabetic mice through inhibiting the activation of Notch4 signaling, promoting M2 macrophage polarization, and alleviating inflammation.
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26
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Zhu S, Yu C, Zhao M, Liu N, Chen Z, Liu J, Li G, Deng Y, Sai X, Huang H, Guo H, Chen C, Wang X, Zheng Y, Sun T, Chen J, Zhuang J, Zhu P. Histatin-1 loaded multifunctional, adhesive and conductive biomolecular hydrogel to treat diabetic wound. Int J Biol Macromol 2022; 209:1020-1031. [PMID: 35390401 DOI: 10.1016/j.ijbiomac.2022.03.214] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/09/2022] [Accepted: 03/31/2022] [Indexed: 11/05/2022]
Abstract
Micro-/macroangiopathy, neuropathy and prolonged inflammation are common in diabetic wound, however, traditional wound dressing cannot treat these problems in the same time. Herein, we developed a multifunctional hydrogel with promoted angiogenesis, cell proliferation and anti-inflammation ability to treat diabetic wound. The hydrogel was composed of natural polymers, including gelatin and chitosan, which have excellent biocompatibility. Histatin-1 (His-1) was added into the hydrogel to improve the cell adhesion, proliferation and angiogenesis. Besides, polypyrrole based conductive nanoparticles (G-Ppy) were introduced in the hydrogel to enhance the electrical signal conduction between skin and promote the mechanical strength of the hydrogel. The polypyrrole nanoparticles were growth in the chain of methacryloyl grafted gelatin (Gel-MA), leading to a better biocompatibility and water dispersibility. In vivo wound healing experiment proved that the hydrogel accelerated the wound healing rate, down regulation the expression of pro-inflammation factor TNF-α and upregulation the expression of CD31 and α-SMA, indicating the prospects in the application of diabetic wound healing.
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Affiliation(s)
- Shuoji Zhu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Changjiang Yu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Mingyi Zhao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Nanbo Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - ZeRui Chen
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Jian Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Ge Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Yuzhi Deng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Xiyalatu Sai
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Huanlei Huang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Huiming Guo
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Chen Chen
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Xiaowu Wang
- Department of Cardiovascular Surgery, ZhuJiang Hospital of Southern Medical University, Guangzhou 510280, China
| | - Yuanyuan Zheng
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Department of Biomedical Engineering, Jinan University, Guangzhou 510632, China
| | - Tucheng Sun
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Jimei Chen
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China.
| | - Jian Zhuang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China.
| | - Ping Zhu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China.
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27
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Monika P, Chandraprabha MN, Rangarajan A, Waiker PV, Chidambara Murthy KN. Challenges in Healing Wound: Role of Complementary and Alternative Medicine. Front Nutr 2022; 8:791899. [PMID: 35127787 PMCID: PMC8811258 DOI: 10.3389/fnut.2021.791899] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/08/2021] [Indexed: 12/26/2022] Open
Abstract
Although the word wound sounds like a simple injury to tissue, individual's health status and other inherent factors may make it very complicated. Hence, wound healing has gained major attention in the healthcare. The biology wound healing is precise and highly programmed, through phases of hemostasis, inflammation, proliferation and remodeling. Current options for wound healing which includes, use of anti-microbial agents, healing promoters along with application of herbal and natural products. However, there is no efficient evidence-based therapy available for specific chronic wounds that can result in definitive clinical outcomes. Under co-morbid conditions, chronic would poses numerous challenges. Use of Complementary and Alternative Medicines (CAMs) in health care sector is increasing and its applications in wound management remains like to "separate the diamonds from ore." Attempts have been made to understand the wound at the molecular level, mainly through the analysis of signature genes and the influence of several synthetic and natural molecules on these. We have outlined a review of challenges in chronic wound healing and the role of CAMs in chronic wound management. The main focus is on the applications and limitations of currently available treatment options for a non-healing wound and the best possible alternates to consider. This information generates broader knowledge on challenges in chronic wound healing, which can be further addressed using multidisciplinary approach and combination therapies.
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Affiliation(s)
- Prakash Monika
- Department of Biotechnology, M.S. Ramaiah Institute of Technology, Bangalore, India
| | | | - Annapoorni Rangarajan
- Department of Molecular Reproduction, Development and Genetics, Indian Institute of Science, Bangalore, India
| | - P. Veena Waiker
- Department of Plastic Surgery, Ramaiah Medical College and Hospitals, Bangalore, India
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28
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Pastar I, Sawaya AP, Marjanovic J, Burgess JL, Strbo N, Rivas KE, Wikramanayake TC, Head CR, Stone RC, Jozic I, Stojadinovic O, Kornfeld EY, Kirsner RS, Lev-Tov H, Tomic-Canic M. Intracellular Staphylococcus aureus triggers pyroptosis and contributes to inhibition of healing due to Perforin-2 suppression. J Clin Invest 2021; 131:133727. [PMID: 34730110 DOI: 10.1172/jci133727] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Impaired wound healing associated with recurrent Staphylococcus aureus infection and unresolved inflammation are hallmarks of non-healing diabetic foot ulcers (DFU). Perforin-2, an innate immunity molecule against intracellular bacteria, limits cutaneous infection and dissemination of S. aureus in mice. Here we report the intracellular accumulation of S. aureus in the epidermis of DFU with no clinical signs of infection due to marked suppression of Perforin-2. S. aureus residing within the epidermis of DFU triggers AIM2-inflammasome activation and pyroptosis. These findings were corroborated in mice lacking Perforin-2. The effects of pyroptosis on DFU clinical outcomes were further elucidated in a 4-week longitudinal clinical study in DFU patients undergoing standard of care. Increased AIM2-inflammasome and ASC-pyroptosome coupled with induction of IL-1β were found in non-healing when compared to healing DFU. Our findings reveal novel mechanism that includes Perforin-2 suppression, intracellular S. aureus accumulation and associated induction of pyroptosis that contribute to healing inhibition and prolonged inflammation in patients with DFU.
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Affiliation(s)
- Irena Pastar
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, United States of America
| | - Andrew P Sawaya
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, United States of America
| | - Jelena Marjanovic
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, United States of America
| | - Jamie L Burgess
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, United States of America
| | - Natasa Strbo
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, United States of America
| | - Katelyn E Rivas
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, United States of America
| | - Tongyu C Wikramanayake
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, United States of America
| | - Cheyanne R Head
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, United States of America
| | - Rivka C Stone
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, United States of America
| | - Ivan Jozic
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, United States of America
| | - Olivera Stojadinovic
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, United States of America
| | - Eran Y Kornfeld
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, United States of America
| | - Robert S Kirsner
- University of Miami Miller School of Medicine, Miami, United States of America
| | - Hadar Lev-Tov
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, United States of America
| | - Marjana Tomic-Canic
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, United States of America
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29
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Burgess JL, Wyant WA, Abdo Abujamra B, Kirsner RS, Jozic I. Diabetic Wound-Healing Science. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1072. [PMID: 34684109 PMCID: PMC8539411 DOI: 10.3390/medicina57101072] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022]
Abstract
Diabetes mellitus is an increasingly prevalent chronic metabolic disease characterized by prolonged hyperglycemia that leads to long-term health consequences. It is estimated that impaired healing of diabetic wounds affects approximately 25% of all patients with diabetes mellitus, often resulting in lower limb amputation, with subsequent high economic and psychosocial costs. The hyperglycemic environment promotes the formation of biofilms and makes diabetic wounds difficult to treat. In this review, we present updates regarding recent advances in our understanding of the pathophysiology of diabetic wounds focusing on impaired angiogenesis, neuropathy, sub-optimal chronic inflammatory response, barrier disruption, and subsequent polymicrobial infection, followed by current and future treatment strategies designed to tackle the various pathologies associated with diabetic wounds. Given the alarming increase in the prevalence of diabetes, and subsequently diabetic wounds, it is imperative that future treatment strategies target multiple causes of impaired healing in diabetic wounds.
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Affiliation(s)
| | | | | | - Robert S. Kirsner
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (J.L.B.); (W.A.W.); (B.A.A.)
| | - Ivan Jozic
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (J.L.B.); (W.A.W.); (B.A.A.)
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30
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Human umbilical cord mesenchymal stem cells in type 2 diabetes mellitus: the emerging therapeutic approach. Cell Tissue Res 2021; 385:497-518. [PMID: 34050823 DOI: 10.1007/s00441-021-03461-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/11/2021] [Indexed: 12/14/2022]
Abstract
The umbilical cord has been proved to be an easy-access, reliable, and useful source of mesenchymal stem cells (MSC) for clinical applications due to its primitive, immunomodulatory, non-immunogenic, secretory and paracrine, migratory, proliferative, and multipotent properties. This set of characteristics has recently attracted great research interest in the fields of nanotechnology and regenerative medicine and cellular therapy. Accumulating evidence supports a pronounced therapeutic potential of MSC in many different pathologies, from hematology to immunology, wound-healing, tissue regeneration, and oncology. Diabetes mellitus, branded the epidemic of the century, is considered a chronic metabolic disorder, representing a major burden for health system sustainability and an important public health challenge to modern societies. The available treatments for type 2 diabetes mellitus (T2DM) still rely mainly on combinations of oral antidiabetic agents with lifestyle and nutritional adjustments. Despite the continuous development of novel and better hypoglycemic drugs, their efficacy is limited in the installment and progression of silent T2DM complications. T2DM comorbidities and mortality rates still make it a serious, common, costly, and long-term manageable disease. Recently, experimental models, preclinical observations, and clinical studies have provided some insights and preliminary promising results using umbilical cord MSCs to treat and manage diabetes. This review focuses on the latest research and applications of human-derived umbilical cord MSC in the treatment and management of T2DM, exploring and systematizing the key effects of both umbilical cord MSC and its factor-rich secretome accordingly with the major complications associated to T2DM.
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31
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Casadei G, Filippini M, Brognara L. Glycated Hemoglobin (HbA1c) as a Biomarker for Diabetic Foot Peripheral Neuropathy. Diseases 2021; 9:16. [PMID: 33671807 PMCID: PMC8006047 DOI: 10.3390/diseases9010016] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is known to predict foot ulceration, lower-extremity amputation and mortality. Patients with diabetes mellitus have a predisposition toward developing chronic inflammatory demyelinating polyneuropathy, and this may also facilitate the formation of diabetic foot and cutaneous impairment, which are considered one of the most serious impairments of diabetes mellitus, with a prevalence of 4-10% in this population. Biomarkers research provides opportunities for the early diagnosis of these complications for specific treatments useful to prevent amputation and, therefore, physical inability and mental disturbance. The recent literature has suggested that glycemic levels may be a novel factor in the pathogenesis of diabetic foot complications and is an important mediator of axonal dysfunction. The aim of this systematic literary review is to determine whether hemoglobin A1c (HbA1c) is a positive predictor for diabetic foot peripheral neuropathy and its complications, such as foot cutaneous impairments. There is a lack of consensus regarding the effect of glycemic variability on diabetic foot peripheral neuropathy, unlike other complications such as retinopathy, nephropathy or micro/macrovascular pathology Methods: Relevant articles were searched in the Medline database using PubMed and Scopus and relevant keywords. The primary search terms used were "glycated hemoglobin" OR "HbA1c" AND "diabetic neuropathies" AND "Foot". RESULTS A number of articles (336) were initially identified while searching the scientific literature regarding this topic, and 32 articles were selected and included in this review. CONCLUSIONS This review highlights the role of HbA1c in diabetic foot peripheral neuropathy. Biomarkers play an important role in the decision-making process, and HbA1c levels are extensively used for diabetic foot clinical outcomes and settings, but biomarker research in diabetic foot peripheral neuropathy is in its infancy and will require careful attention to a number of factors and associations, since the consequences of DPN also include neurological alterations. HbA1c is an accurate and easy-to-administer test and can be an effective biomarker in establishing the diagnosis of diabetes, but future research should focus on standardizing the HbA1c level and selecting which DPN value and its correlated complications, such as foot cutaneous impairments, are the most informative.
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Affiliation(s)
- Giulia Casadei
- Medical Clinic of Doctor Accorsi, Via della Ghisiliera 5, 40123 Bologna, Italy; (G.C.); (M.F.)
| | - Marta Filippini
- Medical Clinic of Doctor Accorsi, Via della Ghisiliera 5, 40123 Bologna, Italy; (G.C.); (M.F.)
| | - Lorenzo Brognara
- Department of Biomedical and Neuromotor Science, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy
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32
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Riedel U, Schüßler E, Härtel D, Keiler A, Nestoris S, Stege H. [Wound treatment in diabetes patients and diabetic foot ulcers]. Hautarzt 2020; 71:835-842. [PMID: 33044558 DOI: 10.1007/s00105-020-04699-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Diabetes mellitus (DM) is a paramount and rising medical challenge in both industrial and emerging nations. For Germany, 6.9 million out of 64.9 million insured persons in 2010 were reported to suffer from DM and approximately 5.8 million suffered from type 2 DM. The prevalence of diabetic foot ulcer (DFU) or diabetic foot syndrome (DFS) is 2-10% and the incidence is 2-6%. In addition, patients with DM present associated skin disorders with chronic wound healing, e.g., pyoderma gangrenosum or lecrobiosis lipoidica. Knowledge of the pathogenesis and skills for treatment of chronic wounds in diabetic patients are important for dermatologists. Patients with diabetes and wound healing disorders and accompanied unspecific skin disorders like eczema, cellulitis or contact dermatitis are often primarily or secondarily treated by dermatologists. In this article, practical hints for the treatment of DFS and other chronic wound in patients with DM are presented.
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Affiliation(s)
- U Riedel
- Dermatologische Klinik, Klinikum Lippe, Bülowstr. 1, 32756, Detmold, Deutschland
| | - E Schüßler
- Dermatologische Klinik, Klinikum Lippe, Bülowstr. 1, 32756, Detmold, Deutschland
| | - D Härtel
- Klinik für Innere Medizin/Kardiologie, Angiologie und Internistische Intensivmedizin, Klinikum Lippe, Detmold, Deutschland
| | - A Keiler
- Dermatologische Klinik, Klinikum Lippe, Bülowstr. 1, 32756, Detmold, Deutschland
| | - S Nestoris
- Dermatologische Klinik, Klinikum Lippe, Bülowstr. 1, 32756, Detmold, Deutschland
| | - H Stege
- Dermatologische Klinik, Klinikum Lippe, Bülowstr. 1, 32756, Detmold, Deutschland.
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Marei A, Alakad R, Wahid RM. Evaluation of intralesional Candida antigen in diabetic patients with multiple warts. J Cosmet Dermatol 2020; 20:1248-1253. [PMID: 32924256 DOI: 10.1111/jocd.13718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Treatment of warts in diabetic patients with ablative modalities poses a significant risk owing to increased possibility of secondary infection, slow healing, and recurrence. Intralesional immunotherapy has gained popularity in the treatment of warts due to its proven efficacy and good tolerability compared with destructive methods. AIM To evaluate the intralesional Candida antigen injection for the treatment of multiple warts in diabetic patients. PATIENTS/METHODS Fifty diabetic patients with multiple genital/nongenital warts were divided into two groups. The first group (30 patients) received intralesional Candida antigen, and the second group (20 patients) had intralesional saline as control. The treatments were injected into the largest wart every 2 weeks until complete clearance of warts or for a maximum of five sessions. RESULTS Complete clearance of warts was observed in 80% of the diabetic patients in the Candida antigen group compared with 15% in the control group (P < .001). Side effects to Candida antigen included pain during injection in all patients, flu-like symptoms, and localized reaction at the injection site in few patients. CONCLUSION Intralesional Candida antigen injection can be a promising effective and safe therapeutic option for the treatment of warts in diabetic patients.
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Affiliation(s)
- Ayman Marei
- Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Interventional Research Lab, Interventional Immunology and Allergy Center, Zagazig, Egypt
| | - Rania Alakad
- Interventional Research Lab, Interventional Immunology and Allergy Center, Zagazig, Egypt.,Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Reham M Wahid
- Physiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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34
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Bostan LE, Almqvist S, Pullar CE. A pulsed current electric field alters protein expression creating a wound healing phenotype in human skin cells. Regen Med 2020; 15:1611-1623. [PMID: 32633622 DOI: 10.2217/rme-2019-0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Pulsed current (PC) electric field (EF) devices promote healing in chronic wounds but the underpinning mechanisms are largely unknown. The gap between clinical evidence and mechanistic understanding limits device uptake in clinics. Materials & methods: Migration, proliferation and gene/protein expression profiles were investigated in the presence/absence of PCEF, in skin: keratinocytes (NHK); dermal fibroblasts (HDF); dermal microvascular endothelial cells (HDMEC) and macrophages (THP-1). Results: While PCEF had little effect on migration or proliferation, it significantly altered the expression of 31 genes and the secretion of 7 pro-angiogenic and pro-regenerative growth factors using ELISAs. Conclusion: PCEF significantly altered skin cell genomes/proteomes which provides some evidence of how PCEF devices promote healing of chronic wounds.
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Affiliation(s)
- Luciana E Bostan
- University of Southampton, Faculty of Medicine, Southampton, SO16 6YD, UK
| | - Sofia Almqvist
- Mölnlycke Health Care AB, (P.O. Box 13080 SE-402 52) Göteborg, Sweden
| | - Christine E Pullar
- Department of Molecular & Cell Biology, College of Life Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
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35
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Isabela Avila-Rodríguez M, Meléndez-Martínez D, Licona-Cassani C, Manuel Aguilar-Yañez J, Benavides J, Lorena Sánchez M. Practical context of enzymatic treatment for wound healing: A secreted protease approach (Review). Biomed Rep 2020; 13:3-14. [PMID: 32440346 PMCID: PMC7238406 DOI: 10.3892/br.2020.1300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/14/2020] [Indexed: 12/13/2022] Open
Abstract
Skin wounds have been extensively studied as their healing represents a critical step towards achieving homeostasis following a traumatic event. Dependent on the severity of the damage, wounds are categorized as either acute or chronic. To date, chronic wounds have the highest economic impact as long term increases wound care costs. Chronic wounds affect 6.5 million patients in the United States with an annual estimated expense of $25 billion for the health care system. Among wound treatment categories, active wound care represents the fastest-growing category due to its specific actions and lower costs. Within this category, proteases from various sources have been used as successful agents in debridement wound care. The wound healing process is predominantly mediated by matrix metalloproteinases (MMPs) that, when dysregulated, result in defective wound healing. Therapeutic activity has been described for animal secretions including fish epithelial mucus, maggot secretory products and snake venom, which contain secreted proteases (SPs). No further alternatives for use, sources or types of proteases used for wound healing have been found in the literature to date. Through the present review, the context of enzymatic wound care alternatives will be discussed. In addition, substrate homology of SPs and human MMPs will be compared and contrasted. The purpose of these discussions is to identify and propose the stages of wound healing in which SPs may be used as therapeutic agents to improve the wound healing process.
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Affiliation(s)
| | - David Meléndez-Martínez
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico
| | | | - José Manuel Aguilar-Yañez
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico
- Scicore Medical SAPI de CV, Monterrey, Nuevo León 64920, Mexico
| | - Jorge Benavides
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico
| | - Mirna Lorena Sánchez
- Laboratorio de Materiales Biotecnológicos, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes-Imbice-Conicet-Cicpba, Bernal, Buenos Aires B1876BXD, Argentina
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36
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Huangbai Liniment Accelerated Wound Healing by Activating Nrf2 Signaling in Diabetes. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:4951820. [PMID: 32566084 PMCID: PMC7271242 DOI: 10.1155/2020/4951820] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/23/2019] [Accepted: 02/19/2020] [Indexed: 12/26/2022]
Abstract
As a serious complication of diabetes, nonhealing skin ulcer leads to high mortality and disability in diabetic patients. However, limited therapy is available in managing diabetic wounds. In this study, RNA-seq technology was used to systematically investigate the effect of Huangbai (HB) liniment, a traditional Chinese medicine, on the streptozotocin- (STZ-) induced diabetic wound. HB liniment significantly accelerated the wound closure and enhanced the generation of extracellular matrix in diabetic rats, and oxidative stress was identified to play a vital role in HB-mediated wound healing. Importantly, HB liniment activated nuclear factor erythroid-derived 2-like 2 (Nrf2) and its downstream antioxidant genes (e.g., genes involved in glutathione system, thioredoxin system, and GAPDH generation as well as other antioxidant genes), which inhibited oxidative damage and apoptosis. By associating drug targets of HB liniment with Nrf2 and its downstream genes, 54 components in HB liniment were screened out, and the majority was from Cortex Phellodendri and Forsythia suspensa. Additionally, HB liniment enhanced TGF-β1 and reduced MMP9 level, accelerating wound healing in diabetes. The in vitro experiment showed HB facilitated cell proliferation and inhibited oxidative damage in high glucose-induced HaCaT cells. Our findings provided the experimental evidence for the treatment of diabetic wound with HB, clarified the potential mechanism of HB, and improved our understanding of diabetic wound healing.
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37
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Crizón-Díaz DP, Morales-Cardona CA. Manifestaciones dermatológicas de la diabetes: clasificación y diagnóstico. IATREIA 2020. [DOI: 10.17533/udea.iatreia.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Se estima que en Colombia hay 2.836.500 adultos con diabetes, una enfermedad con una prevalencia del 8,4 %. La exposición a niveles elevados de glucosa afecta los procesos de proliferación y diferenciación en las células de todos los órganos y tejidos, así mismo en los queratinocitos, fibroblastos y demás células presentes en la piel, alteraciones que ocurren en más de un tercio de los diabéticos y que pueden ser la manifestación inicial de la enfermedad. La frecuencia y presentación de estas dermatosis varía según la población estudiada. La dermopatía diabética, la acantosis nigricans, los fibromas laxos, el prurito y la xerosis son las formas más comunes y se consideran marcadores cutáneos de la diabetes. La presente revisión se enfoca en las manifestaciones dermatológicas específicas y no específicas de la diabetes, así como en las relacionadas con su tratamiento. Estas pueden ser un reflejo del estado metabólico actual o previo del paciente diabético y su oportuna identificación permite orientar el diagnóstico primario, sospechar un estado rediabético u optimizar el tratamiento de la enfermedad en los individuos ya diagnosticados.
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38
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Shi C, Wang C, Liu H, Li Q, Li R, Zhang Y, Liu Y, Shao Y, Wang J. Selection of Appropriate Wound Dressing for Various Wounds. Front Bioeng Biotechnol 2020; 8:182. [PMID: 32266224 PMCID: PMC7096556 DOI: 10.3389/fbioe.2020.00182] [Citation(s) in RCA: 195] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/24/2020] [Indexed: 12/30/2022] Open
Abstract
There are many factors involved in wound healing, and the healing process is not static. The therapeutic effect of modern wound dressings in the clinical management of wounds is documented. However, there are few reports regarding the reasonable selection of dressings for certain types of wounds in the clinic. In this article, we retrospect the history of wound dressing development and the classification of modern wound dressings. In addition, the pros and cons of mainstream modern wound dressings for the healing of different wounds, such as diabetic foot ulcers, pressure ulcers, burns and scalds, and chronic leg ulcers, as well as the physiological mechanisms involved in wound healing are summarized. This article provides a clinical guideline for selecting suitable wound dressings according to the types of wounds.
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Affiliation(s)
- Chenyu Shi
- School of Nursing, Jilin University, Changchun, China.,Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Chenyu Wang
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Qiuju Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Ronghang Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Yan Zhang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Yuzhe Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Ying Shao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China.,Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- School of Nursing, Jilin University, Changchun, China.,Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
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Mehrvar S, Rymut KT, Foomani FH, Mostaghimi S, Eells JT, Ranji M, Gopalakrishnan S. Fluorescence Imaging of Mitochondrial Redox State to Assess Diabetic Wounds. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2019; 7:1800809. [PMID: 32166047 PMCID: PMC6889942 DOI: 10.1109/jtehm.2019.2945323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/15/2019] [Accepted: 09/22/2019] [Indexed: 01/06/2023]
Abstract
Background: Diabetes is known to cause delayed wound healing, and
chronic non-healing lower extremity ulcers may end with lower limb amputations and
mortalities. Given the increasing prevalence of diabetes mellitus worldwide, it is
critical to focus on underlying mechanisms of these debilitating wounds to find novel
therapeutic strategies and thereby improve patient outcome. Methods: This
study aims to design a label-free optical fluorescence imager that captures metabolic
indices (NADH and FAD autofluorescence) and monitors the in vivo wound
healing progress noninvasively. Furthermore, 3D optical cryo-imaging of the mitochondrial
redox state was utilized to assess the volumetric redox state of the wound tissue.
Results: The results from our in vivo fluorescence
imager and the 3D cryo-imager quantify the differences between the redox state of wounds
on diabetic mice in comparison with the control mice. These metabolic changes are
associated with mitochondrial dysfunction and higher oxidative stress in diabetic wounds.
A significant correlation was observed between the redox state and the area of the wounds.
Conclusion: The results suggest that our developed novel optical
imaging system can successfully be used as an optical indicator of the complex wound
healing process noninvasively.
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Affiliation(s)
- Shima Mehrvar
- 1Biophotonics LabDepartment of Electrical EngineeringUniversity of Wisconsin MilwaukeeMilwaukeeWI53211USA
| | - Kevin T Rymut
- 2College of NursingUniversity of Wisconsin MilwaukeeMilwaukeeWI53211USA
| | - Farnaz H Foomani
- 1Biophotonics LabDepartment of Electrical EngineeringUniversity of Wisconsin MilwaukeeMilwaukeeWI53211USA
| | - Soudeh Mostaghimi
- 1Biophotonics LabDepartment of Electrical EngineeringUniversity of Wisconsin MilwaukeeMilwaukeeWI53211USA
| | - Janis T Eells
- 3Department of Biomedical SciencesUniversity of Wisconsin MilwaukeeMilwaukeeWI53211USA
| | - Mahsa Ranji
- 1Biophotonics LabDepartment of Electrical EngineeringUniversity of Wisconsin MilwaukeeMilwaukeeWI53211USA
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40
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Lechner A, Akdeniz M, Tomova-Simitchieva T, Bobbert T, Moga A, Lachmann N, Blume-Peytavi U, Kottner J. Comparing skin characteristics and molecular markers of xerotic foot skin between diabetic and non-diabetic subjects: An exploratory study. J Tissue Viability 2019; 28:200-209. [PMID: 31575473 DOI: 10.1016/j.jtv.2019.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/06/2019] [Accepted: 09/23/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Xerosis cutis of the feet is one of the most common skin conditions among type 2 diabetics. Whether skin dryness among diabetic patients is different from 'general' skin dryness is unclear. The overall aim was to compare the structure, function and molecular markers of dry and cracked foot skin between diabetics and non-diabetics. METHODS The foot skin of 40 diabetics and 20 non-diabetics was evaluated. A clinical assessment of skin dryness was performed and transepidermal water loss, stratum corneum hydration, skin surface pH, epidermal thickness, skin roughness, elasticity and structural stiffness were measured. Ceramides, natural moisturizing factors, histamines, proteins and molecular markers of oxidative stress were analyzed based on a non-invasive sampling method for collection of surface biomarkers. RESULTS The mean number of superficial fissures in the diabetic group was nearly three times higher than in the non-diabetic group (11.0 (SD 6.2) vs. 3.9 (SD 4.2)). The skin stiffness was higher in the diabetic group and the values of almost all molecular markers showed considerably higher values compared to non-diabetics. Malondialdehyde and glutathione were lower in the diabetic sample. CONCLUSIONS The high number of superficial fissures may be based on an increased stiffness of dry diabetic foot skin combined with different concentrations of molecular markers in the stratum corneum compared to dry foot skin of non-diabetics.
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Affiliation(s)
- Anna Lechner
- Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Berlin, Germany.
| | - Merve Akdeniz
- Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Berlin, Germany.
| | - Tsenka Tomova-Simitchieva
- Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Berlin, Germany.
| | - Thomas Bobbert
- Charité-Universitätsmedizin Berlin, Department of Diabetology and Endocrinology, Berlin, Germany.
| | | | | | - Ulrike Blume-Peytavi
- Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Berlin, Germany.
| | - Jan Kottner
- Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Berlin, Germany.
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41
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Cañedo-Dorantes L, Cañedo-Ayala M. Skin Acute Wound Healing: A Comprehensive Review. Int J Inflam 2019; 2019:3706315. [PMID: 31275545 PMCID: PMC6582859 DOI: 10.1155/2019/3706315] [Citation(s) in RCA: 238] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023] Open
Abstract
Experimental work of the last two decades has revealed the general steps of the wound healing process. This complex network has been organized in three sequential and overlapping steps. The first step of the inflammatory phase is an immediate response to injury; primary sensory neurons sense injury and send danger signals to the brain, to stop bleeding and start inflammation. The following target of the inflammatory phase, led by the peripheral blood mononuclear cells, is to eliminate the pathogens and clean the wound. Once this is completed, the inflammatory phase is resolved and homeostasis is restored. The aim of the proliferative phase, the second phase, is to repair wound damage and begin tissue remodeling. Fibroplasia, reepithelialization, angiogenesis, and peripheral nerve repair are the central actions of this phase. Lastly, the objective of the final phase is to complete tissue remodeling and restore skin integrity. This review provides present day information regarding the status of the participant cells, extracellular matrix, cytokines, chemokines, and growth factors, as well as their interactions with the microenvironment during the wound healing process.
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Affiliation(s)
- Luis Cañedo-Dorantes
- Research Division, Faculty of Medicine, Universidad Autónoma del Estado de Morelos, Cuernavaca, Morelos, Mexico
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42
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Atia NM, Hazzah HA, Gaafar PM, Abdallah OY. Diosmin Nanocrystal–Loaded Wafers for Treatment of Diabetic Ulcer: In Vitro and In Vivo Evaluation. J Pharm Sci 2019; 108:1857-1871. [DOI: 10.1016/j.xphs.2018.12.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/23/2018] [Accepted: 12/20/2018] [Indexed: 12/31/2022]
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43
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The Dynamics of the Skin's Immune System. Int J Mol Sci 2019; 20:ijms20081811. [PMID: 31013709 PMCID: PMC6515324 DOI: 10.3390/ijms20081811] [Citation(s) in RCA: 310] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 12/12/2022] Open
Abstract
The skin is a complex organ that has devised numerous strategies, such as physical, chemical, and microbiological barriers, to protect the host from external insults. In addition, the skin contains an intricate network of immune cells resident to the tissue, crucial for host defense as well as tissue homeostasis. In the event of an insult, the skin-resident immune cells are crucial not only for prevention of infection but also for tissue reconstruction. Deregulation of immune responses often leads to impaired healing and poor tissue restoration and function. In this review, we will discuss the defensive components of the skin and focus on the function of skin-resident immune cells in homeostasis and their role in wound healing.
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44
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Wang T, Li X, Fan L, Chen B, Liu J, Tao Y, Wang X. Negative pressure wound therapy promoted wound healing by suppressing inflammation via down-regulating MAPK-JNK signaling pathway in diabetic foot patients. Diabetes Res Clin Pract 2019; 150:81-89. [PMID: 30825563 DOI: 10.1016/j.diabres.2019.02.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/17/2019] [Accepted: 02/25/2019] [Indexed: 12/22/2022]
Abstract
AIMS Negative pressure wound therapy displayed significant clinical benefits in the healing of diabetic foot wounds. In the present study, we investigated the mechanism of regulation of MAPK-JNK (Mitogen-activated protein kinase- c-Jun N-terminal kinase) signaling pathway by negative pressure wound therapy on these wounds. METHODS Twenty-six type 2 diabetes patients with foot ulceration were randomly assigned to the two groups, thirteen treated with negative pressure wound therapy and the others treated with traditional debridement therapy. Skin samples were harvested and histologically and immunohistochemical analyzed in both groups. Immunofluorescence stain, Enzyme-linked immunosorbent assay and Western blotting were performed for inducible nitric oxide synthase, inter leukin-6, tumor necrosis factor-α, P-c-Jun N-terminal kinase and c-Jun N-terminal kinase. Real time-polymerase chain reaction was performed to evaluate expression of c-Jun N-terminal kinase, extracellular signal regulated kinase1/2 and p38. RESULTS Negative pressure wound therapy could effectively alleviate inflammatory reaction and reduce inter leukin-6 and inducible nitric oxide synthase production after 7 days treatment. The level of tumor necrosis factor-α, inter leukin-6 and P-c-Jun N-terminal kinase were significantly decreased. However, there was no statistical difference in messenger ribonucleic acid expression of p38, extracellular signal regulated kinase1 and 2. CONCLUSIONS Negative pressure wound therapy possibly suppress the wound inflammation by inhibiting inter leukin-6, tumor necrosis factor-α and inducible nitric oxide synthase in diabetic foot patients. This effect is maybe mediated at least in part by suppression of Mitogen-activated protein kinase- c-Jun N-terminal kinase signaling pathway.
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Affiliation(s)
- Tao Wang
- Department of Vascular Surgery, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Institute for Vascular Surgery, Fudan University, Shanghai, China
| | - Xu Li
- Department of Vascular Surgery, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Institute for Vascular Surgery, Fudan University, Shanghai, China
| | - Longhua Fan
- Department of Vascular Surgery, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Institute for Vascular Surgery, Fudan University, Shanghai, China.
| | - Bin Chen
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jianjun Liu
- Department of Vascular Surgery, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Institute for Vascular Surgery, Fudan University, Shanghai, China
| | - Yue Tao
- Department of Vascular Surgery, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Institute for Vascular Surgery, Fudan University, Shanghai, China
| | - Xiaojun Wang
- Department of Vascular Surgery, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Institute for Vascular Surgery, Fudan University, Shanghai, China
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45
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Moura J, Madureira P, Leal EC, Fonseca AC, Carvalho E. Immune aging in diabetes and its implications in wound healing. Clin Immunol 2019; 200:43-54. [PMID: 30735729 PMCID: PMC7322932 DOI: 10.1016/j.clim.2019.02.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 02/06/2023]
Abstract
Immune systems have evolved to recognize and eliminate pathogens and damaged cells. In humans, it is estimated to recognize 109 epitopes and natural selection ensures that clonally expanded cells replace unstimulated cells and overall immune cell numbers remain stationary. But, with age, it faces continuous repertoire restriction and concomitant accumulation of primed cells. Changes shaping the aging immune system have bitter consequences because, as inflammatory responses gain intensity and duration, tissue-damaging immunity and inflammatory disease arise. During inflammation, the glycolytic flux cannot cope with increasing ATP demands, limiting the immune response's extent. In diabetes, higher glucose availability stretches the glycolytic limit, dysregulating proteostasis and increasing T-cell expansion. Long-term hyperglycemia exerts an accumulating effect, leading to higher inflammatory cytokine levels and increased cytotoxic mediator secretion upon infection, a phenomenon known as diabetic chronic inflammation. Here we review the etiology of diabetic chronic inflammation and its consequences on wound healing.
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Affiliation(s)
- J Moura
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; INEB - Instituto Nacional de Engenharia Biomédica, University of Porto, Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
| | - P Madureira
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal; IBMC - Instituto de Biologia Celular e Molecular, University of Porto, Porto, Portugal; Immunethep, Biocant Park, Cantanhede, Portugal
| | - E C Leal
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - A C Fonseca
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - E Carvalho
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Instituto de Investigação Interdisciplinar, University of Coimbra, Coimbra, Portugal; Department of Geriatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, AR, United States
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46
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Del Pino-Sedeño T, Trujillo-Martín MM, Andia I, Aragón-Sánchez J, Herrera-Ramos E, Iruzubieta Barragán FJ, Serrano-Aguilar P. Platelet-rich plasma for the treatment of diabetic foot ulcers: A meta-analysis. Wound Repair Regen 2018; 27:170-182. [PMID: 30575212 DOI: 10.1111/wrr.12690] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/22/2018] [Accepted: 11/12/2018] [Indexed: 12/18/2022]
Abstract
Foot ulcer is a major complication of diabetes mellitus and often precedes leg amputation. Among the different methods to achieve ulcer healing, the use of platelet-rich plasma, which is rich in multiple growth factors and cytokines and may have similarities to the natural wound healing process, is gaining in popularity. A systematic review with meta-analyses was performed to evaluate the safety and clinical effectiveness of platelet-rich plasma for the treatment of diabetic foot ulcers compared to standard treatment or any other alternative therapy. The electronic databases Medline, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were consulted in March 2017 with no restrictions placed on the publication date. Predefined criteria were used to determine inclusion of studies and to assess their methodologic quality. Eight randomized clinical trials and two prospective longitudinal-observational studies with control group were included. Platelet-rich plasma treatment increased the likelihood of chronic wound healing (RR = 1.32; 95% CI: 1.11, 1.57, I2 = 15%) while the volume of the ulcer (MD = 0.12 cm2 ; 95% CI: 0.08, 0.16; p < 0.01; I2 = 0%) and time to complete wound healing (MD = -11.18 days; 95% CI: -20.69, -1.68; I2 = 53%) decreased. Regarding safety profile, platelet-rich plasma did not differ from standard treatment in terms of probability of occurrence of wound complications (RR = 0.57; 95% CI: 0.25, 1.28; I2 = 0%) or recurrences (RR = 2.76; 95% CI: 0.23, 33.36; p = 0.43; I2 = 82%) but it decreased the rate of adverse events (RR = 0.80; 95% CI: 0.66, 0.96; p = 0.02; I2 = 0%). Cumulative meta-analysis revealed that there is enough evidence to demonstrate a statistically significant benefit. However, studies included presented serious methodologic flaws. According to the results, platelet-rich plasma could be considered a candidate treatment for nonhealing of diabetic foot ulcers.
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Affiliation(s)
- Tasmania Del Pino-Sedeño
- Department of Clinic Psicology, Psicobiology and Methodoloy, La Laguna University, Santa Cruz de Tenerife, Spain.,Health Services and Chronic Diseases Research Network (REDISSEC), Spain
| | - María M Trujillo-Martín
- Health Services and Chronic Diseases Research Network (REDISSEC), Spain.,Canary Islands Foundation of Health Research (FUNCANIS), El Rosario, Santa Cruz de Tenerife, Spain.,Spanish Network of Health Technology Assessment (RedETS), Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Isabel Andia
- BioCruces Bizkaia Health Research Institute, University Hospital of Cruces, Barakaldo, Vizcaya, Spain
| | | | - Estefanía Herrera-Ramos
- Health Services and Chronic Diseases Research Network (REDISSEC), Spain.,Canary Islands Foundation of Health Research (FUNCANIS), El Rosario, Santa Cruz de Tenerife, Spain.,Spanish Network of Health Technology Assessment (RedETS), Spain
| | - Francisco J Iruzubieta Barragán
- Health Services and Chronic Diseases Research Network (REDISSEC), Spain.,Center for Biomedical Research of La Rioja (CIBIR), La Rioja Health Service, Logroño, Spain.,Pre-Departmental Nursing Unit, Nursing School, La Rioja University, Logroño, Spain
| | - Pedro Serrano-Aguilar
- Health Services and Chronic Diseases Research Network (REDISSEC), Spain.,Spanish Network of Health Technology Assessment (RedETS), Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Santa Cruz de Tenerife, Spain.,Evaluation Service of the Canary Islands Health Service (SESCS), Canary Islands Health Service, El Rosario, Santa Cruz de Tenerife, Spain
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47
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Gkogkolou P, Sarna M, Sarna T, Paus R, Luger T, Böhm M. Protection of glucotoxicity by a tripeptide derivative of α‐melanocyte‐stimulating hormone in human epidermal keratinocytes. Br J Dermatol 2018; 180:836-848. [DOI: 10.1111/bjd.17125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 12/21/2022]
Affiliation(s)
- P. Gkogkolou
- Department of Dermatology Laboratory for Neuroendocrinology of the Skin and Interdisciplinary Endocrinology University of Münster Von Esmarch‐Str. 58 48149 Münster Germany
| | - M. Sarna
- Department of Biophysics Faculty of Biochemistry, Biophysics and Biotechnology Jagiellonian University Cracow Poland
- Laboratory of Imaging and Atomic Force Spectroscopy Malopolska Centre of Biotechnology Jagiellonian University Cracow Poland
| | - T. Sarna
- Department of Biophysics Faculty of Biochemistry, Biophysics and Biotechnology Jagiellonian University Cracow Poland
- Laboratory of Imaging and Atomic Force Spectroscopy Malopolska Centre of Biotechnology Jagiellonian University Cracow Poland
| | - R. Paus
- Department of Dermatology Laboratory for Neuroendocrinology of the Skin and Interdisciplinary Endocrinology University of Münster Von Esmarch‐Str. 58 48149 Münster Germany
- Centre for Dermatology Research Institute of Inflammation and Repair University of Manchester Manchester U.K
| | - T.A. Luger
- Department of Dermatology Laboratory for Neuroendocrinology of the Skin and Interdisciplinary Endocrinology University of Münster Von Esmarch‐Str. 58 48149 Münster Germany
| | - M. Böhm
- Department of Dermatology Laboratory for Neuroendocrinology of the Skin and Interdisciplinary Endocrinology University of Münster Von Esmarch‐Str. 58 48149 Münster Germany
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48
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Kamel MI, Elhenawy YI, Saudi WM. Relation between cutaneous and extracutaneous complications in pediatric patients with type 1 diabetes. DERMATO-ENDOCRINOLOGY 2018; 10:e1467717. [PMID: 30279952 PMCID: PMC6166603 DOI: 10.1080/19381980.2018.1467717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/17/2018] [Indexed: 01/19/2023]
Abstract
Background: The relationship between cutaneous and extracutaneous complications in pediatric patients with type 1 diabetes is unclear. Objective: The objective of the current study is to investigate the relationship between skin disorders and diabetic microangiopathic changes in pediatric and adolescent patients with type 1 diabetes. Patients and methods: Eighty patients with type 1 diabetes and 50 healthy controls were enrolled in the study. All recruited patients were followed up monthly for a total period of 12 month. Monthly visit included thorough clinical examination with system review, as well as whole-body cutaneous examination. HbA1c was assessed every 3 month. Twenty-four hours urine was collected for measurement of urinary albumin. Results: Fifty percent of the screened diabetic cohort had diabetic nephropathy (DN). The overall prevalence of cutaneous lesion among the studied diabetic cohort was high (72.5%), with cutaneous infections (40%) and xerosis (30%) being the most prevalent. The frequency of cutaneous infections, xerosis and rubeosis faciei was higher in patients with nephropathy than in those without nephropathy. Conclusion: cutaneous affection in patients with diabetes may be a clue to the presence of associated microangioapthic complications. The significant association between diabetic nephropathy and cutaneous lesions support the concept that cutaneous lesion in diabetes is a reflection of diabetic angiopathy, highlighting the importance of identifying patients at risk of other microvascular complications.
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Affiliation(s)
- M. I. Kamel
- Department of Dermatology, Venerology and Andrology, Al-Azhar Faculty of Medicine, Cairo, Egypt
| | - Y. I. Elhenawy
- Division of Pediatric Diabetes, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - W. M. Saudi
- Department of Dermatology, Faculty of Medicine, Misr University for Science & Technology (MUST), Cairo, Egypt
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49
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The role of nitric oxide in diabetic skin (patho)physiology. Mech Ageing Dev 2018; 172:21-29. [DOI: 10.1016/j.mad.2017.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/18/2017] [Accepted: 08/28/2017] [Indexed: 01/29/2023]
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50
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Zhang X, Liu Y, Zhang S, Shen T, Wang J, Liu C. Potentiation effect on accelerating diabetic wound healing using 2- N,6- O-sulfated chitosan-doped PLGA scaffold. RSC Adv 2018; 8:19085-19097. [PMID: 35539640 PMCID: PMC9080598 DOI: 10.1039/c8ra02153h] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/20/2018] [Indexed: 12/26/2022] Open
Abstract
Accelerating the wound healing of diabetes-impaired cutaneous tissue is still a challenge due to the aberrant cellular behavior, poor angiogenesis, and pathological micro-environment. Activation with growth factors and modulation of the redox micro-environment of the diabetic wound are considered to be effective strategies. Herein, we have described a highly sulfated heparin-like polysaccharide 2-N, 6-O-sulfated chitosan (26SCS)-doped poly(lactic-co-glycolic acid) scaffold (S-PLGA), which can achieve controlled and sustained release of heparin-binding epidermal growth factor (HB-EGF) owing to its affinity for heparin-binding growth factors. Interestingly, the antioxidant effect of 26SCS was confirmed and it was shown to have a strong scavenging activity towards superoxide radicals, a moderate scavenging activity towards hydroxyl radicals and a lower scavenging activity towards hydrogen peroxide. It also exhibited stronger protective effects in a human keratinocyte cell line (Ha-cat) against H2O2-induced oxidative damage. The Ha-cat cells cultured in the presence of the S-PLGA scaffold were significantly protected against oxidative stress during proliferation. In a full thickness excisional wound model of a diabetic rat, the wound treated with the HB-EGF-loaded S-PLGA scaffold was basically healed after 28 days. Conversely, the wounds in the other diabetic groups were not closed. The migration effect of the keratinocytes was enhanced by the 26SCS-induced sustainable release of HB-EGF and the scavenging of ROS which led to rapid re-epithelialization. Furthermore, histopathological evaluation demonstrated the positive effects on wound contraction, epithelial regeneration, and collagen deposition when treated with the HB-EGF loaded S-PLGA scaffold. These findings highlight that 26SCS may serve as a promising coagent for both controlled release of growth factors and alleviation of excessive ROS production, thus leading to increased regeneration of the diabetic wounds.
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Affiliation(s)
- Xiaohui Zhang
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology Shanghai 200237 PR China .,Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology Shanghai 200237 PR China
| | - Yang Liu
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology Shanghai 200237 PR China .,Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology Shanghai 200237 PR China
| | - Shuang Zhang
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology Shanghai 200237 PR China .,Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology Shanghai 200237 PR China
| | - Tong Shen
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology Shanghai 200237 PR China .,Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology Shanghai 200237 PR China
| | - Jing Wang
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology Shanghai 200237 PR China .,Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology Shanghai 200237 PR China
| | - Changsheng Liu
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology Shanghai 200237 PR China .,Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology Shanghai 200237 PR China.,The State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology Shanghai 200237 PR China
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