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Gościniak A, Stasiłowicz-Krzemień A, Michniak-Kohn B, Fiedor P, Cielecka-Piontek J. One Molecule, Many Faces: Repositioning Cardiovascular Agents for Advanced Wound Healing. Molecules 2024; 29:2938. [PMID: 38931002 PMCID: PMC11206936 DOI: 10.3390/molecules29122938] [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: 05/15/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
Chronic wound treatments pose a challenge for healthcare worldwide, particularly for the people in developed countries. Chronic wounds significantly impair quality of life, especially among the elderly. Current research is devoted to novel approaches to wound care by repositioning cardiovascular agents for topical wound treatment. The emerging field of medicinal products' repurposing, which involves redirecting existing pharmaceuticals to new therapeutic uses, is a promising strategy. Recent studies suggest that medicinal products such as sartans, beta-blockers, and statins have unexplored potential, exhibiting multifaceted pharmacological properties that extend beyond their primary indications. The purpose of this review is to analyze the current state of knowledge on the repositioning of cardiovascular agents' use and their molecular mechanisms in the context of wound healing.
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Affiliation(s)
- Anna Gościniak
- Department of Pharmacognosy and Biomaterials, Poznan University of Medical Sciences, Rokietnicka 3 Str., 60-806 Poznań, Poland; (A.G.); (A.S.-K.)
| | - Anna Stasiłowicz-Krzemień
- Department of Pharmacognosy and Biomaterials, Poznan University of Medical Sciences, Rokietnicka 3 Str., 60-806 Poznań, Poland; (A.G.); (A.S.-K.)
| | - Bożena Michniak-Kohn
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers-The State University of New Jersey, Piscataway, NJ 08854, USA;
- Center for Dermal Research, Rutgers-The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Piotr Fiedor
- Department of General and Transplantation Surgery, Medical University of Warsaw, 02-008 Warsaw, Poland;
| | - Judyta Cielecka-Piontek
- Department of Pharmacognosy and Biomaterials, Poznan University of Medical Sciences, Rokietnicka 3 Str., 60-806 Poznań, Poland; (A.G.); (A.S.-K.)
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Du Y, Wang J, Fan W, Huang R, Wang H, Liu G. Preclinical study of diabetic foot ulcers: From pathogenesis to vivo/vitro models and clinical therapeutic transformation. Int Wound J 2023; 20:4394-4409. [PMID: 37438679 PMCID: PMC10681512 DOI: 10.1111/iwj.14311] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023] Open
Abstract
Diabetic foot ulcer (DFU), a common intractable chronic complication of diabetes mellitus (DM), has a prevalence of up to 25%, with more than 17% of the affected patients at risk of amputation or even death. Vascular risk factors, including vascular stenosis or occlusion, dyslipidemia, impaired neurosensory and motor function, and skin infection caused by trauma, all increase the risk of DFU in patients with diabetes. Therefore, diabetic foot is not a single pathogenesis. Preclinical studies have contributed greatly to the pathogenesis determination and efficacy evaluation of DFU. Many therapeutic tools are currently being investigated using DFU animal models for effective clinical translation. However, preclinical animal models that completely mimic the pathogenesis of DFU remain unexplored. Therefore, in this review, the preparation methods and evaluation criteria of DFU animal models with three major pathological mechanisms: neuropathy, angiopathy and DFU infection were discussed in detail. And the advantages and disadvantages of various DFU animal models for clinical sign simulation. Furthermore, the current status of vitro models of DFU and some preclinical studies have been transformed into clinical treatment programs, such as medical dressings, growth factor therapy, 3D bioprinting and pre-vascularization, Traditional Chinese Medicine treatment. However, because of the complexity of the pathological mechanism of DFU, the clinical transformation of DFU model still faces many challenges. We need to further optimize the existing preclinical studies of DFU to provide an effective animal platform for the future study of pathophysiology and clinical treatment of DFU.
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Affiliation(s)
- Yuqing Du
- Department of Peripheral Vascular SurgeryInstitute of surgery of traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Jie Wang
- Department of Peripheral Vascular SurgeryInstitute of surgery of traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
- Endocrinology departmentShanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Weijing Fan
- Department of Peripheral Vascular SurgeryInstitute of surgery of traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Renyan Huang
- Department of Peripheral Vascular SurgeryInstitute of surgery of traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Hongfei Wang
- Department of Peripheral Vascular SurgeryInstitute of surgery of traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Guobin Liu
- Department of Peripheral Vascular SurgeryInstitute of surgery of traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
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Fouchard M, Brenaut E, Genestet S, Ficheux AS, Marcorelles P, Misery L. Observational case-control study of small-fiber neuropathies, with regards on smoking and vitamin D deficiency and other possible causes. Front Med (Lausanne) 2023; 9:1051967. [PMID: 36714112 PMCID: PMC9877604 DOI: 10.3389/fmed.2022.1051967] [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: 09/23/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Small fiber neuropathies (SFNs) are disorders of skin nerve endings inducing pruritus, burning pain, numbness, and paresthesia. The aims of this study were to search for putative etiologies of SFN and their occurrence in a cohort of patients and to compare patients with SFN to a group of patients without SFN to highlight potential factors associated with SFN. Methods This study was observational, retrospective, and monocentric. All patients with symptoms of SFN who underwent skin biopsies with intraepidermal nerve density counts were included. Patients with a count lower than 5 percentiles were considered to be in the SFN group. Other patients were considered to be the control group. Results A total of 162 patients with SFN and 161 controls were included. No cause was identified for 108 patients (61.7%). The established causes were autoimmune diseases (9.1%), diabetes or glucose intolerance (8%), medication (4%), liver disease (3.4%), and monoclonal gammopathy of undetermined significance (2.9%). Current or former smokers were more numerous in the SFN group (26.5%) than in the control group (16.1%), while vitamin D amounts were significantly lower in the SFN group than in the control group. Discussion Hence, tobacco smoking and vitamin D deficiency might be new putative causes of SFN.
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Affiliation(s)
- Maxime Fouchard
- Department of Dermatology, CHU Brest, Brest, France,Univ Brest, LIEN, Brest, France
| | - Emilie Brenaut
- Department of Dermatology, CHU Brest, Brest, France,Univ Brest, LIEN, Brest, France
| | - Steeve Genestet
- Department of Neurology, CHU Brest, Brest, France,Breton Competence Center of Rare Neuromuscular Diseases and Neuropathies With Cutaneous-Mucosal Symptoms, CHRU de Brest, Brest, France
| | | | - Pascale Marcorelles
- Univ Brest, LIEN, Brest, France,Breton Competence Center of Rare Neuromuscular Diseases and Neuropathies With Cutaneous-Mucosal Symptoms, CHRU de Brest, Brest, France,Department of Pathology, CHU Brest, Brest, France
| | - Laurent Misery
- Department of Dermatology, CHU Brest, Brest, France,Univ Brest, LIEN, Brest, France,Breton Competence Center of Rare Neuromuscular Diseases and Neuropathies With Cutaneous-Mucosal Symptoms, CHRU de Brest, Brest, France,*Correspondence: Laurent Misery,
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Giuliani A, Lorenzini L, Baldassarro VA, Pannella M, Cescatti M, Fernandez M, Alastra G, Flagelli A, Villetti G, Imbimbo BP, Giardino L, Calzà L. Effects of Topical Application of CHF6467, a Mutated Form of Human Nerve Growth Factor, on Skin Wound Healing in Diabetic Mice. J Pharmacol Exp Ther 2020; 375:317-331. [PMID: 32948647 DOI: 10.1124/jpet.120.000110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022] Open
Abstract
Nerve growth factor (NGF) is the protein responsible for the development and maintenance of sensory skin innervation. Given the role of appropriate innervation in skin healing, NGF has been indicated as a possible prohealing treatment in pathologic conditions characterized by nerve-ending loss, such as chronic ulcers in diabetes; however, its use as a therapeutic agent is limited by its hyperalgesic effect. We tested the effect of topical application of the nonalgogenic NGF derivative hNGFP61S/R100E in two models of skin ulcer induced in dbdb diabetic mice, investigating healing time, skin histology, reinnervation, and angiogenesis using morphologic and molecular approaches. We showed that the topical administration of CHF6467, a recombinant human NGF in which an amino acid substitution (R100E) abolished the hyperalgesic effect usually associated with NGF, accelerated skin repair in experimental wounds (full-excision and pressure-ulcer) induced in diabetic mice (dbdb). CHF6467-induced acceleration of wound healing was accompanied by increased re-epithelization, reinnervation, and revascularization as assessed by histology, immunohistochemistry, and image analysis. Bioinformatic analysis of differentially expressed genes and signaling pathways in the wound tissues showed that protein kinase B-mammalian target of rapamycin was the most regulated pathway. In spite of the transdermal absorption leading to measurable, dose-dependent increases in CHF6467 plasma levels, no systemic thermal or local mechanical hyperalgesia was observed in treated mice. When tested in vitro in human cell lines, CHF6467 stimulated keratinocyte and fibroblast proliferation and tube formation by endothelial cells. Collectively, these results support a possible use of CHF6467 as a prohealing agent in skin lesions in diabetes. SIGNIFICANCE STATEMENT: Topical application of CHF6467 accelerates reinnervation, neoangiogenesis, and wound healing in diabetic mice in both full-thickness skin-excision and pressure-ulcer models through the protein kinase B/mammalian target of rapamycin pathway and does not induce hyperalgesia.
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Affiliation(s)
- A Giuliani
- Department of Veterinary Medical Science, University of Bologna, Italy (A.G., L.L., M.F., L.G.); Interdepartmental Center for Industrial Research in Life Sciences and Technologies University of Bologna, Italy (L.L., V.A.B., G.A., A.F, L.G., L.C.); Department of of Pharmacy and Biotechnology, University of Bologna, Italy (L.C.); Fondazione IRET, Ozzano Emilia, Italy (M.P., M.C.); Chiesi Farmaceutici, Parma, Italy (G.V., B.P.I.)
| | - L Lorenzini
- Department of Veterinary Medical Science, University of Bologna, Italy (A.G., L.L., M.F., L.G.); Interdepartmental Center for Industrial Research in Life Sciences and Technologies University of Bologna, Italy (L.L., V.A.B., G.A., A.F, L.G., L.C.); Department of of Pharmacy and Biotechnology, University of Bologna, Italy (L.C.); Fondazione IRET, Ozzano Emilia, Italy (M.P., M.C.); Chiesi Farmaceutici, Parma, Italy (G.V., B.P.I.)
| | - V A Baldassarro
- Department of Veterinary Medical Science, University of Bologna, Italy (A.G., L.L., M.F., L.G.); Interdepartmental Center for Industrial Research in Life Sciences and Technologies University of Bologna, Italy (L.L., V.A.B., G.A., A.F, L.G., L.C.); Department of of Pharmacy and Biotechnology, University of Bologna, Italy (L.C.); Fondazione IRET, Ozzano Emilia, Italy (M.P., M.C.); Chiesi Farmaceutici, Parma, Italy (G.V., B.P.I.)
| | - M Pannella
- Department of Veterinary Medical Science, University of Bologna, Italy (A.G., L.L., M.F., L.G.); Interdepartmental Center for Industrial Research in Life Sciences and Technologies University of Bologna, Italy (L.L., V.A.B., G.A., A.F, L.G., L.C.); Department of of Pharmacy and Biotechnology, University of Bologna, Italy (L.C.); Fondazione IRET, Ozzano Emilia, Italy (M.P., M.C.); Chiesi Farmaceutici, Parma, Italy (G.V., B.P.I.)
| | - M Cescatti
- Department of Veterinary Medical Science, University of Bologna, Italy (A.G., L.L., M.F., L.G.); Interdepartmental Center for Industrial Research in Life Sciences and Technologies University of Bologna, Italy (L.L., V.A.B., G.A., A.F, L.G., L.C.); Department of of Pharmacy and Biotechnology, University of Bologna, Italy (L.C.); Fondazione IRET, Ozzano Emilia, Italy (M.P., M.C.); Chiesi Farmaceutici, Parma, Italy (G.V., B.P.I.)
| | - M Fernandez
- Department of Veterinary Medical Science, University of Bologna, Italy (A.G., L.L., M.F., L.G.); Interdepartmental Center for Industrial Research in Life Sciences and Technologies University of Bologna, Italy (L.L., V.A.B., G.A., A.F, L.G., L.C.); Department of of Pharmacy and Biotechnology, University of Bologna, Italy (L.C.); Fondazione IRET, Ozzano Emilia, Italy (M.P., M.C.); Chiesi Farmaceutici, Parma, Italy (G.V., B.P.I.)
| | - G Alastra
- Department of Veterinary Medical Science, University of Bologna, Italy (A.G., L.L., M.F., L.G.); Interdepartmental Center for Industrial Research in Life Sciences and Technologies University of Bologna, Italy (L.L., V.A.B., G.A., A.F, L.G., L.C.); Department of of Pharmacy and Biotechnology, University of Bologna, Italy (L.C.); Fondazione IRET, Ozzano Emilia, Italy (M.P., M.C.); Chiesi Farmaceutici, Parma, Italy (G.V., B.P.I.)
| | - A Flagelli
- Department of Veterinary Medical Science, University of Bologna, Italy (A.G., L.L., M.F., L.G.); Interdepartmental Center for Industrial Research in Life Sciences and Technologies University of Bologna, Italy (L.L., V.A.B., G.A., A.F, L.G., L.C.); Department of of Pharmacy and Biotechnology, University of Bologna, Italy (L.C.); Fondazione IRET, Ozzano Emilia, Italy (M.P., M.C.); Chiesi Farmaceutici, Parma, Italy (G.V., B.P.I.)
| | - G Villetti
- Department of Veterinary Medical Science, University of Bologna, Italy (A.G., L.L., M.F., L.G.); Interdepartmental Center for Industrial Research in Life Sciences and Technologies University of Bologna, Italy (L.L., V.A.B., G.A., A.F, L.G., L.C.); Department of of Pharmacy and Biotechnology, University of Bologna, Italy (L.C.); Fondazione IRET, Ozzano Emilia, Italy (M.P., M.C.); Chiesi Farmaceutici, Parma, Italy (G.V., B.P.I.)
| | - B P Imbimbo
- Department of Veterinary Medical Science, University of Bologna, Italy (A.G., L.L., M.F., L.G.); Interdepartmental Center for Industrial Research in Life Sciences and Technologies University of Bologna, Italy (L.L., V.A.B., G.A., A.F, L.G., L.C.); Department of of Pharmacy and Biotechnology, University of Bologna, Italy (L.C.); Fondazione IRET, Ozzano Emilia, Italy (M.P., M.C.); Chiesi Farmaceutici, Parma, Italy (G.V., B.P.I.)
| | - L Giardino
- Department of Veterinary Medical Science, University of Bologna, Italy (A.G., L.L., M.F., L.G.); Interdepartmental Center for Industrial Research in Life Sciences and Technologies University of Bologna, Italy (L.L., V.A.B., G.A., A.F, L.G., L.C.); Department of of Pharmacy and Biotechnology, University of Bologna, Italy (L.C.); Fondazione IRET, Ozzano Emilia, Italy (M.P., M.C.); Chiesi Farmaceutici, Parma, Italy (G.V., B.P.I.)
| | - L Calzà
- Department of Veterinary Medical Science, University of Bologna, Italy (A.G., L.L., M.F., L.G.); Interdepartmental Center for Industrial Research in Life Sciences and Technologies University of Bologna, Italy (L.L., V.A.B., G.A., A.F, L.G., L.C.); Department of of Pharmacy and Biotechnology, University of Bologna, Italy (L.C.); Fondazione IRET, Ozzano Emilia, Italy (M.P., M.C.); Chiesi Farmaceutici, Parma, Italy (G.V., B.P.I.)
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Vaccarin Regulates Diabetic Chronic Wound Healing through FOXP2/AGGF1 Pathways. Int J Mol Sci 2020; 21:ijms21061966. [PMID: 32183046 PMCID: PMC7139532 DOI: 10.3390/ijms21061966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/25/2020] [Accepted: 03/03/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Diabetes mellitus is a growing global health issue nearly across the world. Diabetic patients who are prone to develop diabetes-related complications often exhibit progressive neuropathy (painless and sensory loss). It is usual for small wounds to progress to ulceration, which especially worsens with peripheral arterial disease and in the presence of anaerobic bacteria, culminating into gangrene. In our study, vaccarin (VAC), the main active monomer extracted from Chinese herb vaccariae semen, is proven to have a role in promoting diabetic chronic wound healing through a cytoprotective role under high glucose conditions. Materials and methods: We constructed a pressure ulcer on both VAC-treated and control mice based on a type 1 diabetes (T1DM) model. The wound healing index was evaluated by an experimental wound assessment tool (EWAT). We also determined the effect of VAC on the proliferation and cell migration of human microvascular endothelial cells (HMEC-1) by a cell counting kit (CCK-8), a scratch and transwell assay. Results: The results demonstrated that VAC could promote the proliferation and migration of high glucose-stimulated HMEC-1 cells, which depend on the activation of FOXP2/AGGF1. Activation of the angiogenic factor with G patch and FHA domains 1 (AGGF1) caused enhanced phosphorylation of serine/threonine kinase (Akt) and extracellular regulated protein kinases (Erk1/2). By silencing the expression of forkhead box p2 (FOXP2) protein by siRNA, both mRNA and protein expression of AGGF1 were downregulated, leading to a decreased proliferation and migration of HMEC-1 cells. In addition, a diabetic chronic wound model in vivo unveiled that VAC had a positive effect on chronic wound healing, which involved the activation of the above-mentioned pathways. Conclusions: In summary, our study found that VAC promoted chronic wound healing in T1DM mice by activating the FOXP2/AGGF1 pathway, indicating that VAC may be a promising candidate for the treatment of the chronic wounds of diabetic patients.
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Zwanenburg PR, Backer SFM, Obdeijn MC, Lapid O, Gans SL, Boermeester MA. A Systematic Review and Meta-Analysis of the Pressure-Induced Vasodilation Phenomenon and Its Role in the Pathophysiology of Ulcers. Plast Reconstr Surg 2019; 144:669e-681e. [PMID: 31568315 DOI: 10.1097/prs.0000000000006090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Physiologic studies show that tissue perfusion increases during moderate amounts of tissue compression. This is attributed to sensory nerves initiating a vasodilatory cascade referred to as pressure-induced vasodilation. METHODS PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies investigating perfusion during pressure exposure longer than 10 minutes. Retrieved studies were assessed using the Office of Health Assessment and Translation Risk of Bias Rating Tool for Human and Animal Studies. Results were pooled with random effects models. The body of evidence was rated using the Office of Health Assessment and Translation approach. RESULTS Twenty-nine articles were included, of which 19 articles were included in meta-analyses. The evidence indicates that moderate amounts of tissue compression have the capacity to increase perfusion in healthy humans by 46 percent (95 percent CI, 30 to 62 percent). Using the Office of Health Assessment and Translation approach, the authors found a high level of confidence in the body of evidence. Pressure-induced vasodilation blockade was associated with increased pressure ulcer formation. Pressure-induced vasodilation was impaired by neuropathy and by the drugs diclofenac and amiloride. CONCLUSIONS This systematic review and meta-analysis indicates that healthy humans have the capacity to increase local perfusion in response to mechanical stress resulting from tissue compression. Because pressure-induced vasodilation is mediated by sensory nerves, pressure-induced vasodilation emphasizes the importance of sensory innervation for durable tissue integrity. Pressure-induced vasodilation impairment seems to provide a complementary explanation for the susceptibility of neuropathic tissues to pressure-induced lesions.
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Affiliation(s)
- Pieter R Zwanenburg
- From the Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection and Immunity, and the Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam
| | - Sophia F M Backer
- From the Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection and Immunity, and the Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam
| | - Miryam C Obdeijn
- From the Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection and Immunity, and the Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam
| | - Oren Lapid
- From the Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection and Immunity, and the Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam
| | - Sarah L Gans
- From the Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection and Immunity, and the Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam
| | - Marja A Boermeester
- From the Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection and Immunity, and the Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam
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Fouchard M, Misery L, Le Garrec R, Sigaudo-Roussel D, Fromy B. Alteration of Pressure-Induced Vasodilation in Aging and Diabetes, a Neuro-Vascular Damage. Front Physiol 2019; 10:862. [PMID: 31333501 PMCID: PMC6616153 DOI: 10.3389/fphys.2019.00862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/20/2019] [Indexed: 12/11/2022] Open
Abstract
Skin is constantly subjected to pressure at different levels. Pressure-induced vasodilation (PIV) is one of the response mechanisms to low pressure that maintains the homeostasis of the skin. PIV results from the interaction of primary afferent nerves and vascular endothelium of skin vessels. Thanks to this cutaneous neuro-vascular interaction, the cutaneous blood flow increase allows the maintenance of an optimal level of oxygenation and minimizes the lack of vascularization of the skin tissue under low pressure. It seems to be associated with the cutaneous protection mechanisms to prevent pressure ulcers. In some contexts, where microangiopathy and neuropathy can occur, such as aging and diabetes, PIV is impaired, leading to a dramatic early decrease in local skin blood flow when low pressure is applied. In aging, PIV alteration is due to endothelial dysfunction, essentially from an alteration of the nitric oxide pathway. In the inflamm-aging context, oxidative stress increases leading to endothelial cell and nerve damages. An age-related sensory neuropathy will exacerbate the alteration of PIV during the aging process. In diabetes, non-controlled hyperglycaemia leads to an increase in several pathological biochemical pathways that involve oxidative stress and can affect PIV. Sorbinil, alagebrium and alpha-lipoic acid are able individually to restore PIV through a possible oxidative stress reduction. Candesartan, an angiotensin II type 1 receptor blocker, is also able to restore PIV and prevent pressure ulcer formation. The possibility of preventing pressure ulcer associated to diabetes and/or aging with the restoration of PIV seems to be a promising research path.
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Affiliation(s)
- Maxime Fouchard
- LIEN, F-29200, University of Brest, Brest, France.,Department of Dermatology, University Hospital of Brest, Brest, France
| | - Laurent Misery
- LIEN, F-29200, University of Brest, Brest, France.,Department of Dermatology, University Hospital of Brest, Brest, France
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Risk Factors for Pressure Sores in Hospitalized Acute Ischemic Stroke Patients. J Stroke Cerebrovasc Dis 2019; 28:2026-2030. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.02.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/12/2019] [Accepted: 02/23/2019] [Indexed: 02/07/2023] Open
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de Wert LA, Geerts M, van der Brug S, Adriaansen L, Poeze M, Schaper N, Bouvy ND. The Effect of Shear Force on Skin Viability in Patients with Type 2 Diabetes. J Diabetes Res 2019; 2019:1973704. [PMID: 31781661 PMCID: PMC6875394 DOI: 10.1155/2019/1973704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/02/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Shear is a major risk factor in the development of diabetic foot ulcers, but its effect on the skin of patients with type 2 diabetes mellitus (DM) remains to be elucidated. The aim was to determine skin responses to shear in DM patients with and without diabetic polyneuropathy (DNP). METHODS The forearm skin was loaded with 14.5 N shear (+2.4 kPa pressure) and with 3.5 kPa pressure for 30 minutes in 10 type 2 DM patients without DNP, 10 type 2 DM patients with DNP, and 10 healthy participants. A Sebutape collected IL-1α (measure of tissue damage). A laser Doppler flowmeter measured cutaneous blood cell flux (CBF) as a measure of the reactive hyperaemic skin response. FINDINGS Reactive hyperaemia and IL-1α release was significantly increased after shear loading in all three groups and was higher compared to the responses to pressure loading. The reactive hyperaemic response after shear loading was impaired in patients with type 2 DM compared to healthy participants but did not differ between patients with and without DNP. The reactive hyperaemic response was negatively correlated with the blood glucose level but did not correlate with the DNP severity score. INTERPRETATION Shear is important in the development of tissue damage, but the reparative responses to shear are impaired in patients with type 2 DM. DNP was not associated with altered skin responses, suggesting that the loss of protective sensation to sense shear to skin remains a key factor in the development of diabetic foot ulcers in patients with DNP.
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Affiliation(s)
- Luuk A. de Wert
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Margot Geerts
- Department of Neurology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Sander van der Brug
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Laura Adriaansen
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Martijn Poeze
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Nicolaas Schaper
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Nicole D. Bouvy
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
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Scorpion Venom Active Polypeptide May Be a New External Drug of Diabetic Ulcer. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:5161565. [PMID: 29234410 PMCID: PMC5682090 DOI: 10.1155/2017/5161565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/26/2017] [Indexed: 12/26/2022]
Abstract
Background The epidermal growth factor (EGF) is recognized medicine of therapy in ulcer. However, its efficacy has been challenged. We compared scorpion venom active polypeptide and EGF of therapeutic effects in diabetic ulcer. Methods The scorpion venom active polypeptide is made into gel. Fourteen diabetic SD rats were randomly divided into scorpion peptide gel group (SPG group) and EGF group. Before treatment, the rat model of diabetic ulcer was created. The levels of IL-1, IL-6, IL-8, and TNF-α in the wound tissue were measured at different time points during the treatment, secretions of wound were collected for bacterial culture, and the wound healing was recorded. Results Wound healing was faster in SPG group compared to EGF group (3 weeks versus 5 weeks, t-test, p = 0.032). The levels of IL-1, IL-6, IL-8, and TNF-α were not statistically different when the wounds were formed but showed significant differences from the 2nd to the 5th week between two groups. The infection rate was higher in the EGF group (42.86% versus 0, Chi-square test, p = 0.025). Conclusions Scorpion venom active polypeptide shortens wound healing with a stronger anti-inflammation and antibacterial effect and may be a new and effective topical drug for the treatment of diabetic ulcers.
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Bessaguet F, Danigo A, Magy L, Sturtz F, Desmoulière A, Demiot C. Candesartan prevents resiniferatoxin-induced sensory small-fiber neuropathy in mice by promoting angiotensin II-mediated AT2 receptor stimulation. Neuropharmacology 2017; 126:142-150. [PMID: 28882562 DOI: 10.1016/j.neuropharm.2017.08.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/04/2017] [Accepted: 08/31/2017] [Indexed: 12/27/2022]
Abstract
Sensory defects associated with small-fiber neuropathy (SFN) can lead to profound disabilities. The relationship between the sensory nervous system and modulation of the renin-angiotensin system (RAS) has been described and focused on pain and neurodegeneration in several animal models. We have recently developed an experimental model of functional sensory neuropathy showing thermal hypoalgesia and neuropeptide depletion without nerve fiber degeneration. Here, we aimed to determine whether the modulation of angiotensin II (Ang II) activity could prevent sensory neuropathy induced by RTX. Control and RTX mice received ramipril, an Ang II converting enzyme (ACE) inhibitor, (0.5 mg/kg/day) or candesartan, an Ang II type 1 receptor (AT1R) blocker (0.5 mg/kg/day), one day before vehicle or RTX administration, and each day for the next seven days. Ramipril did not have a beneficial effect in RTX mice, whereas candesartan prevented thermal hypoalgesia and reduced neuropeptide depletion in intraepidermal nerve fibers and dorsal root ganglion neurons. The preventive effect of candesartan was not observed in mice deficient for the Ang II type 2 receptor (AT2R) and was counteracted in wild type mice by EMA200, an AT2R antagonist (3 mg/kg/day). Thus, candesartan may promote AT2R activation by blocking AT1R and increasing Ang II production and enhance its mechanisms of neuroprotection in our RTX model. Our finding that candesartan prevents nociception deficits and neuropeptide depletion encourages the evaluation of its therapeutic potential in patients presenting SFN, particularly those who experience chemotherapy-induced SFN.
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Affiliation(s)
- Flavien Bessaguet
- EA 6309 - Myelin Maintenance & Peripheral Neuropathy, Faculties of Medicine and Pharmacy, University of Limoges, Limoges, France
| | - Aurore Danigo
- EA 6309 - Myelin Maintenance & Peripheral Neuropathy, Faculties of Medicine and Pharmacy, University of Limoges, Limoges, France
| | - Laurent Magy
- Department of Neurology, Reference Center for Rare Peripheral Neuropathies, University Hospital of Limoges, Limoges, France
| | - Franck Sturtz
- EA 6309 - Myelin Maintenance & Peripheral Neuropathy, Faculties of Medicine and Pharmacy, University of Limoges, Limoges, France
| | - Alexis Desmoulière
- EA 6309 - Myelin Maintenance & Peripheral Neuropathy, Faculties of Medicine and Pharmacy, University of Limoges, Limoges, France
| | - Claire Demiot
- EA 6309 - Myelin Maintenance & Peripheral Neuropathy, Faculties of Medicine and Pharmacy, University of Limoges, Limoges, France.
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