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Cacua Sanchez MT, Vargas Abello LM, Orrego Á, Ortiz P, Segura H, Berrio Caicedo JJ, Zuluaga LM, Ordoñez J, Fernández Montequin JI, Ulloa J. Use of Intralesional and Perilesional Human Recombinant Epidermal Growth Factor (hrEGF) in the Local Treatment of Venous Ulcer - Review Article - Expert Recommendation. Vasc Health Risk Manag 2023; 19:595-603. [PMID: 37701155 PMCID: PMC10494861 DOI: 10.2147/vhrm.s417447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/25/2023] [Indexed: 09/14/2023] Open
Abstract
Venous Ulcers (VU) represent 60-80% of all leg ulcers and are the final stage of the disease secondary to venous hypertension or valve insufficiency. Conventional treatment that focuses on its etiological factors continues to be the gold standard; however, 30% of ulcers do not heal with this treatment; thus, it has been seen that the use of growth factor can be used as an adjuvant for this pathology. A literature review was carried out to evaluate the evidence from systematic reviews, meta-analyses, case studies, and quantitative studies that respond to the objective of this analysis review in the different databases with specific inclusion criteria with publications between 2002 and 2022, initially finding the topical application of the factor and later, more recently, the intralesional and perilesional application, the latter being an alternative treatment for this type of pathology and generating some recommendations for using the Factor.
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Affiliation(s)
| | | | | | - Paola Ortiz
- Uruguay Vein Center, Universidad de la República Oriental de Uruguay, Montevideo, Uruguay
| | - Héctor Segura
- Vascular and Endovascular Surgery Department, Hospital Español, Mexico City, Mexico
| | | | | | - José Ordoñez
- Department of Vascular Surgery, Fundación Santa Fe, Bogotá, Colombia
| | | | - Jorge Ulloa
- Department of Vascular Surgery, Fundación Santa Fe de Bogotá, Universidad de los Andes, Bogota, Colombia
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2
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Worsley AL, Lui DH, Ntow-Boahene W, Song W, Good L, Tsui J. The importance of inflammation control for the treatment of chronic diabetic wounds. Int Wound J 2022. [PMID: 36564054 DOI: 10.1111/iwj.14048] [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: 03/21/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/25/2022] Open
Abstract
Diabetic chronic wounds cause massive levels of patient suffering and economic problems worldwide. The state of chronic inflammation arises in response to a complex combination of diabetes mellitus-related pathophysiologies. Advanced treatment options are available; however, many wounds still fail to heal, exacerbating morbidity and mortality. This review describes the chronic inflammation pathophysiologies in diabetic ulcers and treatment options that may help address this dysfunction either directly or indirectly. We suggest that treatments to reduce inflammation within these complex wounds may help trigger healing.
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Affiliation(s)
- Anna L Worsley
- Royal Veterinary College, Department of Pathobiology and Population Sciences, London, UK.,UCL Centre for Biomaterials in Surgical Reconstruction and Regeneration, Department of Surgical Biotechnology, UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Dennis H Lui
- UCL Centre for Biomaterials in Surgical Reconstruction and Regeneration, Department of Surgical Biotechnology, UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Winnie Ntow-Boahene
- Royal Veterinary College, Department of Pathobiology and Population Sciences, London, UK.,UCL Centre for Biomaterials in Surgical Reconstruction and Regeneration, Department of Surgical Biotechnology, UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Wenhui Song
- UCL Centre for Biomaterials in Surgical Reconstruction and Regeneration, Department of Surgical Biotechnology, UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Liam Good
- Royal Veterinary College, Department of Pathobiology and Population Sciences, London, UK
| | - Janice Tsui
- UCL Centre for Biomaterials in Surgical Reconstruction and Regeneration, Department of Surgical Biotechnology, UCL Division of Surgery and Interventional Science, University College London, London, UK
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Cho KH, Kim JH, Nam HS, Kang DJ. Efficacy Comparison Study of Human Epidermal Growth Factor (EGF) between Heberprot-P® and Easyef® in Adult Zebrafish and Embryo under Presence or Absence Combination of Diabetic Condition and Hyperlipidemia to Mimic Elderly Patients. Geriatrics (Basel) 2022; 7:geriatrics7020045. [PMID: 35447848 PMCID: PMC9028627 DOI: 10.3390/geriatrics7020045] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/02/2022] [Accepted: 04/02/2022] [Indexed: 12/30/2022] Open
Abstract
Recombinant human epidermal growth factor (EGF) has been used to treat adult diabetic foot ulcers and pediatric burns by facilitating wound healing and epithelization, especially for elderly patients. Several formulation types of EGF from different expression hosts are clinically available, such as intralesional injection and topical application. On the other hand, no study has compared the in vivo efficacy of EGF products directly in terms of tissue regeneration and wound healing activity. The present study compared two commercial products, Heberprot-P75® and Easyef®, in terms of their tissue regeneration activity in adult zebrafish and the developmental speed of zebrafish embryos. Fluorescence spectroscopy showed that the two EGF products had different Trp fluorescence emission spectra: Easyef® showed a wavelength of maximum fluorescence (WMF) of 337 nm with weak fluorescence intensity (FI), while Heberprot-P75® showed WMF of 349 nm with a 4.1 times stronger FI than that of Easyef®. The WMF of Heberprot-P75® was quenched by adding singlet oxygen in ozonated oil, while the WMF of Easyef® was not quenched. Treatment with Heberprot-P75® induced greater embryo development speed with a higher survival rate after exposure to EGF in water and microinjection into embryos. Under normal diet (ND) consumption, Heberprot-P75® showed a 1.4 times higher tail fin regeneration activity than Easyef® during seven days from the intraperitoneal injection (10 μL, 50 μg/mL) after amputating the tail fin. Under ND consumption and diabetic condition caused by streptozotocin (STZ) treatment, Heberprot-P75® showed 2.1 times higher tail fin regeneration activity than Easyef® from the same injection and amputation protocol. Under a high-cholesterol diet (HCD) alone, Heberprot-P75® showed 1.2 times higher tail fin regeneration activity than the Easyef® group and PBS group from the same injection and amputation. Under diabetic conditions (STZ-injected) and HCD consumption, the Heberprot-P75® group showed 1.7 and 1.5 times higher tail fin regeneration activity than the Easyef® group and PBS group, respectively, with a distinct and clean regeneration pattern. In contrast, the Easyef® group and PBS group showed ambiguous regeneration patterns with a severe fissure of the tail fin, which is a typical symptom of a diabetic foot. In conclusion, Heberprot-P75® and Easyef® have different Trp fluorescence properties in terms of the WMF and fluorescence quenching. Treatment of Heberprot-P75® induced a greater developmental speed of zebrafish embryos in both water exposure and microinjection. Heberprot-P75® induced significantly higher wound healing and tissue regeneration activity than Easyef® and PBS in the presence or absence of diabetic conditions and cholesterol supplementation.
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Affiliation(s)
- Kyung-Hyun Cho
- Raydel Research Institute, Medical Innovation Complex, Daegu 41061, Korea; (J.-H.K.); (H.-S.N.); (D.-J.K.)
- LipoLab, Yeungnam University, Gyeongsan 38541, Korea
- Correspondence: ; Tel.: +82-53-964-1990; Fax: +82-53-965-1992
| | - Ju-Hyun Kim
- Raydel Research Institute, Medical Innovation Complex, Daegu 41061, Korea; (J.-H.K.); (H.-S.N.); (D.-J.K.)
| | - Hyo-Seon Nam
- Raydel Research Institute, Medical Innovation Complex, Daegu 41061, Korea; (J.-H.K.); (H.-S.N.); (D.-J.K.)
| | - Dae-Jin Kang
- Raydel Research Institute, Medical Innovation Complex, Daegu 41061, Korea; (J.-H.K.); (H.-S.N.); (D.-J.K.)
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Cacua Sanchez MT, Buenahora G. Socio-Demographic Characteristics and Associated Factors of Morbidity in Patients with Venous Ulcers Treated in Two Institutions of Contributive and Subsidized Regime in Colombia: Retrospective, Multicenter, Observational Study. Vasc Health Risk Manag 2022; 18:89-104. [PMID: 35264854 PMCID: PMC8901223 DOI: 10.2147/vhrm.s345542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/09/2022] [Indexed: 11/23/2022] Open
Abstract
Aim Objective Methodology Results Conclusion
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Affiliation(s)
- Maria Teresa Cacua Sanchez
- Vascular Surgery, Ambulatory Surgery Center, Vascular Laboratory Kennedy Hospital, Bogotá, Colombia
- Correspondence: Maria Teresa Cacua Sanchez, Tel +57-1-3057470125, Email
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Çetinkaya ÖA, Çelik SU, Erzincan MB, Hazır B, Uncu H. Intralesional epidermal growth factor application is a potential therapeutic strategy to improve diabetic foot ulcer healing and prevent amputation. Turk J Surg 2020; 36:15-22. [PMID: 32637871 DOI: 10.5578/turkjsurg.4541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/27/2019] [Indexed: 12/25/2022]
Abstract
Objectives This study aimed to investigate the efficacy of intralesional epidermal growth factor (EGF) in preventing the extremity from a major amputation and its effects on wound healing in chronic diabetic foot ulcers (DFUs). Material and Methods Thirty-three patients with DFUs were treated with intralesional EGF application between January 2013 and January 2017. The first endpoint was to determine the prevention rate of major amputation within 12 months following treatment. The second endpoints were the recovery of ulcer surface area with ≥ 50% granulation following two months and the healing of ulcer surface area with ≥ 75% granulation following six months after the first application of EGF. Results After three patients were excluded because of major side effects in the remaining 30 patients (48 DFUs), granulation rate of ≥ 50% was achieved in 24 (37 DFUs) patients, and not achieved in 6 (11 DFUs) patients eight weeks following the EGF application. A granulation rate of ≥ 75% was achieved in 21 (31 DFUs) patients after six months. At 12 months following the treatment, one major and seven minor amputations were performed, a total of 10 DFUs in five patients were not healed, and the DFUs in 17 patients completely recovered. Conclusion Intralesional EGF application has positive results in addition to good foot care in DFUs, and promising results can be obtained by protecting the extremity from amputation by using it in patients whose vascular intervention methods are not appropriate and have DFUs that do not heal with conventional wound care treatments.
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Affiliation(s)
- Ömer Arda Çetinkaya
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Süleyman Utku Çelik
- Clinic of General Surgery, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Miraç Barış Erzincan
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Barış Hazır
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Hakan Uncu
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
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Abstract
Wound healing is a complex physiological process that occurs in the human body involving the sequential activation of multiple cell types and signaling pathways in a coordinated manner. Chronic wounds and burns clearly decrease quality of life of the patients since they are associated with an increase in physical pain and socio-economical complications. Furthermore, incidence and prevalence of chronic wounds (unlike burns) have been increasing mainly due to population aging resulting in increased costs for national health systems. Thus, the development of new and more cost-effective technologies/therapies is not only of huge interest but also necessary to improve the long-term sustainability of national health systems. This review covers the current knowledge on recent technologies/therapies for skin regeneration, such as: wound dressings; skin substitutes; exogenous growth factor based therapy and systemic therapy; external tissue expanders; negative pressure; oxygen; shock wave, and photobiomodulation wound therapies. Associated benefits and risks as well as the clinical use and availability are all addressed for each therapy. Moreover, future trends in wound care including novel formulations using metallic nanoparticles and topical insulin are herein presented. These novel formulations have shown to be promising therapeutic options in the near future that may change the wound care paradigm.
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Affiliation(s)
- André Oliveira
- Faculty of Pharmacy, Universidade de Lisboa, Lisboa, Portugal
| | - Sandra Simões
- Faculty of Pharmacy, Research Institute for Medicines, iMed.ULisboa, Universidade de Lisboa, Lisboa, Portugal
| | - Andreia Ascenso
- Faculty of Pharmacy, Research Institute for Medicines, iMed.ULisboa, Universidade de Lisboa, Lisboa, Portugal
| | - Catarina Pinto Reis
- Faculty of Pharmacy, Research Institute for Medicines, iMed.ULisboa, Universidade de Lisboa, Lisboa, Portugal.,Faculty of Sciences, Biophysics and Biomedical Engineering, IBEB, Universidade de Lisboa, Lisboa, Portugal
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Carvalho MRD, Silveira IA, Oliveira BGRBD. Treatment of venous ulcers with growth factors: systematic review and meta-analysis. Rev Bras Enferm 2019; 72:200-210. [PMID: 30916287 DOI: 10.1590/0034-7167-2017-0865] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/08/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To identify evidence about the effects of growth factor application on venous ulcer healing. METHOD Systematic review and meta-analysis, including Randomized Clinical Trials. Searches: Ovid MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, LILACS, Web of Science, Digital Library of Theses and Dissertations; Google Scholar and list of references. RESULTS 802 participants were recruited from the 10 included studies: 472 in the intervention group (growth factors) and 330 as control. The relative risk for the complete healing outcome was 1.06 [95% CI 0.92-1.22], p = 0.41. Participants who received Platelet-Rich Plasma and Epidermal Growth Factor showed a slight tendency to achieve complete healing, but without statistical relevance (p <0.05). Most of the studies were classified as moderate risk of bias. CONCLUSION The effect of the application of growth factors for complete healing in venous ulcers is not clear, and clinical trials with methodological quality are required for more accurate recommendations.
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Affiliation(s)
- Magali Rezende de Carvalho
- Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa. Niterói, Rio de Janeiro, Brazil
| | - Isabelle Andrade Silveira
- Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa. Niterói, Rio de Janeiro, Brazil
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Zhang J, Hu W, Diao Q, Wang Z, Miao J, Chen X, Xue Z. Therapeutic effect of the epidermal growth factor on diabetic foot ulcer and the underlying mechanisms. Exp Ther Med 2019; 17:1643-1648. [PMID: 30783432 PMCID: PMC6364187 DOI: 10.3892/etm.2018.7133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 12/15/2017] [Indexed: 01/24/2023] Open
Abstract
The present study aimed to explore the therapeutic effect and underlying mechanism of epidermal growth factor (EGF) on the wound healing of diabetic foot ulcers (DFU). A total of 48 rabbits with DFU were randomly divided into 2 groups, comprising the treatment and control groups. Full-thickness skin (10×10 mm) was excised from the thigh of each rabbit. The wounds in the treatment group were treated with 100 mg/l EGF once a day for 1 month. The control group received no treatment. At 20 days following treatment, new granulation tissues that formed beyond the edge of the wound were collected for subsequent analysis. Tissues from rabbits in the treatment group produced a greater number of fibroblasts, which exhibited a fibroblastic morphology when compared with those in the control group. In the treatment group, a larger number of these fibroblasts were observed as clusters, and there were numerous blood vessels when compared with the control group. The fibroblasts in the control group exhibited an irregular morphology, contained fewer organelles and the surrounding collagenous fibers were sparse. These fibroblasts also demonstrated a disordered arrangement and it was revealed that the wound healed at a slower rate compared with the treatment group. Endogenous EGF mRNA detection revealed that there was a significant difference (P<0.05) in the relative gray value of EGF mRNA between the treatment (103.27±4.27) and control (63.88±4.36) groups. In conclusion, EGF may accelerate the healing of DFU, and exogenous EGF treatment may upregulate the expression of EGF mRNA in newly generated tissues.
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Affiliation(s)
- Juanzi Zhang
- Department of Vascular Surgery, The Affiliated Qingdao Hiser Hospital of Qingdao University, Qingdao, Shandong 266033, P.R. China
| | - Wenxian Hu
- Department of Vascular Surgery, The Affiliated Qingdao Hiser Hospital of Qingdao University, Qingdao, Shandong 266033, P.R. China
| | - Qixian Diao
- Department of General Surgery, The Affiliated Qingdao Hiser Hospital of Qingdao University, Qingdao, Shandong 266033, P.R. China
| | - Zhaowei Wang
- Department of Vascular Surgery, The Affiliated Qingdao Hiser Hospital of Qingdao University, Qingdao, Shandong 266033, P.R. China
| | - Jin Miao
- Department of Vascular Surgery, The Affiliated Qingdao Hiser Hospital of Qingdao University, Qingdao, Shandong 266033, P.R. China
| | - Xiao Chen
- Department of Vascular Surgery, The Affiliated Qingdao Hiser Hospital of Qingdao University, Qingdao, Shandong 266033, P.R. China
| | - Zhijun Xue
- Department of Vascular Surgery, The Affiliated Qingdao Hiser Hospital of Qingdao University, Qingdao, Shandong 266033, P.R. China
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Kahraman M, Misir A, Kizkapan TB, Ozcamdalli M, Uzun E, Mutlu M. The Long-Term Outcomes Following the Application of Intralesional Epidermal Growth Factor in Patients With Diabetic Foot Ulcers. J Foot Ankle Surg 2019; 58:282-287. [PMID: 30612874 DOI: 10.1053/j.jfas.2018.08.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Indexed: 02/03/2023]
Abstract
Epidermal growth factor is used as an adjuvant to close the wound in addition to standard care in diabetic foot ulcers. This study aimed to investigate the long-term outcomes after intralesional epidermal growth factor injections in the treatment of diabetic foot ulcers. Thirty-six feet of 34 patients (n = 34) with diabetic foot ulcers were included. Patient demographics, Wagner classifications, recurrence and amputation rates, Foot Function Index, Short Form 36, and American Academy of Orthopedic Surgeons Foot and Ankle Module scores were evaluated at the final follow-up examination. The mean age was 61.000 ± 13.743 years. The mean duration of wounds was 240.200 ± 146.385 days. A mean of 18.125 ± 4.494 (range 9 to 24) doses were applied. Wound closure was achieved in 33 of the 36 (91.7%) lesions. A complete response (granulation tissue >75% or wound closure) was observed in 29 (87.9%) lesions. The mean time to wound closure was 52.08 ± 10.65 (range 25 to 72) days. At the 5-year follow-up, 4 patients were lost to follow-up because of exitus owing to diabetic complications. Of the remaining 29 patients, 27 were ulcer free. In 2 patients (2 lesions, 6.9%) toe amputation was performed due to ischemic necrosis. The mean Foot Function Index, American Academy of Orthopedic Surgeons Foot and Ankle Core Scale, and AAOS Shoe Comfort Scale scores were 55.40 ± 12.15, 65.92 ± 17.56, and 56.42 ± 11.98, respectively. Complete wound healing and a low recurrence and amputation rates could be obtained with intralesional epidermal growth factor added to the standard treatment protocol.
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Affiliation(s)
- Murat Kahraman
- Surgeon, Department of Orthopaedics and Traumatology, Necip Fazil City Hospital, Kahramanmaras, Turkey.
| | - Abdulhamit Misir
- Surgeon, Department of Orthopaedics and Traumatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Turan Bilge Kizkapan
- Surgeon, Department of Orthopaedics and Traumatology, Bursa Cekirge State Hospital, Bursa, Turkey
| | - Mustafa Ozcamdalli
- Surgeon, Department of Orthopaedics and Traumatology, Ahi Evran University Faculty of Medicine, Kirsehir, Turkey
| | - Erdal Uzun
- Surgeon, Department of Orthopaedics and Traumatology, Ordu University Faculty of Medicine, Ordu, Turkey
| | - Mahmut Mutlu
- Professor, Department of Orthopaedics and Traumatology, Medicana Bahcelievler Hospital, Istanbul, Turkey
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Liu Y, Zhou S, Gao Y, Zhai Y. Electrospun nanofibers as a wound dressing for treating diabetic foot ulcer. Asian J Pharm Sci 2019; 14:130-143. [PMID: 32104445 PMCID: PMC7032134 DOI: 10.1016/j.ajps.2018.04.004] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/25/2018] [Accepted: 04/19/2018] [Indexed: 01/14/2023] Open
Abstract
Diabetes is one of the most prevalent diseases in the world with high-mortality and complex complications including diabetic foot ulcer (DFU). It has been reported that the difficulties in repairing the wound related to DFU has much relationship with the wound infection, change of inflammatory responses, lack of extracellular matrix (ECM), and the failure of angiogenesis. Following the development of medical materials and pharmaceutical technology, nanofibers has been developed by electrospinning with huge porosity, excellent humidity absorption, a better oxygen exchange rate, and some antibacterial activities. That is to say, as a potential material, nanofibers must be a wonderful candidate for the DFU treatment with so many benefits. Careful selection of polymers from natural resource and synthetic resource can widen the nanofibrous application. Popular methods applied for the nanofibrous fabrication consist of uniaxial electrospinning and coaxial electrospinning. Furthermore, nanofibers loading chemical, biochemical active pharmaceutical ingredient (API) or even stem cells can be wonderful dosage forms for the treatment of DFU. This review summarizes the present techniques applied in the fabrication of nanofibrous dressing (ND) that utilizes a variety of materials and active agents to offer a better health care for the patients suffering from DFU.
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Affiliation(s)
- Yan Liu
- Shenyang Pharmaceutical University, No.103, Shenyang 110016, China
| | - Shiya Zhou
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Yanlin Gao
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Yinglei Zhai
- School of Medical Devices, Shenyang Pharmaceutical University, Shenyang 110016, China
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Hu X, Lian W, Zhang X, Yang X, Jiang J, Li M. Efficacy of negative pressure wound therapy using vacuum-assisted closure combined with photon therapy for management of diabetic foot ulcers. Ther Clin Risk Manag 2018; 14:2113-2118. [PMID: 30498354 PMCID: PMC6207409 DOI: 10.2147/tcrm.s164161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diabetes mellitus, one of the most prevalent chronic metabolic diseases, causes many complications. Among the complications, one of the most common chronic complications is diabetic foot ulcers (DFUs). OBJECTIVE This study was conducted to investigate the efficacy of negative pressure wound therapy using vacuum-assisted closure (VAC) combined with photon therapy for the management of DFUs. PATIENTS AND METHODS The study included a total of 69 patients with DFUs during the period from January 2014 to December 2015. All patients were diagnosed with DFUs with Wagner's stage 2 or 3 and were divided into two groups - the VAC group in which patients received only VAC and the combined group in which patients received both VAC and photon therapy. Data on duration of the treatment, pre- and postoperative wound surface areas, dressing changing times, pain conditions assessed using visual analog scale scores, recurrence rate and amputation rate were collected. RESULTS Among all patients, 35 patients were divided into the VAC group and 34 patients into the combined group. Areas of foot ulcers for all patients ranged from 5 to 100 cm2. The treatment duration, dressing changing times and the peak value of visual analog scale scores were all significantly lower in the combined group compared with the VAC group (P < 0.05). However, the reduced area for wound surface showed no significant difference between the two groups. Both recurrence and amputation rates showed no significant difference between the two groups of patients. CONCLUSION Both VAC and VAC combined with photon therapy were effective and safe in the treatment of DFUs, while the combined therapy might have accelerated wound healing, but did not influence the long-term efficacy.
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Affiliation(s)
- Xiaoxiao Hu
- Department of interventional Vascular Surgery, The Tenth People's Hospital affiliated to Tongji University, Tongji University School of Medicine, shanghai, 200072, China,
| | - Weishuai Lian
- Department of interventional Vascular Surgery, The Tenth People's Hospital affiliated to Tongji University, Tongji University School of Medicine, shanghai, 200072, China,
| | - Xiaojun Zhang
- Department of interventional Catheter, The Tenth People's Hospital affiliated to Tongji University, Shanghai, 200072, China
| | - Xue Yang
- Department of Anesthesiology, eastern hospital affiliated to Tongji University, Shanghai, 200120, China
| | - Jinxia Jiang
- Department of Emergency, The Tenth People's Hospital affiliated to Tongji University, Shanghai, 200072, China,
| | - Maoquan Li
- Department of interventional Vascular Surgery, The Tenth People's Hospital affiliated to Tongji University, Tongji University School of Medicine, shanghai, 200072, China,
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12
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Involvement of growth factors in diabetes mellitus and its complications: A general review. Biomed Pharmacother 2018; 101:510-527. [DOI: 10.1016/j.biopha.2018.02.105] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/03/2018] [Accepted: 02/22/2018] [Indexed: 01/04/2023] Open
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13
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García-Honduvilla N, Cifuentes A, Ortega MA, Pastor M, Gainza G, Gainza E, Buján J, Álvarez-Mon M. Immuno-modulatory effect of local rhEGF treatment during tissue repair in diabetic ulcers. Endocr Connect 2018; 7:584-594. [PMID: 29592858 PMCID: PMC5900456 DOI: 10.1530/ec-18-0117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/27/2018] [Indexed: 12/26/2022]
Abstract
Wound healing is a complex process that can be severely impaired due to pathological situations such as diabetes mellitus. Diabetic foot ulcers are a common complication of this pathology and are characterized by an excessive inflammatory response. In this work, the effects of local treatment with recombinant human epidermal growth factor (rhEGF) were studied using a full-thickness wound healing model in streptozotocin-induced diabetic rats. Wound healing process was assessed with different concentrations of rhEGF (0.1, 0.5, 2.0 and 8.0 µg/mL), placebo and both diabetic and non-diabetic controls (n = 53). The macroscopic healing observed in treated diabetic rats was affected by rhEGF concentration. Histologically, we also observed an improvement in the epithelialization, granulation tissue formation and maturation in treated groups, finding again the best response at doses of 0.5 and 2.0 µg/mL. Afterwards, the tissue immune response over time was assessed in diabetic rats using the most effective concentrations of rhEGF (0.5 and 2.0 µg/mL), compared to controls. The presence of macrophages, CD4+ T lymphocytes and CD8+ T lymphocytes, in the reparative tissue was quantified, and cytokine expression was measured by quantitative real-time PCR. rhEGF treatment caused a reduction in the number of infiltrating macrophages in the healing tissue of diabetic, as well as diminished activation of these leukocytes. These findings show that local administration of rhEGF improves the healing process of excisional wounds and the quality of the neoformed tissue in a dose-dependent manner. Besides, this treatment reduces the local inflammation associated with diabetic healing, indicating immuno-modulatory properties.
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Affiliation(s)
- Natalio García-Honduvilla
- Department of Medicine and Medical SpecialitiesFaculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Networking Biomedical Research Center on BioengineeringBiomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS)Madrid, Spain
- University Center of Defense of Madrid (CUD-ACD)Madrid, Spain
| | - Alberto Cifuentes
- Department of Medicine and Medical SpecialitiesFaculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Networking Biomedical Research Center on BioengineeringBiomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS)Madrid, Spain
| | - Miguel A Ortega
- Department of Medicine and Medical SpecialitiesFaculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Networking Biomedical Research Center on BioengineeringBiomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS)Madrid, Spain
| | | | | | | | - Julia Buján
- Department of Medicine and Medical SpecialitiesFaculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Networking Biomedical Research Center on BioengineeringBiomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS)Madrid, Spain
- University Center of Defense of Madrid (CUD-ACD)Madrid, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical SpecialitiesFaculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Networking Biomedical Research Center on BioengineeringBiomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS)Madrid, Spain
- University Center of Defense of Madrid (CUD-ACD)Madrid, Spain
- Immune System Diseases-Rheumatology and Oncology ServiceUniversity Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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14
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Sridharan K, Sivaramakrishnan G. Growth factors for diabetic foot ulcers: mixed treatment comparison analysis of randomized clinical trials. Br J Clin Pharmacol 2018; 84:434-444. [PMID: 29148070 DOI: 10.1111/bcp.13470] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 12/30/2022] Open
Abstract
AIMS Topical growth factors accelerate wound healing in patients with diabetic foot ulcers (DFU). Due to the absence of head-to-head comparisons, we carried out Bayesian network meta-analysis to compare the efficacy and safety of growth factors. METHODS Using an appropriate search strategy, randomized controlled trials on topical growth factors compared with standard of care in patients with DFU, were included. Proportion of patients with complete healing was the primary outcome. Odds ratio (95% confidence interval) was used as the effect estimate and random effects model was used for both direct and indirect comparisons. Markov Chain Monte Carlo simulation was used to obtain pooled estimates. Rankogram was generated based on surface under the cumulative ranking curve (SUCRA). RESULTS A total of 26 studies with 2088 participants and 1018 events were included. The pooled estimates for recombinant epidermal growth factor (rhEGF), autologous platelet rich plasma (PRP), recombinant human platelet-derived growth factor (rhPDGF) were 5.72 [3.34, 10.37], 2.65 [1.60, 4.54] and 1.97 [1.54, 2.55] respectively. SUCRA for rhEGF was 0.95. Sensitivity analyses did not reveal significant changes from the pooled estimates and rankogram. No differences were observed in the overall risk of adverse events between the growth factors. However, the growth factors were observed to lower the risk of lower limb amputation compared to standard of care. CONCLUSION To conclude, rhEGF, rhPDGF and autologous PRP significantly improved the healing rate when used as adjuvants to standard of care, of which rhEGF may perform better than other growth factors. The strength of most of the outcomes assessed was low and the findings may not be applicable for DFU with infection or osteomyelitis. The findings of this study needs to be considered with caution as the results might change with findings from head-to-head studies.
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Affiliation(s)
- Kannan Sridharan
- Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Gowri Sivaramakrishnan
- Department of Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
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15
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Tan L, Hou Z, Gao Y. Efficacy of combined treatment with vacuum sealing drainage and recombinant human epidermal growth factor for refractory wounds in the extremities and its effect on serum levels of IL-6, TNF-α and IL-2. Exp Ther Med 2017; 15:288-294. [PMID: 29250151 PMCID: PMC5729703 DOI: 10.3892/etm.2017.5360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/06/2017] [Indexed: 12/27/2022] Open
Abstract
The objective of this study was to investigate the efficacy of combined treatment with vacuum sealing drainage (VSD) and recombinant human epidermal growth factor (rhEGF) for refractory wounds in the extremities, and its effect on serum levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and IL-2. Ninety-eight patients with refractory wounds in the extremities were recruited and randomly divided into the combined treatment group (underwent VSD and rhEGF treatment) and control group (underwent VSD only) with 49 cases each. Formation of granulation tissue on the wound surface was assessed and scored. The wound healing rate was calculated after 1 week of treatment, and the time of complete healing was recorded. Serum levels of IL-6, IL-2, and TNF-α were measured using enzyme-linked immunosorbent assay. After 1 week of treatment, granulation tissue formation on wound surfaces was significantly improved (p<0.05) compared with that before treatment in both groups. Moreover, granulation tissue formation on wound surfaces was superior in the combined treatment group than in the control group (p<0.05). The wound healing rate was 63.50±4.75% in the combined treatment group and 31.79±3.52% in the control group, and the difference was statistically significant (p<0.05). The time of complete healing was 15.11±2.24 days in the combined treatment group and 19.63±2.76 days in the control group, and the difference was statistically significant (p<0.05). The serum levels of IL-6, IL-2, and TNF-α, in the two groups were significantly lower than those before treatment (p<0.05). Moreover, the levels in the combined treatment group were significantly lower than those in the control group (p<0.05). In conclusion, combined treatment with VSD and rhEGF reduced inflammation and shortened the time of complete healing of refractory wounds in the extremities. Measurement of the levels of related inflammatory factors provided a reference for the prognosis of refractory wounds.
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Affiliation(s)
- Lei Tan
- Traumatology Ward I, Zhangqiu Hospital of Chinese Medicine, Zhangqiu, Shandong 250200, P.R. China
| | - Zhongyu Hou
- Traumatology Ward II, Laiwu Iron and Steel Group Co. Ltd. Hospital, Laiwu, Shandong 271126, P.R. China
| | - Yanzhi Gao
- Department of Emergency, The Central Hospital of Shengli Oilfield, Dongying, Shandong 257034, P.R. China
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16
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Adeghate J, Nurulain S, Tekes K, Fehér E, Kalász H, Adeghate E. Novel biological therapies for the treatment of diabetic foot ulcers. Expert Opin Biol Ther 2017; 17:979-987. [PMID: 28532226 DOI: 10.1080/14712598.2017.1333596] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The number of people with diabetes mellitus (DM) is estimated to exceed 640 million by the year 2040. Diabetic foot ulcer (DFU) is a debilitating illness that affects more than 2% of DM patients. DFU is caused by DM-induced neural and vascular lesions leading to a reduced sensation and microcirculation. The increase in the prevalence of DFU has prompted researchers to find new therapies for the management of DFU. Areas covered: This review presents the current status of novel biological therapies used in the treatment of DFU. Literature information and data analysis were collected from PubMed, the website of the American Diabetes Association, and ClinicalTrials.gov. The keywords used in the search were: DM, DFU, complications of DM. Expert opinion: Many biological agents have been investigated in a bid to find an effective therapy for DFU. These include growth factors (platelet-derived growth factor, vascular endothelial growth factor etc), stem cells (epithelial progenitor-, adipose-derived stem cells etc), anti-diabetic drugs (insulin, exendin-4), herbs, urokinase, dalteparin, statins and bio-agents such as acid peptide matrix. Biological agents that can reduce hyperglycaemia, increase sensation, microcirculation and oxygenation and repair lost tissue are the most ideal for the treatment of DFU.
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Affiliation(s)
- Jennifer Adeghate
- a Department of Anatomy , Semmelweis University , Budapest , Hungary
| | - Syed Nurulain
- b COMSATS Institute of Information Technology , Islamabad , Pakistan
| | - Kornélia Tekes
- c Department of Pharmacodynamics , Semmelweis University , Budapest , Hungary
| | - Erzsébet Fehér
- a Department of Anatomy , Semmelweis University , Budapest , Hungary
| | - Huba Kalász
- d Department of Pharmacology and Pharmacotherapy , Semmelweis University , Budapest , Hungary
| | - Ernest Adeghate
- e Department of Anatomy, College of Medicine & Health Sciences , United Arab Emirates University , Al Ain , United Arab Emirates
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17
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Zheng Z, Liu Y, Yang Y, Tang J, Cheng B. Topical 1% propranolol cream promotes cutaneous wound healing in spontaneously diabetic mice. Wound Repair Regen 2017; 25:389-397. [PMID: 28494521 DOI: 10.1111/wrr.12546] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/04/2017] [Indexed: 12/11/2022]
Abstract
Diabetic foot ulcers (DFUs) are a constant threat to diabetic patients and can lead to amputations and even death. Intralesional administration of propranolol in diabetic wounds has not been reported previously. This study aimed to investigate the efficacy of propranolol cream in diabetic wounds. Fifty-six spontaneously diabetic mice were divided into the propranolol group and the control group. After preparing full-thickness wounds on the back of the mice, 1% propranolol cream was topically applied to wounds in the experimental group and 0% propranolol cream in controls. The wound sizes were measured and calculated against the original area. The wounds were analyzed up to 21 days after injury. At all evaluation time-points, the wound size (%) in the propranolol group was significantly smaller than in the controls. Epidermal growth factor (EGF) protein expression increased in the experimental vs. CONTROL GROUP Vascular endothelial growth factor (VEGF) expression was significantly lower in the experimental vs. control group whereas NG2 proteoglycan was increased throughout the study. However, matrix metallopeptidase (MMP)-9 expression was at first significantly higher in the experimental vs. control group then the MMP-9 protein level in the control group increased and surpassed that in the experimental group. In conclusion, intralesional administration of 1% propranolol cream promotes reepithelialization and regulates abnormal angiogenesis in diabetic wounds. Propranolol cream may become a new drug for the treatment of DFUs.
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Affiliation(s)
- Zhifang Zheng
- The Graduate School of Southern Medical University, Guangzhou, China.,Department of Plastic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Yishu Liu
- Department of Plastic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.,The Graduate School of Third Military Medical University, Chongqing, China
| | - Yu Yang
- The Graduate School of Southern Medical University, Guangzhou, China.,Department of Plastic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Jianbing Tang
- Department of Plastic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Biao Cheng
- The Graduate School of Southern Medical University, Guangzhou, China.,Department of Plastic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.,The Graduate School of Third Military Medical University, Chongqing, China.,Center of Wound Treatment, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.,The Key Laboratory of Trauma Treatment & Tissue Repair of Tropical Area, PLA, Guangzhou, China
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18
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Yang S, Geng Z, Ma K, Sun X, Fu X. Efficacy of Topical Recombinant Human Epidermal Growth Factor for Treatment of Diabetic Foot Ulcer. INT J LOW EXTR WOUND 2016; 15:120-5. [PMID: 27151755 DOI: 10.1177/1534734616645444] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diabetic foot ulceration is a major complication of diabetes mellitus. Recombinant human epidermal growth factor (rhEGF) is used topically in the treatment of diabetic foot ulcers. This meta-analysis was designed to evaluate if rhEGF increased the complete healing rate of diabetic foot compared with controls. We searched the MEDLINE, Cochrane Library, EMBASE, and Web of Knowledge databases (up to December 22, 2015). Studies were identified and selected, and data were extracted by 2 independent reviewers. A total of 4 randomized controlled trials including 294 patients were identified. The studies evaluated the rate of healing of diabetic foot that were treated with rhEGF or controls. On account of study heterogeneity, a random-effects model was performed, and the combined odds ratio (OR) indicated a significantly greater complete healing rate in patients treated with rhEGF compared to placebo. The ORs ranged from 1.66 to 14.64, with a combined OR of 4.36 (95% confidence interval = 1.48-12.81, P = .007). These results indicate that rhEGF is efficacious in the treatment of diabetic foot ulcers by increasing the rate of wound healing. These findings support the use of rhEGF in treating diabetic foot.
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Affiliation(s)
- Shaowei Yang
- Chinese PLA General Hospital, Beijing, People’s Republic of China
- First Affiliated Hospital to the Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Zhijun Geng
- First Affiliated Hospital to the Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Kui Ma
- First Affiliated Hospital to the Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Xiaoyan Sun
- Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Xiaobing Fu
- Chinese PLA General Hospital, Beijing, People’s Republic of China
- First Affiliated Hospital to the Chinese PLA General Hospital, Beijing, People’s Republic of China
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Lee JB, Shin B, Lee SH, Lee BY, Kim TH, Kim MG, Yoo SD. Exposure assessment of epidermal growth factor to various tissues in mice after intravenous and subcutaneous administration. ACTA ACUST UNITED AC 2015; 67:1519-27. [PMID: 26255780 DOI: 10.1111/jphp.12464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/15/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study was conducted to examine the tissue distribution of human recombinant epidermal growth factor (EGF) after multiple intravenous and subcutaneous injections in mice. METHODS Male BALB/c mice were divided into (1) EGF 1 mg/kg intravenous dose, (2) EGF 5 mg/kg intravenous dose, (3) drug-free intravenous control, (4) EGF 1 mg/kg subcutaneous dose, (5) EGF 5 mg/kg subcutaneous dose and (6) drug-free subcutaneous control groups. EGF and drug-free dosing solutions were injected by intravenous and subcutaneous injections once a day for 3 days. EGF concentrations in serum and tissues of kidney, liver, lung, small intestine and tongue were determined by ELISA. KEY FINDINGS As the intravenous and subcutaneous doses were increased from 1 to 5 mg/kg, serum Cmax and area under the concentration-time curve (AUC) values were increased dose-proportionally. In lung, tongue and small intestine, increases in AUC were dose-proportional after intravenous injections, but greater than dose-proportional after subcutaneous injections. The fold-increases in Cmax and AUC values were lowest in liver and highest in kidney. CONCLUSION Based on Cmax and AUC data, the systemic exposure achieved by subcutaneous injections was comparable with that achieved by intravenous injections.
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Affiliation(s)
- Jong Bong Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Beomsoo Shin
- College of Pharmacy, Catholic University of Daegu, Gyeongbuk, South Korea
| | - Sang Ho Lee
- Pharmaceutical Research Institute, Daewoong Pharmaceutical Corporation, Yongin, South Korea
| | - Bong Yong Lee
- Pharmaceutical Research Institute, Daewoong Pharmaceutical Corporation, Yongin, South Korea
| | - Tae Hwan Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Min Gi Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Sun Dong Yoo
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
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