Application of Topical Sucralfate and Topical Platelet-Rich Plasma Improves Wound Healing in Diabetic Ulcer Rats Wound Model

Abstract

Purpose One of the most serious and devastating complications of diabetes mellitus is diabetic ulcers. They are difficult to treat and often result in limb loss. Topical sucralfate and platelet-rich plasma have the potential to improve the healing outcomes of chronic ulcers, including diabetic ulcers. This research aims to determine the effectiveness of sucralfate and platelet-rich plasma therapy for the improvement of diabetic ulcer wound healing. Patients and Methods Ninety Wistar rats were used in this study and were classified into five groups. Four of the five groups were diabetic induced and were treated with topical sucralfate only, platelet-rich plasma only, combination of topical sucralfate and platelet-rich plasma, and diabetic control group which received standard therapy only. The non-diabetic control group did not receive any therapy. We observed macrophage amount, platelet-derived growth factor, vascular endothelial growth factor, and hypoxia-inducible factor as a biomarker. Rats were terminated after 7th and 14th days and were subjected to immunohistochemistry staining and examination. Results We found that topical sucralfate and platelet-rich plasma increase macrophage levels, vascular endothelial growth factor expression and platelet-derived growth factor expression in diabetic wound cells. We also found a reduction in hypoxia inducible factor-1α expression. Combination of topical sucralfate and platelet-rich plasma for 14 days gave the most significant improvement in terms of wound healing compared to topical sucralfate or platelet-rich plasma alone. Conclusion The combination of topical sucralfate and platelet-rich plasma therapy results in the best improvement in diabetic ulcer wound healing compared to sucralfate or platelet-rich plasma monotherapy or conventional wound healing therapy.

Effectiveness of Topical Sucralfate in the Management of Diabetic Foot Ulcers: An Open-Labeled Randomized Study

“…Thus, in our study, there was no statistical difference in the healing rates of diabetic foot ulcer with and without adding sucralfate to topical mupirocin ointment. This is in contrast with some studies, which have observed better healing rates of DFUs following the addition of sucralfate [17][18][19][20]. However, our study is consistent with the study by Ala et al, which did not observe any improvement in the healing rates of chronic ulcers after the addition of sucralfate [21].…”

The Use of Sucralfate in Clinical Practice

“…The wound protection and repair mechanism of sucralfate appears to be related to its ability to maintain blood vessel integrity. As one of the main pathological mechanisms of diabetes mellitus is vasculopathy, sucralfate would help in maintaining adequate blood flow, thus improving the bioavailability of wound healing growth factors [12]. The results of this research also seem to follow the clinical evidence noted by Nagalakshmi, Amalan and Anandan [13] regarding the topical use of sucralfate in the healing of epithelial wounds.…”

Comparison of topical sucralfate with dexpanthenol in rat wound model

“…41 It is a cytoprotective agent used to prevent and treat various diseases such F I G U R E 3 EGF immunohistochemistry staining of groups at days 7, 14 and 21 as gastrointestinal diseases, reflux, gastritis and peptic ulcer. 42,43 At low pH conditions, sucralfate produces a polyanionic gel that binds proteins in the ulcer crater, which binds many growth factors, protecting them from proteolytic degradation 44 and increasing their availability. 45 Previous studies have proven that sucralfate interacts with several growth factors to promote epithelial wound healing.…”

“…Sucralfate is the aluminium hydroxide salt of the disaccharide sucrose octasulphate 41 . It is a cytoprotective agent used to prevent and treat various diseases such as gastrointestinal diseases, reflux, gastritis and peptic ulcer 42,43 . At low pH conditions, sucralfate produces a polyanionic gel that binds proteins in the ulcer crater, which binds many growth factors, protecting them from proteolytic degradation 44 and increasing their availability 45 .…”