Current and emerging therapies in the management of diabetic foot ulcers

Karri, Veera Venkata Satyanarayana Reddy; Kuppusamy, Gowthamarajan; Talluri, Siddhartha Venkata; Yamjala, Karthik; Mannemala, Sai Sandeep; Malayandi, Rajkumar

doi:10.1185/03007995.2015.1128888

Cited by 54 publications

(34 citation statements)

References 137 publications

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“…DFU is a main reason for amputation and death among diabetic patients, moreover, the treatments for DFU lead to a heavy economic burden to the patients and their family. [ 18 ] Early detection and timely treatment may significantly improve life quality and outcomes of the patients. [ 19 ] There are 2 major reasons contributing to the occurrence of DFU: diabetic neuropathy and peripheral vascular diseases.…”

Section: Discussionmentioning

confidence: 99%

The association between MCP-1, VEGF polymorphisms and their serum levels in patients with diabetic foot ulcer

Li¹

2018

Medicine

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The purpose of the present study was to investigate distribution of monocyte chemoattractant protein-1 (MCP-1) –2518A/G and vascular endothelial growth factor (VEGF) –634G/C polymorphisms in type 2 diabetes melitus patients (T2DM) presenting diabetic foot ulcer (DFU). Additionally, we evaluated the effects of these 2 polymorphisms on serum levels of MCP-1 and VEGF in the study population.Patients diagnosed with T2DM without or with DFU were recruited in the study. The distribution of MCP-1 –2518A/G and VEGF –634G/C polymorphisms was investigated by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Enzyme-linked immunosorbent assay (ELISA) was applied to detect the protein levels of MCP-1 and VEGF. The comparisons of protein levels in DFU patients were performed by student t test according to their genotypes.The frequencies of GG genotype and G allele of MCP-1 –2518A/G was increased in DFU patients, compared with T2DM patients (odds ratio [OR] = 2.60, 95% confidence interval [CI] = 1.23–5.50, P = .011 and OR = 1.72, 95% CI = 1.18–2.50, P = .005, respectively). Moreover, the increased frequency of GG was significantly associated with up-regulated MCP-1 level in DFU patients (P < .001). Analysis for VEGF –634G/C polymorphisms indicated that the prevalence of CC genotype and C allele of the polymorphisms was decreased in DFU patients, compared with T2DM patients (OR = 0.36, 95% CI = 0.17–0.77, P = .008 and OR = 0.63, 95% CI = 0.43–0.91, P = .015, respectively). DFU patients carrying CC genotype had a higher level of VEGF than those with other genotypes (P = .007).MCP-1 –2518A/G and VEGF –634G/C polymorphisms may involve in occurrence and progress of DFU through regulating transcription activity of the genes.

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Section: Discussionmentioning

confidence: 99%

The association between MCP-1, VEGF polymorphisms and their serum levels in patients with diabetic foot ulcer

Li¹

2018

Medicine

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“…The treatment of choice for this diagnostic is a piperacillin/tazobactam combination and linezolid. Specifically, for osteomyelitis associated with overlying DFI, there are currently no approved drugs [44].…”

Section: Systemic Antibiotic Therapymentioning

confidence: 99%

“…EGF was also used in several clinical studies in advanced DFUs, and its administration showed promising results in the formation of granulation tissue and the prevention of amputation in patients [56]. Intra-lesion injection of the recombinant form of EGF (rhEGF) directly at the site of the wound demonstrated a greater pharmacodynamic response in terms of granulation tissue growth and wound closure [44]; while PDGF-BB, FGFb, VEGF, and EGF were the most frequently used factors to improve the wound's healing time, there were also clinical trials studying growth factors in the context of infection management. For instance, G-CSF was used in patients with ulcers complicated by soft-tissue infection, but it did not show a benefit in the treatment of the infection or cure the ulcer.…”

Section: Growth Factorsmentioning

confidence: 99%

Diabetic Foot Ulcers: Current Advances in Antimicrobial Therapies and Emerging Treatments

et al. 2019

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Diabetic foot ulcers (DFUs) are very important diabetes-related lesions that can lead to serious physical consequences like amputations of limbs and equally severe social, psychological, and economic outcomes. It is reported that up to 25% of patients with diabetes develop a DFU in their lifetime, and more than half of them become infected. Therefore, it is essential to manage infection and ulcer recovery to prevent negatives outcomes. The available information plays a significant role in keeping both physicians and patients aware of the emerging therapies against DFUs. The purpose of this review is to compile the currently available approaches in the managing and treatment of DFUs, including molecular and regenerative medicine, antimicrobial and energy-based therapies, and the use of plant extracts, antimicrobial peptides, growth factors, ozone, devices, and nano-medicine, to offer an overview of the assessment of this condition.2 of 32 history [2]. DFUs are one of the most severe complications of diabetes, and more than half of those ulcers become infected. Every single one of these infected lesions has the potential to get worse and compromise the integrity of the lower limbs. To avoid amputations and improve the patient's quality of life, it is very important to implement a strict program for the prevention and treatment of ulcers, as well as proper management of infections [3]. Thus, it is critical to keep diabetes patients aware of new therapies and treatments and their availability in the healthcare system. The treatment of DFUs requires a multidisciplinary approach with proper medical tools, skills, and knowledge. This starts from patient education, with the application of new classifications to guide the treatment to prevent amputations. New diagnosis methods should become available, such as the 16S ribosomal DNA sequence in bacteria, to provide a better understanding of the microbiota in DFUs. It is reported that DFU has a polymicrobial nature, and, according to its geographical location, certain marked differences, wound characteristics, antibiograms according to local epidemiology, individualized antimicrobial guided therapy, regular debridement, regular assessment of wounds, and change of dressings. The latter characteristics are also aided by new biological and molecular therapies that were proven to improve infection control, the regulation of the local inflammatory profile, and improved quality of the cicatrizing process. In the next sections, this review presents an approach for the diagnosis and treatment of DFUs, focusing on the current advances in antimicrobial therapies, such as dressings,

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“…More than 10% of diabetic patients develop DFUs at some point in their lives [3]. Treatments for DFUs include various drugs [4], several types of wound dressing or skin substitutes such as Integra V R dermal regeneration template [5] and dermal replacement [6][7][8]. Wound dressings using nanotechnology have been developed as tissue-engineered scaffolds for skin [9].…”

Section: Introductionmentioning

confidence: 99%

Neurotensin-loaded PLGA/CNC composite nanofiber membranes accelerate diabetic wound healing

Zheng

Liu

Huang

et al. 2018

Artificial Cells, Nanomedicine, and Biotechnology

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Diabetic foot ulcers (DFUs) are a threat to human health and can lead to amputation and even death. Recently neurotensin (NT), an inflammatory modulator in wound healing, was found to be beneficial for diabetic wound healing. As we demonstrated previously, polylactide-polyglycolide (PLGA) and cellulose nanocrystals (CNCs) (PLGA/CNC) nanofiber membranes show good cytocompatibility and facilitate fibroblast adhesion, spreading and proliferation. PLGA/CNC nanofiber membranes are novel materials that have not been used previously as NT carriers in diabetic wounds. This study aims to explore the therapeutic efficacy and possible mechanisms of NT-loaded PLGA/CNC nanofiber membranes in full-thickness skin wounds in spontaneously diabetic mice. The results showed that NT could be sustained released from NT-loaded PLGA/CNC composite nanofiber membranes for 2 weeks. NT-loaded PLGA/CNC composite nanofiber membranes induced more rapid healing than other control groups. After NT exposure, the histological scores of the epidermal and dermal regeneration and the ratios of the fibrotic area to the whole area were increased. NT-loaded PLGA/CNC composite nanofiber membranes also decreased the expressions of the inflammatory cytokines IL-1β and IL-6. These results suggest that NT-loaded PLGA/CNC composite nanofiber membranes for sustained delivery of NT should effectively promote tissue regeneration for the treatment of DFUs.

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Current and emerging therapies in the management of diabetic foot ulcers

Cited by 54 publications

References 137 publications

The association between MCP-1, VEGF polymorphisms and their serum levels in patients with diabetic foot ulcer

The association between MCP-1, VEGF polymorphisms and their serum levels in patients with diabetic foot ulcer

Diabetic Foot Ulcers: Current Advances in Antimicrobial Therapies and Emerging Treatments

Neurotensin-loaded PLGA/CNC composite nanofiber membranes accelerate diabetic wound healing

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