Ointments containing Ceratothoa oestroides extract: Evaluation of their healing potential in the treatment of diabetic foot ulcers

Abstract

Diabetic foot ulceration is a common and severe complication of diabetes, causing substantial social, medical, and economic burdens. Treatment of foot ulcers remains challenging, thus requiring increasing awareness and more efficient management. This study investigates the efficacy of ointments, containing as main active ingredient the olive oil extract of the marine isopod Ceratothoa oestroides, in the treatment of patients with diabetic foot ulcers. Fifty‐two patients were allocated into four treatment groups either receiving therapy with an ointment containing extract of C. oestroides or extract of C. oestroides and eosin or extract of C. oestroides and cefaclor or no treatment. Patients were monitored for a period of 135 days by evaluation of transepidermal water loss, skin hydration, planimetry, photo‐documentation, and clinical condition. Treatment with the extract of C. oestroides demonstrated significant healing properties that became evident after 45 days of treatment and resulted in complete ulcer healing in 61% of the patients. A significant improvement in transepidermal water loss (p < 0.001), skin hydration levels (p < 0.001), and wound area (p < 0.001) was observed in all patients. Similar efficacy was demonstrated for the combination of C. oestroides extract with eosin treatment (p < 0.001). On the contrary, the combination of C. oestroides extract with cefaclor antibiotic agent completely inhibited the healing properties of the isopod extract and did not improve water loss, skin hydration, or wound area. An important factor for C. oestroides extract healing properties is its selective activity against Gram negative bacteria. Ointments containing C. oestroides extract alone or combined with the antimicrobial agent eosin emerges as an effective regimen for the treatment of diabetic foot ulcers.

In Vivo Evaluation of Wound Healing Efficacy of Gel-Based Dressings Loaded with Pycnogenol™ and Ceratothoa oestroides Extracts

“…Focusing on the results of the formulations containing C. oestroides olive oil extract, based on the observed outcomes, the extract has a positive impact on the healing process compared to the control. This confirms our laboratory's previous observations regarding its excellent healing activity [11][12][13][14][15][16][17].…”

“…Ceratothoa oestroides, an isopod parasite found in the oral cavity of large fish, is currently identified as one of the most significant threats to aquaculture. The olive oil extract of C. oestroides, formulated as an ointment, has been studied over the last decade by our laboratories, focusing primarily on its healing properties but also exploring its antiinflammatory, anti-psoriatic, and anti-atopic dermatitis effects, yielding highly significant outcomes both in preclinical and clinical trials [11][12][13][14][15][16][17].…”

“…Pycnogenol and C. oestroides extracts have shown their effectiveness in promoting wound healing when formulated as ointments [8][9][10][11][12][13][14][15][16][17]. However, the pharmaceutical form of ointment presents notable drawbacks concerning wound healing.…”

“…This study aimed to enhance the pharmaceutical form of the extracts while maintaining their effectiveness, as well as to investigate their combined administration in topically applied formulations. The doses were established by referring to previous relevant studies [10,11], with a specific dosage of 5% for Pycnogenol™ and 10% for the extract of C. oestroides. The gel dressings were chosen based on their ability to continuously release the active ingredients that were included, as well as due to their simple preparation.…”

Update of Topical Interventions for Healing Diabetic Ulcers—A Systematic Review

“…16 The propolis-based ointment and ointment containing 10% of the isopod Ceratothoa oestroides extract showed significant results in terms of area reduction and area reduction rate. 17,18 The healing rate of the ointments ranged from 61% to 63.6%. The other results related to the use of ointments are reported in Table 1.…”