Momordica charantia ointment accelerates diabetic wound healing and enhances transforming growth factor-β expression

Insights into the mechanisms of diabetic wounds: pathophysiology, molecular targets, and treatment strategies through conventional and alternative therapies

Diabetes mellitus is a prevalent cause of mortality worldwide and can lead to several secondary issues, including DWs, which are caused by hyperglycemia, diabetic neuropathy, anemia, and ischemia. Roughly 15% of diabetic patient's experience complications related to DWs, with 25% at risk of lower limb amputations. A conventional management protocol is currently used for treating diabetic foot syndrome, which involves therapy using various substances, such as bFGF, pDGF, VEGF, EGF, IGF-I, TGF-β, skin substitutes, cytokine stimulators, cytokine inhibitors, MMPs inhibitors, gene and stem cell therapies, ECM, and angiogenesis stimulators. The protocol also includes wound cleaning, laser therapy, antibiotics, skin substitutes, HOTC therapy, and removing dead tissue. It has been observed that treatment with numerous plants and their active constituents, including Globularia Arabica, Rhus coriaria L., Neolamarckia cadamba, Olea europaea, Salvia kronenburgii, Moringa oleifera, Syzygium aromaticum, Combretum molle, and Myrtus communis, has been found to promote wound healing, reduce inflammation, stimulate angiogenesis, and cytokines production, increase growth factors production, promote keratinocyte production, and encourage fibroblast proliferation. These therapies may also reduce the need for amputations. However, there is still limited information on how to prevent and manage DWs, and further research is needed to fully understand the role of alternative treatments in managing complications of DWs. The conventional management protocol for treating diabetic foot syndrome can be expensive and may cause adverse side effects. Alternative therapies, such as medicinal plants and green synthesis of nano-formulations, may provide efficient and affordable treatments for DWs.

Acknowledging the use of botanicals to treat diabetic foot ulcer during the 21st century: A systematic review

BACKGROUND

Diabetic foot ulcer (DFU) is a serious health issue of diabetes mellitus that affects innumerable people worldwide. Management and treatment of this complication are challenging, especially for those whose immune system is weak.

AIM

To discuss the plants and their parts used to heal DFU, along with the mode of their administration in diabetic patients.

METHODS

The original articles on “the plants for the treatment of DFU” studied in clinical cases only were obtained from various bibliographic databases using different keywords.

RESULTS

The search resulted in 22 clinical cases records with 20 medicinal plants belonging to 17 families on 1553 subjects. The fruits and leaves were the most preferentially used parts for DFU treatment, regardless of whether they were being administered orally or applied topically. Of the 20 medicinal plants, 19 reported their effectiveness in increasing angiogenesis, epithelialization, and granulation, thus hastening the wound-healing process. The efficacy of these botanicals might be attributed to their major bioactive compounds, such as actinidin and ascorbic acid (in Actinidia deliciosa), 7-O-(β-D-glucopyranosyl)-galactin (in Ageratina pichinchensis), omega-3-fatty acid (in Linum usitatissimum), isoquercetin (in Melilotus officinalis), anthocyanins (in Myrtus communis), and plantamajoside (in Plantago major).

CONCLUSION

The validation of mechanisms of action underlying these phytocompounds contributing to the management of DFU can aid in our better understanding of creating efficient treatment options for DFU and its associated problems.

Antioxidant Activities of Natural Compounds from Caribbean Plants to Enhance Diabetic Wound Healing

Diabetic wound healing is a global medical challenge. Several studies showed that delayed healing in diabetic patients is multifactorial. Nevertheless, there is evidence that excessive production of ROS and impaired ROS detoxification in diabetes are the main cause of chronic wounds. Indeed, increased ROS promotes the expression and activity of metalloproteinase, resulting in a high proteolytic state in the wound with significant destruction of the extracellular matrix, which leads to a stop in the repair process. In addition, ROS accumulation increases NLRP3 inflammasome activation and macrophage hyperpolarization in the M1 pro-inflammatory phenotype. Oxidative stress increases the activation of NETosis. This leads to an elevated pro-inflammatory state in the wound and prevents the resolution of inflammation, an essential step for wound healing. The use of medicinal plants and natural compounds can improve diabetic wound healing by directly targeting oxidative stress and the transcription factor Nrf2 involved in the antioxidant response or the mechanisms impacted by the elevation of ROS such as NLRP3 inflammasome, the polarization of macrophages, and expression or activation of metalloproteinases. This study of the diabetic pro-healing activity of nine plants found in the Caribbean highlights, more particularly, the role of five polyphenolic compounds. At the end of this review, research perspectives are presented.

A bio-polymeric scaffold incorporated with p-Coumaric acid enhances diabetic wound healing by modulating MMP-9 and TGF-β3 expression

Diabetic wounds lead to severe health complications as the tissue regeneration process fails predominantly due to prolonged inflammation, reactive oxygen species generation, and imbalance in collagen turnover. Modern wound dressings that can aid in wound management thus improving the public healthcare system, is the present need. This study aims to fabricate an effective wound dressing using plant polyphenol to treat chronic wounds as polyphenols possess excellent wound-healing ability. The collagen scaffold enriched with the polyphenol, p-Coumaric acid, was fabricated by freeze-drying method (Col-OxP3-Ca) and examined for its wound-healing ability by in vitro and in vivo analyses. Col-OxP3-Ca scaffold exhibited 85% antioxidant activity, biocompatibility in fibroblast cells, enhanced cell proliferation and migration rate. The diabetic excision wound treated with Col-OxP3-Ca scaffold healed within 21 days and a well-developed epidermis, blood vessels, hair follicle formation, fewer inflammatory cells and collagen deposition was observed in histological analysis. The immunohistochemical results depicted the enhanced expression of TGF-β3 and lessened expression of the MMP-9 in Col-OxP3-Ca scaffold treatment group. p-Coumaric acid shortened the inflammatory stage, enhanced angiogenesis, tissue regeneration and balanced collagen turnover during healing. From this, we can accomplish that the Col-OxP3-Ca wound dressing could be an outstanding alternative to treat chronic wounds.

Herbal Products and Their Active Constituents for Diabetic Wound Healing-Preclinical and Clinical Studies: A Systematic Review

The purpose of this review is to provide verified data on the current knowledge acquired in preclinical and clinical studies regarding topically used herbal products and their active constituents (formulations and dressings) with diabetic wound healing activity. Moreover, herbal products and their active constituents used for diabetic wound infections, and various cellular and molecular mechanisms of their actions will also be described. The electronic databases were searched for articles published from 2012 to 2022. Publications with oral or systemic administration of herbal products in diabetic wound healing, published before 2012, available only as an abstract, or in languages other than English were excluded from the study. The 59 articles comparing topically used herbal products in diabetic wound healing treatment versus control treatments (placebo or active therapy) were selected. Herbal products through different mechanisms of action, including antimicrobial, anti-inflammatory, antioxidant activity, stimulation of angiogenesis, production of cytokines and growth factors, keratinocytes, and fibroblast migration and proliferation may be considered as an important support during conventional therapy or even as a substitute for synthetic drugs used for diabetic wound treatment.

A Review of Traditional Uses, Phytochemistry and Pharmacological Properties of Some Vietnamese Wound-Healing Medicinal Plants

Wound healing is a sophisticated process that results in the repair of damaged tissues. Any impairment to this process can lead to non-healing (chronic) wounds. Since these can cause a massive burden on the healthcare system, alternative therapies that promote wound healing should be considered. Therapies of natural origins that are safe and with no adverse side effects are especially promising. Vietnam, a tropical-climate country, has many medicinal plants that possess the potential for healing wounds. This report explores the use of some common plants used in Traditional Vietnamese medicine and their molecular mechanisms.

Improving Diabetic Foot Ulcer Healing with Adjuvant Bitter Melon Leaf Extract (Momordica charantia L.)

BACKGROUND: Diabetes mellitus is a serious disease that affects more than 340 million people and causes approximately 20% of diabetic ulcer cases worldwide. Wound healing is a complex and dynamic process in restoring cellular structures and tissue layers. It consists of four continuous overlapping phases that are precisely programmed AIM: This study aims to examine the adjuvant administration of bitter melon leaf extract to increase the healing of diabetic foot ulcers (DFU). METHODS: This study used a randomized, double-blind, and placebo-controlled trial. A total of 30 DFU patients with a perfusion, extent, depth, infection, and sensation (PEDIS) score of 1–8 who met the criteria were divided into two groups, namely, the treatment group with adjuvant administration of bitter melon leaf extract at a dose of 6 g/day as many as 15 patients and the control group 15 patients with placebo. This intervention was carried out for 4 weeks. DFU cure was measured by PEDIS scores at baseline, weeks 2, 3, and the end of week 4. Data were analyzed using paired t-test and independent t-test. RESULTS: After 4 weeks of treatment, the PEDIS score in the treatment group decreased at week 2 (0.9 ± 1.8), but not significant (p = 0.19), decreased at week 3 (1.9 ± 1.9) and significant (p = 0.01), decreased in week IV (2.3 ± 2.1) and significantly (p = 0.001). The control group experienced a decrease in week 2 (0.3 ± 2.3), but not significant (p = 0.71), decreased in week 3 (1.2 ± 2.5), but not significant (p = 0.18), decreased in week 4 (1.9 ± 2.7) and significantly (p = 0.03), and there was an effect of adjuvant administration of bitter melon leaf extract on the cure of DFU (p = 0.004). CONCLUSION: Adjuvant administration of bitter melon leaf extract has been shown to increase the healing of DFU.

Wound healing by topical application of Momordica charantia L. formulations on mice

Background and Aim

Momordica charantia is mainly characterized by its antimicrobial and antioxidant properties. The current study aimed to evaluate the healing activity of gel and cream formulations based on M. charantia on induced wounds in mice.

Materials and Methods

Acetonic extract of M. charantia was prepared and incorporated into gel and cream formulations. Mus musculus Balb/c (n=30) with induced injury were distributed into five groups: Group I (control - day 7), Group II (control - day 14), Group III (1% gel - day 7), and Group IV (1% gel - day 14) to which 1% M. charantia gel was dermally applied daily for 7 and 14 days, respectively, Group V (1% cream - day 7) and Group VI (1% cream - day 14) to which of M. charantia 1% cream were dermally applied daily for 7 and 14 days, respectively. Time of wound closure was determined during the experimentation; rats were euthanized with sodium pentobarbital 60 mg/kg/pc v.ip. for obtaining skin samples for histopathological analysis.

Results

Groups IV and VI showed a higher percentage of wound closure on day 14, and in histopathological analysis, effect was greater in Group VI with the presence of fibroblasts and abundant collagen and elastic fibers.

Conclusion

M. charantia gel and cream showed wound healing activity on induced wounded mice; the most effective treatment was M. charantia 1% cream formulation.

HISTOPATHOLOGICAL AND BIOMECHANICAL INVESTIGATION OF THE EFFECT OF MOMORDICA CHARANTIA ON FRACTURE HEALING, KIDNEY, AND LIVER: AN EXPERIMENTAL RAT MODEL

Momordica charantia (MC) is a plant belonging to the family Cucurbitaceae. MC has antidiabetic, antibacterial, antioxidant, antimutagenic, antiulcerative, antiinflammatory and antilipidemic effects. However, information on the effect of MC on fracture union is lacking. This study aimed to examine the effect of MC on fracture union histopathologically and biomechanically. A total of 42 male Wistar-Albino rats were randomly divided into 3 groups, 14 in each group. A diaphyseal fracture was created on the right tibia of all rats. All fractures were fixed with a Kirschner (K) wire. The rats in Group I did not undergo any further procedures (Control group). Group II rats were treated with 0.9% saline oral gavage at a dose of [Formula: see text]L/day for 28 days [Saline (S) group]. The rats in Group III were given 300[Formula: see text]mg/kg MC extract per day, dissolved in [Formula: see text]L 0.9% saline by oral gavage for 28 days [MC (Extract) group]. After 28 days, all rats were sacrificed. Each group was randomly divided into two subgroups. The histopathological examination was performed on the right tibia of rats in the first subgroup and the biomechanical examination in the second subgroup. The kidneys and livers of all rats were evaluated histopathologically. Fracture union was significantly better in the Extract group compared with the Control and S groups histopathologically. The fracture inflammation values were lower in the Extract group than in the other groups. No statistically significant difference was found between the groups in terms of possible side effects to kidneys and livers. In terms of biomechanics, fracture union was significantly better in the Extract group compared with the Control and S groups except yield displacement values. MC had a positive effect on fracture union histopathologically and biomechanically.

Involvement of TGF-β and Autophagy Pathways in Pathogenesis of Diabetes: A Comprehensive Review on Biological and Pharmacological Insights

Despite recent advancements in clinical drugs, diabetes treatment still needs further progress. As such, ongoing research has attempted to determine the precise molecular mechanisms of the disorder. Specifically, evidence supports that several signaling pathways play pivotal roles in the development of diabetes. However, the exact molecular mechanisms of diabetes still need to be explored. This study examines exciting new hallmarks for the strict involvement of autophagy and TGF-β signaling pathways in the pathogenesis of diabetes and the design of novel therapeutic strategies. Dysregulated autophagy in pancreatic β cells due to hyperglycemia, oxidative stress, and inflammation is associated with diabetes and accompanied by dysregulated autophagy in insulin target tissues and the progression of diabetic complications. Consequently, several therapeutic agents such as adiponectin, ezetimibe, GABA tea, geniposide, liraglutide, guava extract, and vitamin D were shown to inhibit diabetes and its complications through modulation of the autophagy pathway. Another pathway, TGF-β signaling pathway, appears to play a part in the progression of diabetes, insulin resistance, and autoimmunity in both type 1 and 2 diabetes and complications in diabetes. Subsequently, drugs that target TGF-β signaling, especially naturally derived ones such as resveratrol, puerarin, curcumin, hesperidin, and silymarin, as well as Propolis, Lycopus lucidus, and Momordica charantia extracts, may become promising alternatives to current drugs in diabetes treatment. This review provides keen insights into novel therapeutic strategies for the medical care of diabetes.

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

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.

Momordicoside G Regulates Macrophage Phenotypes to Stimulate Efficient Repair of Lung Injury and Prevent Urethane-Induced Lung Carcinoma Lesions

Momordicoside G is a bioactive component from Momordica charantia, this study explores the contributions of macrophages to the effects of momordicoside G on lung injury and carcinoma lesion. In vitro, when administered at the dose that has no effect on cell viability in M2-like macrophages, momordicoside G decreased ROS and promoted autophagy and thus induced apoptosis in M1-like macrophages with the morphological changes. In the urethane-induced lung carcinogenic model, prior to lung carcinoma lesions, urethane induced obvious lung injury accompanied by the increased macrophage infiltration. The lung carcinoma lesions were positively correlated with lung tissue injury and macrophage infiltration in alveolar cavities in the control group, these macrophages showed mainly a M1-like (iNOS⁺/CD68⁺) phenotype. ELISA showed that the levels of IL-6 and IL-12 were increased and the levels of IL-10 and TGF-β1 were reduced in the control group. After momordicoside G treatment, lung tissue injury and carcinoma lesions were ameliorated with the decreased M1-like macrophages and the increased M2-like (arginase⁺/CD68⁺) macrophages, whereas macrophage depletion by liposome-encapsulated clodronate (LEC) decreased significantly lung tissue injury and carcinoma lesions and also attenuated the protective efficacy of momordicoside G. The M2 macrophage dependent efficacy of momordicoside G was confirmed in a LPS-induced lung injury model in which epithelial closure was promoted by the transfer of M2-like macrophages and delayed by the transfer of M1-like macrophages. To acquire further insight into the underlying molecular mechanisms by which momordicoside G regulates M1 macrophages, we conduct a comprehensive bioinformatics analysis of momordicoside G relevant targets and pathways involved in M1 macrophage phenotype. This study suggests a function of momordicoside G, whereby it selectively suppresses M1 macrophages to stimulate M2-associated lung injury repair and prevent inflammation-associated lung carcinoma lesions.

Molecular Concept of Diabetic Wound Healing: Effective Role of Herbal Remedies

The incidence of diabetes mellitus (DM) is on the rise, worldwide. One of the main complications in DM is delayed wound healing and it often requires amputation. Various drugs were used to treat DM but they presented with adverse effects. Often, patients failed to comply with such treatment. This opened the door for complementary and alternative medicine. In the present review, we explored the molecular concept of wound healing occurring in different stages with special emphasis to DM. We also highlighted the potential herbal products such as NF3 (Chinese 2-Herb Formula), Zicao, Jing Wan Hong ointment, Aleo vera, mixture of Adiantum capillus-veneris, Commiphora molmol, Aloe vera, and henna, Phenol-rich compound sweet gel, Jinchuang ointment, San-huang-sheng-fu (S) oil, Yi Bu A Jie extract, Astragali Radix (AR) and Rehmanniae Radix (RR), Yiqi Huayu, Tangzu yuyang ointment, Shengji Huayu recipe, Angelica sinensis, Lithospermun erythrorhison, Hippophae rhamnoides L., Curcuma longa and Momordica charantia that could be used effectively to treat DM wounds. Future clinical trials are needed for designing potential drugs which may be effective in treating DM wounds.

Recent Advances in Momordica charantia: Functional Components and Biological Activities

Momordica charantia L. (M. charantia), a member of the Cucurbitaceae family, is widely distributed in tropical and subtropical regions of the world. It has been used in folk medicine for the treatment of diabetes mellitus, and its fruit has been used as a vegetable for thousands of years. Phytochemicals including proteins, polysaccharides, flavonoids, triterpenes, saponins, ascorbic acid and steroids have been found in this plant. Various biological activities of M. charantia have been reported, such as antihyperglycemic, antibacterial, antiviral, antitumor, immunomodulation, antioxidant, antidiabetic, anthelmintic, antimutagenic, antiulcer, antilipolytic, antifertility, hepatoprotective, anticancer and anti-inflammatory activities. However, both in vitro and in vivo studies have also demonstrated that M. charantia may also exert toxic or adverse effects under different conditions. This review addresses the chemical constituents of M. charantia and discusses their pharmacological activities as well as their adverse effects, aimed at providing a comprehensive overview of the phytochemistry and biological activities of M. charantia.