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Wang F, Zhang X, Zhang J, Xu Q, Yu X, Xu A, Yi C, Bian X, Shao S. Recent advances in the adjunctive management of diabetic foot ulcer: Focus on noninvasive technologies. Med Res Rev 2024; 44:1501-1544. [PMID: 38279968 DOI: 10.1002/med.22020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 12/15/2023] [Accepted: 01/10/2024] [Indexed: 01/29/2024]
Abstract
Diabetic foot ulcer (DFU) is one of the most costly and serious complications of diabetes. Treatment of DFU is usually challenging and new approaches are required to improve the therapeutic efficiencies. This review aims to update new and upcoming adjunctive therapies with noninvasive characterization for DFU, focusing on bioactive dressings, bioengineered tissues, mesenchymal stem cell (MSC) based therapy, platelet and cytokine-based therapy, topical oxygen therapy, and some repurposed drugs such as hypoglycemic agents, blood pressure medications, phenytoin, vitamins, and magnesium. Although the mentioned therapies may contribute to the improvement of DFU to a certain extent, most of the evidence come from clinical trials with small sample size and inconsistent selections of DFU patients. Further studies with high design quality and adequate sample sizes are necessitated. In addition, no single approach would completely correct the complex pathogenesis of DFU. Reasonable selection and combination of these techniques should be considered.
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Affiliation(s)
- Fen Wang
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Xiaoling Zhang
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Jing Zhang
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Qinqin Xu
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Xuefeng Yu
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Anhui Xu
- Division of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengla Yi
- Division of Trauma Surgery, Tongji Hospital, Tongji Medical College, Wuhan, China
| | - Xuna Bian
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Shiying Shao
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
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Wang F, Zhang XL, Zhang J, Gong S, Tao J, Xiang H, Fu XQ, Bian XN, Yu XF, Xu AH, Yi CL, Shao SY. Therapeutic Effectiveness of Leukocyte- and Platelet-rich Fibrin for Diabetic Foot Ulcers: A Retrospective Study. Curr Med Sci 2024:10.1007/s11596-024-2874-2. [PMID: 38789818 DOI: 10.1007/s11596-024-2874-2] [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: 01/15/2024] [Accepted: 03/13/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes. Leukocyte- and platelet-rich fibrin (L-PRF) is a second-generation autologous platelet-rich plasma. This study aims to investigate the clinical effects of L-PRF in patients with diabetes in real clinical practice. METHODS Patients with DFU who received L-PRF treatment and standard of care (SOC) from 2018 to 2019 in Tongji Hospital were enrolled. The clinical information including patient characteristics, wound evaluation (area, severity, infection, blood supply), SOC of DFU, and images of ulcers was retrospectively extracted and analyzed. L-PRF treatment was performed every 7±2 days until the ulcer exhibited complete epithelialization or an overall percent volume reduction (PVR) greater than 80%. Therapeutic effectiveness, including overall PVR and the overall and weekly healing rates, was evaluated. RESULTS Totally, 26 patients with DFU were enrolled, and they had an ulcer duration of 47.0 (35.0, 72.3) days. The severity and infection of ulcers varied, as indicated by the Site, Ischemia, Neuropathy, Bacterial Infection, and Depth (SINBAD) scores of 2-6, Wagner grades of 1-4, and the Perfusion, Extent, Depth, Infection and Sensation (PEDIS) scores of 2-4. The initial ulcer volume before L-PRF treatment was 4.94 (1.50, 13.83) cm3, and the final ulcer volume was 0.35 (0.03, 1.76) cm3. The median number of L-PRF doses was 3 (2, 5). A total of 11 patients achieved complete epithelialization after the fifth week of treatment, and 19 patients achieved at least an 80% volume reduction after the seventh week. The overall wound-healing rate was 1.47 (0.63, 3.29) cm3/week, and the healing rate was faster in the first 2 weeks than in the remaining weeks. Concurrent treatment did not change the percentage of complete epithelialization or healing rate. CONCLUSION Adding L-PRF to SOC significantly improved wound healing in patients with DFU independent of the ankle brachial index, SINBAD score, or Wagner grade, indicating that this method is appropriate for DFU treatment under different clinical conditions.
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Affiliation(s)
- Fen Wang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Xiao-Ling Zhang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Jing Zhang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Song Gong
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Jing Tao
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Hui Xiang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Xiao-Qing Fu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Xu-Na Bian
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Xue-Feng Yu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - An-Hui Xu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Cheng-la Yi
- Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shi-Ying Shao
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China.
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Patenall BL, Carter KA, Ramsey MR. Kick-Starting Wound Healing: A Review of Pro-Healing Drugs. Int J Mol Sci 2024; 25:1304. [PMID: 38279304 PMCID: PMC10816820 DOI: 10.3390/ijms25021304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/28/2024] Open
Abstract
Cutaneous wound healing consists of four stages: hemostasis, inflammation, proliferation/repair, and remodeling. While healthy wounds normally heal in four to six weeks, a variety of underlying medical conditions can impair the progression through the stages of wound healing, resulting in the development of chronic, non-healing wounds. Great progress has been made in developing wound dressings and improving surgical techniques, yet challenges remain in finding effective therapeutics that directly promote healing. This review examines the current understanding of the pro-healing effects of targeted pharmaceuticals, re-purposed drugs, natural products, and cell-based therapies on the various cell types present in normal and chronic wounds. Overall, despite several promising studies, there remains only one therapeutic approved by the United States Food and Drug Administration (FDA), Becaplermin, shown to significantly improve wound closure in the clinic. This highlights the need for new approaches aimed at understanding and targeting the underlying mechanisms impeding wound closure and moving the field from the management of chronic wounds towards resolving wounds.
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Affiliation(s)
| | | | - Matthew R. Ramsey
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA (K.A.C.)
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Izzo P, De Intinis C, Molle M, Polistena A, Sibio S, Codacci-Pisanelli M, Biacchi D, Di Cello P, Santini D, Izzo L, Izzo S. Case report: The use of PRP in the treatment of diabetic foot: case series and a review of the literature. Front Endocrinol (Lausanne) 2023; 14:1286907. [PMID: 38170077 PMCID: PMC10760803 DOI: 10.3389/fendo.2023.1286907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Background Diabetes mellitus is a prevalent chronic condition that significantly impacts global health. Diabetic foot complications, such as foot ulcers, pose a substantial burden on individuals with diabetes and can lead to serious consequences, including amputation. Platelet-rich plasma (PRP) has emerged as a promising therapeutic approach for enhancing the healing of diabetic foot ulcers. Methods In our study, we treated 12 patients with chronic diabetic ulcers using PRP injections administered at three-week intervals. Our objective was to assess the reduction in wound size and the rate of complete healing at 6 months after the start of the treatment. Additionally, we conducted a comprehensive literature review to contextualize our findings. Results Out of the 12 patients, 8 achieved complete healing of their diabetic foot ulcers, while the remaining four showed significant improvement with more than 50% reduction in the initial lesion size. 3 patients developed mild irritation at the inoculation site. These outcomes, combined with the evidence from published studies, highlight the effectiveness of PRP in promoting the healing of diabetic foot ulcers. Conclusion In conclusion, our study demonstrates the potential of platelet-rich plasma (PRP) as a successful therapeutic option for enhancing the healing process of chronic diabetic foot ulcers. The favorable outcomes observed, including a high rate of complete healing and significant wound size reduction, underscore the value of PRP treatment in managing this challenging complication. Further research and larger studies may provide additional insights into the mechanisms and long-term benefits of PRP in diabetic wound healing.
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Affiliation(s)
- Paolo Izzo
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Sapienza University of Rome, Rome, RM, Italy
| | - Claudia De Intinis
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Sapienza University of Rome, Rome, RM, Italy
| | - Marcello Molle
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Polistena
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Sapienza University of Rome, Rome, RM, Italy
| | - Simone Sibio
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Sapienza University of Rome, Rome, RM, Italy
| | - Massimo Codacci-Pisanelli
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Sapienza University of Rome, Rome, RM, Italy
| | - Daniele Biacchi
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Sapienza University of Rome, Rome, RM, Italy
| | - Pierfrancesco Di Cello
- Department of General Surgery, Unità Operativa Complessa (UOC) General Surgery Frosinone-Alatri at ASL Frosinone, Frosinone, Italy
| | - Daniele Santini
- Department of Pathology, Oncology and Radiology, Sapienza University of Rome, Rome, Italy
| | - Luciano Izzo
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Sapienza University of Rome, Rome, RM, Italy
| | - Sara Izzo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
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Mendivil JM, Henderson LC, Olivas OS, Deanda MA, Johnson ML. Retrospective Data Analysis of the Use of an Autologous Multilayered Leukocyte, Platelet, and Fibrin Patch for Diabetic Foot Ulcers Treatment in Daily Clinical Practice. Adv Skin Wound Care 2023; 36:579-585. [PMID: 37861663 DOI: 10.1097/asw.0000000000000054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To describe the healing outcome of chronic, hard-to-heal diabetic foot ulcers (DFUs) treated with an autologous multilayered leukocyte, platelet, and fibrin (MLPF) patch in addition to the best standard of care, in a real-world clinical setting of two US amputation preventive centers. METHODS In this retrospective study of patients treated between September 2021 and October 2022, the authors analyzed DFU healing outcomes based on Wound, Ischemia, and foot Infection-derived amputation risk. RESULTS All 36 patients had a diagnosis of type 2 diabetes and 29 (81%) were male. Their average age was 61.4 years, body mass index was 29.2 kg/m2, and glycated hemoglobin was 7.9. Twenty-seven patients (78%) were diagnosed with peripheral vascular disease, 20 (56%) underwent a peripheral vascular procedure, 15 (42%) had a prior amputation, and 6 (17%) were on hemodialysis. Average wound size was 4.9 cm2, and wound age was 9.5 months. Twelve patients (32%) were classified as low risk, 15 (39%) as moderate risk, and 11 (29%) as high risk for amputation. Within 12 weeks of the first MLPF patch application, nine wounds (24%) healed. After 20 weeks, 23 wounds (61%) were closed, and by follow-up, 30 wounds (79%) healed. No amputations were noted. Compared with published data, 40% fewer patients underwent readmission within 30 days, with 72% shorter admission duration. CONCLUSIONS Real-world clinical experiences using the MLPF patch to treat hard-to-heal DFUs resulted in the majority of wounds healing. Few patients experienced a readmission within 30 days, and the average admission duration was short.
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Affiliation(s)
- Jason M Mendivil
- At PULSE Amputation Prevention Centers, El Paso, Texas, USA, Jason M. Mendivil, DPM, is Medical Director; and Lorena C. Henderson, APRN, MSN, FNP-C, is Clinical Research Coordinator. Orion S. Olivas is Pre-medical Student, Houston Christian University, Texas. Mia A. Deanda is Undergraduate Student, University of Texas at El Paso. Martin L. Johnson, MD, MPH, FACS, is Plastic Surgeon, Casa Colina Hospital and Centers for Healthcare, Casa Colina Hyperbaric Medicine & Wound Care Center, Casa Colina, California. The authors have disclosed no financial relationships related to this article. Submitted January 6, 2023; accepted in revised form March 24, 2023
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Kim J, Nomkhondorj O, An CY, Choi YC, Cho J. Management of diabetic foot ulcers: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2023; 40:335-342. [PMID: 37735855 PMCID: PMC10626295 DOI: 10.12701/jyms.2023.00682] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/23/2023]
Abstract
Diabetic foot ulcers (DFUs) are among the most serious complications of diabetes and are a source of reduced quality of life and financial burden for the people involved. For effective DFU management, an evidence-based treatment strategy that considers the patient's clinical context and wound condition is required. This treatment strategy should include conventional practices (surgical debridement, antibiotics, vascular assessment, offloading, and amputation) coordinated by interdisciplinary DFU experts. In addition, several adjuvant therapies can be considered for nonhealing wounds. In this narrative review, we aim to highlight the current trends in DFU management and review the up-to-date guidelines.
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Affiliation(s)
- Jahyung Kim
- Department of Orthopaedic Surgery, Armed Forces Yangju Hospital, Yangju, Korea
| | - Otgonsaikhan Nomkhondorj
- Department of Orthopaedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea
| | - Chi Young An
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Ye Chan Choi
- Department of Orthopaedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jaeho Cho
- Department of Orthopaedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea
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Sharma AD, Jarman EH, Fox PM. Scoping Review of Hydrogel Therapies in the Treatment of Diabetic Chronic Wounds. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4984. [PMID: 37250833 PMCID: PMC10219739 DOI: 10.1097/gox.0000000000004984] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/09/2023] [Indexed: 05/31/2023]
Abstract
Chronic diabetic wounds are a significant issue that can be treated with topical hydrogel therapies. The aim of this study was to review the different compositions of hydrogel that have been developed and analyze their clinical relevance in the treatment of chronic diabetic wounds. Methods We conducted a scoping review in which twelve articles were selected for review after applying relevant inclusion and exclusion criteria using a two-reviewer strategy. Data extracted from these studies was used to answer the following research question: What is the composition of hydrogels used to treat chronic diabetic wounds and how effective are they? Results We analyzed five randomized controlled trials, two retrospective studies, three reviews, and two case reports. Hydrogel compositions discussed included mesenchymal stem cell sheets, carbomer, collagen, and alginate hydrogels, as well as hydrogels embedded with platelet-derived growth factor. Synthetic hydrogels, largely composed of carbomers, were found to have high levels of evidence supporting their wound healing properties, though few articles described their routine use in a clinical setting. Collagen hydrogels dominate the present-day hydrogel market in the clinical treatment of chronic diabetic wounds. The augmentation of hydrogels with therapeutic biomaterials is a new field of hydrogel research, with studies demonstrating promising early in vitro and in vivo animal studies demonstrating promising early results for in vitro and in vivo animal investigations. Conclusions Current research supports hydrogels as a promising topical therapy in the treatment of chronic diabetic wounds. Augmenting Food & Drug Administration-approved hydrogels with therapeutic substances remains an interesting early area of investigation.
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Affiliation(s)
- Ayushi D. Sharma
- From the Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
- Division of Plastic & Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif
- Creighton University School of Medicine, Phoenix, Ariz
| | - Evan H. Jarman
- From the Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
- Division of Plastic & Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif
| | - Paige M. Fox
- From the Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
- Division of Plastic & Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif
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Han SL, Zhou HG, Li N, Zhang XH, Chen HH. Research progress of platelet-rich fibrin in alveolar ridge preservation. Rev Assoc Med Bras (1992) 2022; 68:1115-1119. [PMID: 36134841 PMCID: PMC9574995 DOI: 10.1590/1806-9282.20211383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Shi-Lei Han
- Changshu Yuhui Debtal Hospital, Department of Dental implantology - Changshu, China
| | - Hui-Guo Zhou
- Changshu Yuhui Debtal Hospital, Department of Dental implantology - Changshu, China
| | - Na Li
- Changshu Yuhui Debtal Hospital, Department of Dental implantology - Changshu, China
| | - Xiao-Hui Zhang
- Changshu Yuhui Debtal Hospital, Department of Dental implantology - Changshu, China
| | - Hong-Hui Chen
- Changshu Yuhui Debtal Hospital, Department of Dental implantology - Changshu, China
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Dorjay K, Tandon S, Singh A, Sharma S, Sardana K. Platelet rich fibrin: A novel treatment for trophic ulcer in Hansen's disease. Trop Doct 2022; 52:293-297. [PMID: 35018841 DOI: 10.1177/00494755211069440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with Hansen's disease are liable to develop non-healing trophic ulcers. The aim of this study was to determine the efficacy of autologous platelet rich fibrin (PRF) applied at weekly intervals in the management of trophic ulcers. The mean age of the patients, duration and size of ulcer were 44.3 years, 7.4 months and 6.25cm2 respectively. After the third sessions of weekly dressing, there was a significant reduction in the ulcer area (p value = 0.015). All ulcers healed by a maximum of six weeks. No adverse events were noted. PRF thus seems a feasible, safe, simple and cost-effective treatment method.
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Affiliation(s)
- Konchok Dorjay
- Department of Dermatology, 28781Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi
| | - Sidharth Tandon
- Department of Dermatology, 28781Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi
| | - Ajeet Singh
- Department of Dermatology, 28781Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi
| | - Satish Sharma
- Department of Dermatology, 28781Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi
| | - Kabir Sardana
- Department of Dermatology, 28781Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi
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10
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Dorjay K, Sinha S. Platelet-rich Fibrin in Nonhealing Leg Ulcers: A Simple and Effective Therapeutic Option. J Cutan Aesthet Surg 2021; 14:160-165. [PMID: 34566357 PMCID: PMC8423206 DOI: 10.4103/jcas.jcas_130_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Nonhealing ulcers can occur due to a variety of causes and are associated with high morbidity, expensive, and prolonged treatment. We conducted this study to determine the efficacy of autologous platelet-rich fibrin (PRF) in nonhealing ulcers in various disorders, which is a very cost-effective and safe treatment option. Materials and Methods Eighteen patients with nonhealing leg ulcers were included. The ulcers were treated with PRF at weekly intervals. The response to treatment was recorded by calculating the area of ulcer at baseline and at every subsequent visit till the ulcers healed. Results The study included 18 patients of nonhealing leg ulcers due to leprosy (n = 6), neuropathic ulcer (n = 4), venous ulcer (n = 3), diabetic foot ulcer (n = 2), post-traumatic ulcer (n = 2), and post-full-thickness skin graft ulcer (n = 1). The mean size of the ulcers was 8.44 cm2 and mean duration was 5.55 months. The mean age of the patients was 40.5 years. The minimum and the maximum sittings required were three and nine, respectively (mean 5). No adverse events were noted. Conclusion The treatment of nonhealing ulcer with PRF is an easy, safe, simple, and cost-effective method.
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Affiliation(s)
- Konchok Dorjay
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Surabhi Sinha
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
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Hjorth MK, Burian EA, Glud M, Mogensen M, Karlsmark T, Karmisholt KE. Closing of surgical wounds on ala nasi with an autologous patch: A case series and in vivo wound imaging using Reflectance Confocal Microscopy. Skin Res Technol 2021; 27:988-990. [PMID: 33665916 DOI: 10.1111/srt.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Marie K Hjorth
- Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ewa A Burian
- Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Martin Glud
- Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mette Mogensen
- Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tonny Karlsmark
- Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Katrine E Karmisholt
- Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Shao S, Pan R, Chen Y. Autologous Platelet-Rich Plasma for Diabetic Foot Ulcer. Trends Endocrinol Metab 2020; 31:885-890. [PMID: 33199085 DOI: 10.1016/j.tem.2020.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 12/28/2022]
Abstract
Application of autologous platelet-rich plasma (PRP), especially leukocyte- and platelet-rich fibrin (L-PRF), has emerged as a promising adjuvant therapy for the treatment of diabetic foot ulcers (DFUs). Conflicting results of PRP efficacy can be attributed to the lack of standardization in the PRP preparation process in addition to a paucity of well-designed randomized clinic trials (RCTs).
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Affiliation(s)
- Shiying Shao
- Division of Endocrinology, Internal Medicine, Tongji Hospital, Huazhong University of Science & Technology, Wuhan, China, 430030
| | - Ruping Pan
- Department of Nuclear Medicine, Tongji Hospital, Huazhong University of Science & Technology, Wuhan, China, 430030
| | - Yong Chen
- Division of Endocrinology, Internal Medicine, Tongji Hospital, Huazhong University of Science & Technology, Wuhan, China, 430030; Laboratory of Endocrinology, Tongji Hospital, Huazhong University of Science & Technology, Wuhan, China, 430030.
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Autologous Matrix of Platelet-Rich Fibrin in Wound Care Settings: A Systematic Review of Randomized Clinical Trials. J Funct Biomater 2020; 11:jfb11020031. [PMID: 32422949 PMCID: PMC7353494 DOI: 10.3390/jfb11020031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/03/2020] [Accepted: 05/06/2020] [Indexed: 01/13/2023] Open
Abstract
Platelet-rich fibrin (PRF) consists of a matrix that provides the necessary elements for wound healing, acting as a biodegradable scaffold for cell migration, proliferation, and differentiation, in addition to the delivery of growth factors and angiogenesis. This study aims to determine the effectiveness of the autologous PRF in the treatment of wounds of different etiologies. We carried out a systematic review of randomized clinical trials, guided by the recommendations of the Cochrane Collaboration using the following databases: Pubmed/MEDLINE, EMBASE, Web of Science, and CENTRAL. The search strategy resulted in the inclusion of ten studies that evaluated the use of PRF dressings for the healing of acute or chronic wounds of multiple etiologies. Among the 172 participants treated with PRF in wounds of varying etiologies and different segment times, 130 presented favorable events with the use of the intervention. Among the 10 studies included, only two of them did not demonstrate better results than the control group. The studies showed clinical heterogeneity, making it impossible to perform a meta-analysis. The findings do not provide enough evidence to support the routine use of PRF dressings as the first line of treatment for the healing of acute or chronic wounds of different etiologies. There was great variability in the application of the various protocols and the ways to prepare the PRF, resulting in clinical heterogeneity. Therefore, it makes it impossible to synthesize and to collect evidence from different types of studies in the meta-analysis, which affects the results and their proper discussion.
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Natural polymeric biomaterials in growth factor delivery for treating diabetic foot ulcers. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2019.101385] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Tsai HC, Lehman CW, Chen CM. Use of platelet-rich plasma and platelet-derived patches to treat chronic wounds. J Wound Care 2019; 28:15-21. [PMID: 30625042 DOI: 10.12968/jowc.2019.28.1.15] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare the healing results between platelet-rich plasma (PRP) and platelet-derived patches versus traditional advanced wound dressings in patients with chronic wounds. METHOD Patients with and without diabetes were divided into two groups, each of which received either PRP patch treatments or the advanced wound dressings. All wounds were cleaned, debrided and assessed by physicians. The data were analysed and represented as mean ± standard deviation (SD). Student's t-test was used to calculate the significance of differences between both groups. Values of p<0.05 were considered statistically significant. RESULTS Patients with and without diabetes receiving PRP patch treatments saw improvement in wound healing in two weeks (p=0.0083). Patients with diabetes who received platelet-derived patch treatment and PRP injection experienced wound size reduction to <25% of the original area by the fourth week of treatment, and >90% of the subjects had wounds of <10% their original size in the last three weeks of the trial. Conversely, the wound area in the control subjects receiving traditional advanced wound dressings remained at 25-50% of their original size from the fourth week of treatment to the end of the trial. The healing process of the PRP patch experimental group was statistically significant compared with the control group (p<0.0001). CONCLUSION Combining treatments of PRP injections and platelet-derived patches significantly improved the healing outcomes of patients with chronic wounds, most notably in patients with diabetes, when compared with a traditional treatment of advanced wound dressings.
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Affiliation(s)
- Hsin-Chung Tsai
- Department of Surgery, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Caitlin W Lehman
- National Center for Biodefense and Infectious Diseases, George Mason University, Manassas, VA, US
| | - Chuan-Mu Chen
- Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan
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Qiu H, Liu S, Wu K, Zhao R, Cao L, Wang H. Prospective application of exosomes derived from adipose-derived stem cells in skin wound healing: A review. J Cosmet Dermatol 2019; 19:574-581. [PMID: 31755172 DOI: 10.1111/jocd.13215] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 10/14/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Wound healing has always been an intractable medical problem for both clinicians and researchers and a burden for patients both physically and financially. Poor wound healing at the injury site, especially in an exposed site, is associated with an unappealing esthetic appearance in patients and also results in a bad skin barrier, tissue infection and necrosis, loss of main function in extreme cases and other serious local and systemic consequences. There is a crucial and urgent need for newer, more efficacious methods for enhancing the healing process to achieve optimal outcomes morphologically and functionally. Recent advances have focused on developing therapies that promote tissue regeneration through positively activating the mechanism of tissue repair. Given the increasing high-quality studies concerning exosomes derived from adipose-derived stem cells (ADSCs-Exos), their potential use in accelerating or supporting the wound healing process has gained increasing attention in recent years. AIMS In this review, we present an overview of the recent advances in the field of ADSCs-Exos and investigate their benefit in wound healing for skin regeneration with the expectation of providing a perspective on how to best utilize this powerful cell-free therapy in the future. METHODS A retrospective review of the published data was conducted. RESULTS Most studies have shown the possible roles of ASCs-derived exosomes (ADSCs-Exos) in cutaneous wound healing through regulation of the inflammatory response and promotion of cell proliferation, migration, differentiation, angiogenesis and matrix reconstruction to provide a new perspective strategy for the use of ASCs-Exos in skin wound healing. CONCLUSION ADSCs-Exos are likely to achieve the best functionally and cosmetic skin wound healing while avoiding undesirable consequences. ADSCs-Exos represent a novel therapeutic tool in soft tissue repair; however, further randomized, double-blind, comparative clinical trials must be performed to determine the specific mechanisms, safety and other relevant cosmetic concerns.
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Affiliation(s)
- He Qiu
- Department of Cosmetic and Plastic Surgery, Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Shuo Liu
- Department of Cosmetic and Plastic Surgery, Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Kelun Wu
- Department of Cosmetic and Plastic Surgery, Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Rui Zhao
- Department of Cosmetic and Plastic Surgery, Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lideng Cao
- Department of Cosmetic and Plastic Surgery, Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hang Wang
- Department of Cosmetic and Plastic Surgery, Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Reyes‐Martínez JE, Ruiz‐Pacheco JA, Flores‐Valdéz MA, Elsawy MA, Vallejo‐Cardona AA, Castillo‐Díaz LA. Advanced hydrogels for treatment of diabetes. J Tissue Eng Regen Med 2019; 13:1375-1393. [DOI: 10.1002/term.2880] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 03/31/2019] [Accepted: 04/29/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Juana E. Reyes‐Martínez
- Departamento de Biología. División de Ciencias Naturales y ExactasUniversidad de Guanajuato Guanajuato México
| | | | - Mario A. Flores‐Valdéz
- Biotecnología Médica y FarmacéuticaCentro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco (CIATEJ) Guadalajara México
| | - Mohamed A. Elsawy
- School of Pharmacy and Biomedical SciencesUniversity of Central Lancashire Preston UK
| | - Alba A. Vallejo‐Cardona
- Biotecnología Médica y FarmacéuticaCentro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco (CIATEJ) Guadalajara México
| | - Luis A. Castillo‐Díaz
- Departamento de Medicina y Ciencias de la Salud, División de Ciencias Biológicas y de la SaludUniversidad de Sonora Hermosillo México
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Álvaro-Afonso FJ, Lázaro-Martínez JL, García-Álvarez Y, Papanas N. Management of hard-to-heal diabetic foot ulcers: local use of autologous leucocytes, platelets and fibrin multi-layered patches (LeucoPatch). ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:S126. [PMID: 30740447 DOI: 10.21037/atm.2018.12.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Francisco Javier Álvaro-Afonso
- Diabetic Foot Unit, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Jose Luis Lázaro-Martínez
- Diabetic Foot Unit, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Yolanda García-Álvarez
- Diabetic Foot Unit, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Edmonds M. A renaissance in diabetic foot care: new evidence-based treatments. Lancet Diabetes Endocrinol 2018; 6:837-838. [PMID: 30243804 DOI: 10.1016/s2213-8587(18)30262-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 08/21/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Michael Edmonds
- Diabetic Foot Clinic, King's College Hospital, London SE5 9RS, UK.
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Game F, Jeffcoate W, Tarnow L, Jacobsen JL, Whitham DJ, Harrison EF, Ellender SJ, Fitzsimmons D, Löndahl M. LeucoPatch system for the management of hard-to-heal diabetic foot ulcers in the UK, Denmark, and Sweden: an observer-masked, randomised controlled trial. Lancet Diabetes Endocrinol 2018; 6:870-878. [PMID: 30243803 DOI: 10.1016/s2213-8587(18)30240-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND The LeucoPatch device uses bedside centrifugation without additional reagents to generate a disc comprising autologous leucocytes, platelets, and fibrin, which is applied to the surface of the wound. We aimed to test the effectiveness of LeucoPatch on the healing of hard-to-heal foot ulcers in people with diabetes. METHODS This was a multicentre, international, observer-masked, randomised controlled trial of people with diabetes and a hard-to-heal foot ulcer done in 32 specialist diabetic foot clinics in three countries (UK, Denmark, and Sweden). After a 4-week run-in period, those with a reduction in ulcer area of less than 50% were randomly allocated (1:1) by computer-generated, web-based randomisation (block sizes of two, four, and six) to either prespecified good standard care alone or care plus weekly application of LeucoPatch. The primary outcome was the proportion of ulcers that healed within 20 weeks assessed in the intention-to-treat population (all participants with post-randomisation data collected), defined as complete epithelialisation (confirmed by an observer who was masked to randomisation group), and remained healed for 4 weeks. This trial is registered with the ISRCTN registry, number 27665670, and ClinicalTrials.gov, number NCT02224742. FINDINGS Between Aug 30, 2013, and May 3, 2017, 269 participants were randomly allocated to receive treatment (137 to receive standard care and 132 to receive LeucoPatch). The mean age was 61·9 years (SD 11·6), 217 (82%) were men, and 222 (83%) had type 2 diabetes. In the LeucoPatch group, 45 (34%) of 132 ulcers healed within 20 weeks versus 29 (22%) of 134 ulcers in the standard care group (odds ratio 1·58, 96% CI 1·04-2·40; p=0·0235) by intention-to-treat analysis. Time to healing was shorter in the LeucoPatch group (p=0·0246) than in the standard care group. No difference in adverse events was seen between the groups. The most common serious adverse event (SAE) was diabetic foot infection (24 events in the LeucoPatch group [24% of all SAEs] and 20 in the standard care group [27% of all SAEs]. There were no device-related adverse events. INTERPRETATION The use of LeucoPatch is associated with significant enhancement of healing of hard-to-heal foot ulcers in people with diabetes. FUNDING Reapplix ApS.
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Affiliation(s)
- Frances Game
- Department of Diabetes and Endocrinology, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK.
| | - William Jeffcoate
- Department of Diabetes and Endocrinology, Nottingham University Hospitals Trust, Nottingham, UK
| | - Lise Tarnow
- Steno Diabetes Center Zealand, Holbaek Sygehus, Holbaek, Denmark; Department of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
| | - Judith L Jacobsen
- Statcon ApS, Kokkedal, Denmark; Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Diane J Whitham
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Eleanor F Harrison
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sharon J Ellender
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Magnus Löndahl
- Department of Endocrinology, Skane University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund, Lund University
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Piaggesi A, Låuchli S, Bassetto F, Biedermann T, Marques A, Najafi B, Palla I, Scarpa C, Seimetz D, Triulzi I, Turchetti G, Vaggelas A. Advanced therapies in wound management: cell and tissue based therapies, physical and bio-physical therapies smart and IT based technologies. J Wound Care 2018; 27:S1-S137. [DOI: 10.12968/jowc.2018.27.sup6a.s1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Alberto Piaggesi
- Prof, Director, EWMA Scientific Recorder (Editor), Diabetic Foot Section of the Pisa University Hospital, Department of Endocrinology and Metabolism, University of Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Severin Låuchli
- Chief of Dermatosurgery and Woundcare, EWMA Immediate Past President (Co-editor), Department of Dermatology, University Hospital, Zurich, Råmistrasse 100, 8091 Zärich, Schwitzerland
| | - Franco Bassetto
- Prof, Head of Department, Clinic of Plastic and Reconstructive Surgery, University of Padova, Via Giustiniani, 35100 Padova
| | - Thomas Biedermann
- Tissue Biology Research Unit, Department of Surgery, University Children's Hospital Zurich, August Forel-Strasse 7, 8008 Zürich, Switzerland
| | - Alexandra Marques
- University of Minho, 3B's Research Group in Biomaterials, Biodegradables and Biomimetics, Avepark - Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco GMR, Portugal
| | - Bijan Najafi
- Professor of Surgery, Director of Clinical Research, Division of Vascular Surgery and Endovascular Therapy, Director of Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX 77030-3411, US
| | - Ilaria Palla
- Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Carlotta Scarpa
- Clinic of Plastic and Reconstructive Surgery, University of Padova, Via Giustiniani, 35100 Padova
| | - Diane Seimetz
- Founding Partner, Biopharma Excellence, c/o Munich Technology Center, Agnes-Pockels-Bogen 1, 80992 Munich, Germany
| | - Isotta Triulzi
- Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Giuseppe Turchetti
- Fulbright Scholar, Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Annegret Vaggelas
- Consultant, Biopharma Excellence, c/o Munich Technology Center, Agnes-Pockels-Bogen 1, 80992 Munich, Germany
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Tonaco LAB, Gomes FL, Velasquez-Melendez G, Lopes MTP, Salas CE. The Proteolytic Fraction from Latex of Vasconcellea cundinamarcensis (P1G10) Enhances Wound Healing of Diabetic Foot Ulcers: A Double-Blind Randomized Pilot Study. Adv Ther 2018; 35:494-502. [PMID: 29564750 DOI: 10.1007/s12325-018-0684-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The aim of the study was to investigate the role of the proteolytic fraction from Vasconcellea cundinamarcensis, designated as P1G10, on the healing of chronic foot ulcers in neuropathic patients with diabetes 2. METHODS Fifty patients were enrolled in a prospective, randomized, double-blind trial, to verify the efficacy and safety of a topical dressing formulated with 0.1% P1G10, intended for wound healing, versus a hydrogel (control) protocol. Upon completion of the intervention, the outcome evaluated the number of patients attaining full epithelization (100%), or at least 80% healing. Statistical analysis compared the data on each group for the significance of the differences. RESULTS Collection of data was finished in week 16, and the results were analyzed by intention to treat. The results showed that, in the control group, 5 patients attained 100% ulcer healing, 3 patients ≥ 80% healing and 11 experienced ulcer changes ≤ 80%, and the remainder showed no changes or their wounds became worse. Meanwhile, in the P1G10 group, 11 patients experienced full healing, 4 had healing ≥ 80% and 5 had ulcer changes ≤ lower than 80%, and the remainder showed no changes or their wounds became worse. The healing incidence for the first endpoint (100% healing) showed that the P1G10 group was 2.95-fold more efficacious than the control group (CI 95%) and 2.52-fold (CI, 95%) higher than its control for the second endpoint (80% healing). CONCLUSIONS These data support the hypothesis that topical application of the proteolytic fraction identified as P1G10 significantly enhances foot ulcer healing compared to hydrogel treatment.
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Affiliation(s)
- Luís A B Tonaco
- Escola de Enfermagem Departamento de Enfermagem Materno-Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Flavia L Gomes
- Escola de Enfermagem Departamento de Enfermagem Materno-Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Gustavo Velasquez-Melendez
- Escola de Enfermagem Departamento de Enfermagem Materno-Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Miriam T P Lopes
- Departamentos de Farmacologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carlos E Salas
- Departamentos de Farmacologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Yu P, Zhai Z, Jin X, Yang X, Qi Z. Clinical Application of Platelet-Rich Fibrin in Plastic and Reconstructive Surgery: A Systematic Review. Aesthetic Plast Surg 2018; 42:511-519. [PMID: 29396591 DOI: 10.1007/s00266-018-1087-0] [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: 12/04/2017] [Accepted: 01/14/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Platelet-rich fibrin (PRF) has been applied in the clinical field for more than a decade, but largely in oral surgery and implant dentistry. Its utilization in plastic and reconstructive surgery is limited and lacking a comprehensive review. Hence, this article focuses on the various clinical applications of PRF pertaining to the plastic and reconstructive field through a systematic review. METHODS In this review, articles describing the clinical application of PRF in plastic and reconstructive surgery were screened using predetermined inclusion and exclusion criteria. The articles were summarized and divided into groups based on the utilization of PRF. The effects and complications of PRF were analyzed and concluded. RESULTS Among the 634 articles searched, 7 articles describing 151 cases are eligible. PRF was applied on 116 (76.8%) wounds to facilitate tissue healing, and the complete wound closure rate was 91.4% (106/116). Otherwise, PRF was applied in 10 (6.6%) cases of zygomaticomaxillary fracture to reconstruct orbital floor defects and in 25 (16.6%) cases of facial autologous fat grafts to increase the fat retention rate successfully. There is no report of PRF-related complications. CONCLUSIONS PRF could facilitate wound healing, including the healing of soft tissues and bony tissues, and facilitate fat survival rate. Further studies are needed to test the mechanism of PRF and expand its scope of application in plastic and reconstructive surgery. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Ann N Y Acad Sci 2018; 1411:153-165. [PMID: 29377202 PMCID: PMC5793889 DOI: 10.1111/nyas.13569] [Citation(s) in RCA: 376] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023]
Abstract
Diabetic foot ulcers (DFUs) are a serious complication of diabetes that results in significant morbidity and mortality. Mortality rates associated with the development of a DFU are estimated to be 5% in the first 12 months, and 5-year morality rates have been estimated at 42%. The standard practices in DFU management include surgical debridement, dressings to facilitate a moist wound environment and exudate control, wound off-loading, vascular assessment, and infection and glycemic control. These practices are best coordinated by a multidisciplinary diabetic foot wound clinic. Even with this comprehensive approach, there is still room for improvement in DFU outcomes. Several adjuvant therapies have been studied to reduce DFU healing times and amputation rates. We reviewed the rationale and guidelines for current standard of care practices and reviewed the evidence for the efficacy of adjuvant agents. The adjuvant therapies reviewed include the following categories: nonsurgical debridement agents, dressings and topical agents, oxygen therapies, negative pressure wound therapy, acellular bioproducts, human growth factors, energy-based therapies, and systemic therapies. Many of these agents have been found to be beneficial in improving wound healing rates, although a large proportion of the data are small, randomized controlled trials with high risks of bias.
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Affiliation(s)
- Estelle Everett
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nestoras Mathioudakis
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Game F, Jeffcoate W, Tarnow L, Day F, Fitzsimmons D, Jacobsen J. The LeucoPatch® system in the management of hard-to-heal diabetic foot ulcers: study protocol for a randomised controlled trial. Trials 2017; 18:469. [PMID: 29017535 PMCID: PMC5633898 DOI: 10.1186/s13063-017-2216-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/22/2017] [Indexed: 11/25/2022] Open
Abstract
Background Diabetic foot ulcers are a common and severe complication of diabetes mellitus. Standard treatment includes debridement, offloading, management of infection and revascularisation where appropriate, although healing times may be long. The LeucoPatch® device is used to generate an autologous platelet-rich fibrin and leucocyte wound dressing produced from the patient’s own venous blood by centrifugation, but without the addition of any reagents. The final product comprises a thin, circular patch composed predominantly of fibrin together with living platelets and leucocytes. Promising results have been obtained in non-controlled studies this system, but this now needs to be tested in a randomised controlled trial (RCT). If confirmed, the LeucoPatch® may become an important new tool in the armamentarium in the management of diabetic foot ulcers which are hard-to-heal. Methods People with diabetes and hard-to-heal ulcers of the foot will receive either pre-specified good standard care or good standard care supplemented by the application of the LeucoPatch® device. The primary outcome will be the percentage of ulcers healed within 20 weeks. Healing will be defined as complete epithelialisation without discharge that is maintained for 4 weeks and is confirmed by an observer blind to randomisation group. Discussion Ulcers of the foot are a major source of morbidity to patients with diabetes and costs to health care economies. The study population is designed to be as inclusive as possible with the aim of maximising the external validity of any findings. The primary outcome measure is healing within 20 weeks of randomisation and the trial also includes a number of secondary outcome measures. Among these are rate of change in ulcer area as a predictor of the likelihood of eventual healing, minor and major amputation of the target limb, the incidence of infection and quality of life. Trial registration International Standard Randomised Controlled Trial, ISRCTN27665670. Registered on 5 July 2013.
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Affiliation(s)
- Frances Game
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK.
| | - William Jeffcoate
- Foot Ulcer Trials Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Florence Day
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
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Ciofu O, Rojo-Molinero E, Macià MD, Oliver A. Antibiotic treatment of biofilm infections. APMIS 2017; 125:304-319. [PMID: 28407419 DOI: 10.1111/apm.12673] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 01/10/2017] [Indexed: 12/24/2022]
Abstract
Bacterial biofilms are associated with a wide range of infections, from those related to exogenous devices, such as catheters or prosthetic joints, to chronic tissue infections such as those occurring in the lungs of cystic fibrosis patients. Biofilms are recalcitrant to antibiotic treatment due to multiple tolerance mechanisms (phenotypic resistance). This causes persistence of biofilm infections in spite of antibiotic exposure which predisposes to antibiotic resistance development (genetic resistance). Understanding the interplay between phenotypic and genetic resistance mechanisms acting on biofilms, as well as appreciating the diversity of environmental conditions of biofilm infections which influence the effect of antibiotics are required in order to optimize the antibiotic treatment of biofilm infections. Here, we review the current knowledge on phenotypic and genetic resistance in biofilms and describe the potential strategies for the antibiotic treatment of biofilm infections. Of note is the optimization of PK/PD parameters in biofilms, high-dose topical treatments, combined and sequential/alternate therapies or the use antibiotic adjuvants.
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Affiliation(s)
- Oana Ciofu
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
| | - Estrella Rojo-Molinero
- Servicio de Microbiología, Hospital Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain
| | - María D Macià
- Servicio de Microbiología, Hospital Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain
| | - Antonio Oliver
- Servicio de Microbiología, Hospital Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain
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Platelet Rich Fibrin “PRF” and Regenerative Medicine: ‘The Low-Speed Concept’. STEM CELL BIOLOGY AND REGENERATIVE MEDICINE 2017. [DOI: 10.1007/978-3-319-55645-1_2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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28
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Pourmoussa A, Gardner DJ, Johnson MB, Wong AK. An update and review of cell-based wound dressings and their integration into clinical practice. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:457. [PMID: 28090513 DOI: 10.21037/atm.2016.12.44] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic wounds affect over 4 million individuals and pose a significant burden to the US healthcare system. Diabetes, venous stasis, radiation or paralysis are common risk factors for chronic wounds. Unfortunately, the current standard of care (SOC) has a high relapse rate and these wounds continue to adversely affect patients' quality of life. Fortunately, advances in tissue engineering have allowed for the development of cell-based wound dressings that promote wound healing by improving cell migration and differentiation. As the available options continue to increase in quantity and quality, physicians should have a user-friendly guide to reference when deciding which dressing to use. The objective of this review is to identify the currently available biologic dressings, describe their indications, and provide a framework for integration into clinical practice. This review included 53 studies consisting of prospective and retrospective cohorts as well as several randomized control trials. Three general categories of cell-based biologic dressings were identified and nine brands were included. Cell-based biologic dressings have shown efficacy in a broad range of scenarios, and studies examining their efficacy have improved our understanding of the pathophysiology of chronic wounds. Amniotic and placental membranes have the widest scope and can be used to treat all subtypes of chronic wounds. Human skin allografts and bioengineered skin substitutes can be used for chronic ulcers but generally require a vascularized wound bed. Autologous platelet rich plasma (PRP) has shown promise in venous stasis ulcers and decubitus ulcers that have failed conventional treatment. Overall, more research is necessary to determine if these novel therapeutic options will change the current SOC, but current studies demonstrate encouraging results in the treatment of chronic wounds.
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Affiliation(s)
- Austin Pourmoussa
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Daniel J Gardner
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Maxwell B Johnson
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Alex K Wong
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
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29
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Miron RJ, Fujioka-Kobayashi M, Bishara M, Zhang Y, Hernandez M, Choukroun J. Platelet-Rich Fibrin and Soft Tissue Wound Healing: A Systematic Review. TISSUE ENGINEERING PART B-REVIEWS 2016; 23:83-99. [PMID: 27672729 DOI: 10.1089/ten.teb.2016.0233] [Citation(s) in RCA: 220] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The growing multidisciplinary field of tissue engineering aims at predictably regenerating, enhancing, or replacing damaged or missing tissues for a variety of conditions caused by trauma, disease, and old age. One area of research that has gained tremendous awareness in recent years is that of platelet-rich fibrin (PRF), which has been utilized across a wide variety of medical fields for the regeneration of soft tissues. This systematic review gathered all the currently available in vitro, in vivo, and clinical literature utilizing PRF for soft tissue regeneration, augmentation, and/or wound healing. In total, 164 publications met the original search criteria, with a total of 48 publications meeting inclusion criteria (kappa score = 94%). These studies were divided into 7 in vitro, 11 in vivo, and 31 clinical studies. In summary, 6 out of 7 (85.7%) and 11 out of 11 (100%) of the in vitro and in vivo studies, respectively, demonstrated a statistically significant advantage for combining PRF to their regenerative therapies. Out of the remaining 31 clinical studies, a total of 8 reported the effects of PRF in a randomized clinical trial, with 5 additional studies (13 total) reporting appropriate controls. In those clinical studies, 9 out of the 13 studies (69.2%) demonstrated a statistically relevant positive outcome for the primary endpoints measured. In total, 18 studies (58% of clinical studies) reported positive wound-healing events associated with the use of PRF, despite using controls. Furthermore, 27 of the 31 clinical studies (87%) supported the use of PRF for soft tissue regeneration and wound healing for a variety of procedures in medicine and dentistry. In conclusion, the results from the present systematic review highlight the positive effects of PRF on wound healing after regenerative therapy for the management of various soft tissue defects found in medicine and dentistry.
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Affiliation(s)
- Richard J Miron
- 1 Department of Periodontology, Nova Southeastern University , Fort Lauderdale, Florida
| | - Masako Fujioka-Kobayashi
- 1 Department of Periodontology, Nova Southeastern University , Fort Lauderdale, Florida.,2 Cranio-Maxillofacial Surgery, Bern University Hospital , Inselspital, Bern, Switzerland .,3 Department of Oral Surgery, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima, Japan
| | - Mark Bishara
- 4 West Bowmanville Family Dental , Ontario, Canada
| | - Yufeng Zhang
- 5 Department of Oral Implantology, University of Wuhan , Wuhan, China
| | - Maria Hernandez
- 1 Department of Periodontology, Nova Southeastern University , Fort Lauderdale, Florida
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Ahmad E, Fatima MT, Hoque M, Owais M, Saleemuddin M. Fibrin matrices: The versatile therapeutic delivery systems. Int J Biol Macromol 2015; 81:121-36. [PMID: 26231328 DOI: 10.1016/j.ijbiomac.2015.07.054] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 07/24/2015] [Accepted: 07/26/2015] [Indexed: 12/12/2022]
Abstract
Fibrin sealants, that have been employed for over a century by surgeons to stop post surgery bleeding, are finding novel applications in the controlled delivery of antibiotics and several other therapeutics. Fibrinogen can be easily purified from blood plasma and converted by thrombolysis to fibrin that undergoes spontaneous aggregation to form insoluble clot. During the gelling, fibrin can be formulated into films, clots, threads, microbeads, nanoconstructs and nanoparticles. Whole plasma clots in the form of beads and microparticles can also be prepared by activating endogenous thrombin, for possible drug delivery. Fibrin formulations offer remarkable scope for controlling the porosity as well as in vivo degradability and hence the release of the associated therapeutics. Binding/covalent-linking of therapeutics to the fibrin matrix, crosslinking of the matrix with bifunctional reagents and coentrapment of protease inhibitors have been successful in regulating both in vitro and in vivo release of the therapeutics. The release rates can also be remarkably lowered by preentrapment of therapeutics in insoluble particles like liposomes or by anchoring them to the matrix via molecules that bind them as well as fibrin.
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Affiliation(s)
- Ejaj Ahmad
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh 202002, India
| | | | - Mehboob Hoque
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh 202002, India
| | - Mohammad Owais
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh 202002, India
| | - Mohammed Saleemuddin
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh 202002, India.
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