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Cannellotto M, Yasells García A, Landa MS. Hyperoxia: Effective Mechanism of Hyperbaric Treatment at Mild-Pressure. Int J Mol Sci 2024; 25:777. [PMID: 38255851 PMCID: PMC10815786 DOI: 10.3390/ijms25020777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
HBOT increases the proportion of dissolved oxygen in the blood, generating hyperoxia. This increased oxygen diffuses into the mitochondria, which consume the majority of inhaled oxygen and constitute the epicenter of HBOT effects. In this way, the oxygen entering the mitochondria can reverse tissue hypoxia, activating the electron transport chain to generate energy. Furthermore, intermittent HBOT is sensed by the cell as relative hypoxia, inducing cellular responses such as the activation of the HIF-1α pathway, which in turn, activates numerous cellular processes, including angiogenesis and inflammation, among others. These effects are harnessed for the treatment of various pathologies. This review summarizes the evidence indicating that the use of medium-pressure HBOT generates hyperoxia and activates cellular pathways capable of producing the mentioned effects. The possibility of using medium-pressure HBOT as a direct or adjunctive treatment in different pathologies may yield benefits, potentially leading to transformative therapeutic advancements in the future.
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Affiliation(s)
- Mariana Cannellotto
- Research Department, International Hyperbaric Medicine and Research Association (IHMERA), Buenos Aires 1429, Argentina
| | | | - María Silvina Landa
- Research Department, International Hyperbaric Medicine and Research Association (IHMERA), Buenos Aires 1429, Argentina
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2
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Jeyaraman M, Nagarajan S, Maffulli N, R P P, Jeyaraman N, N A, Khanna M, Yadav S, Gupta A. Stem Cell Therapy in Critical Limb Ischemia. Cureus 2023; 15:e41772. [PMID: 37575721 PMCID: PMC10416751 DOI: 10.7759/cureus.41772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Critical limb ischemia (CLI), a serious outcome of peripheral artery disease, is frequently associated with morbid outcomes. The available treatment modalities do not provide satisfactory results, leading to marked morbidities such as joint contracture and amputations, resulting in a high economic burden. The peripheral vascular disease tends to cause more morbidity in patients with diabetes and atherosclerosis, given the pre-existing compromised perfusion of medium and small vessels in diabetic patients. With surgical procedures, the chance of vascular compromise further increases, inducing a significantly greater rate of amputation. Hence, the need for nonsurgical treatment modalities such as stem cell therapy (SCT), which promotes angiogenesis, is warranted. In CLI, SCT acts through neovascularization and the development of collateral arteries, which increases blood supply to the soft tissues of the ischemic limb, providing satisfactory outcomes. An electronic database search was performed in PubMed, SCOPUS, EMBASE, and ScienceDirect to identify published clinical trial data, research studies, and review articles on stem cell therapy in critical limb ischemia. The search resulted in a total of 2391 results. Duplicate articles screening resulted in 565 articles. In-depth screening of abstracts and research titles excluded 520 articles, yielding 45 articles suitable for full-text review. On review of full text, articles with overlapping and similar results were filtered, ending in 25 articles. SCT promotes arteriogenesis, and bone marrow-derived mesenchymal stromal cells produce significant effects like reduced morbidity, improved amputation-free survival (AFS ) rate, and improved distal perfusion even in "no-option" CLI patients. SCT is a promising treatment modality for CLI patients, even in those in whom endovascular and revascularization procedures are impossible. SCT assures a prolonged AFS rate, improved distal perfusion, improved walking distances, reduced amputation rates, and increased survival ratio, and is well-tolerated.
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Affiliation(s)
- Madhan Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
- Regenerative Medicine, Indian Stem Cell Study Group Association, Lucknow, IND
- Regenerative Medicine, Datta Meghe Institute of Higher Education and Research, Wardha, IND
- Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, IND
- Orthopaedics, South Texas Orthopaedic Research Institute, Laredo, USA
| | - Somumurthy Nagarajan
- Orthopaedic Rheumatology, Dr. Ram Manohar Lohiya National Law University, Lucknow, IND
| | - Nicola Maffulli
- Orthopedics, School of Medicine and Surgery, University of Salerno, Fisciano, ITA
- Orthopaedics, San Giovanni di Dio e Ruggi D'Aragona Hospital, Hospital of Salerno, Salerno, ITA
- Orthopedics, Barts and the London School of Medicine and Dentistry, London, GBR
- Orthopedics, Keele University School of Medicine, Stoke-on-Trent, GBR
| | - Packkyarathinam R P
- Regenerative Medicine, Indian Stem Cell Study Group Association, Lucknow, IND
- Orthopaedic Rheumatology, Dr. Ram Manohar Lohiya National Law University, Lucknow, IND
- Regenerative and Interventional Orthobiologics, Dr. Ram Manohar Lohiya National Law University, Lucknow, IND
| | - Naveen Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
- Regenerative Medicine, Indian Stem Cell Study Group Association, Lucknow, IND
- Regenerative Medicine, Datta Meghe Institute of Higher Education and Research, Wardha, IND
- Orthopaedic Rheumatology, Dr. Ram Manohar Lohiya National Law University, Lucknow, IND
- Regenerative and Interventional Orthobiologics, Dr. Ram Manohar Lohiya National Law University, Lucknow, IND
| | - Arulkumar N
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
- Regenerative Medicine, Indian Stem Cell Study Group Association, Lucknow, IND
- Regenerative Medicine, Datta Meghe Institute of Higher Education and Research, Wardha, IND
- Orthopaedic Rheumatology, Dr. Ram Manohar Lohiya National Law University, Lucknow, IND
- Regenerative and Interventional Orthobiologics, Dr. Ram Manohar Lohiya National Law University, Lucknow, IND
| | - Manish Khanna
- Regenerative Medicine, Indian Stem Cell Study Group Association, Lucknow, IND
- Orthopaedics, Autonomous State Medical College, Ayodhya, IND
| | - Sankalp Yadav
- Internal Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
| | - Ashim Gupta
- Regenerative Medicine, Indian Stem Cell Study Group Association, Lucknow, IND
- Orthopaedics, South Texas Orthopaedic Research Institute, Laredo, USA
- Regenerative Medicine, Future Biologics, Lawrenceville, USA
- Regenerative Medicine, BioIntegrate, Lawrenceville, USA
- Regenerative Medicine, Regenerative Orthopaedics, Noida, IND
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MacLaughlin KJ, Barton GP, Braun RK, MacLaughlin JE, Lamers JJ, Marcou MD, Eldridge MW. Hyperbaric air mobilizes stem cells in humans; a new perspective on the hormetic dose curve. Front Neurol 2023; 14:1192793. [PMID: 37409020 PMCID: PMC10318163 DOI: 10.3389/fneur.2023.1192793] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/11/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Hyperbaric air (HBA) was first used pharmaceutically in 1662 to treat lung disease. Extensive use in Europe and North America followed throughout the 19th century to treat pulmonary and neurological disorders. HBA reached its zenith in the early 20th century when cyanotic, moribund "Spanish flu pandemic" patients turned normal color and regained consciousness within minutes after HBA treatment. Since that time the 78% Nitrogen fraction in HBA has been completely displaced by 100% oxygen to create the modern pharmaceutical hyperbaric oxygen therapy (HBOT), a powerful treatment that is FDA approved for multiple indications. Current belief purports oxygen as the active element mobilizing stem progenitor cells (SPCs) in HBOT, but hyperbaric air, which increases tensions of both oxygen and nitrogen, has been untested until now. In this study we test HBA for SPC mobilization, cytokine and chemokine expression, and complete blood count. Methods Ten 34-35-year-old healthy volunteers were exposed to 1.27ATA (4 psig/965 mmHg) room air for 90 min, M-F, for 10 exposures over 2-weeks. Venous blood samples were taken: (1) prior to the first exposure (served as the control for each subject), (2) directly after the first exposure (to measure the acute effect), (3) immediately prior to the ninth exposure (to measure the chronic effect), and (4) 3 days after the completion of tenth/final exposure (to assess durability). SPCs were gated by blinded scientists using Flow Cytometry. Results SPCs (CD45dim/CD34+/CD133-) were mobilized by nearly two-fold following 9 exposures (p = 0.02) increasing to three-fold 72-h post completion of the final (10th) exposure (p = 0.008) confirming durability. Discussion This research demonstrates that SPCs are mobilized, and cytokines are modulated by hyperbaric air. HBA likely is a therapeutic treatment. Previously published research using HBA placebos should be re-evaluated to reflect a dose treatment finding rather than finding a placebo effect. Our findings of SPC mobilization by HBA support further investigation into hyperbaric air as a pharmaceutical/therapy.
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Affiliation(s)
- Kent J. MacLaughlin
- Department of Pediatrics, University of Wisconsin–Madison, Madison, WI, United States
| | - Gregory P. Barton
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Rudolf K. Braun
- Department of Pediatrics, University of Wisconsin–Madison, Madison, WI, United States
| | - Julia E. MacLaughlin
- Medical Oxygen Outpatient Clinic, The American Center, Madison, WI, United States
| | - Jacob J. Lamers
- Department of Pediatrics, University of Wisconsin–Madison, Madison, WI, United States
| | - Matthew D. Marcou
- Department of Pediatrics, University of Wisconsin–Madison, Madison, WI, United States
| | - Marlowe W. Eldridge
- Department of Pediatrics, University of Wisconsin–Madison, Madison, WI, United States
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Kerns SL, Williams JP, Marples B. Modeling normal bladder injury after radiation therapy. Int J Radiat Biol 2023; 99:1046-1054. [PMID: 36854008 PMCID: PMC10330568 DOI: 10.1080/09553002.2023.2182000] [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: 12/19/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE For decades, Dr. John Moulder has been a leading radiation biologist and one of the few who consistently supported the study of normal tissue responses to radiation. His meticulous modeling and collaborations across the field have offered a prime example of how research can be taken from the bench to the bedside and back, with the ultimate goal of providing benefit to patients. Much of the focus of John's work was on mitigating damage to the kidney, whether as the result of accidental or deliberate clinical exposures. Following in his footsteps, we offer here a brief overview of work conducted in the field of radiation-induced bladder injury. We then describe our own preclinical experimental studies which originated as a response to reports from a clinical genome-wide association study (GWAS) investigating genomic biomarkers of normal tissue toxicity in prostate cancer patients treated with radiotherapy. In particular, we discuss the use of Renin-Angiotensin System (RAS) inhibitors as modulators of injury, agents championed by the Moulder group, and how RAS inhibitors are associated with a reduction in some measures of toxicity. Using a murine model, along with precise CT-image guided irradiation of the bladder using single and fractionated dosing regimens, we have been able to demonstrate radiation-induced functional injury to the bladder and mitigation of this functional damage by an inhibitor of angiotensin-converting enzyme targeting the RAS, an experimental approach akin to that used by the Moulder group. We consider our scientific trajectory as a bedside-to-bench approach because the observation was made clinically and investigated in a preclinical model; this experimental approach aligns with the exemplary career of Dr. John Moulder. CONCLUSIONS Despite the differences in functional endpoints, recent findings indicate a commonality between bladder late effects and the work in kidney pioneered by Dr. John Moulder. We offer evidence that targeting the RAS pathway may provide a targetable pathway to reducing late bladder toxicity.
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Affiliation(s)
- Sarah L. Kerns
- Department of Department of Radiation Oncology, the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jacqueline P. Williams
- Departments of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
- Departments of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Brian Marples
- Departments of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
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Eldisoky RH, Younes SA, Omar SS, Gharib HS, Tamara TA. Hyperbaric oxygen therapy efficacy on mandibular defect regeneration in rats with diabetes mellitus: an animal study. BMC Oral Health 2023; 23:101. [PMID: 36793042 PMCID: PMC9930221 DOI: 10.1186/s12903-023-02801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND This study aimed to investigate the influence of hyperbaric oxygen therapy on mandibular critical-sized defect regeneration in rats with experimentally induced type I diabetes mellitus. Restoration of large osseous defects in an impaired osteogenic condition such as diabetes mellitus is a challenging task in clinical practice. Therefore, investigating adjunctive therapies to accelerate the regeneration of such defects is crucial. MATERIALS AND METHODS Sixteen albino rats were divided into two groups (n = 8/group). To induce diabetes mellitus, a single streptozotocin dosage was injected. Critical-sized defects were created in the right posterior mandibles and filled with beta-tricalcium phosphate graft. The study group was subjected to 90-min sessions of hyperbaric oxygen at 2.4 ATA, for 5 consecutive days per week. Euthanasia was carried out after 3 weeks of therapy. Bone regeneration was examined histologically and histomorphometrically. Angiogenesis was assessed by immunohistochemistry against vascular endothelial progenitor cell marker (CD34) and the microvessel density was calculated. RESULTS Exposure of diabetic animals to hyperbaric oxygen resulted in superior bone regeneration and increased endothelial cell proliferation, which were revealed histologically and immunohistochemically, respectively. These results were confirmed by histomorphometric analysis which disclosed a higher percentage of new bone surface area and microvessel density in the study group. CONCLUSIONS Hyperbaric oxygen has a beneficial effect on bone regenerative capacity, qualitatively and quantitively, as well as the ability to stimulate angiogenesis.
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Affiliation(s)
- Rodina H. Eldisoky
- grid.7155.60000 0001 2260 6941Department of Oral Biology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Salwa A. Younes
- grid.7155.60000 0001 2260 6941Department of Oral Biology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Samia S. Omar
- grid.7155.60000 0001 2260 6941Department of Oral Biology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Hagar S. Gharib
- grid.7155.60000 0001 2260 6941Department of Oral Biology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Tarek A. Tamara
- grid.489816.a0000000404522383Naval Hyperbaric Medical Institute, Military Medical Academy, Alexandria, Egypt
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Margolis DJ, Mitra N, Hoffstad O, Malay DS, Mirza ZK, Lantis JC, Lev-Tov HA, Kirsner RS, Ruhela D, Bhopale VM, Thom SR. Circulating endothelial precursor cells are associated with a healed diabetic foot ulcer evaluated in a prospective cohort study. Wound Repair Regen 2023; 31:128-134. [PMID: 36177665 PMCID: PMC10319405 DOI: 10.1111/wrr.13055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/24/2022] [Indexed: 02/01/2023]
Abstract
The goal of this multicentre study was to evaluate whether circulating endothelial precursor cells and microparticles can predict diabetic foot ulcer healing by the 16th week of care. We enrolled 207 subjects, and 40.0% (28.4, 41.5) healed by the 16th week of care. Using flow cytometry analysis, several circulating endothelial precursor cells measured at the first week of care were associated with healing after adjustment for wound area and wound duration. For example, CD34+ CD45dim , the univariate odds ratio was 1.19 (95% confidence interval: 0.88, 1.61) and after adjustment for wound area and wound duration, the odds ratio was (1.67 (1.16, 2.42) p = 0.006). A prognostic model using CD34+ CD45dim , wound area, and wound duration had an area under the curve of 0.75 (0.67, 0.82) and CD34+ CD45dim per initial wound area, an area under the curve of 0.72 (0.64, 0.79). Microparticles were not associated with a healed wound. Previous studies have indicated that circulating endothelial precursor cells measured at the first office visit are associated with a healed diabetic foot ulcer. In this multicentred prospective study, we confirm this finding, show the importance of adjusting circulating endothelial precursor cells measurements by wound area, and show circulating endothelial precursor cells per wound area is highly predictive of a healed diabetic foot ulcer by 16th week of care.
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Affiliation(s)
- David J. Margolis
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ole Hoffstad
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - D. Scot Malay
- Department of Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | | | - John C. Lantis
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Hadar A. Lev-Tov
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida
| | - Robert S. Kirsner
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida
| | - Deepa Ruhela
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Veena M. Bhopale
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Stephan R. Thom
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Hyperbaric Oxygen Therapy and Tissue Regeneration: A Literature Survey. Biomedicines 2022; 10:biomedicines10123145. [PMID: 36551901 PMCID: PMC9775938 DOI: 10.3390/biomedicines10123145] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
By addressing the mechanisms involved in transcription, signaling, stress reaction, apoptosis and cell-death, cellular structure and cell-to-cell contacts, adhesion, migration as well as inflammation; HBO upregulates processes involved in repair while mechanisms perpetuating tissue damage are downregulated. Many experimental and clinical studies, respectively, cover wound healing, regeneration of neural tissue, of bone and cartilage, muscle, and cardiac tissue as well as intestinal barrier function. Following acute injury or in chronic healing problems HBO modulates proteins or molecules involved in inflammation, apoptosis, cell growth, neuro- and angiogenesis, scaffolding, perfusion, vascularization, and stem-cell mobilization, initiating repair by a variety of mechanisms, some of them based on the modulation of micro-RNAs. HBO affects the oxidative stress response via nuclear factor erythroid 2-related factor 2 (Nrf2) or c-Jun N-terminal peptide and downregulates inflammation by the modulation of high-mobility group protein B1 (HMGB-1), toll-like receptor 4 and 2 (TLR-4, TLR-2), nuclear factor kappa-B (NFκB), hypoxia-inducible factor (HIF-1α) and nitric oxide (NO•). HBO enhances stem-cell homeostasis via Wnt glycoproteins and mammalian target of rapamycin (mTOR) and improves cell repair, growth, and differentiation via the two latter but also by modulation of extracellular-signal regulated kinases (ERK) and the phosphatidylinositol-3-kinase (PI3K)/protein kinase B (AKT) pathway. The HBO-induced downregulation of matrix metalloproteinases-2 and 9 (MMP-2/-9), rho-associated protein kinase (ROCK) and integrins improve healing by tissue remodeling. Interestingly, the action of HBO on single effector proteins or molecules may involve both up- or downregulation, respectively, depending on their initial level. This probably mirrors a generally stabilizing potential of HBO that tends to restore the physiological balance rather than enhancing or counteracting single mechanisms.
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Gottfried I, Schottlender N, Ashery U. Hyperbaric Oxygen Treatment-From Mechanisms to Cognitive Improvement. Biomolecules 2021; 11:biom11101520. [PMID: 34680155 PMCID: PMC8533945 DOI: 10.3390/biom11101520] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 12/19/2022] Open
Abstract
Hyperbaric oxygen treatment (HBOT)—the medical use of oxygen at environmental pressure greater than one atmosphere absolute—is a very effective therapy for several approved clinical situations, such as carbon monoxide intoxication, incurable diabetes or radiation-injury wounds, and smoke inhalation. In recent years, it has also been used to improve cognition, neuro-wellness, and quality of life following brain trauma and stroke. This opens new avenues for the elderly, including the treatment of neurological and neurodegenerative diseases and improvement of cognition and brain metabolism in cases of mild cognitive impairment. Alongside its integration into clinics, basic research studies have elucidated HBOT’s mechanisms of action and its effects on cellular processes, transcription factors, mitochondrial function, oxidative stress, and inflammation. Therefore, HBOT is becoming a major player in 21st century research and clinical treatments. The following review will discuss the basic mechanisms of HBOT, and its effects on cellular processes, cognition, and brain disorders.
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Affiliation(s)
- Irit Gottfried
- School of Neurobiology, Biochemistry and Biophysics, Life Sciences Faculty, Tel Aviv University, Tel Aviv 6997801, Israel; (I.G.); (N.S.)
| | - Nofar Schottlender
- School of Neurobiology, Biochemistry and Biophysics, Life Sciences Faculty, Tel Aviv University, Tel Aviv 6997801, Israel; (I.G.); (N.S.)
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Uri Ashery
- School of Neurobiology, Biochemistry and Biophysics, Life Sciences Faculty, Tel Aviv University, Tel Aviv 6997801, Israel; (I.G.); (N.S.)
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-3-6409827
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Levitan DM, Hitt M, Geiser DR, Lyman R. Rationale for hyperbaric oxygen therapy in traumatic injury and wound care in small animal veterinary practice. J Small Anim Pract 2021; 62:719-729. [PMID: 34018618 PMCID: PMC8519146 DOI: 10.1111/jsap.13356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/25/2021] [Accepted: 04/18/2021] [Indexed: 12/30/2022]
Abstract
Hyperbaric oxygen therapy is in wide use in human medicine around the world. Although hyperbaric oxygen therapy is available for veterinary use, it is still significantly underutilised. The physical principles, gas laws and physiologic mechanisms by which hyperbaric oxygen therapy is therapeutic, especially in traumatic injuries and complicated wound care, are discussed. Then, considerations are offered for the implementation of hyperbaric oxygen therapy in veterinary practices. Finally, a review of clinical indications for veterinary practices, including a presentation of select literature, is provided. Applying hyperbaric oxygen therapy in an earlier and more consistent manner could improve short- and long-term outcomes in complicated wounds. The authors also hope this information may stimulate interest in the design of future, prospective studies for the various clinical situations described.
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Affiliation(s)
- D. M. Levitan
- College of Veterinary MedicineLong Island UniversityBrookvilleNY11548USA
| | - M. Hitt
- Atlantic Veterinary Internal Medicine and OncologyAnnapolisMD21401USA
| | - D. R. Geiser
- College of Veterinary MedicineUniversity of TennesseeKnoxvilleTN37996USA
| | - R. Lyman
- Animal Emergency and Referral CenterFort PierceFL34982USA
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Oropallo AR, Serena TE, Armstrong DG, Niederauer MQ. Molecular Biomarkers of Oxygen Therapy in Patients with Diabetic Foot Ulcers. Biomolecules 2021; 11:biom11070925. [PMID: 34206433 PMCID: PMC8301753 DOI: 10.3390/biom11070925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 12/28/2022] Open
Abstract
Hyperbaric oxygen therapy (HBOT) and topical oxygen therapy (TOT) including continuous diffuse oxygen therapy (CDOT) are often utilized to enhance wound healing in patients with diabetic foot ulcerations. High pressure pure oxygen assists in the oxygenation of hypoxic wounds to increase perfusion. Although oxygen therapy provides wound healing benefits to some patients with diabetic foot ulcers, it is currently performed from clinical examination and imaging. Data suggest that oxygen therapy promotes wound healing via angiogenesis, the creation of new blood vessels. Molecular biomarkers relating to tissue inflammation, repair, and healing have been identified. Predictive biomarkers can be used to identify patients who will most likely benefit from this specialized treatment. In diabetic foot ulcerations, specifically, certain biomarkers have been linked to factors involving angiogenesis and inflammation, two crucial aspects of wound healing. In this review, the mechanism of how oxygen works in wound healing on a physiological basis, such as cell metabolism and growth factor signaling transduction is detailed. Additionally, observable clinical outcomes such as collagen formation, angiogenesis, respiratory burst and cell proliferation are described. The scientific evidence for the impact of oxygen on biomolecular pathways and its relationship to the outcomes in clinical research is discussed in this narrative review.
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Affiliation(s)
- Alisha R. Oropallo
- Comprehensive Wound Healing Center and Hyperbarics, Department of Vascular Surgery, Zucker School of Medicine Hofstra/Northwell, Hempstead, NY 11549, USA
- Correspondence: ; Tel.: +1-516-233-3780
| | | | - David G. Armstrong
- Limb Preservation Program, Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA;
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Resanović I, Zarić B, Radovanović J, Sudar-Milovanović E, Gluvić Z, Jevremović D, Isenović ER. Hyperbaric Oxygen Therapy and Vascular Complications in Diabetes Mellitus. Angiology 2020; 71:876-885. [PMID: 32638622 DOI: 10.1177/0003319720936925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Vascular complications in patients with diabetes mellitus (DM) are common. Since impaired oxygen balance in plasma plays an important role in the pathogenesis of chronic DM-associated complications, the administration of hyperbaric oxygen therapy (HBOT) has been recommended to influence development of vascular complications. Hyperbaric oxygen therapy involves inhalation of 100% oxygen under elevated pressure from 1.6 to 2.8 absolute atmospheres in hyperbaric chambers. Hyperbaric oxygen therapy increases plasma oxygen solubility, contributing to better oxygen diffusion to distant tissues and preservation of the viability of tissues reversibly damaged by atherosclerosis-induced ischemia, along with microcirculation restoration. Hyperbaric oxygen therapy exerts antiatherogenic, antioxidant, and cardioprotective effects by altering the level and composition of plasma fatty acids and also by promoting signal transduction through membranes, which are impaired by hyperglycemia and hypoxia. In addition, HBOT affects molecules involved in the regulation of nitric oxide synthesis and in that way exerts anti-inflammatory and angiogenic effects in patients with DM. In this review, we explore the recent literature related to the effects of HBOT on DM-related vascular complications.
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Affiliation(s)
- Ivana Resanović
- Department of Radiobiology and Molecular Genetics, "VINČA" Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Božidarka Zarić
- Department of Radiobiology and Molecular Genetics, "VINČA" Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Jelena Radovanović
- Department of Radiobiology and Molecular Genetics, "VINČA" Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Emina Sudar-Milovanović
- Department of Radiobiology and Molecular Genetics, "VINČA" Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Zoran Gluvić
- Department of Endocrinology and Diabetes, Zemun Clinical Hospital, School of Medicine, University of Belgrade, Serbia
| | - Danimir Jevremović
- Faculty of Stomatology in Pancevo, University Business Academy, Novi Sad, Serbia
| | - Esma R Isenović
- Department of Radiobiology and Molecular Genetics, "VINČA" Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
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Cozene B, Sadanandan N, Gonzales-Portillo B, Saft M, Cho J, Park YJ, Borlongan CV. An Extra Breath of Fresh Air: Hyperbaric Oxygenation as a Stroke Therapeutic. Biomolecules 2020; 10:biom10091279. [PMID: 32899709 PMCID: PMC7563917 DOI: 10.3390/biom10091279] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 12/15/2022] Open
Abstract
Stroke serves as a life-threatening disease and continues to face many challenges in the development of safe and effective therapeutic options. The use of hyperbaric oxygen therapy (HBOT) demonstrates pre-clinical effectiveness for the treatment of acute ischemic stroke and reports reductions in oxidative stress, inflammation, and neural apoptosis. These pathophysiological benefits contribute to improved functional recovery. Current pre-clinical and clinical studies are testing the applications of HBOT for stroke neuroprotection, including its use as a preconditioning regimen. Mild oxidative stress may be able to prime the brain to tolerate full extensive oxidative stress that occurs during a stroke, and HBOT preconditioning has displayed efficacy in establishing such ischemic tolerance. In this review, evidence on the use of HBOT following an ischemic stroke is examined, and the potential for HBOT preconditioning as a neuroprotective strategy. Additionally, HBOT as a stem cell preconditioning is also discussed as a promising strategy, thus maximizing the use of HBOT for ischemic stroke.
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Baiula M, Greco R, Ferrazzano L, Caligiana A, Hoxha K, Bandini D, Longobardi P, Spampinato S, Tolomelli A. Integrin-mediated adhesive properties of neutrophils are reduced by hyperbaric oxygen therapy in patients with chronic non-healing wound. PLoS One 2020; 15:e0237746. [PMID: 32810144 PMCID: PMC7433869 DOI: 10.1371/journal.pone.0237746] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/31/2020] [Indexed: 12/30/2022] Open
Abstract
In recent years, several studies suggested that the ability of hyperbaric oxygen therapy (HBOT) to promote healing in patients with diabetic ulcers and chronic wounds is due to the reduction of inflammatory cytokines and to a significant decrease in neutrophils recruitment to the damaged area. α4 and β2 integrins are receptors mediating the neutrophil adhesion to the endothelium and the comprehension of the effects of hyperbaric oxygenation on their expression and functions in neutrophils could be of great importance for the design of novel therapeutic protocols focused on anti-inflammatory agents. In this study, the α4 and β2 integrins' expression and functions have been evaluated in human primary neutrophils obtained from patients with chronic non-healing wounds and undergoing a prolonged HBOT (150 kPa per 90 minutes). The effect of a peptidomimetic α4β1 integrin antagonist has been also analyzed under these conditions. A statistically significant decrease (68%) in β2 integrin expression on neutrophils was observed during the treatment with HBO and maintained one month after the last treatment, while α4 integrin levels remained unchanged. However, cell adhesion function of both neutrophilic integrins α4β1 and β2 was significantly reduced 70 and 67%, respectively), but α4β1 integrin was still sensitive to antagonist inhibition in the presence of fibronectin, suggesting that a combined therapy between HBOT and integrin antagonists could have greater antinflammatory efficacy.
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Affiliation(s)
- Monica Baiula
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Roberto Greco
- Department of Chemistry “Giacomo Ciamician”, Alma Mater Studiorum -University of Bologna, Bologna, Italy
| | - Lucia Ferrazzano
- Department of Chemistry “Giacomo Ciamician”, Alma Mater Studiorum -University of Bologna, Bologna, Italy
| | - Alberto Caligiana
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | | | | | | | - Santi Spampinato
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Alessandra Tolomelli
- Department of Chemistry “Giacomo Ciamician”, Alma Mater Studiorum -University of Bologna, Bologna, Italy
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Liu C, Zhu J, Hai B, Zhang W, Wang H, Leng H, Xu Y, Song C. Single Intraosseous Injection of Simvastatin Promotes Endothelial Progenitor Cell Mobilization, Neovascularization, and Wound Healing in Diabetic Rats. Plast Reconstr Surg 2020; 145:433-443. [DOI: 10.1097/prs.0000000000006502] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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15
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Xu Y, Chen J, Zhou H, Wang J, Song J, Xie J, Guo Q, Wang C, Huang Q. Effects and mechanism of stem cells from human exfoliated deciduous teeth combined with hyperbaric oxygen therapy in type 2 diabetic rats. Clinics (Sao Paulo) 2020; 75:e1656. [PMID: 32520222 PMCID: PMC7247751 DOI: 10.6061/clinics/2020/e1656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/10/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Mesenchymal stem cells (MSCs) are potentially ideal for type 2 diabetes treatment, owing to their multidirectional differentiation ability and immunomodulatory properties. Here we investigated whether the stem cells from human exfoliated deciduous teeth (SHED) in combination with hyperbaric oxygen (HBO) could treat type 2 diabetic rats, and explored the underlying mechanism. METHODS SD rats were used to generate a type 2 diabetes model, which received stem cell therapy, HBO therapy, or both together. Before and after treatment, body weight, blood glucose, and serum insulin, blood lipid, pro-inflammatory cytokines (tumor necrosis factor-alpha and interleukin-6), and urinary proteins were measured and compared. After 6 weeks, rats were sacrificed and their organs were subjected to hematoxylin and eosin staining and immunofluorescence staining for insulin and glucagon; apoptosis and proliferation were analyzed in islet cells. Structural changes in islets were observed under an electron microscope. Expression levels of Pdx1, Ngn3, and Pax4 mRNAs in the pancreas were assessed by real-time quantitative polymerase chain reaction (RT-qPCR). RESULTS In comparison with diabetic mice, those treated with the combination or SHE therapy showed decreased blood glucose, insulin resistance, serum lipids, and pro-inflammatory cytokines and increased body weight and serum insulin. The morphology and structure of pancreatic islets improved, as evident from an increase in insulin-positive cells and a decrease in glucagon-positive cells. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining of islet cells revealed the decreased apoptosis index, while Ki67 and proliferating cell nuclear antigen staining showed increased proliferation index. Pancreatic expression of Pdx1, Ngn3, and Pax4 was upregulated. CONCLUSION SHED combined with HBO therapy was effective for treating type 2 diabetic rats. The underlying mechanism may involve SHED-mediated increase in the proliferation and trans-differentiation of islet β-cells and decrease in pro-inflammatory cytokines and apoptosis of islets.
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Affiliation(s)
- Yifeng Xu
- Department of Endocrinology, Changhai Hospital, the First Affiliated Hospital of the Naval Medical University, Shanghai 200433, China
- Department of Endocrinology, Air Force Hospital of Northern Theater Command of PLA, Shenyang 110042, China
| | - Jin Chen
- Department of Endocrinology, Changhai Hospital, the First Affiliated Hospital of the Naval Medical University, Shanghai 200433, China
| | - Hui Zhou
- Department of Out-patient, Changning retired cadre retreat of Shanghai garrison command, Shanghai 200050, China
| | - Jing Wang
- Department of Endocrinology, Changhai Hospital, the First Affiliated Hospital of the Naval Medical University, Shanghai 200433, China
- Department of Internal Medcine, Hotan Country People’s Hospital of Xinjiang, Hotan Country 848000, China
| | - Jingyun Song
- Department of Endocrinology, Changhai Hospital, the First Affiliated Hospital of the Naval Medical University, Shanghai 200433, China
| | - Junhao Xie
- Department of Endocrinology, Changhai Hospital, the First Affiliated Hospital of the Naval Medical University, Shanghai 200433, China
| | - Qingjun Guo
- Department of Endocrinology, Changhai Hospital, the First Affiliated Hospital of the Naval Medical University, Shanghai 200433, China
| | - Chaoqun Wang
- Department of Endocrinology, Changhai Hospital, the First Affiliated Hospital of the Naval Medical University, Shanghai 200433, China
| | - Qin Huang
- Department of Endocrinology, Changhai Hospital, the First Affiliated Hospital of the Naval Medical University, Shanghai 200433, China
- *Corresponding author. E-mail:
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16
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Estrada EJ, Decima JL, Bortman G, Roberti J, Romero EB, Samaja G, Saavedra AR, Martínez G, Gutiérrez S. Combination treatment of autologous bone marrow stem cell transplantation and hyperbaric oxygen therapy for type 2 diabetes mellitus: A randomized controlled trial. Cell Transplant 2019; 28:1632-1640. [PMID: 31665912 PMCID: PMC6923554 DOI: 10.1177/0963689719883813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 01/06/2023] Open
Abstract
The objective of this study was to compare standard treatment versus the combination of intrapancreatic autologous stem cell (ASC) infusion and hyperbaric oxygen treatment (HBOT) before and after ASC in the metabolic control of patients with type 2 diabetes mellitus (T2DM). This study was a prospective, randomized controlled trial. The combined intervention consisted of 10 sessions of HBOT before the intrapancreatic infusion of ASC and 10 sessions afterwards. ASCs were infused into the main arterial supply of the pancreas to maximize the presence of the stem cells where the therapeutic effect is most desired. A total of 23 patients were included (control group = 10, intervention group = 13). Age, gender, diabetes duration, number of medications taken, body weight and height, and insulin requirements were recorded at baseline and every three months. Also, body mass index, fasting plasma glucose, C-peptide, and HbA1c, C-peptide/glucose ratio (CPGR) were measured every three months for one year. HbA1c was significantly lower in the intervention group compared with control throughout follow-up. Overall, 77% of patients in the intervention group and 30% of patients in the control group demonstrated a decrease of HbA1c at 180 days (compared with baseline) of at least 1 unit. Glucose levels were significantly lower in the intervention group at all timepoints during follow-up. C-peptide levels were significantly higher in the intervention group during follow-up and at one year: 1.9 ± 1.0 ng/mL versus 0.7 ± 0.4 ng/mL in intervention versus control groups, respectively, p = 0.0021. CPGR was higher in the intervention group at all controls during follow-up. The requirement for insulin was significantly lower in the intervention group at 90, 180, 270, and 365 days. Combined therapy of intrapancreatic ASC infusion and HBOT showed increased metabolic control and reduced insulin requirements in patients with T2DM compared with standard treatment.
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Affiliation(s)
- Esteban J. Estrada
- Hospital de Alta Complejidad Pte. Juan Domingo Perón, Formosa,
Argentina
| | - José Luis Decima
- Hospital de Alta Complejidad Pte. Juan Domingo Perón, Formosa,
Argentina
| | - Guillermo Bortman
- Hospital de Alta Complejidad Pte. Juan Domingo Perón, Formosa,
Argentina
| | - Javier Roberti
- Hospital de Alta Complejidad Pte. Juan Domingo Perón, Formosa,
Argentina
| | | | - Gustavo Samaja
- Hospital de Alta Complejidad Pte. Juan Domingo Perón, Formosa,
Argentina
| | | | - Gerardo Martínez
- Hospital de Alta Complejidad Pte. Juan Domingo Perón, Formosa,
Argentina
| | - Samuel Gutiérrez
- Hospital de Alta Complejidad Pte. Juan Domingo Perón, Formosa,
Argentina
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17
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Kaushik K, Das A. Endothelial progenitor cell therapy for chronic wound tissue regeneration. Cytotherapy 2019; 21:1137-1150. [PMID: 31668487 DOI: 10.1016/j.jcyt.2019.09.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023]
Abstract
Despite advancements in wound care, healing of chronic diabetic wounds remains a great challenge for the clinical fraternity because of the intricacies of the healing process. Due to the limitations of existing treatment strategies for chronic wounds, stem/progenitor cell transplantation therapies have been explored as an alternative for tissue regeneration at the wound site. The non-healing phenotype of chronic wounds is directly associated with lack of vascularization. Therefore, endothelial progenitor cell (EPC) transplantation is proving to be a promising approach for the treatment of hypo-vascular chronic wounds. With the existing knowledge in EPC biology, significant efforts have been made to enrich EPCs at the chronic wound site, generating EPCs from somatic cells, induced pluripotent stem cells (iPSCs) using transcription factors, or from adult stem cells using chemicals/drugs for use in transplantation, as well as modulating the endogenous dysfunctional/compromised EPCs under diabetic conditions. This review mainly focuses on the pre-clinical and clinical approaches undertaken to date with EPC-based translational therapy for chronic diabetic as well as non-diabetic wounds to evaluate their vascularity-mediated regeneration potential.
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Affiliation(s)
- Komal Kaushik
- Department of Applied Biology, CSIR-Indian Institute of Chemical Technology, Uppal Road, Tarnaka, Hyderabad, India; Academy of Scientific and Innovative Research (AcSIR), CSIR-IICT Campus, Hyderabad, India
| | - Amitava Das
- Department of Applied Biology, CSIR-Indian Institute of Chemical Technology, Uppal Road, Tarnaka, Hyderabad, India; Academy of Scientific and Innovative Research (AcSIR), CSIR-IICT Campus, Hyderabad, India.
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18
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Tanaka T, Minami A, Uchida J, Nakatani T. Potential of hyperbaric oxygen in urological diseases. Int J Urol 2019; 26:860-867. [DOI: 10.1111/iju.14015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/08/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Tomoaki Tanaka
- Department of Urology Suita Municipal Hospital Suita Osaka Japan
- Department of Urology Osaka City University Graduate School of Medicine Osaka Osaka Japan
| | - Akinori Minami
- Department of Urology Osaka City University Graduate School of Medicine Osaka Osaka Japan
| | - Junji Uchida
- Department of Urology Osaka City University Graduate School of Medicine Osaka Osaka Japan
| | - Tatsuya Nakatani
- Department of Urology Osaka City University Graduate School of Medicine Osaka Osaka Japan
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19
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Benincasa JC, de Freitas Filho LH, Carneiro GD, Sielski MS, Giorgio S, Werneck CC, Vicente CP. Hyperbaric oxygen affects endothelial progenitor cells proliferation in vitro. Cell Biol Int 2019; 43:136-146. [DOI: 10.1002/cbin.11070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/12/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Julia C. Benincasa
- Department of Structural and Functional Biology; State University of Campinas (UNICAMP); São Paulo Brazil
| | - Luiz H. de Freitas Filho
- Department of Structural and Functional Biology; State University of Campinas (UNICAMP); São Paulo Brazil
| | - Giane D. Carneiro
- Department of Structural and Functional Biology; State University of Campinas (UNICAMP); São Paulo Brazil
| | - Micheli S. Sielski
- Department of Structural and Functional Biology; State University of Campinas (UNICAMP); São Paulo Brazil
| | - Selma Giorgio
- Department of Animal Biology; State University of Campinas; Campinas 13083-865 Brazil
| | - Claudio C. Werneck
- Department of Biochemistry and Tissue Biology; Institute of Biology, State University of Campinas (UNICAMP); São Paulo Brazil
| | - Cristina P. Vicente
- Department of Structural and Functional Biology; State University of Campinas (UNICAMP); São Paulo Brazil
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20
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Li Z, Shen D, Hu S, Su T, Huang K, Liu F, Hou L, Cheng K. Pretargeting and Bioorthogonal Click Chemistry-Mediated Endogenous Stem Cell Homing for Heart Repair. ACS NANO 2018; 12:12193-12200. [PMID: 30511851 PMCID: PMC6472971 DOI: 10.1021/acsnano.8b05892] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Stem cell therapy is one of the promising strategies for the treatment of ischemic heart disease. However, the clinical application of stem cells transplantation is limited by low cell engraftment in the infarcted myocardium. Taking advantage of pretargeting and bioorthogonal chemistry, we engineered a pretargeting and bioorthogonal chemistry (PTBC) system to capture endogenous circulating stem cells and target them to the injured heart for effective repair. Two bioorthogonal antibodies were i.v. administrated with a pretargeting interval (48 h). Through bioorthogonal click reaction, the two antibodies are linked in vivo, engaging endogenous stem cells with circulating platelets. As a result, the platelets redirect the stem cells to the injured heart. In vitro and in vivo studies demonstrated that bioorthogonal click reaction was able to induce the conjugation of platelets and endothelial progenitor cells (EPCs) and enhance the binding of EPCs to collagen and injured blood vessels. More importantly, in a mouse model of acute myocardial infarction, the in vivo results of cardiac function, heart morphometry, and immunohistochemistry assessment all confirmed effective heart repair by the PTBC system.
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Affiliation(s)
- Zhenhua Li
- Department of Molecular Biomedical Sciences and Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina 27607, United States
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, and North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Deliang Shen
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Shiqi Hu
- Department of Molecular Biomedical Sciences and Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina 27607, United States
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, and North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Teng Su
- Department of Molecular Biomedical Sciences and Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina 27607, United States
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, and North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Ke Huang
- Department of Molecular Biomedical Sciences and Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina 27607, United States
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, and North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Feiran Liu
- Department of Molecular Biomedical Sciences and Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina 27607, United States
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, and North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Lei Hou
- Department of Cardiology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, China
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200433, China
| | - Ke Cheng
- Department of Molecular Biomedical Sciences and Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina 27607, United States
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, and North Carolina State University, Raleigh, North Carolina 27695, United States
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Minami A, Tanaka T, Otoshi T, Kuratsukuri K, Nakatani T. Hyperbaric oxygen significantly improves frequent urination, hyperalgesia, and tissue damage in a mouse long-lasting cystitis model induced by an intravesical instillation of hydrogen peroxide. Neurourol Urodyn 2018; 38:97-106. [PMID: 30411813 DOI: 10.1002/nau.23822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/29/2018] [Indexed: 02/02/2023]
Abstract
AIM To investigate whether hyperbaric oxygen (HBO) is effective for the pathophysiological findings in an IC/PBS-like mouse model induced by intravesical hydrogen peroxide (H2 O2 ). METHODS Six-week-old ICR female mice (N = 16) were divided into four experimental groups: (1) sham control with intravesical vehicle instillation twice, and without subsequent treatment (N = 4); (2) H2 O2 instillation twice, followed by HBO (100% O2 , 2 ATA, 30 min per session) (N = 4); (3) H2 O2 instillation twice, followed by dummy hyperbaric treatment (air, 2ATA, 30 min per session) (N = 4); and (4) H2 O2 instillation twice, followed by no treatment (N = 4). Body weight, voiding frequency, tidal voiding volume, and individual bladder pain threshold using the von-Frey test were measured. Whole body uptake of an inflammation-specific fluorescent pan-cathepsin was assessed by an in vivo imaging. Immunohistochemical staining and the mRNA expression of several biomarkers associated with chronic inflammation in resected bladders were evaluated. RESULTS The HBO-treated group showed significant improvement in voiding frequency, tidal voiding volume, and the individual bladder pain threshold. Moreover, HBO markedly suppressed H2 O2 -induced inflammation, edema, and fibrosis in bladder wall, concomitant with a significant decrease in mRNA expressions of inflammation biomarkers and a significant increase in endothelial nitric oxide synthase expression. HBO also inhibited the expression of transient receptor potential channels induced by H2 O2 instillation. CONCLUSION These results suggest that HBO contributes to elimination of H2 O2 -induced long-lasting cystitis through the repair of chronically inflamed bladder tissue and inhibition of the bladder sensory system.
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Affiliation(s)
- Akinori Minami
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomoaki Tanaka
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Taiyo Otoshi
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Katsuyuki Kuratsukuri
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tatsuya Nakatani
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
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22
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Li X, Li J, Yang X, Sun Z, Zhang J, Zhao W, Dong S, Li C, Ye Y, Chen J, Li Y, Xiang Y, Mao J, Li G, Guo H, Zhang W, Guo H, Zhang Y, Zhang M, Zhang W, Xu Z, Zhao B, Wei J, Zhao G, Ma R, Shen X, Ge C, Zheng C, Li S, Wang Y. Hyperbaric-Oxygen Therapy Improves Survival and Functional Outcome of Acute Severe Intracerebral Hemorrhage. Arch Med Res 2018; 48:638-652. [PMID: 29548729 DOI: 10.1016/j.arcmed.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 03/01/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Prognosis of spontaneous intracerebral hemorrhage (ICH) remains poor worldwide. AIMS OF THE STUDY To investigate the effect and optimal protocol for hyperbaric-oxygen therapy (HBOT), and reduce incidence of upper gastrointestinal bleeding (UGIB) in ICH. METHODS This prospective, randomized, controlled trial included 565 patients with acute severe ICH. Participants were randomly assigned to a sham-control group (Group A) and four intervention groups: Groups B and C with 2.0 atmospheres absolute (ATA) pressure and HBOT exposure for 60 or 90 sessions, respectively; and Groups D and E with 1.5 ATA for 60 or 90 sessions, respectively. All patients received emergency craniotomy with hematoma evacuation. Outcome measures were modified Barthel Index (MBI) and modified Rankin Scale (mRS) scores, mortality rates at follow-up six months. UGIB rates were assessed as potential side effect. RESULTS In four intervention groups, MBI and mRS scores were all significantly improved, and mortality rates were all significantly decreased compared with Group A (all p < 0.005). UGIB rates were 39.25, 60.00, 64.49, 36.79, and 34.26% in Groups A, B, C, D, and E, respectively. UGIB rates in Groups B and C were significantly increased compared with Groups A, D and E (all p < 0.005). None of UGIB were clinically significant. CONCLUSIONS HBOT significantly improves survival and functional outcomes of ICH. HBOT at 1.5 and 2.0 ATA had the same beneficial effect. A pressure of 1.5 ATA and 60 HBOT exposures represents an optimal protocol for HBOT. Further studies are needed to optimize the protocol per specific patient.
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Affiliation(s)
- Xiaowei Li
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China.
| | - Jingze Li
- Clinical Medicine Specialty of the First Clinical Medical College, Hebei North University, Changqing Road, Qiaoxi District, Zhangjiakou City, Hebei Province, People's Republic of China
| | - Xuehui Yang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Zhaosheng Sun
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Jinrong Zhang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Wangmiao Zhao
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Shuzhi Dong
- Department of Hyperbaric Medicine, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Cong Li
- Department of Hyperbaric Medicine, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Yanqiao Ye
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Jianchao Chen
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Yongqian Li
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Yi Xiang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Jianhui Mao
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Guangjie Li
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Hong Guo
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Wenchao Zhang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Hao Guo
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Yazhao Zhang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Mingzhe Zhang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Wanzeng Zhang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Zhanyi Xu
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Baoshuai Zhao
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Jianhui Wei
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Gengshui Zhao
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Ronghua Ma
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Xiuzhi Shen
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Chunyan Ge
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Cunling Zheng
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Shang Li
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
| | - Yan Wang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China
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Fernández Canedo I, Padilla España L, Francisco Millán Cayetano J, Repiso Jiménez JB, Pérez Delgado M, de Troya Martín M. Hyperbaric oxygen therapy: An alternative treatment for radiation-induced cutaneous ulcers. Australas J Dermatol 2017; 59:e203-e207. [DOI: 10.1111/ajd.12763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/30/2017] [Indexed: 01/11/2023]
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A Molecular and Clinical Review of Stem Cell Therapy in Critical Limb Ischemia. Stem Cells Int 2017; 2017:3750829. [PMID: 29358955 PMCID: PMC5735649 DOI: 10.1155/2017/3750829] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/05/2017] [Indexed: 12/20/2022] Open
Abstract
Peripheral artery disease (PAD) is one of the major vascular complications in individuals suffering from diabetes and in the elderly that can progress to critical limb ischemia (CLI), portending significant burden in terms of patient morbidity and mortality. Over the last two decades, stem cell therapy (SCT) has risen as an attractive alternative to traditional surgical and/or endovascular revascularization to treat this disorder. The primary benefit of SCT is to induce therapeutic neovascularization and promote collateral vessel formation to increase blood flow in the ischemic limb and soft tissue. Existing evidence provides a solid rationale for ongoing in-depth studies aimed at advancing current SCT that may change the way PAD/CLI patients are treated.
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Abstract
Vascular complications contribute significantly to morbidity and mortality of diabetes mellitus. The primary cause of vascular complications in diabetes mellitus is hyperglycaemia, associated with endothelial dysfunction and impaired neovascularization. Circulating endothelial progenitor cells was shown to play important roles in vascular repair and promoting neovascularization. In this review, we will demonstrate the individual effect of high glucose on endothelial progenitor cells. Endothelial progenitor cells isolated from healthy subjects exposed to high glucose conditions or endothelial progenitor cells isolated from diabetic patients exhibit reduced number of endothelial cell colony forming units, impaired abilities of differentiation, proliferation, adhesion and migration, tubulization, secretion, mobilization and homing, whereas enhanced senescence. Increased production of reactive oxygen species by the mitochondria seems to play a crucial role in high glucose-induced endothelial progenitor cells deficit. Later, we will review the agents that might be used to alleviate dysfunction of endothelial progenitor cells induced by high glucose. The conclusions are that the relationship between hyperglycaemia and endothelial progenitor cells dysfunction is only beginning to be recognized, and future studies should pay more attention to the haemodynamic environment of endothelial progenitor cells and ageing factors to discover novel treatment agents.
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Affiliation(s)
- Hongyan Kang
- 1 Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xuejiao Ma
- 1 Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jiajia Liu
- 1 Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yubo Fan
- 1 Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- 2 National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Xiaoyan Deng
- 1 Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Nonhealing Wounds Caused by Brown Spider Bites: Application of Hyperbaric Oxygen Therapy. Adv Skin Wound Care 2017; 29:560-566. [PMID: 27846029 DOI: 10.1097/01.asw.0000504578.06579.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bites by Loxosceles spiders (also known as recluse spiders or brown spiders) can cause necrotic ulcerations of various sizes and dimensions. The current standard of care for brown spider bites includes analgesics, ice, compression, elevation, antihistamines, and surgical debridement. Hyperbaric oxygen therapy (HBOT) in the treatment of brown spider bites has been administered in the early stage of ulceration, or 2 to 6 days after the bite. Unfortunately, the diagnosis of spider bite-related ulcers is often delayed and weeks or months may elapse before HBOT is considered. OBJECTIVE To evaluate the effect of HBOT on nonhealing wounds caused by brown spider bites in the late, chronic, nonhealing stage. METHODS Analysis of 3 patients with brown spider-bite healing wounds treated at The Sagol Center for Hyperbaric Medicine and Research in Israel. Patients presented 2 to 3 months after failure of other therapies including topical dressings, antibiotics, and corticosteroids. All patients were treated with daily 2 ATA (atmospheres absolute) with 100% oxygen HBOT sessions. RESULTS All 3 patients were previously healthy without any chronic disease. Their ages were 30, 42, and 73 years. They were treated once daily for 13, 17, and 31 sessions, respectively. The wounds of all 3 patients healed, and there was no need for additional surgical intervention. There were no significant adverse events in any of the patients. CONCLUSIONS Microvascular injury related to brown spider bites may culminate in ischemic nonhealing wounds even in a relatively young, healthy population. Hyperbaric oxygen therapy should be considered as a valuable therapeutic tool even months after the bite.
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Heyboer M, Sharma D, Santiago W, McCulloch N. Hyperbaric Oxygen Therapy: Side Effects Defined and Quantified. Adv Wound Care (New Rochelle) 2017; 6:210-224. [PMID: 28616361 PMCID: PMC5467109 DOI: 10.1089/wound.2016.0718] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/26/2017] [Indexed: 12/20/2022] Open
Abstract
Significance: Hyperbaric oxygen therapy (HBOT) is an important advanced therapy in the treatment of problem wounds, including diabetic foot ulcers and late effect radiation injury. HBOT remains among the safest therapies used today. Nonetheless, there are side effects associated with HBOT. It is important for providers to be able to identify, understand, and quantify these side effects for prevention, management, and informed consent. Recent Advances: The past two decades have seen significant advancements in our understanding of the underlying mechanisms of HBOT. This has led to a better understanding of the underlying reason for clinical benefit. It has also led to a better understanding of its side effects. Moreover, more recent literature allows for better quantification of these side effects. This review will highlight these side effects. Critical Issues: Wound healing in the case of problem nonhealing wounds requires the use of various advanced treatment modalities, including HBOT. HBOT has been shown to significantly improve healing rates in certain problem wounds, including advanced diabetic foot ulcers and late effect radiation injury. It is provided in a variety of clinical settings by providers with varying levels of expertise. It is important for those providing this therapy to understand the potential side effects. Future Directions: Research in HBOT has led to significant advancements in the area of wound healing. At the same time, there remains a variety of treatment protocols used at different institutions. It is important to quantify risk and benefit at different treatment pressures and times to better standardize treatment and improve patient care.
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Affiliation(s)
- Marvin Heyboer
- Division of Hyperbaric Medicine and Wound Care, Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - Deepali Sharma
- Division of Hyperbaric Medicine and Wound Care, Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - William Santiago
- Division of Hyperbaric Medicine and Wound Care, Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - Norman McCulloch
- Division of Hyperbaric Medicine and Wound Care, Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, New York
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Yümün G, Kahaman C, Kahaman N, Yalçınkaya U, Akçılar A, Akgül E, Vural AH. Effects of hyperbaric oxygen therapy combined with platelet-rich plasma on diabetic wounds: an experimental rat model. Arch Med Sci 2016; 12:1370-1376. [PMID: 27904531 PMCID: PMC5108389 DOI: 10.5114/aoms.2016.62905] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/24/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Hyperbaric oxygen and platelet-rich plasma are used in the treatment of diabetic wounds. The aim of this study is to evaluate the effects of hyperbaric oxygen therapy and autologous platelet concentrates in healing diabetic wounds. MATERIAL AND METHODS Thirty-six female Wistar albino rats were used in this study. Diabetes mellitus was induced chemically with an intraperitoneal injection of streptozotocin. The rats were divided into a control group, a hyperbaric oxygen group, a platelet-rich plasma group, and a combined therapy group. Platelet-rich plasma was applied just after the creation of the wound; hyperbaric oxygen treatment was carried out daily over 7 days. Wound healing was evaluated according to four parameters: ulcerations, epidermal thickness, density of dermal collagen fibers, and proliferation of dermal blood vessels. RESULTS The number of active ulcers in the combined therapy group was fewer than in the control group (p = 0.039), and the wound area was greatest in controls (p < 0.001). The epidermal thickness in platelet-rich plasma and combined therapy groups was non-significantly greater than in the control group (p = 0.097 and p = 0.074, respectively). The amount of fibrous collagen in these two groups was greater than in the control group (p = 0.002). CONCLUSIONS Combined hyperbaric oxygen and platelet-rich plasma therapy was found to be successful in diabetic wound healing. The combination therapy had no additive effect in terms of angiogenesis and the development of new collagen fibers.
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Affiliation(s)
- Gündüz Yümün
- Department of Cardiovascular Surgery, Medical School, Namik Kemal University, Tekirdag, Turkey
| | - Cüneyt Kahaman
- Department of Internal Medicine, Medical School, Dumlupinar University, Kütahya, Turkey
| | - Nail Kahaman
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Hospital, Bursa, Turkey
| | - Ulviye Yalçınkaya
- Department of Pathology, Medical School, Uludag University, Bursa, Turkey
| | - Aydin Akçılar
- Laboratory Animal Research Center, Medical School, Dumlupinar University, Kütahya, Turkey
| | - Engin Akgül
- Department of Cardiovascular Surgery, Medical School, Dumlupinar University, Kütahya, Turkey
| | - Ahmet Hakan Vural
- Department of Cardiovascular Surgery, Medical School, Dumlupinar University, Kütahya, Turkey
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Gallagher KA, Goldstein LJ, Thom SR, Velazquez OC. Hyperbaric Oxygen and Bone Marrow–Derived Endothelial Progenitor Cells in Diabetic Wound Healing. Vascular 2016; 14:328-37. [PMID: 17150153 DOI: 10.2310/6670.2006.00057] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Endothelial progenitor cells (EPCs) are the key cellular effectors of postnatal vasculogenesis and play a central role in wound healing. In diabetes, there is a significant impairment in the number and function of circulating and wound-tissue EPC. Recent evidence indicates, that tissue-level hyperoxia achieved by therapeutic hyperbaric oxygen protocols (HBO2) can increase the mobilization of EPC from the bone marrow into peripheral blood. In this paper we review the recent reports on hyperoxia-mediated mobilization of bone marrow-derived EPC and postulate avenues of future research in this area as it applies to improving healing in chronic wounds affected by diabetes and peripheral arterial disease (PAD).
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Affiliation(s)
- Katherine A Gallagher
- Department of Surgery, Institute for Environmental Medicine, University of Pennsylvania Medical Center, Philadelphia 19124, USA
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Zhou X, Patel D, Sen S, Shanmugam V, Sidawy A, Mishra L, Nguyen BN. Poly-ADP-ribose polymerase inhibition enhances ischemic and diabetic wound healing by promoting angiogenesis. J Vasc Surg 2016; 65:1161-1169. [PMID: 27288104 DOI: 10.1016/j.jvs.2016.03.407] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/02/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Chronic nonhealing wounds are a major health problem for patients in the United States and worldwide. Diabetes and ischemia are two major risk factors behind impaired healing of chronic lower extremity wounds. Poly-ADP-ribose polymerase (PARP) is found to be overactivated with both ischemic and diabetic conditions. This study seeks a better understanding of the role of PARP in ischemic and diabetic wound healing, with a specific focus on angiogenesis and vasculogenesis. METHODS Ischemic and diabetic wounds were created in FVB/NJ mice and an in vitro scratch wound model. PARP inhibitor PJ34 was delivered to the animals at 10 mg/kg/d through implanted osmotic pumps or added to the culture medium, respectively. Animal wound healing was assessed by daily digital photographs. Animal wound tissues, peripheral blood, and bone marrow cells were collected at different time points for further analysis with Western blot and flow cytometry. Scratch wound migration and invasion angiogenesis assays were performed using human umbilical vein endothelial cells (HUVECs). Measurements were reported as mean ± standard deviation. Continuous measurements were compared by t-test. P < .05 was considered statistically significant. RESULTS A significant increase in PARP activity was observed under ischemic and diabetic conditions that correlated with delayed wound healing and slower HUVEC migration. The beneficial effect of PARP inhibition with PJ34 on ischemic and diabetic wound healing was observed in both animal and in vitro models. In the animal model, the percentage of wound healing was significantly enhanced from 43% ± 6% to 71% ± 9% (P < .05) by day 7 with the addition of PJ34. PARP inhibition promoted angiogenesis at the ischemic and diabetic wound beds as evidenced by significantly higher levels of endothelial cell markers (vascular endothelial growth factor receptor 2 [VEGFR2] and endothelial nitric oxide synthase) in mice treated with PJ34 compared with controls. Flow cytometry analysis of peripheral blood mononuclear cells showed that PARP inhibition increased mobilization of endothelial progenitor cells (VEGFR2+/CD133+ and VEGFR2+/CD34+) into the systemic circulation. Furthermore, under in vitro hyperglycemia and hypoxia conditions, PARP inhibition enhanced HUVEC migration and invasion in Boyden chamber assays by 80% and 180% (P < .05), respectively. CONCLUSIONS Delayed healing in ischemic and diabetic wounds is caused by PARP hyperactivity, and PARP inhibition significantly enhanced ischemic and diabetic wound healing by promoting angiogenesis.
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Affiliation(s)
- Xin Zhou
- Department of Surgery, School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Darshan Patel
- Department of Surgery, School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Sabyasachi Sen
- Division of Endocrinology and Metabolism, Department of Medicine, George Washington University, Washington, D.C
| | - Victoria Shanmugam
- Division of Rheumatology, Department of Medicine, George Washington University, Washington, D.C
| | - Anton Sidawy
- Department of Surgery, School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Lopa Mishra
- Department of Surgery, School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Bao-Ngoc Nguyen
- Department of Surgery, School of Medicine and Health Sciences, George Washington University, Washington, D.C..
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Amlodipine Ameliorates Ischemia-Induced Neovascularization in Diabetic Rats through Endothelial Progenitor Cell Mobilization. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3182764. [PMID: 27243031 PMCID: PMC4875975 DOI: 10.1155/2016/3182764] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/16/2016] [Accepted: 03/30/2016] [Indexed: 01/12/2023]
Abstract
Objectives. We investigated whether amlodipine could improve angiogenic responses in a diabetic rat model of acute myocardial infarction (AMI) through improving bone marrow endothelial progenitor cell (EPC) mobilization, in the same way as angiotensin converting enzyme inhibitors. Methods. After induction of AMI by coronary artery ligation, diabetic rats were randomly assigned to receive perindopril (2 mgkg−1 day−1), amlodipine (2.5 mgkg−1 day−1), or vehicle by gavage (n = 20 per group). Circulating EPC counts before ligation and on days 1, 3, 5, 7, 14, and 28 after AMI were measured in each group. Microvessel density, cardiac function, and cardiac remodeling were assessed 4 weeks after treatment. The signaling pathway related to EPC mobilization was also measured. Results. Circulating EPC count in amlodipine- and perindopril-treated rats peaked at day 7, to an obvious higher level than the control group peak which was reached earlier (at day 5). Rats treated with amlodipine showed improved postischemia neovascularization and cardiac function, together with reduced cardiac remodeling, decreased interstitial fibrosis, and cardiomyocyte apoptosis. Amlodipine treatment also increased cardiac SDF-1/CXCR4 expression and gave rise to activation of VEGF/Akt/eNOS signaling in bone marrow. Conclusions. Amlodipine promotes neovascularization by improving EPC mobilization from bone marrow in diabetic rats after AMI, and activation of VEGF/Akt/eNOS signaling may in part contribute to this.
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Thom SR, Hampton M, Troiano MA, Mirza Z, Malay DS, Shannon S, Jennato NB, Donohue CM, Hoffstad O, Woltereck D, Yang M, Yu K, Bhopale VM, Kovtun S, Margolis DJ. Measurements of CD34+/CD45-dim Stem Cells Predict Healing of Diabetic Neuropathic Wounds. Diabetes 2016; 65:486-97. [PMID: 26487786 PMCID: PMC4747459 DOI: 10.2337/db15-0517] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 10/14/2015] [Indexed: 12/12/2022]
Abstract
Management of neuropathic foot ulcers in patients with diabetes (DFUs) has changed little over the past decade, and there is currently no objective method to gauge probability of successful healing. We hypothesized that studies of stem/progenitor cells (SPCs) in the early weeks of standard wound management could predict who will heal within 16 weeks. Blood and debrided wound margins were collected for 8 weeks from 100 patients undergoing weekly evaluations and treatment. SPC number and intracellular content of hypoxia-inducible factors (HIFs) were evaluated by flow cytometry and immunohistochemistry. More SPCs entered the bloodstream in the first 2 weeks of care in patients who healed (n = 37) than in those who did not (n = 63). Logistic regression demonstrated that the number of blood-borne SPCs and the cellular content of HIFs at study entry and the first-week follow-up visit predicted healing. Strong correlations were found among week-to-week assessments of blood-borne SPC HIF factors. We conclude that assays of SPCs during the first weeks of care in patients with DFUs can provide insight into how well wounds will respond and may aid with decisions on the use of adjunctive measures.
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Affiliation(s)
- Stephen R Thom
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Michelle Hampton
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael A Troiano
- Podiatric Surgery and Medicine, Penn Presbyterian Medical Center, Philadelphia, PA
| | - Ziad Mirza
- Department of Medicine, Greater Baltimore Medical Center, Baltimore, MD
| | - D Scot Malay
- Podiatric Surgery and Medicine, Penn Presbyterian Medical Center, Philadelphia, PA
| | - Steven Shannon
- Podiatric Surgery and Medicine, Penn Presbyterian Medical Center, Philadelphia, PA
| | - Nathan B Jennato
- Podiatric Surgery and Medicine, Penn Presbyterian Medical Center, Philadelphia, PA
| | | | - Ole Hoffstad
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Diana Woltereck
- Department of Medicine, Greater Baltimore Medical Center, Baltimore, MD
| | - Ming Yang
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Kevin Yu
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Veena M Bhopale
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Svitlana Kovtun
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - David J Margolis
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Stem Cells for Cutaneous Wound Healing. BIOMED RESEARCH INTERNATIONAL 2015; 2015:285869. [PMID: 26137471 PMCID: PMC4468276 DOI: 10.1155/2015/285869] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 03/20/2015] [Indexed: 01/08/2023]
Abstract
Optimum healing of a cutaneous wound involves a well-orchestrated cascade of biological and molecular processes involving cell migration, proliferation, extracellular matrix deposition, and remodelling. When the normal biological process fails for any reason, this healing process can stall resulting in chronic wounds. Wounds are a growing clinical burden on healthcare systems and with an aging population as well as increasing incidences of obesity and diabetes, this problem is set to increase. Cell therapies may be the solution. A range of cell based approaches have begun to cross the rift from bench to bedside and the supporting data suggests that the appropriate administration of stem cells can accelerate wound healing. This review examines the main cell types explored for cutaneous wound healing with a focus on clinical use. The literature overwhelmingly suggests that cell therapies can help to heal cutaneous wounds when used appropriately but we are at risk of clinical use outpacing the evidence. There is a need, now more than ever, for standardised methods of cell characterisation and delivery, as well as randomised clinical trials.
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Fosen KM, Thom SR. Hyperbaric oxygen, vasculogenic stem cells, and wound healing. Antioxid Redox Signal 2014; 21:1634-47. [PMID: 24730726 PMCID: PMC4175035 DOI: 10.1089/ars.2014.5940] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/14/2014] [Indexed: 12/15/2022]
Abstract
SIGNIFICANCE Oxidative stress is recognized as playing a role in stem cell mobilization from peripheral sites and also cell function. RECENT ADVANCES This review focuses on the impact of hyperoxia on vasculogenic stem cells and elements of wound healing. CRITICAL ISSUES Components of the wound-healing process in which oxidative stress has a positive impact on the various cells involved in wound healing are highlighted. A slightly different view of wound-healing physiology is adopted by departing from the often used notion of sequential stages: hemostatic, inflammatory, proliferative, and remodeling and instead organizes the cascade of wound healing as overlapping events or waves pertaining to reactive oxygen species, lactate, and nitric oxide. This was done because hyperoxia has effects of a number of cell signaling events that converge to influence cell recruitment/chemotaxis and gene regulation/protein synthesis responses which mediate wound healing. FUTURE DIRECTIONS Our alternative perspective of the stages of wound healing eases recognition of the multiple sites where oxidative stress has an impact on wound healing. This aids the focus on mechanistic events and the interplay among various cell types and biochemical processes. It also highlights the areas where additional research is needed.
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Affiliation(s)
- Katina M. Fosen
- Department of Emergency Medicine, Institute for Environmental Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Stephen R. Thom
- Department of Emergency Medicine, University of Maryland, Baltimore, Maryland
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King A, Balaji S, Keswani SG, Crombleholme TM. The Role of Stem Cells in Wound Angiogenesis. Adv Wound Care (New Rochelle) 2014; 3:614-625. [PMID: 25300298 DOI: 10.1089/wound.2013.0497] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 03/19/2014] [Indexed: 12/18/2022] Open
Abstract
Significance: Revascularization plays a critical role in wound healing and is regulated by a complex milieu of growth factors and cytokines. Deficiencies in revascularization contribute to the development of chronic nonhealing wounds. Recent Advances: Stem-cell-based therapy provides a novel strategy to enhance angiogenesis and improve wound healing. With bioethical concerns associated with embryonic stem cells, focus has shifted to different populations of vascular precursors, isolated from adult somatic tissue. Three main populations have been identified: endothelial progenitor cells, mesenchymal stem cells, and induced-pluripotent stem cells. These populations demonstrate great promise to positively influence neovascularization and wound repair. Critical Issues: Further studies to more definitively define each population are necessary to efficiently translate stem-cell-based therapeutic angiogenesis to the bedside. Better understanding of the physiologic pathways of how stem cells contribute to angiogenesis in normal tissue repair will help identify targets for successful therapeutic angiogenesis. Future Directions: Active studies in both animal models and clinical trials are being conducted to develop effective delivery routes, including dosing, route, and timing. Stem-cell-based therapy holds significant potential as a strategy for therapeutic angiogenesis in the care of patients with chronic nonhealing wounds.
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Affiliation(s)
- Alice King
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Swathi Balaji
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sundeep G. Keswani
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Timothy M. Crombleholme
- Center for Children's Surgery, Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital Colorado, School of Medicine, University of Colorado, Aurora, Colorado
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Abstract
Hyperbaric oxygen (HBO2) is the inhalation of 100% oxygen at pressures > 1.4 times atmospheric pressure. Hyperbaric oxygen can be delivered in monoplace (single person) or multiplace (multi-person) chambers. Most clinical HBO2 exposures are between 2 and 2.4 atm abs for approximately 2 hours. Hyperbaric oxygen causes the blood and tissue oxygen levels to increase, reduces the volume of intravascular and tissue bubbles (to treat decompression sickness [DCS] and arterial gas embolism [AGE]), and accelerates wash-out of other gases, such as nitrogen or carbon monoxide (CO), which is important for DCS, AGE, and CO poisoning. Hyperbaric oxygen favorably modulates ischemia-reperfusion injury by transiently inhibiting neutrophil-endothelial interactions, which is important for patients with DCS, AGE, CO poisoning, and potentially other acute ischemic conditions. Because of enhanced oxygen delivery, HBO2 is used for acute crush injury, ischemic flaps and grafts, acute central retinal arterial occlusion, other acute arterial occlusions, and idiopathic sudden sensorineural hearing loss. Hyperbaric oxygen has antimicrobial effects and is offered for patients with limb- or life-threatening infections, such as clostridial gas gangrene and necrotizing fasciitis. The most common US indication for HBO2 is the treatment of ischemic wounds (eg, diabetic lower extremity wounds, late effects of radiation, and refractory osteomyelitis). In ischemic wounds, HBO2 can deliver sufficient oxygen to the nonhealing wound to stimulate angiogenesis and healing through multiple mechanisms, including increased collagen production, increased growth factor receptor numbers, upregulation of vascular endothelial growth factor, increased circulating endothelial progenitor cells, and improvement in neutrophil-mediated host defense. Clinical trials support efficacy of HBO2 for acute CO poisoning, diabetic lower extremity wounds, crush injury, and radiation necrosis. Most hyperbaric chambers are associated with wound care centers and may be hospital based or nonhospital based. We review some of the disorders treated with HBO2 that hospital-based clinicians may be asked to evaluate.
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Affiliation(s)
- Lindell K Weaver
- Medical Director and Division Chief, Hyperbaric Medicine, LDS Hospital, Salt Lake City, UT; Intermountain Medical Center, Murray, UT; Professor of Medicine, University of Utah School of Medicine, Salt Lake City, UT.
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Fotino C, Molano RD, Ricordi C, Pileggi A. Transdisciplinary approach to restore pancreatic islet function. Immunol Res 2014; 57:210-21. [PMID: 24233663 DOI: 10.1007/s12026-013-8437-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The focus of our research is on islet immunobiology. We are exploring novel strategies that could be of assistance in the treatment and prevention of type 1 diabetes, as well as in the restoration of metabolic control via transplantation of insulin producing cells (i.e., islet cells). The multiple facets of diabetes and β-cell replacement encompass different complementary disciplines, such as immunology, cell biology, pharmacology, and bioengineering, among others. Through their interaction and integration, a transdisciplinary dimension is needed in order to address and overcome all aspects of the complex puzzle toward a successful clinical translation of a biological cure for diabetes.
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Heyboer M, Grant WD, Byrne J, Pons P, Morgan M, Iqbal B, Wojcik SM. Hyperbaric oxygen for the treatment of nonhealing arterial insufficiency ulcers. Wound Repair Regen 2014; 22:351-5. [DOI: 10.1111/wrr.12176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/05/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Marvin Heyboer
- Department of Emergency Medicine, Division of Hyperbaric Medicine and Wound Care; SUNY Upstate Medical University; Syracuse New York
| | - William D. Grant
- Department of Emergency Medicine, Division of Hyperbaric Medicine and Wound Care; SUNY Upstate Medical University; Syracuse New York
| | - Joseph Byrne
- Center for Wound Care and Hyperbaric Medicine; St. Joseph's Hospital; Fayetteville New York
| | - Paula Pons
- Center for Wound Care and Hyperbaric Medicine; St. Joseph's Hospital; Fayetteville New York
| | - Monica Morgan
- Department of Emergency Medicine, Division of Hyperbaric Medicine and Wound Care; SUNY Upstate Medical University; Syracuse New York
| | - Bilal Iqbal
- School of Medicine; SUNY Upstate Medical University; Syracuse
| | - Susan M. Wojcik
- Department of Emergency Medicine, Division of Hyperbaric Medicine and Wound Care; SUNY Upstate Medical University; Syracuse New York
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Heyboer M, Milovanova TN, Wojcik S, Grant W, Chin M, Hardy KR, Lambert DS, Logue C, Thom SR. CD34+/CD45-dim stem cell mobilization by hyperbaric oxygen - changes with oxygen dosage. Stem Cell Res 2014; 12:638-45. [PMID: 24642336 PMCID: PMC4037447 DOI: 10.1016/j.scr.2014.02.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 02/14/2014] [Accepted: 02/22/2014] [Indexed: 11/16/2022] Open
Abstract
Because hyperbaric oxygen treatment mobilizes bone marrow derived-stem/progenitor cells by a free radical mediated mechanism, we hypothesized that there may be differences in mobilization efficiency based on exposure to different oxygen partial pressures. Blood from twenty consecutive patients was obtained before and after the 1st, 10th and 20th treatment at two clinical centers using protocols involving exposures to oxygen at either 2.0 or 2.5 atmospheres absolute (ATA). Post-treatment values of CD34+, CD45-dim leukocytes were always 2-fold greater than the pre-treatment values for both protocols. Values for those treated at 2.5 ATA were significantly greater than those treated at 2.0 ATA by factors of 1.9 to 3-fold after the 10th and before and after the 20th treatments. Intracellular content of hypoxia inducible factors -1, -2, and -3, thioredoxin-1 and poly-ADP-ribose polymerase assessed in permeabilized CD34+ cells with fluorophore-conjugated antibodies were twice as high in all post- versus pre-treatment samples with no significant differences between 2.0 and 2.5 ATA protocols. We conclude that putative progenitor cell mobilization is higher with 2.5 versus 2.0 ATA treatments, and all newly mobilized cells exhibit higher concentrations of an array of regulatory proteins.
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Affiliation(s)
- Marvin Heyboer
- Department of Emergency Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Tatyana N Milovanova
- Institute for Environmental Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Susan Wojcik
- Department of Emergency Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - William Grant
- Department of Emergency Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Mary Chin
- Institute for Environmental Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kevin R Hardy
- Institute for Environmental Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David S Lambert
- Institute for Environmental Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Christopher Logue
- Institute for Environmental Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Stephen R Thom
- Institute for Environmental Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Xiao M, Lu X, Li J, Li L, Li Y. Physiologic ischaemic training induces endothelial progenitor cell mobilization and myocardial angiogenesis via endothelial nitric oxide synthase related pathway in rabbits. J Cardiovasc Med (Hagerstown) 2014; 15:280-7. [DOI: 10.2459/jcm.0b013e32836009fe] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Karakoyun R, Koksoy C, Yilmaz T, Altun H, Banli O, Albayrak A, Alper M, Şener Z. The Angiogenic Effects of Ischemic Conditioning in Experimental Critical Limb Ischemia. Eur J Vasc Endovasc Surg 2014; 47:172-9. [DOI: 10.1016/j.ejvs.2013.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 11/02/2013] [Indexed: 10/26/2022]
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Abstract
OBJECTIVE To investigate the duration of time elapsed between the onset of symptoms for necrotizing external otitis (NEO) and admission to hospital that may play a role in patient outcome. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Fourteen consecutive male patients with NEO with no improvement from the previous course of antibiotherapy and with findings of osteomyelitis on temporal bone CT, MRI, and positive detection of Tc-99m methylene diphosphonate on temporal bone, admitted as inpatients between 2008 and 2012. INTERVENTION(S) Medical treatment of NEO and surgical debridement. MAIN OUTCOME MEASURE(S) Patients were divided into 2 groups according to median time elapsed between onset of symptoms and hospitalization (<30 d or >30 d). HbA1c, fasting blood sugar, erythrocyte sedimentation rate, C-reactive protein, pain intensity, radiologic grade, improvement since diagnosis, and total time to cure were compared according to the groups. The relationships between the laboratory data were analyzed to determine the parameters associated with time to recovery. RESULTS Otalgia was significantly worse in patients who were admitted to hospital greater than 30 days after symptom onset (Mann-Whitney U test, p < 0.002). Blood glucose increased related to delayed admission time (p < 0.001). CRP results were independently elevated from the admission time (p < 0.112). There was a statistically significant difference between groups according to ESR levels and recovery time (Mann-Whitney U test, p < 0.004 and p < 0.01). There was a positive correlation between HbA1c levels and recovery time in Group 1 and between ESR levels and recovery time in Group 2 (r = 0.872, p = 0.044; r = 0.630, p = 0.039). CONCLUSION Clinical, laboratory, and outcome data worsen later than 30 days in NEO.
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Hyperbaric Oxygen Reduces Matrix Metalloproteinases in Ischemic Wounds through a Redox-Dependent Mechanism. J Invest Dermatol 2014; 134:237-246. [DOI: 10.1038/jid.2013.301] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 05/15/2013] [Accepted: 06/06/2013] [Indexed: 12/15/2022]
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Abstract
Oxygen treatment has been a cornerstone of acute medical care for numerous pathological states. Initially, this was supported by the assumed need to avoid hypoxaemia and tissue hypoxia. Most acute treatment algorithms, therefore, recommended the liberal use of a high fraction of inspired oxygen, often without first confirming the presence of a hypoxic insult. However, recent physiological research has underlined the vasoconstrictor effects of hyperoxia on normal vasculature and, consequently, the risk of significant blood flow reduction to the at-risk tissue. Positive effects may be claimed simply by relief of an assumed local tissue hypoxia, such as in acute cardiovascular disease, brain ischaemia due to, for example, stroke or shock or carbon monoxide intoxication. However, in most situations, a generalized hypoxia is not the problem and a risk of negative hyperoxaemia-induced local vasoconstriction effects may instead be the reality. In preclinical studies, many important positive anti-inflammatory effects of both normobaric and hyperbaric oxygen have been repeatedly shown, often as surrogate end-points such as increases in gluthatione levels, reduced lipid peroxidation and neutrophil activation thus modifying ischaemia-reperfusion injury and also causing anti-apoptotic effects. However, in parallel, toxic effects of oxygen are also well known, including induced mucosal inflammation, pneumonitis and retrolental fibroplasia. Examining the available 'strong' clinical evidence, such as usually claimed for randomized controlled trials, few positive studies stand up to scrutiny and a number of trials have shown no effect or even been terminated early due to worse outcomes in the oxygen treatment arm. Recently, this has led to less aggressive approaches, even to not providing any supplemental oxygen, in several acute care settings, such as resuscitation of asphyxiated newborns, during acute myocardial infarction or after stroke or cardiac arrest. The safety of more advanced attempts to deliver increased oxygen levels to hypoxic or ischaemic tissues, such as with hyperbaric oxygen therapy, is therefore also being questioned. Here, we provide an overview of the present knowledge of the physiological effects of oxygen in relation to its therapeutic potential for different medical conditions, as well as considering the potential for harm. We conclude that the medical use of oxygen needs to be further examined in search of solid evidence of benefit in many of the current clinical settings in which it is routinely used.
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Affiliation(s)
- F Sjöberg
- Departments of Hand and Plastic Surgery and Intensive Care, Burn Center, Linköping County Council, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Abstract
Hyperbaric oxygen therapy (HBOT), the administration of pressurized 100% oxygen, is used as an adjunct to aid healing in selected chronic wounds. Though the therapy has had a controversial history, research is now elucidating the mechanisms by which HBOT helps to heal wounds. HBOT increases growth factors and local wound signaling, while also promoting a central stem cell release of endothelial progenitor cells from the bone marrow via nitric oxide pathways. The clinical data continue to accumulate in support of HBOT to help hasten wound healing, and reduce the amputation rate in diabetic ulcers. In appropriate patients, HBOT is an effective, noninvasive, adjunct modality that can be used to hasten chronic wound healing.
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Affiliation(s)
- Lee J Goldstein
- Division of Vascular and Endovascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, Florida 33169, USA.
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Liu X, Liang F, Yang J, Li Z, Hou X, Wang Y, Gao C. Effects of stromal cell derived factor-1 and CXCR4 on the promotion of neovascularization by hyperbaric oxygen treatment in skin flaps. Mol Med Rep 2013; 8:1118-24. [PMID: 23969990 DOI: 10.3892/mmr.2013.1638] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 08/08/2013] [Indexed: 02/06/2023] Open
Abstract
Hyperbaric oxygen (HBO) is known to increase the survival of skin flaps by promoting neovascularization; however, the detailed mechanisms involved are not fully understood. In the present study, we aimed to characterize the effects of HBO treatment on neovascularization and skin flap survival. We also analyzed the mechanisms associated with the expression of angiogenic molecules, such as stromal cell derived factor-1 (SDF‑1) and its specific receptor CXCR4, to assess the effects of SDF-1 and CXCR4 on the promotion of neovascularization by HBO treatment in skin flaps. The epigastric pedicle skin flap model was established in rats that were randomly divided into the following groups: i) sham‑operated (SH group); ii) ischemia followed by reperfusion and analysis on the third and fifth day (IR3d and IR5d groups, respectively) postoperatively; iii) ischemia followed by reperfusion, HBO treatment and analysis on the third and fifth day (HBO3d and HBO5d groups, respectively) postoperatively. In the two HBO groups, animals received 1 h of HBO treatment in a 2.0 ATA chamber with 100% O2 twice per day for 3 days and then daily for 2 consecutive days following surgery. On the postoperative third and fifth day, skin flap survival measurement, histological analysis, immunohistochemical staining and western blotting for SDF‑1 and CXCR4 expression, were performed. Compared with those of the IR groups, skin flap survival, microvessel density (MVD) and expression of SDF‑1 and CXCR4 proteins were significantly increased in the HBO groups. Pearson's correlation analysis demonstrated a positive correlation between MVD and the high expression of SDF‑1 and CXCR4 following HBO treatment. Results of this study suggested that the effects of HBO treatment in promoting neovascularization may be explained by the upregulation of SDF‑1 and CXCR4 expression in the skin flaps of rats.
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Affiliation(s)
- Xuehua Liu
- Department of Hyperbaric Oxygen, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
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Synergistic vasculogenic effects of AMD3100 and stromal-cell-derived factor-1α in vasa nervorum of the sciatic nerve of mice with diabetic peripheral neuropathy. Cell Tissue Res 2013; 354:395-407. [PMID: 23942895 DOI: 10.1007/s00441-013-1689-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 06/27/2013] [Indexed: 02/05/2023]
Abstract
Autologous endothelial progenitor cell (EPC) transplantation has been suggested as a potential therapeutic approach in diabetic neuropathy (DN). However, such treatment might be limited by safety concerns regarding possible unwanted proliferation or differentiation of the transplanted stem cells. An alternative approach is the stimulation of endogenous bone-marrow-derived EPC (BM-EPC) recruitment into ischemic lesions by the administration of stem cell mobilization agents or chemokines. We first tested the EPC mobilization effect of vascular endothelial growth factor (VEGF) and AMD3100 in a mouse model of diabetes and found that AMD3100 was effective as an EPC mobilization agent, whereas VEGF did not increase circulating EPCs in these animals. Because recent studies have suggested that deceased local expression of stromal-cell-derived factor (SDF)-1α in diabetes is the main cause of defective EPC migration, AMD3100 was administrated systemically to stimulate EPC mobilization and SDF-1α was injected locally to enhance its migration into the streptozotocin-induced DN mice model. This combined therapy increased local expression levels of vasculogenesis-associated factors and newly formed endothelial cells in the sciatic nerve, resulting in the restoration of the sciatic vasa nervorum. The treatment also improved the impaired conduction velocity of the sciatic nerve in DN mice. Thus, AMD3100 might be an effective EPC mobilization agent in diabetes, with local SDF-1α injection synergistically increasing vascularity in diabetic nerves. This represents a novel potential therapeutic option for DN patients.
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Premature aging of cardiovascular/platelet function in polycystic ovarian syndrome. Am J Med 2013; 126:640.e1-7. [PMID: 23688663 DOI: 10.1016/j.amjmed.2012.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 12/19/2012] [Accepted: 12/28/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this study was to compare the impact of aging on nitric oxide (NO) modulation of platelet and vascular function in healthy women and women with polycystic ovary syndrome. METHODS AND RESULTS A case-control study of women ages 18 to 60 years, comparing women with polycystic ovarian syndrome against age-matched healthy controls, was performed. A total of 242 women, of whom 109 had polycystic ovarian syndrome (based on Rotterdam criteria), participated in the study. Women who were pregnant or on clopidogrel were excluded from the study. Inhibition of platelet aggregation by nitric oxide (primary outcome measure), vascular endothelial function, plasma concentrations of N(G), N(G)-dimethyl-L-arginine (ADMA), endothelial progenitor cell count, and high-sensitivity C-reactive protein (markers of endothelial dysfunction and inflammation) were assessed. With increasing age in control women, there was progressive attenuation of platelet responses to NO, impairment of endothelial function, and elevation of ADMA levels (P ≤.001). Irrespective of age, women with polycystic ovarian syndrome exhibited greater impairment of all these parameters (all P <.05, 2-way analysis of variance) and demonstrated these anomalies earlier in life. CONCLUSIONS Normal aging in women is associated with attenuation of NO-based signaling in platelets and blood vessels. In women with polycystic ovarian syndrome, these changes are present from early adult life and may contribute to premature atherogenesis.
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Hyperbaric oxygen stimulates vascularization and bone formation in rat calvarial defects. Int J Oral Maxillofac Surg 2013; 42:907-14. [DOI: 10.1016/j.ijom.2013.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/05/2012] [Accepted: 01/09/2013] [Indexed: 11/19/2022]
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