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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Thom SR, Bhopale VM, Arya AK, Ruhela D, Bhat AR, Mitra N, Hoffstad O, Malay DS, Mirza ZK, Lantis JC, Lev-Tov HA, Kirsner RS, Hsia RC, Levinson SL, DiNubile MJ, Margolis DJ. Blood-Borne Microparticles Are an Inflammatory Stimulus in Type 2 Diabetes Mellitus. Immunohorizons 2023; 7:71-80. [PMID: 36645851 PMCID: PMC10563440 DOI: 10.4049/immunohorizons.2200099] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 01/18/2023] Open
Abstract
The proinflammatory state associated with diabetes mellitus (DM) remains poorly understood. We found patients with DM have 3- to 14-fold elevations of blood-borne microparticles (MPs) that bind phalloidin (Ph; Ph positive [+] MPs), indicating the presence of F-actin on their surface. We hypothesized that F-actin-coated MPs were an unrecognized cause for DM-associated proinflammatory status. Ph+MPs, but not Ph-negative MPs, activate human and murine (Mus musculus) neutrophils through biophysical attributes of F-actin and membrane expression of phosphatidylserine (PS). Neutrophils respond to Ph+MPs via a linked membrane array, including the receptor for advanced glycation end products and CD36, PS-binding membrane receptors. These proteins in conjunction with TLR4 are coupled to NO synthase 1 adaptor protein (NOS1AP). Neutrophil activation occurs because of Ph+MPs causing elevations of NF-κB and Src kinase (SrcK) via a concurrent increased association of NO synthase 2 and SrcK with NOS1AP, resulting in SrcK S-nitrosylation. We conclude that NOS1AP links PS-binding receptors with intracellular regulatory proteins. Ph+MPs are alarmins present in normal human plasma and are increased in those with DM and especially those with DM and a lower-extremity ulcer.
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Affiliation(s)
- Stephen R. Thom
- 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
| | - Awadhesh K. Arya
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Deepa Ruhela
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Abid R. Bhat
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ole Hoffstad
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - D. Scot Malay
- Department of Surgery, Penn Presbyterian Medical Center, Philadelphia, PA
| | | | - John C. Lantis
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Hadar A. Lev-Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL
| | - Robert S. Kirsner
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL
| | - Ru-Ching Hsia
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD; and
| | | | | | - David J. Margolis
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Margolis DJ, Mitra N, Malay DS, Mirza ZK, Lantis JC, Lev-Tov HA, Kirsner RS, Thom SR. Further evidence that wound size and duration are strong prognostic markers of diabetic foot ulcer healing. Wound Repair Regen 2022; 30:487-490. [PMID: 35470507 DOI: 10.1111/wrr.13019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/25/2022] [Accepted: 04/23/2022] [Indexed: 11/29/2022]
Abstract
Diabetic foot ulcers (DFU) are a critical problem for those with diabetes mellitus. Predicting the healing likelihood of a DFU is important to implementing appropriate care, allocating resources, having access to advanced therapies, having successful clinical trials, calibrating clinical trial results, and providing information to administrative entities on patient and provider outcomes. Prognostic modeling can also be important when attempting to compare results across trials or care centers. In a prospective cohort study, we demonstrate and replicate that simple wound characteristics like wound area and wound duration can be used to predict wound healing by the 16th week of care. The models were based on previous literature and replicated using a machine learning algorithm. The use of wound duration and wound area in a prognostic model continues to be important when comparing study results, center-based outcomes, as well as designing clinical trials.
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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
| | - D Scott Malay
- Department of Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | | | - John C Lantis
- Department of Surgery, Icahn School of Medicine at Mount Sinaim, New York City, New York
| | - Hadar A Lev-Tov
- Department of Dermatology, University of Miami School of Medicine, Miami, Florida
| | - Robert S Kirsner
- Department of Dermatology, University of Miami School of Medicine, Miami, Florida
| | - Stephan R Thom
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Feldmeier JJ, Kirby JP, Buckey JC, Denham DW, Evangelista JS, Gelly HB, Harlan NP, Mirza ZK, Ray KL, Robins M, Savaser DJ, Wainwright S, Bird N, Huang ET, Moon RE, Thom SR, Weaver LK. Physiologic and biochemical rationale for treating COVID-19 patients with hyperbaric oxygen. Undersea Hyperb Med 2021; 48:1-12. [PMID: 33648028 DOI: 10.22462/01.03.2021.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The SARS-Cov-2 (COVID-19) pandemic remains a major worldwide public health issue. Initially, improved supportive and anti-inflammatory intervention, often employing known drugs or technologies, provided measurable improvement in management. We have recently seen advances in specific therapeutic interventions and in vaccines. Nevertheless, it will be months before most of the world's population can be vaccinated to achieve herd immunity. In the interim, hyperbaric oxygen (HBO2) treatment offers several potentially beneficial therapeutic effects. Three small published series, one with a propensity-score-matched control group, have demonstrated safety and initial efficacy. Additional anecdotal reports are consistent with these publications. HBO2 delivers oxygen in extreme conditions of hypoxemia and tissue hypoxia, even in the presence of lung pathology. It provides anti-inflammatory and anti-proinflammatory effects likely to ameliorate the overexuberant immune response common to COVID-19. Unlike steroids, it exerts these effects without immune suppression. One study suggests HBO2 may reduce the hypercoagulability seen in COVID patients. Also, hyperbaric oxygen offers a likely successful intervention to address the oxygen debt expected to arise from a prolonged period of hypoxemia and tissue hypoxia. To date, 11 studies designed to investigate the impact of HBO2 on patients infected with SARS-Cov-2 have been posted on clinicaltrials.gov. This paper describes the promising physiologic and biochemical effects of hyperbaric oxygen in COVID-19 and potentially in other disorders with similar pathologic mechanisms.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Kristy L Ray
- Louisiana State University Undersea and Hyperbaric Medicine
| | | | - Davut J Savaser
- Hyperbaric Medicine / Wound Healing, Legacy Emanuel Medical Center
| | | | | | - Enoch T Huang
- Hyperbaric Medicine / Wound Healing, Legacy Emanuel Medical Center
| | - Richard E Moon
- Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center
| | | | - Lindell K Weaver
- LDS Hospital, Salt Lake City, and Intermountain Medical Center, Murray, Utah
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Mirza ZK, Das KK, Slate J, Mapitigama RN, Amenta PS, Griffel LH, Ramsundar L, Watari J, Yokota K, Tanabe H, Sato T, Kohgo Y, Das KM. Gastric intestinal metaplasia as detected by a monoclonal antibody is highly associated with gastric adenocarcinoma. Gut 2003; 52:807-12. [PMID: 12740335 PMCID: PMC1773674 DOI: 10.1136/gut.52.6.807] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Some forms of gastric intestinal metaplasia (GIM) may be precancerous but the cellular phenotype that predisposes to gastric carcinogenesis is not well characterised. Mucin staining, as a means of differentiating GIM, is difficult. A monoclonal antibody, mAb Das-1 (initially called 7E(12)H(12)), whose staining is phenotypically specific to colon epithelium, was used to investigate this issue. METHODS Using mAb Das-1, by a sensitive immunoperoxidase assay, we examined histologically confirmed GIM specimens from two countries, the USA and Japan. A total of 150 patients comprised three groups: group A, GIM (fields away from the cancer area) from patients with gastric carcinoma (n=60); group B, GIM with chronic gastritis (without gastric carcinoma) (n=72); and group C, chronic gastritis without GIM (n=18). RESULTS Fifty six of 60 (93%) patients with GIM (both goblet and non-goblet metaplastic cells) from group A reacted intensely with mAb Das-1. Cancer areas from the same 56 patients also reacted. In contrast, 25/72 (35%) samples of GIM from patients in group B reacted with mAb Das-1 (group A v B, p<0.0001). None of the samples from group C reacted with the mAb. CONCLUSIONS Reactivity of mAb Das-1 is clinically useful to simplify and differentiate the phenotypes of GIM. The colonic phenotype of GIM, as identified by mAb Das-1, is strongly associated with gastric carcinoma.
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Affiliation(s)
- Z K Mirza
- Departments of Medicine and Pathology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - K K Das
- Departments of Medicine and Pathology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - J Slate
- Departments of Medicine and Pathology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - P S Amenta
- Departments of Medicine and Pathology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - L H Griffel
- Departments of Medicine and Pathology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - L Ramsundar
- Departments of Medicine and Pathology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - J Watari
- Asahikawa Medical College, Asahikawa, Japan
| | - K Yokota
- Asahikawa Medical College, Asahikawa, Japan
| | - H Tanabe
- Asahikawa Medical College, Asahikawa, Japan
| | - T Sato
- Asahikawa Medical College, Asahikawa, Japan
| | - Y Kohgo
- Asahikawa Medical College, Asahikawa, Japan
| | - K M Das
- Departments of Medicine and Pathology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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