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      Eficacia del Heberprot-P® en el tratamiento de las úlceras del pie diabético Translated title: Effectiveness of the Heberprot-P® in the treatment of diabetic foot ulcers

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          Abstract

          Se realizó un estudio descriptivo y transversal de 120 pacientes con úlceras del pie diabético, atendidos en el Centro de Diagnóstico Integral "El Bajo" perteneciente al municipio San Francisco, Maracaibo, Estado de Zulia, República Bolivariana de Venezuela, desde febrero de 2011 hasta igual mes de 2012, con vistas a evaluar la efectividad de la administración del factor de crecimiento epidérmico humano. En la casuística predominaron el grupo etario de 55-59 años y el sexo femenino. En todos los integrantes de la serie se logró la granulación y la cicatrización de las lesiones y no fue necesario efectuar la amputación. La administración intralesional del Heberprot-P® puede completar el cierre de la lesión, por lo cual es un medicamento seguro y conveniente para sanar dichas úlceras.

          Translated abstract

          A descriptive and cross-sectional study was conducted in 120 patients with diabetic foot ulcers treated at "El Bajo" Comprehensive Diagnosis Center belonging to San Francisco municipality, Maracaibo, State of Zulia, Bolivarian Republic of Venezuela, from February 2011 to February 2012 in order to evaluate the effectiveness of the administration of human epidermal growth factor. Age group of 55-59 years and the females prevailed in the case material. In all patients of the series granulation and healing of lesions was obtained and amputation was not necessary. Intralesional administration of Heberprot-P® can complete closure of the lesion; therefore it is a safe and advisable drug to heal these ulcers.

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          Clinical evaluation of recombinant human platelet-derived growth factor for the treatment of lower extremity ulcers.

          L Steed (2006)
          Diabetic foot ulcer is a major health care problem that leads to amputation. Patients with full-thickness diabetic neurotrophic foot ulcers present for longer than 8 weeks without healing were entered into one of five randomized, prospective, blinded clinical trials comparing treatment with platelet-derived growth factor (PDGF) or placebo gel for up to 20 weeks. The purpose of these trials was to assess the safety and efficacy of PDGF used with good wound care. Each patient had an adequate arterial blood supply, was free of infection, was off-loaded, and was extensively débrided. The ulcers had been present for at least 8 weeks. A total of 922 patients were entered into the study. Analysis of ulcers with a baseline area of less than 10 cm (95 percent of patients) showed that patients treated with PDGF at 100 mug/g had a significant increase in complete healing compared with patients given placebo (50 percent versus 36 percent, p < 0.007). PDGF also decreased the time to complete healing by 30 percent (14 weeks versus 20 weeks, p = 0.01). Adverse events were similar in both treatment groups, as were recurrent ulcer rates. PDGF applied once daily was effective in healing chronic diabetic neurotrophic foot ulcers when used in conjunction with good wound care.
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            Methylglyoxal administration induces diabetes-like microvascular changes and perturbs the healing process of cutaneous wounds.

            Jose Montequin, Freya Freyre, Danay Cibrian … (2005)
            Increased formation of MG (methylglyoxal) and related protein glycation in diabetes has been linked to the development of diabetic vascular complications. Diabetes is also associated with impaired wound healing. In the present study, we investigated if prolonged exposure of rats to MG (50-75 mg/kg of body weight) induced impairment of wound healing and diabetes-like vascular damage. MG treatment arrested growth, increased serum creatinine, induced hypercholesterolaemia (all P < 0.05) and impaired vasodilation (P < 0.01) compared with saline controls. Degenerative changes in cutaneous microvessels with loss of endothelial cells, basement membrane thickening and luminal occlusion were also detected. Acute granulation appeared immature (P < 0.01) and was associated with an impaired infiltration of regenerative cells with reduced proliferative rates (P < 0.01). Immunohistochemical staining indicated the presence of AGEs (advanced glycation end-products) in vascular structures, cutaneous tissue and peripheral nerve fibres. Expression of RAGE (receptor for AGEs) appeared to be increased in the cutaneous vasculature. There were also pro-inflammatory and profibrotic responses, including increased IL-1beta (interleukin-1beta) expression in intact epidermis, TNF-alpha (tumour necrosis factor-alpha) in regions of angiogenesis, CTGF (connective tissue growth factor) in medial layers of arteries, and TGF-beta (transforming growth factor-beta) in glomerular tufts, tubular epithelial cells and interstitial endothelial cells. We conclude that exposure to increased MG in vivo is associated with the onset of microvascular damage and other diabetes-like complications within a normoglycaemic context.
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              Prophylactic use of epidermal growth factor reduces ischemia/reperfusion intestinal damage.

              Jorge Berlanga, Pedro Prats, Diadelis Remirez … (2002)
              Ischemia/reperfusion of mesenteric vessels is a useful model for acute vascular insufficiency and the early stages of multiorgan failure, conditions associated with high morbidity and mortality. Epidermal growth factor (EGF) is a potent mitogen that shows potential for use in intestinal injury. We therefore examined its influence on this model. Male Sprague-Dawley rats received human recombinant EGF (2 mg/kg i.p., n = 14) or saline (n = 16); 25 minutes before arterial clamping of the superior mesenteric artery (ischemic period) for 60 minutes followed by a final 60-minute reperfusion period. Additional rats were not operated on (controls, n = 7) or had sham operation (laparotomy only, n = 10). Ischemia/reperfusion caused macroscopic damage affecting 56%, 51 to 67% (median, interquartile range), of small intestinal length and intraluminal bleeding. Malondialdehyde levels (free radical marker) increased eightfold compared to nonoperated animals (2400, 2200 to 2700 micro mol/mg protein versus 290, 250 to 350 micro mol/mg protein, P < 0.01) and myeloperoxidase levels (marker for inflammatory infiltrate) increased 15-fold (3150, 2670 to 4180 U/g tissue versus 240, 190 to 250 U/g tissue, P < 0.01). Pretreatment with EGF reduced macroscopic injury to 11%, 0 to 15%; prevented intraluminal bleeding; and reduced malondialdehyde and myeloperoxidase levels by approximately 60% and 90% (all P < 0.01 versus non-EGF-treated). Mesenteric ischemia/reperfusion also damaged the lungs and kidneys and increased serum tumor necrosis factor-alpha levels (circulating cytokine activity marker). EGF pretreatment also reduced these changes. These studies provide preliminary evidence that EGF is a novel therapy for the early treatment or prevention of intestinal damage and multiorgan failure resulting from mesenteric hypoperfusion.
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                Author and article information

                Journal
                Journal ID (publisher-id): san
                Title: MEDISAN
                Abbreviated Title: MEDISAN
                Publisher: Centro Provincial de Información de Ciencias Médicas (Santiago de Cuba, , Cuba )
                ISSN (Electronic): 1029-3019
                Publication date (Print and electronic): November 2012
                Volume: 16
                Issue: 11
                Pages: 1707-1711
                Affiliations
                [01] Santiago de Cuba orgnameHospital General Universitario Dr. Juan Bruno Zayas Alfonso Cuba
                Article
                Publisher ID: S1029-30192012001100007 Publisher ID: S1029-3019(12)01601107
                SO-VID: 34996345-0b4e-401d-8536-8f6ade7d5e9e
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                Date received : 28 June 2012
                Date revision received : 19 August 2012
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 9, Pages: 5
                Product

                SciELO Cuba

                Categories
                Subject: ARTÍCULOS ORIGINALES

                Keywords: diabetic foot ulcer,clasificación de Wagner,factor de crecimiento epidérmico humano,Heberprot-P®,Wagner classification,human epidermal growth factor,úlcera de pie diabético
                Data availability:
                Keywords: diabetic foot ulcer, clasificación de Wagner, factor de crecimiento epidérmico humano, Heberprot-P®, Wagner classification, human epidermal growth factor, úlcera de pie diabético

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