Motzkau M, Tautenhahn J, Lehnert H, Lobmann R
Department of Nephrology, Section Endocrinology and Metabolism, University of Magdeburg Medical School, Germany.
Exp Clin Endocrinol Diabetes. 2011 May;119(5):286-90. doi: 10.1055/s-0030-1267235. Epub 2010 Oct 28.
It is well known, that wound healing in diabetes is impaired. Persistently high levels of matrix-metalloproteases (MMPs) contribute to wound persistence. The topical use of protease-inhibitors might beneficially affect wound healing.
19 patients with chronic diabetic foot lesions (Wagner/Armstrong 2A) were studied. 6 patients received "good standard wound care", 13 patients were treated with a protease-inhibitor-modulating-matrix (ORC/collagen matrix) that was changed daily. At day 1 and 5 biopsies were taken from the wounds; wound fluids were collected daily. Biopsies were analysed using quantitative real-time-PCR and all samples were analysed using ELISA and zymography for MMPs, TIMPs, IL 1-β and TNFα levels.
No differences in mRNA-expression of MMPs, TNFα and for MMP levels in wound tissue were detected between both groups or between the 2 sampling time points. MMP-2 active was significantly reduced in wound fluids of ORC/collagen treated lesions (p=0.043) after 5 days. MMP-2 pro was also reduced by about 25% when compared to increasing levels in the control group (+27%). We observed a significant reduction of the wound area in the ORC/collagen group (p=0.003).
Local treatment with a protease-inhibitor has a beneficial effect on wound healing. In contrast to unchanged mRNA-levels and protein levels of MMPs there was a clear reduction of MMP-2-levels in wound fluids. Our data support the potential role of ORC/collagen as a wound dressing. Modulation of MMPs appears to be beneficial in the treatment of chronic diabetic wounds.
众所周知，糖尿病患者的伤口愈合受损。基质金属蛋白酶（MMPs）持续高水平会导致伤口迁延不愈。局部使用蛋白酶抑制剂可能对伤口愈合产生有益影响。
对19例慢性糖尿病足病变患者（瓦格纳/阿姆斯特朗2A期）进行了研究。6例患者接受“标准良好伤口护理”，13例患者使用每日更换的蛋白酶抑制剂调节基质（ORC/胶原基质）进行治疗。在第1天和第5天从伤口取材活检；每天收集伤口渗出液。使用定量实时PCR分析活检样本，所有样本使用ELISA和酶谱法分析MMPs、TIMPs、IL-1-β和TNFα水平。
两组之间或两个采样时间点之间，伤口组织中MMPs、TNFα的mRNA表达及MMP水平均未检测到差异。5天后，ORC/胶原治疗的伤口渗出液中MMP-2活性显著降低（p=0.043）。与对照组水平升高（+27%）相比，MMP-2前体也降低了约25%。我们观察到ORC/胶原组的伤口面积显著减小（p=0.003）。
蛋白酶抑制剂局部治疗对伤口愈合有有益作用。与MMPs的mRNA水平和蛋白质水平未改变相反，伤口渗出液中MMP-2水平明显降低。我们的数据支持ORC/胶原作为伤口敷料的潜在作用。调节MMPs似乎对慢性糖尿病伤口的治疗有益。
