Morishima Atsutomo, Inagawa Hiroyuki
Lavita Medical Clinic, Osaka, Japan
Faculty of Medicine, Kagawa University, Kagawa, Japan.
Anticancer Res. 2018 Jul;38(7):4375-4379. doi: 10.21873/anticanres.12739.
BACKGROUND/AIM: The wound-healing effect of lipopolysaccharide (LPS) reportedly results from its ability to induce the removal of foreign bodies, anti-inflammatory function, and tissue-repair function. We reported the improvement of patients with protracted wound healing after the dermal administration of topical cream containing LPS derived from Pantoea agglomerans, which is a symbiotic bacterium present in wheat and confirmed as safe.
Topical cream with LPS was applied on four patients who showed protracted wound healing, after their informed consent. The wound was evaluated on the basis of the change in the approximate wound volume calculated from the width, length, and depth of the wound.
Case 1: A 76-year-old man developed infection at the puncture site after endovascular laser treatment of the right lower extremity varicose veins and suffered protracted wound healing. The wound was treated with gentamicin application containing LPS, and shrank in two weeks. Case 2: A 72-year-old man developed a wound infection and had purulent drainage one week after endovascular laser treatment of the left lower extremity varicose veins. The wound was closed in one month using gentamicin application containing LPS. Case 3: A 67-year-old woman with protracted wound healing developed infection in the right inguinal region after the surgical treatment of acute aortic dissection and experienced complete wound dehiscence. The wound shrank one week after gauze packing with LPS and was temporarily sutured. The wound was completely closed in two weeks with gentamicin application containing LPS. Case 4: An 86-year-old woman with protracted wound healing became bedridden after cerebral infarction and developed pressure ulcers in the sacral area. The ulcer disappeared in four months with LPS-containing sugar and povidone-iodine application twice a day. There were no adverse effects from LPS application in any of these patients.
In diabetes, one cause of protracted wound healing is the low innate immune function, such as the phagocytic activity of macrophages. LPS is expected to promote healing by improving innate immunity, and its beneficial effect of promoting wound healing was clearly demonstrated in the present cases. The topical application of LPS is clinically effective for wound healing and is considered a potentially novel treatment method.
背景/目的：据报道，脂多糖（LPS）的伤口愈合作用源于其诱导异物清除的能力、抗炎功能和组织修复功能。我们报告了在对4例伤口愈合迁延的患者经皮给予含有成团泛菌来源LPS的外用乳膏后，患者病情得到改善，成团泛菌是一种存在于小麦中的共生细菌，且已确认为安全。
在4例伤口愈合迁延的患者签署知情同意书后，对其使用含LPS的外用乳膏。根据由伤口宽度、长度和深度计算得出的近似伤口体积变化来评估伤口情况。
病例1：一名76岁男性在右下肢静脉曲张血管内激光治疗后穿刺部位发生感染，伤口愈合迁延。使用含LPS的庆大霉素进行治疗，伤口在两周内缩小。病例2：一名72岁男性在左下肢静脉曲张血管内激光治疗一周后发生伤口感染并有脓性分泌物。使用含LPS的庆大霉素，伤口在一个月内愈合。病例3：一名67岁女性伤口愈合迁延，在急性主动脉夹层手术治疗后右腹股沟区发生感染，伤口完全裂开。用含LPS的纱布填塞一周后伤口缩小，并进行了临时缝合。使用含LPS的庆大霉素，伤口在两周内完全愈合。病例4：一名86岁女性伤口愈合迁延，脑梗死后卧床，骶骨部位发生压疮。每天两次使用含LPS的糖和聚维酮碘，溃疡在四个月内消失。这些患者中使用LPS均未出现不良反应。
在糖尿病中，伤口愈合迁延的一个原因是先天性免疫功能低下, 如巨噬细胞的吞噬活性。LPS有望通过改善先天性免疫来促进愈合，并且在本病例中清楚地证明了其促进伤口愈合的有益作用。LPS的局部应用对伤口愈合具有临床疗效，被认为是一种潜在的新型治疗方法。
