Brocco Enrico, Curci Vincenzo, Da Ros Roberto, Miranda Cesare, Boschetti Giovanni, Barone Sara, Tedeschi Anna, Salutini Elisabetta, Anichini Roberto
UO Trattamento del Piede Diabetico Policlinico Abano Terme, Terme, Italy.
Istituto Clinico Città Studi di Milano, Milan, Italy.
Int J Low Extrem Wounds. 2022 Jun;21(2):137-140. doi: 10.1177/1534734620929889. Epub 2020 Jun 19.
Diabetic foot ulcers (DFUs) are common, complex, costly complications, associated with frequent recurrences and increased morbidity and mortality. DFUs can be prevented and their healing can be mostly influenced by appropriately and aggressively managing any infection, but the role of antiseptic therapies in reducing healing time lacks sufficient evidence. Several therapeutic interventions have been developed based on the principles of photomedicine to overcome the issue of poor drug circulation in infected areas, with the aim of killing microbial agents while leaving the surrounding host cells unharmed. Such techniques use absorption of photons by specific chromophores. Among these, RLP068 is a tetracationic Zn(II) phthalocyanine derivative activated by exposure to red light, used as a topical treatment for superficial bacterial and fungal infections. The photoactivation of RLP068 results in the production of singlet oxygen and other reactive oxygen species, able to affect a range of cellular targets, including cell membrane and/or wall, cytoplasm, and cellular components, resulting in a rapid, broad range, bactericidal and fungicidal effect. The phase IIa study showed that photoactivated RPL068 is capable of inducing a dose-dependent reduction in total and pathogen microbial load in infected diabetic foot ulcers. In this article, a case series of 22 DFU treated with photoactivated RLP068 at 5 different centers in Italy is presented. Considering microbial agents reduction, ulcer healing facilitation, healing rate (9 DFUs out of 22), and amputation rate (only 1 case over 22), the decrease in the cost of DFU seems to be a point in favor of RLP068 and its cost-effectiveness.
糖尿病足溃疡（DFUs）是常见、复杂且代价高昂的并发症，常伴有复发以及发病率和死亡率的增加。DFUs可以预防，其愈合在很大程度上受对任何感染进行适当且积极的管理的影响，但抗菌疗法在缩短愈合时间方面的作用缺乏充分证据。基于光医学原理已开发出几种治疗干预措施，以克服感染区域药物循环不良的问题，目的是杀死微生物制剂，同时不损伤周围宿主细胞。此类技术利用特定发色团对光子的吸收。其中，RLP068是一种通过暴露于红光激活的四价锌（II）酞菁衍生物，用作浅表细菌和真菌感染的局部治疗药物。RLP068的光激活会产生单线态氧和其他活性氧物质，能够影响一系列细胞靶点，包括细胞膜和/或细胞壁、细胞质及细胞成分，从而产生快速、广泛的杀菌和杀真菌作用。IIa期研究表明，光激活的RPL068能够使感染的糖尿病足溃疡中的总微生物负荷和病原体微生物负荷呈剂量依赖性降低。本文介绍了在意大利5个不同中心对22例DFU患者使用光激活的RLP068进行治疗的病例系列。考虑到微生物制剂减少、溃疡愈合促进、愈合率（22例中有9例）和截肢率（22例中仅1例），DFU治疗成本的降低似乎有利于RLP068及其成本效益。
