Abstract
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.
Research design and methods: 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.
Results: 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).
Conclusions: 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.
Key words
diabetic foot syndrome - matrix-metalloproteases - protease absorbent dressing
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Correspondence
R. LobmannMD
Department of Endocrinology
Diabetology and Geriatric Medicine
Klinikum Stuttgart –
Bürgerhospital
Tunzhofer Straße 14–16
70191 Stuttgart
Phone: +49/0711/253 2600
Fax: +49/0711/253 2173
Email: R.Lobmann@klinikum-stuttgart.de
