Document Detail


Clinical efficacy and mechanism of bilayered living human skin equivalent (HSE) in treatment of diabetic foot ulcers.
MedLine Citation:
PMID:  12931279     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Bilayered living human skin equivalent (HSE) consists of cultured keratinocytes residing on the surface of a fibroblast-populated collagen lattice. Although HSE is FDA-approved for treatment of diabetic foot and venous stasis ulcers, its clinical efficacy remains limited, because the molecular mechanisms underlying its therapeutic effect are not fully understood. It is, therefore, often applied mistakenly as a skin graft. In this report, we delineate a mechanism of HSE biological effect and consequent optimal clinical use in accelerating closure of diabetic foot ulcers. Experimental: HSE was grafted onto nude mice and the release of various growth factors was evaluated by reverse transcription-polymerase chain reaction (RT-PCR) and immunochemistry. Clinical: HSE was grafted onto 11 consecutive patients with diabetes who had 13 non-ischemic foot ulcers and healing was measured as time to 100% closure (e.g., no drainage and 100% epithelialized). Experimental: HSE cellular components were determined to express 15 different growth factors/cytokine genes known to promote wound healing. Histological evidence from the nude mice showed that the collagen component of HSE underwent remodeling within the first seven days of grafting. Clinical: All diabetic foot ulcers healed in 31.8 12.4 days. Local release of a unique combination of 15 growth factors expressed by HSE keratinocyte and fibroblast components generates closure of diabetic foot ulcers. HSE should be applied with the same surgical conditions for a skin graft (i.e., no cellulitis, no drainage, and negligible bacteria). We hypothesize that bilayered HSE generates its effect by way of the local synthesis and release of multiple growth factors in specific combination and concentration, which improves the impaired reparative process of chronic wounds.
Authors:
Harold Brem; Jan Young; Marjana Tomic-Canic; Cary Isaacs; H Paul Ehrlich
Related Documents :
16980729 - Diabetes mellitus and the elderly: special considerations for foot ulcer prevention and...
9365879 - Options for diabetic patients with chronic heel ulcers.
2689849 - Equine laminitis--another hypothesis for pathogenesis.
9198349 - Hyperbaric oxygen therapy and the diabetic foot.
9874429 - Resection of the metatarsal head for diabetic foot ulcers.
8872749 - Leukocytosis is a poor indicator of acute osteomyelitis of the foot in diabetes mellitus.
3666059 - Properties of in vitro nonenzymatically glycated plasma fibrinogens.
16718629 - The effect of oral glucose loads on tissue metabolism during angiotensin ii receptor an...
11213069 - Posttransplant diabetes mellitus in pediatric thoracic organ recipients receiving tacro...
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  Surgical technology international     Volume:  11     ISSN:  1090-3941     ISO Abbreviation:  Surg Technol Int     Publication Date:  2003  
Date Detail:
Created Date:  2003-08-21     Completed Date:  2004-05-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9604509     Medline TA:  Surg Technol Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  23-31     Citation Subset:  IM    
Affiliation:
Angiogenesis and Wound Healing Laboratory, Mount Sinai Medical Center, New York, NY, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Animals
Base Sequence
Biopsy, Needle
Cells, Cultured
Clinical Trials as Topic
Cytokines / metabolism
Diabetic Foot / pathology*,  surgery*
Disease Models, Animal
Fibroblasts / transplantation*
Graft Survival
Humans
Immunohistochemistry
Mice
Molecular Sequence Data
Polymerase Chain Reaction
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Skin Transplantation / methods*
Skin, Artificial*
Tissue and Organ Harvesting / methods
Treatment Outcome
Wound Healing / physiology
Grant Support
ID/Acronym/Agency:
AR 45974/AR/NIAMS NIH HHS; DK 59424/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Cytokines

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Plasma insulin and glucagon concentrations and biochemical variables in regularly menstruating femal...
Next Document:  Introducing the Xitact LS500 laparoscopy simulator: toward a revolution in surgical education.