Pathogenetic substantiation of therapy of the diabetic foot syndrome on a modern stage

Keywords: diabetic foot syndrome; serotonin adipinate; stem cells of adipose tissue; cellular therapy

Abstract

Objective. Studying the impact of exogenous serotonin and of the adipose tissue stem cells on reparative processes in purulent–necrotic wounds of soft tissues in ischemic form of diabetic foot syndrome (DFS).

Materials and methods. In the investigation 35 patients were incorporated, including  20 with Stage II, 15 – Stage III of ischemic form of DFS in accordance to classification of Fontaine–Pokrovskyi on background of diabetes mellitus type II. Control group consisted of 15 healthy patients without signs of the lower extremities arteries affection while examined. About atherosclerosis severity it was possible to mention due to data of lipidogram and the aortal arch rentgenography. Impact of the adipose tissue stem cells on regenerative processes in chronic ulcer of rabbits was studied in experiment.

Results. Intravenous injection of serotonin adipinate have improved the blood flow in the lower extremities, what may be connected with mechanisms of endothelial dependence of vasorelaxation and enhancement of production of endothelial vasodilators. There were conducted experimental investigations for studying of impact of the adipose tissue stem cells on reparative processes in chronic ulcer, which have shown potential possibilities of application of these cells in treatment of patients, suffering ulcerative–necrotic defects.

Conclusion. Intravenous injection of serotonin adipinate impacts favorably the pathogenetic mechanisms of development of atherosclerotic ischemia. The stem–cell therapy, using the stem cells of adipose tissue in experimental animals with chronic ulcerative defects improves reparative processes in the tissues damaged. This permits to make a conclusion, that such therapy owes a potential in treatment of purulent–necrotic wounds of soft tissues.

Author Biography

V. I. Lupaltsov, Kharkov National Medical University, Kharkov, Ukraine

Lupaltsov Volodymyr I, MD, DSci (Med), Professor,
Head of the Department of surgery No 3,
Kharkiv National Medical University,
Nauky Ave., 4, Kharkiv, 61022, Ukraine;
tel: +38(057) 725-57-74;
е-mail: surgdis@ukr.net;
ORCID ID: 0000-0003-2121-529X

References

Mitish VA, Paskhalova YuS, Eroshkin IA, Galstyan GR, Blatun LA. Gnoyno-nekroticheskie porazheniya pri neyroishemicheskoy forme sindroma diabeticheskoy stopy. Khirurgiya. Zhurnal im. N. I. Pirogova. 2014;(1):48-53. [In Russian].

Prompers L, Schaper N, Apelqvist J, Edmonds M, Jude E, Mauricio D, et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia. 2008;51(5):747–55. doi 10.1007/s00125-008-0940-0.

Zelenov MA. Angiograficheskaya semiotika i rentgenokhirurgicheskaya korrektsiya porazheniy arteriy nizhnikh konechnostey u bol'nykh sakharnym diabetom. PhD [thesis]. Moskva, 2008. 26 р. [In Russian].

Eroshkin IA. Rentgenokhirurgicheskaya korrektsiya porazheniy arteriy nizhnikh konechnostey u bolnykh sakharnym diabetom i ee rol v kompleksnom lechenii sindroma diabeticheskoy stopy. DSci [thesis]. Moskva, 2010. 57 p. [In Russian].

Svetukhin AM, Zemlyanoy AB, Mitish VA. Taktika khirurgicheskogo lecheniya gnoyno-nekroticheskikh form diabeticheskoy stopy. Meditsinskiy nauchnyy internet-zhurnal MedWeb. 2002;4:68-96. [In Russian].

Bokeriya LA, Spiridonov AA, Abalmasov KG i Morozov KN. Mikrokhirurgiya pri porazhenii arteriy distalnogo rusla nizhney konechnosti. Moskva: NTsSSKh im. A. N. Bakuleva RAMN; 2004; 56 p. [In Russian].

Moncada S, Higgs A. The L-arginine-nitric oxide pathway. N Engl J Med. 1993;329(27):2002-12. doi: 10.1056/NEJM199312303292706.

Beckman JA, Goldfine AB, Gordon MB, Creager MA. Ascorbate restores endothelium-dependent vasodilation impaired by acute hyperglycemia in humans. Circulation. 2001;103(12):1618-23. doi: 10.1161/01.cir.103.12.1618.

Paneni F, Beckman JA, Creager MA, Cosentino F. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I. Eur Heart J. 2013;34(31):2436-43. doi: 10.1093/eurheartj/eht149.

Giacco F, Brownlee M. Oxidative stress and diabetic complications. Circ Res. 2010;107(9):1058-70. doi: 10.1161/CIRCRESAHA.110.223545.

Schaper NC, Huijberts M, Pickwell K. Neurovascular control and neurogenic inflammation in diabetes. Diabetes Metab Res Rev. 2008;24(Suppl 1):S40-4. doi: 10.1002/dmrr.862.

Apelqvist J. Diagnostics and treatment of the diabetic foot. Endocrine. 2012;41(3):384-97. doi: 10.1007/s12020-012-9619-x.

De Vivo S, Palmer-Kazen U, Kalin B, Wahlberg E. Risk factors for poor collateral development in claudication. Vasc Endovascular Surg. 2005;39(6):519-24. doi: 10.1177/153857440503900609.

Published
2019-09-28
How to Cite
Lupaltsov, V. I. (2019). Pathogenetic substantiation of therapy of the diabetic foot syndrome on a modern stage. Klinicheskaia Khirurgiia, 86(9), 12-15. https://doi.org/10.26779/2522-1396.2019.09.12
Section
General Problems of Surgery