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A Journal on Physiopathology and Therapy of Chronic Cutaneous Ulcers
Official Journal of the Italian Association for Cutaneous Ulcers
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Acta Vulnologica 2008 March;6(1):3-17
Effect of α-lipoic acid in the treatment of chronic wounds with hyperbaric oxygen therapy: modulation of genes involved in angiogenesis and tissue remodelling
Alleva R. 1, Tomasetti M. 2, Sartini D. 3, Emanuelli M. 3, Borghi B. 1, Di Donato F. 4, Nasole E. 4
1 Dipartimento di Anestesia IRCCS Istituti Ortopedici Rizzoli, Bologna
2 Dipartimento di Patologia Molecolare e Terapie Innovative Università Politecnica delle Marche, Ancona
3 Istituto di Biotecnologie Biochimiche Università Politecnica delle Marche, Ancona
4 Centro Medicina Iperbarica, Bologna
Aim. Chronic ulcers are characterized by a persistent inflammation leading to a high proteases levels. The latter are involved in the degradation of growth factors and extracellular matrix proteins which are important for the healing process. The hyperbaric oxygen therapy (HBO) is an efficient approach in the chronic wound treatment. The aim of the present study was to evaluate the effect of α-lipoic acid in patients affected by chronic ulcers treated with HBO.
Methods. The expression of genes involved in the angiogenesis and tissue remodelling has been evaluated by microarray technique. Twenty patients underwent HBO therapy; they were double-blind randomised in two groups, the α-lipoic acid group and the placebo group. Gene expression profiles for extracellular matrix and angiogenesis mediators were evaluated in biopsies collected at the first HBO session (T0), at the 5th HBO session (T1) and after 10 days of HBO treatment (T2). Enzyme-linked immunosorbent assay tests were used to validate microarray expression profiles of selected genes, both in the biopsy and in the plasma samples.
Results. Lipoic acid supplementation in combination with HBO therapy down-regulated the inflammation which in turn affected the protease/antiprotease levels into wound environment. Clinical analysis showed wound area reduction of 6±10% and 17±43% after 14 and 42 days of HBO treatment, respectively. The use of α-lipoic acid significantly reduced the wound area with respect to HBO treatment alone (8±16% e 31±42%, P=0.02, after 14 e 42 days of treatment, respectively).
Conclusion. The α-lipoic acid contributed to the disruption of the positive autocrine feedback loops that maintain the chronic wound state, promoting the progression of the healing process.