The effect of topical therapies on ulcer healing and the wound micro-environment in diabetes mellitus

Abstract

Wounds in people with diabetes typically show abnormal healing. The diabetic wound is generally characterised by its chronicity, persistent inflammation, copious exudate, hypergranulation, increased bacterial load and reduced ability to heal. This delayed healing is thought to be attributable to a variety of factors including micro- and macrovascular disease, neuropathy, bacterial infection, local pressure due to foot deformity and the adverse local metabolic environment caused by diabetes. The series of studies presented in this thesis demonstrate for the first time that the topical growth factor CTGF is able to improve diabetic wound healing in a preclinical model. Furthermore, the potential of the anti-inflammatory agent propolis to enhance wound healing in human subjects has been established in the preliminary studies in this research. The safety of propolis has been substantiated and laboratory studies of wound fluid have provided data to enable exploratory hypotheses such as propolis’ mechanism of action to be subsequently developed in further research. This novel work contributes to our understanding of the complex and dysregulated diabetic wound micro-environment. It is anticipated that further work studying the topical therapies examined in this thesis may ultimately lead to improvement in healing rates in burdensome chronic diabetic wounds