BACKGROUND: Diabetic foot ulcer (DFU) is the most common and threatening complication of Diabetes Mellitus (DM). Ideal wound dressing for DFU management should relieve symptoms, provide wound protection, and encourage healing. Advanced-Platelet Rich Fibrin (A-PRF) and Hyaluronic Acid (HA) have been proven to improve wound healing process. This study was aimed to demonstrate the ability of combination of A-PRF and HA in reducing inflammation and improving DFU tissue healing.METHODS: Twenty DFU subjects were involved in this study, and divided into two groups based on the topical fibrin gel treatment: A-PRF + HA group and A-PRF only group. A-PRF was obtained by peripheral blood centrifugation. A-PRF + HA was prepared by homogening A-PRF and AH with a ratio of 1:0.6. Interleukin-6 (IL-6) level, granulation index (GI), numeric pain score (NPS), and inflammation clinical symptoms (ICS) were assessed on day-0, 3, 7 and 14.RESULTS: Wound swabs’ IL-6 level on day-7 was found to be significantly lower in A-PRF + HA compared to A-PRF alone (p=0.041). The IL-6 level reduction also found to be significant higher either in wound swabs (day 0-7, p=0.015) or fibrin gel (day 0-3, p=0.049; day 0-7, p=0.034). A-PRF + HA treatment significantly increased the GI even since day-3 (p=0.043), with lower NPS (p<0.001), and ICS score.CONCLUSION: The combination of A-PRF and HA increases the GI in DFU healing by reducing the inflammation state which will induce the angiogenesis process, as well as reducing pain in DFU subjects better than A-PRF alone.KEYWORDS: inflammation, interleukin-6, wound healing, angiogenesis, proliferation

Diabetes Mellitus (DM) is one of the major health problems in the world and Indonesia. The prevalence is more increasing and also shows the trend of events is shifting to young age. Diabetes mellitus treatment requires high costs and also a lifetime. Most of the people of Indonesia still use traditional methods of treatment, especially herbs from various biological substances that are available in the environment. Undur-undur (myrmeleon sp.) is believed to have the effect of anti-hyperglycemia, and also anti-viscosity. The aim of this study was to determine anti-hyperglycemia and anti-viscosity of myrmeleon sp. extract in diabetic rats. The design of study is randomized experiment. Diabetic rats were induced by streptozocin 100mg/ kg BW intraperitoneal. Fifty rats were divided into 2 groups administered by Myrmeleon sp. extract dose 0,01ml/ 200 gram BW (100%) and 0,005ml/ 200 gram BW (50%). Myrmeleon sp. shows the effect of anti-hyperglycemic and anti-viscosity in diabetic rats. There was a difference between 50% and 100% doses. The effect of anti-hyperglycemia and anti-viscosity occurs after the second day. Conclusion: the extract of myrmeleon sp. could be considered as one of the traditional treatments of diabetic patients.

BACKGROUND: Hyaluronic acid (HA) is an essential component of extracellular matrix and mediates signaling in wound healing. HA could induce growth factor release from Advanced Platelet Rich Fibrin (A-PRF), including Vascular Endothelial Growth Factor (VEGF) and Platelet-derived Growth Factor (PDGF). However, concentrations of the released-VEGF and PDGF have not been clearly disclosed. Therefore, current study was conducted to measure the release of these growth factors in HA + A-PRF gel of diabetic foot ulcer (DFU) subjects.METHODS: Twenty DFU subjects were included in the study and treated with A-PRF or HA+A-PRF. A-PRF was derived from autologous peripheral blood and processed with low-speed centrifugation. HA was added with a ratio of 1:0.6. A-PRF or HA + A-PRF was applied topically on DFU. Upper tips of A-PRF or HA + A-PRF gels were collected on day 0, 3 and 7 for measurements of VEGF and PDGF concentrations with Enzyme-linked Immune-sorbent Assay (ELISA) methods.RESULTS: On day-3, both VEGF and PDGF concentrations of HA + A-PRF group were significantly higher than the VEGF (p=0.000) and PDGF (p=0.019) concentrations of A-PRF group. The VEGF and PDGF concentrations were continuously and significantly increased on day-7 of HA + A-PRF group, compared to the VEGF (p=0.000) and PDGF (p=0.004) concentrations of A-PRF group.CONCLUSION: Combination HA+A-PRF induces VEGF and PDGF release from A-PRF. A mixture of A-PRF and HA could be more effective than A-PRF alone for treatment of DFU.KEYWORDS: hyaluronic acid, advanced platelet rich fibrin, PRF, growth factor, VEGF, PDGF, diabetic foot ulcer

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Umbilical Cord Mesenchyme stem cell (UC-MSCs) /secretome has been applied for treating several diseases, such as cardio-protection and diabetes. Secretome-derived paracrine modulating effects of various growth factors, cytokines, chemokines, angiogenic factors, and exosomes are used in aging therapy. In recent clinical trials on sarcopenia therapy such as pharmaceutical interventions, nutrition, and physical exercise are reported to be effective strategies to reduce sarcopenia. The pathomechanism of the secretome in the treatment of sarcopenia is unclear. This study looked into how secretome might affect myostatin, a biomarker of sarcopenia, at the molecular level. Myostatin, a member of the TGF-family, significantly increases muscle growth when it is absent while suppressing muscle growth when it is present. A bioactive substance called secretome is secreted by MSCs in conditioned conditions. It is rich in growth factors and cytokines, which are crucial for speeding up tissue regeneration. Secretome intervention is a promising approach for treating sarcopenia as showed by its ability to prevent muscle loss and to improve molecular biomarkers.