A pilot trial using topical regular crystalline insulin vs. aqueous zinc solution for uncomplicated cutaneous wound healing: Impact on quality of life

Attia, Enas A. S.; Belal, Dina M. I.; Samahy, May H. El; Hamamsy, Manal Hamed El

doi:10.1111/wrr.12122

Cited by 25 publications

(50 citation statements)

References 17 publications

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“…Their results showed that the insulin and zinc solution induced faster wound healing than saline treated groups. However, the insulin treated groups appeared to provide a superior effect compared with the zinc group, but this effect was not significant due to the heterogeneity of the wounds types and sizes (Attia, Belal et al 2014). …”

Section: Insulinmentioning

confidence: 99%

Diabetes medications: Impact on inflammation and wound healing

Salazar

Ennis

Koh

2016

Journal of Diabetes and its Complications

162

101

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Chronic wounds are a common complication in patients with diabetes that often lead to amputation. These non-healing wounds are described as being stuck in a persistent inflammatory state characterized by accumulation of pro-inflammatory macrophages, cytokines and proteases. Some medications approved for management of type 2 diabetes have demonstrated anti-inflammatory properties independent of their marketed insulinotropic effects and thus have underappreciated potential to promote wound healing. In this review, the potential for insulin, metformin, specific sulfonylureas, thiazolidinediones, and dipeptidyl peptidase-4 inhibitors to promote healing is evaluated by reviewing human and animal studies on inflammation and wound healing. The available evidence indicates that diabetic medications have potential to prevent wounds from becoming arrested in the inflammatory stage of healing and to promote wound healing by downregulating pro-inflammatory cytokines, upregulating growth factors, lowering matrix metalloproteinases, stimulating angiogenesis, and increasing epithelization. However, no clinical recommendations currently exist on the potential for specific diabetic medications to impact healing of chronic wounds. Thus, we encourage further research that may guide physicians on providing personalized diabetes treatments that achieve glycemic goals while promoting healing in patients with chronic wounds.

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Section: Insulinmentioning

confidence: 99%

Diabetes medications: Impact on inflammation and wound healing

Salazar

Ennis

Koh

2016

Journal of Diabetes and its Complications

162

101

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“…The possibility that insulin may promote wound healing following simple deep burn skin flap transplantation in humans and its possible mechanism were analyzed in this clinical case-control study. Regular insulin was chosen because of its higher purity, easy absorbability, fast actions, and infimal probability of causing anaphylactic reactions (11). From the research findings it may be concluded that the wound healing rate of the low-dose insulin group significantly improved, the wound healing time shortened, the flap survival rate increased and the wound blood flow volume increased.…”

Section: Discussionmentioning

confidence: 99%

Clinical study on local application of low-dose insulin for promoting wound healing after operation for deep burns

Zeng

Zhi

Liu

et al. 2016

Experimental and Therapeutic Medicine

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Transplanted free skin flaps are often needed to treat deep burns; their survival, however, is less than optimal. This study examined whether local low-dose insulin injections can promote flap survival and wound healing after surgery. A total of 165 patients who underwent free skin flap transplantation for simple deep burns were enrolled in the study and divided into 5 groups of 33 patients each: Blank control group (no local subcutaneous drug injections), saline control group (saline injections), low-dose insulin group (0.5 units regular insulin injections), medium-dose group (1.0 units regular insulin injections) and high-dose group (2.0 units regular insulin injections). Wound healing and flap survival conditions were assessed and compared among groups. The best wound healing rate found was that of the low-dose insulin injection group where all the parameters measured improved significantly: The healing time was shorter; the blood flow volume, the flap survival, the number of fibroblasts and new vessels increased; the re-epithelialization occurred faster; the infiltration of inflammatory cells was reduced; the expression levels of heat shock protein-90, vascular endothelial growth factor, transforming growth factor-β and interleukin-1 were higher; and the plasma glucose levels only fluctuated slightly. The results clearly demonstrate that a local low-dose insulin regime after flap transplantation can accelerate the healing time and improve the surgical outcome without exerting detrimental secondary effects on the glucose plasma level of deep burn patients.

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“…The antibody was applied to the ulcers either as a 10 mg/mL solution covered with an adhesive sheet or as a gel formulation (0.45, 1 or 4.5 mg/g) under a hydrofiber dressing adhesive sheet. Although a cocktail containing additional healing agents (Attia et al, 2014;Burek-Kozlowska et al, 1994;Jackson et al, 2012;Kopecki et al, 2013;Pinho et al, 2014;Ruzehaji et al, 2014) may have an improved effect, this initial pioneering study is important in demonstrating the feasibility of the topical route in the clinical setting and again suggests that a high local concentration of anti-TNF favors prompt and definitive healing. Supporting evidence was recently provided by Teich & Klugmann (Teich & Klugmann, 2014), who reported a rapid improvement in refractory pyoderma gangrenosum, a reaction causing local skin ulceration, following the topical application of Infliximab in a sterile hydroxylethyl cellulose gel.…”

Section: Dermal Usementioning

confidence: 97%

Targeted localized use of therapeutic antibodies: a review of non-systemic, topical and oral applications

Jones

Martino

2015

Critical Reviews in Biotechnology

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Therapeutic antibodies provide important tools in the "medicine chest" of today's clinician for the treatment of a range of disorders. Typically monoclonal or polyclonal antibodies are administered in large doses, either directly or indirectly into the circulation, via a systemic route which is well suited for disseminated ailments. Diseases confined within a specific localized tissue, however, may be treated more effectively and at reduced cost by a delivery system which targets directly the affected area. To explore the advantages of the local administration of antibodies, we reviewed current alternative, non-systemic delivery approaches which are in clinical use, being trialed or developed. These less conventional approaches comprise: (a) local injections, (b) topical and (c) peroral administration routes. Local delivery includes intra-ocular injections into the vitreal humor (i.e. Ranibizumab for age-related macular degeneration), subconjunctival injections (e.g. Bevacizumab for corneal neovascularization), intra-articular joint injections (i.e. anti-TNF alpha antibody for persistent inflammatory monoarthritis) and intratumoral or peritumoral injections (e.g. Ipilimumab for cancer). A range of other strategies, such as the local use of antibacterial antibodies, are also presented. Local injections of antibodies utilize doses which range from 1/10th to 1/100th of the required systemic dose therefore reducing both side-effects and treatment costs. In addition, any therapeutic antibody escaping from the local site of disease into the systemic circulation is immediately diluted within the large blood volume, further lowering the potential for unwanted effects. Needle-free topical application routes become an option when the condition is restricted locally to an external surface. The topical route may potentially be utilized in the form of eye drops for infections or corneal neovascularization or be applied to diseased skin for psoriasis, dermatitis, pyoderma gangrenosum, antibiotic resistant bacterial infections or ulcerated wounds. Diseases confined to the gastrointestinal tract can be targeted directly by applying antibody via the injection-free peroral route. The gastrointestinal tract is unusual in that its natural immuno-tolerant nature ensures the long-term safety of repeatedly ingesting heterologous antiserum or antibody materials. Without the stringent regulatory, purity and clean room requirements of manufacturing parenteral (injectable) antibodies, production costs are minimal, with the potential for more direct low-cost targeting of gastrointestinal diseases, especially with those caused by problematic antibiotic resistant or toxigenic bacteria (e.g. Clostridium difficile, Helicobacter pylori), viruses (e.g. rotavirus, norovirus) or inflammatory bowel disease (e.g. ulcerative colitis, Crohn's disease). Use of the oral route has previously been hindered by excessive antibody digestion within the gastrointestinal tract; however, this limitation may be overcome by intelligently applying one or more strate...

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A pilot trial using topical regular crystalline insulin vs. aqueous zinc solution for uncomplicated cutaneous wound healing: Impact on quality of life

Cited by 25 publications

References 17 publications

Diabetes medications: Impact on inflammation and wound healing

Diabetes medications: Impact on inflammation and wound healing

Clinical study on local application of low-dose insulin for promoting wound healing after operation for deep burns

Targeted localized use of therapeutic antibodies: a review of non-systemic, topical and oral applications

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