A study of extracellular vesicle concentration in active diabetic Charcot neuroarthropathy

Schara, Karin; Štukelj, Roman; Krek, Judita Lea; Lakota, Katja; Sodin-Šemrl, S.; Boulton, Andrew J.M.; Kralj‐Iglič, Veronika

doi:10.1016/j.ejps.2016.09.009

Cited by 13 publications

(15 citation statements)

References 42 publications

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“…Moreover, in diabetic rat models, cutaneous wound healing could be accelerated by exosomes from adipose-derived stem cells [43]. Interestingly, in a study on active Charcot neuropathy, it was found that concentrations of extracellular MVs correlated to the elevation of CRP and varying foot temperatures [44]. Such data suggests that MVs can be of great interest as therapeutic agents or as diagnostic tools in patients with complications due to diabetes.…”

Section: Discussionmentioning

confidence: 99%

Effects of Negative Pressure Wound Therapy on Levels of Angiopoetin-2 and Other Selected Circulating Signaling Molecules in Patients with Diabetic Foot Ulcer

Hohendorff

Drożdż

Borys

et al. 2019

Journal of Diabetes Research

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Background and Aims Diabetic foot ulcers (DFUs) are linked to amputations and premature deaths. Negative pressure wound therapy (NPWT) has been used for DFUs. The mechanism of NPWT's action may be associated with its influence on circulating molecules. We assessed NPWT's effect on the plasma levels of angiopoietin-2 (Ang2), a key regulator of angiogenesis, and its microvesicular receptors (Tie2) as well as the microvesicles (MVs) themselves in DFU patients. Materials and Methods We included 69 patients with type 2 diabetes mellitus (T2DM) and neuropathic, noninfected DFUs—49 were treated with NPWT and 20 were treated with standard therapy (ST). Assigning patients to the NPWT group was not random but based on DFU characteristics, especially wound area. Ang2 was measured by ELISA in the entire group, while in a subgroup of 19 individuals on NPWT and 10 on ST, flow cytometry was used to measure Tie2+ and the corresponding isotype control (Iso+) and annexin V (AnnV+) as well as total MVs. Measurements were performed at the beginning and after 8 ± 1 days of therapy. Results Treatment groups were similar for basic characteristics but differed by their median DFU areas (10.3 (4.2-18.9) vs. 1.3 (0.9-3.4) cm2, p = 0.0001). At day 0, no difference was observed in Ang2 levels, total MVs, MV Tie+, and MV AnnV+ between the groups. Ang2 decreased after 8 days in the NPWT group, unlike in the ST group (3.54 (2.40-5.40) vs. 3.32 (2.33-4.61), p = 0.02, and 3.19 ± 1.11 vs. 3.19 ± 1.29 ng/mL, p = 0.98, respectively). No other parameters were identified that may have been influenced by the NPWT treatment. Conclusion NPWT in T2DM patients with neuropathic, noninfected DFU seems to lead to reduction of the Ang2 level. Influencing the level of Ang2 may constitute one of NPWT-related mechanisms to accelerate wound healing.

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Section: Discussionmentioning

confidence: 99%

Effects of Negative Pressure Wound Therapy on Levels of Angiopoetin-2 and Other Selected Circulating Signaling Molecules in Patients with Diabetic Foot Ulcer

Hohendorff

Drożdż

Borys

et al. 2019

Journal of Diabetes Research

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“…[62][63][64][65][66] ESR in active CNO patients with intact skin ranged from a mild increase (5%) to as high as 350% above the reference range (<20 mm/ h). 63,64,66 WBC was reported normal 63,65 in two studies (reference range <10⁹/L) and mildly elevated (10% above reference range) in one study. 66 Serum alkaline phosphate was found to be normal in active CNO in two studies.…”

Section: Rationalementioning

confidence: 96%

Guidelines on the diagnosis and treatment of active Charcot neuro‐osteoarthropathy in persons with diabetes mellitus (IWGDF 2023)

Wukich

Schaper

Gooday

et al. 2023

Diabetes Metabolism Res

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This is the first guideline on the diagnosis and treatment of active Charcot neuro‐osteoarthropathy in persons with diabetes published by the IWGDF. We followed the GRADE Methodology to devise clinical questions in the PACO (Population, Assessment, Comparison, Outcome) and PICO (Population, Intervention, Comparison, Outcome) format, conducted a systematic review of the medical literature, and developed recommendations with the rationale. The recommendations are based on the evidence from our systematic review, expert opinion when evidence was not available, and also taking into account weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to an intervention. We here present the 2023 Guidelines on the diagnosis and treatment of active Charcot neuro‐osteoarthropathy in persons with diabetes mellitus and also suggest key future topics of research.

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“…Median alkaline phosphatase (standard assay 30-130 IU/L) at presentation was 105 U/L . Baseline data for the measurement of high 60 Mean CRP in was 19 � 45 mg/L. It should be noted that the description of patients included in their methods section states "all presented with a unilateral red, hot (>2°C difference from the contra-lateral foot), swollen foot in the presence of neuropathy and a normal peripheral circulation," however whether or not the skin was intact was not specifically described.…”

Section: Qoe: Lowmentioning

confidence: 99%

“…It should be noted that the description of patients included in their methods section states "all presented with a unilateral red, hot (>2°C difference from the contra-lateral foot), swollen foot in the presence of neuropathy and a normal peripheral circulation," however whether or not the skin was intact was not specifically described. 60 Gough et al performed an observational, cross-sectional study evaluating bone turnover markers in 16 patients with active CNO compared to 10 patients with inactive CNO, 10 diabetes mellitus control patients and 10 healthy controls. 57 Mean alkaline phosphatase in patients with active CNO was 78.7 � 1.4 mg/L, in patients with inactive CNO was 92.5 � 1.4 IU/L, in the diabetes mellitus controls, it was 66.7 � 1.5 IU/L, and in the healthy controls it was 50.8 � 1.2 IU/L (standard assay 30-120 IU/L).…”

Section: Qoe: Lowmentioning

confidence: 99%

Diagnosis and treatment of active charcot neuro‐osteoarthropathy in persons with diabetes mellitus: A systematic review

Raspovic

Schaper

Gooday

et al. 2023

Diabetes Metabolism Res

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BackgroundThere are uncertainties regarding the diagnostic criteria, optimal treatment methods, interventions, monitoring and determination of remission of Charcot neuro‐osteoarthropathy (CNO) of the foot and ankle in people with diabetes mellitus (DM). The aims of this systematic review are to investigate the evidence for the diagnosis and subsequent treatment, to clarify the objective methods for determining remission and to evaluate the evidence for the prevention of re‐activation in people with CNO, DM and intact skin.MethodsWe performed a systematic review based on clinical questions in the following categories: Diagnosis, Treatment, Identification of Remission and Prevention of Re‐Activation in people with CNO, DM and intact skin. Included controlled studies were assessed for methodological quality and key data from all studies were extracted.ResultsWe identified 37 studies for inclusion in this systematic review. Fourteen retrospective and observational studies relevant to the diagnosis of active CNO with respect to clinical examination, imaging and blood laboratory tests in patients with DM and intact skin were included. We identified 18 studies relevant to the treatment of active CNO. These studies included those focused on offloading (total contact cast, removable/non‐removable knee high devices), medical treatment and surgical treatment in the setting of active CNO. Five observational studies were identified regarding the identification of remission in patients who had been treated for active CNO. We did not identify any studies that met our inclusion criteria for the prevention of re‐activation in patients with DM and intact skin who had been previously treated for active CNO and were in remission.ConclusionsThere is a paucity of high‐quality data on the diagnosis, treatment, and prognosis of active CNO in people with DM and intact skin. Further research is warranted to address the issues surrounding this complex disease.

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A study of extracellular vesicle concentration in active diabetic Charcot neuroarthropathy

Cited by 13 publications

References 42 publications

Effects of Negative Pressure Wound Therapy on Levels of Angiopoetin-2 and Other Selected Circulating Signaling Molecules in Patients with Diabetic Foot Ulcer

Effects of Negative Pressure Wound Therapy on Levels of Angiopoetin-2 and Other Selected Circulating Signaling Molecules in Patients with Diabetic Foot Ulcer

Guidelines on the diagnosis and treatment of active Charcot neuro‐osteoarthropathy in persons with diabetes mellitus (IWGDF 2023)

Diagnosis and treatment of active charcot neuro‐osteoarthropathy in persons with diabetes mellitus: A systematic review

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