Combined application of alginate dressing and human granulocyte-macrophage colony stimulating factor promotes healing in refractory chronic skin ulcers

Abstract

The aim of the present study was to evaluate the clinical therapeutic effect of the combined application of alginate and recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) on the healing of refractory chronic skin ulcers. A single center, three arm, randomized study was performed at Jinan Central Hospital (Jinan, Shandong, China). A total of 60 patients with refractory chronic skin ulcers, which persisted for >1 month, were enrolled and randomly assigned into one of the following three groups: alginate dressing/rhGM-CSF group (group A), rhGM-CSF only group (group B) and conventional (vaseline dressing) group (group C). The wound area rate was measured, granulation and color were observed and pain was evaluated. The data were summarized and statistical analysis was performed. The results demonstrated that group A exhibited a significantly faster wound healing rate and lower pain score compared with the other groups (P<0.01). In conclusion, the combined application of alginate dressing and rhGM-CSF for the treatment of refractory chronic skin ulcers demonstrated significant advantages. It promoted the growth of granulation tissue, accelerated re-epithelialization and also effectively reduced wound pain, and thus improved the quality of life for the patient. This suggests that the combined application of alginate and rhGM-CSF may be an effective therapeutic strategy for the clinical treatment of refractory chronic skin ulcers.

Macrophages: A review of their role in wound healing and their therapeutic use

“…Evidence is thus limited to support the use of macrophage therapy in the clinical setting. Another wound therapy that targets macrophages to make them more effective is macrophage stimulation, which has stronger current evidence supporting its use in clinical practice, including four recent RCTs, 1 systematic review, one phase 1 trial, and multiple animal studies and in vitro models (Table ) …”

“…Granulocyte macrophage colony‐stimulating factor (GM‐CSF) stimulates the production of granulocytes and monocytes by stem cells in which the monocytes become macrophages upon localization in tissue . The use of recombinant human GM‐CSF (rhGM‐CSF) in the treatment of chronic wounds has been investigated in eight randomized controlled trials (RCTs) and 23 clinical studies and case reports .…”

“…A systematic review conducted by Hu et al concluded that topically applied rhGM‐CSF had a positive therapeutic effect on deep partial‐thickness burn wounds, chronic leg ulcers, and leprosy ulcers, and a possible beneficial effect on PUs and cancer‐related ulcers. The three most recent RCTs support the use of rhGM‐CSF on PUs, varicose ulcers, DFUs, and burns . A single center, three‐arm, randomized Chinese study of 60 patients with PUs, varicose ulcers, and DFUs found that the application of alginate dressing with rhGM‐CSF resulted in a significantly faster healing rate and lower pain score ( p < 0.01) compared to patients treated with rhGM‐CSF alone or a conventional dressing .…”

“…The three most recent RCTs support the use of rhGM‐CSF on PUs, varicose ulcers, DFUs, and burns . A single center, three‐arm, randomized Chinese study of 60 patients with PUs, varicose ulcers, and DFUs found that the application of alginate dressing with rhGM‐CSF resulted in a significantly faster healing rate and lower pain score ( p < 0.01) compared to patients treated with rhGM‐CSF alone or a conventional dressing . However, analysis was limited to a small sample size.…”

Evaluation of Cypholophus macrocephalus sap as a treatment for infected cutaneous ulcers in Papua New Guinea

“…There is some precedent this; the macrophage stimulating agent, recombinant GM-CSF has been trialled as a topical therapy for non-healing ulcers with some limited indication of success. (Huang et al, 2014). However, it is not clear to what extent enhanced clearance of bacterial bioburden is involved in the improved healing rates observed (Khan and Davies, 2006).…”