The effect of continuous diffusion of oxygen treatment on cytokines, perfusion, bacterial load, and healing in patients with diabetic foot ulcers

Abstract

To evaluate continuous diffusion of oxygen therapy (CDO) on cytokines, perfusion, and bacterial load in diabetic foot ulcers we evaluated 23 patients for 3 weeks. Tissues biopsies were obtained at each visit to evaluate cytokines and quantitative bacterial cultures. Perfusion was measured with hyperspectral imaging and transcutaneous oxygen. We used paired T tests to compare continuous variables and independent T tests to compare healers and nonhealers. There was an increase from baseline to week 1 in TGF‐β (P = .008), TNF‐α (P = .014), VEGF (P = .008), PDGF (P = .087), and IGF‐1 (P = .058); baseline to week 2 in TGF‐β (P = .010), VEGF (P = .051), and IL‐6 (P = .031); and baseline to week 3 with TGF‐β (P = .055) and IL‐6 (P = .054). There was a significant increase in transcutaneous oxygen after 1 week of treatment on both medial and lateral foot (P = .086 and .025). Fifty‐three percent of the patients had at least a 50% wound area reduction (healers). At baseline, there were no differences in cytokines between healers and nonhealers. However, there was an increase in CXCL8 after 1 week of treatment (P = .080) and IL‐6 after 3 weeks of treatment in nonhealers (P = .099). There were no differences in quantitative cultures in healers and nonhealers.

Topical Wound Oxygen Therapy in the Treatment of Chronic Diabetic Foot Ulcers

“…Interestingly, they did not find a significant increase in VEGF expression in those patients treated with HBOT. Similar increases in VEGF and other cytokines in healers vs. non-healers were reported more recently in patients treated with CDO [14,31].…”

Molecular Biomarkers of Oxygen Therapy in Patients with Diabetic Foot Ulcers

“…Results showed significant increases in growth factors, cytokines and transcutaneous oxygen pressure measurement levels after application of CDOT. Growth factors significantly increased from 280% to 820% of base levels in the first week and decreased in subsequent weeks [50] (Figure 1). Cytokines increased significantly (up to 680% compared to baseline levels) in the first two weeks and then decreased.…”

“…In a study using supplemental oxygen at a rate of 4 L/min through nasal cannula for 12 h a day for 3 days, it was found that three times as much collagen was deposited in patients with well-perfused and oxygenated wounds compared with those with lower oxygenation and perfusion scores [54]. A separate study using direct topical oxygen on chronic diabetic foot ulcers showed significant increases in the expression of genes associated with collagen production (TGF-β, VEGF and IL-6) during weekly follow-up visits after application of CDO in patients with diabetic foot ulcers [50].…”

“…This is evidence that the topically applied oxygen not only saturated the wound bed, yet also elevated the levels of oxygen in the surrounding tissues. The impact of continuous diffusion of oxygen therapy (CDOT) on wound cytokines and growth factors was recently demonstrated in a prospective study of 23 patients with diabetic foot ulcers below the malleolus [50]. Results showed significant increases in growth factors, cytokines and transcutaneous oxygen pressure measurement levels after application of CDOT.…”

Continuous Diffusion of Oxygen Adjunct Therapy to Improve Scar Reduction After Cervicotomy – A Proof of Concept Randomized Controlled Trial

“…9 Applied oxygen to wounds has proven to stimulate collagen synthesis, matrix deposition, keratinocyte differentiation, and fibroblast migration, through cytokines and growth factors activated by the release of reactive oxygen species (ROS), which also play an antibacterial role in the wound site. [9][10][11] Moreover, oxygen may promote angiogenesis, and the process itself could be more efficient if the cutaneous tissue is sufficiently maintained oxygenated. 9 , 12 Therefore, the level of transcutaneous oxygen could be a determinant factor of excessive SF 13 .…”