Topical Effectiveness of Molgramostim (GM-CSF) in Sickle Cell Leg Ulcers

Abstract

Background: Leg ulcers are a frequently neglected, severe complication of sickle cell disease (SCD), responsible for significant altering quality of life. The management of leg ulcers remains disappointing. Local application of recombinant human granulocyte-macrophage colony-stimulating factor has been shown to be effective in several types of chronic wound healing. Methods: We report 5 homozygous sickle cell patients with 14 leg ulcers lasting from 1 month to 6 years, treated with topical dripping of molgramostim solution. Results: Healing was obtained for 9/14 ulcers, with no local or systemic adverse reactions. Comments: Molgramostim solution appears to be an adequate therapy for SCD leg ulcers but a more conclusive evaluation will depend on larger series of patients and other types of formulations for topical applications could be even more effective in the future.

Combined Use of Acid Fibroblast Growth Factor, Granulocyte Colony-stimulating Factor and Zinc Sulphate Accelerates Diabetic Ulcer Healing

“…Our results support the previous finding that G-CSF is another important factor during ulcer healing period. 33,52) In the study with immunohistochemical stain results of MMPs and TIMP-1, we found the group combined using with ZnSO 4 had lower MMPs and higher TIMP-1 expression. Zn links with Znbinding protein metallothionein as described in previous study.…”

“…We did not include non-diabetic group in this study since each of the approach used in the combination has been used extensively to non-diabetic animals. 19,33,[39][40][41] In these previous studies, application of the exogenous growth factors or Zn did not always stimulate the wound healing process, for which one of the reasons is because normal tissue is not defect for these growth factors or nutrients such as Zn. 42) Diabetic induction by STZ and the full-thickness skin wound for the diabetic rats was made as described in the pilot study.…”

“…15) Granulocyte colony-stimulating factor (G-CSF) is a colony-stimulating factor, which is produced by a number of different tissues to stimulate the bone marrow to produce granulocytes and stem cells and then mobilize these cells into the blood and wound tissue for participating the new blood vessel generation. 32,33) Therefore, in vivo application of G-CSF stimulated wound healing under non-diabetic condition. 32,33) The beneficial effects of these different approaches, such as topical application of FGF or Zn and/or systemic application of G-CSF imply that there may be a significantly synergistic stimulation of the wound healing when these multiple approaches are applied together.…”

“…32,33) Therefore, in vivo application of G-CSF stimulated wound healing under non-diabetic condition. 32,33) The beneficial effects of these different approaches, such as topical application of FGF or Zn and/or systemic application of G-CSF imply that there may be a significantly synergistic stimulation of the wound healing when these multiple approaches are applied together. A few studies have preliminarily explored the combined therapeutic effects with two growth factors.…”

Recombinant human granulocyte macrophage colony-stimulating factor (rhGM-CSF) could accelerate burn wound healing in hamster skin

“…In an attempt to improve wound healing, various agents, including granulocyte macrophage colony-stimulating factor (GM-CSF), basic fibroblast growth factor, and GM-CSF hydrogel, have been used. Although GM-CSF has been applied successfully in treatment of various clinical problems, its application in burn treatment has not been well reported (DorsettMartin 2004;Méry et al 2004;Cianfaran et al 2006).…”