Hyperbaric oxygen therapy and chemokine administration - a combination with potential therapeutic value for treating diabetic wounds

Abstract

Non-healing wounds impart serious medical problems to people with diabetes. Amongst 15% of diabetic patients, the incidence of foot ulcer is the most prevailing, which confers a significant risk of limb amputation, mainly due to hypoxia and impairment in cell signaling. Alteration in the expression of chemokines and the related factors in diabetic conditions delays the recruitment of different cell types, including fibroblasts, keratinocytes, and immune cells such as macrophages to the site of injury, further impairing neovasculogenesis, re-epithelialization, and extracellular matrix formation. Thus, proper activation of effector cells through an accurate signal pathway is necessary for better therapeutic application. Hyperbaric oxygen therapy (HBOT) is the current treatment prescribed by medical practitioners, shown to have increased the wound healing rate by reducing the need for significant amputation among the diabetic population. However, the risk of morbidity associated with HBOT needs complete attention through rigorous research to avoid adverse outcomes. Altering the level of pro-angiogenic chemokines may regulate the inflammatory response, further promote vascularization, and enhance the complete healing of wounds in diabetic patients. Thus, a combination of better therapeutic approaches could pave the way for developing a successful treatment for diabetic foot and wound healing.

Keywords: Diabetic foot; Wound healing; Hyperbaric oxygen therapy; Chemokines; Combinatorial therapy

Core Tip: Diabetes induces slow or non-healing of wounds, increasing the risk of developing infection and other complications. Proper management of blood sugar levels is essential to improve the overall health. Hyperbaric oxygen therapy (HBOT) enhances the efficacy of wound healing rate in chronic diabetic foot ulcer patients. However, the systemic and meta-analysis data contradicts in cases associated with ischemic wounds. Also, the uncordial functioning of effector cells due to the interrupted signaling pathway involving chemokines and related growth factors worsens the condition of wound healing to a greater extent. Thus, a combinatorial approach of HBOT and chemokine administration could have potential therapeutic value for treating diabetic wounds with the existing clinical protocol.