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Clinical, pathomorphological and immunohistochemical evaluation of tissue repair in diabetic foot ulcers

https://doi.org/10.14341/DM9823

Abstract

Background: It is known that wound healing is Impaired in diabetes mellitus. Possible reasons are widely being searched. However, despite all the available data, reliable markers of reparative processes in diabetes mellitus are needed to be found.


Aim: To study morphological and some immunohistochemical markers of tissue repair in patients with diabetic foot ulcers after local treatment.


Materials and methods: 70 patients with diabetic foot ulcers before and after surgical debridement were included. Histological (light microscopy) and immunohistochemical (CD68, MMP-9, TIMP-1) characteristics of tissue repair processes in soft tissues of the lower extremities in patients with diabetes mellitus were analyzed. Histological and immunohistochemical examination of soft tissues were performed in 63 patients before and after surgical debridement and 10 days after local treatment.


Results: After the surgical debridement a significant reduction in the area of wounds was registered by 23.4% (p <0.05), wound depth by 29.4% (p <0.05). Based on the results of the morphological study, the presence of mature granulation tissue in the wounds was confirmed. Immunohistochemical study of wound biopsies demonstrated a significant decrease in proteolytic activity in the wound as a decrease in MMP-9 expression (p <0.05). Statistically significant changes in the number of macrophages against the initial data were not found, as well as increased expression of TIMP-1 was observed (p> 0.05 and <0.05, respectively).


Conclusion: According to the data, there was a significant decrease in the area and depth of wounds during local treatment. The intensity of tissue repair was confirmed by the results of histological and immunohistochemical studies. However, the absence of a statistically significant change in the amount of macrophages on the background of treatment suggests that this repair link is disrupted in diabetes mellitus, which is the reason for the "chronic" wounds and requires further studies.

About the Authors

Alla Y. Tokmakova

Endocrinology Research Centre


Russian Federation

MD, PhD



Ekaterina L. Zaitseva

Endocrinology Research Centre


Russian Federation

MD, PhD



Iya A. Voronkova

Endocrinology Research Centre


Russian Federation

MD, PhD



Marina V. Shestakova

Endocrinology Research Centre


Russian Federation

MD, PhD, Professor



References

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Supplementary files

1. Fig. 1. Tissue biopsy wound before and after treatment. A. The histological picture of the biopsy of the wound defect before treatment. A pronounced inflammatory infiltration (lymphocytes and leukocytes, plasma cells), intercellular edema (GE-200) are determined. B. Maturing granulation tissue. Lymphoid and leukocytes, fibroblasts, few plasma cells are located between the numerous newly formed vessels in the loose intercellular substance (GE-X200). B. A small number of CD68-positive macrophages in the inflammatory infiltration of the wound before treatment (x400). G. Increase in the number of macrophages immunopositive to CD68 in wound biopsy after treatment (x400). D. Moderate cytoplasmic expression of MMP-9 before treatment with inflammatory infiltrate cells (x400). E. Reducing the number of immunopositive cells to anti-MMP-9 after therapy (x400). G. Weak cytoplasmic expression of TIMP-1 by myofibroblasts in the tissue of the wound biopsy before treatment (x400). H. Expressed expression of TIMP-1 by fibroblastic cells after therapy (x400).
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2. Fig. 2. Correlation between the values of TIMP and the depth of wounds.
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Review

For citations:


Tokmakova A.Y., Zaitseva E.L., Voronkova I.A., Shestakova M.V. Clinical, pathomorphological and immunohistochemical evaluation of tissue repair in diabetic foot ulcers. Diabetes mellitus. 2018;21(6):490-496. (In Russ.) https://doi.org/10.14341/DM9823

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ISSN 2072-0351 (Print)
ISSN 2072-0378 (Online)