Nitric oxide role in development of the endothelial dysfunction in diabetic foot syndrome
DOI:
https://doi.org/10.34287/MMT.4(43).2019.5Abstract
Introduction. Diabetes mellitus causes many acute and chronic complications, including diabetic foot syndrome (DFS) – a serious complication that can be a test for patients and directly affect their quality of life.
One of the most effective treatments for DFS is the use of nitric oxide (NO). The main advantage of using NO-therapy is the effect of polyfunctional nitrogen monoxide on all phases of purulent-inflammatory process.
Purpose of the study. The nitric oxide effect features on the development of endothelial dysfunctions in patients with diabetic foot syndrome are explored.
Materials and methods. In the department of purulent surgery at Kyiv City Clinical Hospital No. 6 in 2019 from January to June, 76 patients with DFS in stages II–V were treated by F. Wagner. In 47 (61.8%) patients the neuropathic form of DFS was observed, and 29 (38,2%) were neuroichemic form. According to the DFS rates of F. Wagner patients were distributed: II – 24 (31,7%) patient, III – 29 (38,1%) patient, IV – 15 (19,7%) and V stages – 8 (10,5%). All patients were studied in the capillary zone of necrotic lesions of the content of NO, the activity of superoxide dismutase (SOD).
Results and discussion. The signaling role of NO in cells is highly dependent on the level of superoxide. The balance between systems that synthesize NO and superoxide determines the regulatory orientation of the signals, and its disruption contributes significantly to inflammation in diabetes.
Conclusions. The use of NO-therapy helps to optimize the processes of regulation of the induction of nitric oxide and to improve the clinical results in the treatment of diabetic foot syndrome.
References
American Diabetes Association. Introduction: Standards of Medical Care in Diabetes – 2018. Diabetes Care. 2018; 41 (Supplement 1): S1–S2. DOI: 10.2337/dc18-Sint01.
Vishnu DM, Gowda DV, Karthik S et al. Complications and risk management of diabetic foot ulcer: a review. J Scientific Innovat Res. 2014; 3 (3): 363–371.
Meriç M, Ergün G, Demirci İ, Azal Ö. It is not diabetic foot: it is my foot. J Wound Care. 2019; 28 (1): 30–37. DOI: 10.12968/jowc.2019.28.1.30.
Lipsky BA, Arag n-S nchez J, Diggle M et al. IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev. 2016; 32 (1): 45–74. DOI: 10.1002/dmrr.2699.
Aliasgharpour M, Nayeri ND. The care process of diabetic foot ulcer patients: a qualitative study in Iran. J Diabetes Metab Disord. 2012; 11 (1): 27. DOI: 10.1186/2251-6581-11-27.
Lavery LA, Ryan EC, Ahn J et al. The Infected Diabetic Foot: Re-Evaluating the IDSA Diabetic Foot Infection Classification. Clin Infect Dis. 2019 Jun 8. pii: ciz489. DOI: 10.1093/cid/ciz489.
Lavery LA, Lavery DC, Hunt NA et al. Amputations and foot-related hospitalisations disproportionately affect dialysis patients. Int Wound J. 2015; 12 (5): 523–526. DOI: 10.1111/iwj.12146.
Lavery LA, Armstrong DG, Wunderlich RP et al. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006; 29 (6): 1288–1293. DOI: 10.2337/dc05-2425.
Lavery LA, Armstrong DG, Wunderlich RP et al. Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort. Diabetes Care. 2003; 26 (5): 1435–1438. DOI: 10.2337/diacare.26.5.1435.
Kuzin MM, Kostyuchenok BM (ed). Wounds and wound infection 2nd ed., Rev. and add. Moscow, Medicine, 1990.
Lipatov KB et al. The use of physical methods in the treatment of purulent wounds. Khirurgiya. 2001; 10: 56–61.
Vanin AF. Nitric oxide is a regulator of cellular metabolism. Sorosovskiy obrazovatelnyy zhurnal. 2001; 7 (11): 7–12.
Bilyaeva OO, Balinska MI, Ulanovich FA et al. Evaluation of complex treatment of chronic venous insufficiency in the stage of trophic ulcers with the use of nitric oxide and application sorbents. Kharkivska khirurhichna shkola. 2015; 6 (75): 144–147.
Patent 96629 Ukrayiny, MPK A61N 5/067 (2006.01) A61K 31/409 (2006.01) A61R 17/02 (2006.01). The method of treatment of trophic ulcers of venous genesis with the use of nitric oxide / Bilyaeva OO, Balinskaya MI, Ulanovich LI, Yemets VV; zayav. 05.09.2014; opubl. 10.02.2015; Prom. Vlasnist, Byul. № 3, 2015.
Yefimenko NA, Khrupkin VI, Marakhonich LA et al. Air-plasma flows and NO-therapy – new technology in the clinical practice of military medical institutions. Voyennomeditsinskiy zhurnal. 2005; 5: 51–54.
Krotovskiy GS, Pekshev AV, Zudin A et al. Exogenous nitric oxide therapy is a new method of stimulating the healing of trophic skin defects in the presence of chronic venous insufficiency. Grudnaya i serdechno-sosudistaya khirurgiya. 2001; 3: 37–42.
Krylov AY, Shulutko AM, Chirikov EG, Osmanov EG. The use of exogenous NO-therapy for the treatment of hypertensive-ischemic ulcers of the lower extremities. Rossiyskiy meditsinskiy zhurnal. 2002; 2: 23–25.
Lipatov KB, Sopromadze MA, Schekhter AB et al. The use of a gas stream containing nitric oxide (NO-therapy) in the complex treatment of purulent wounds. Khirurgiya. 2002; 2: 41–43.
Shekhter AB, Kabisov RK, Pekshev AB et al. Experimental and clinical substantiation of plasmodynamic therapy of wounds with nitric oxide. Byulleten eksperimentalnoy biologii i meditsiny. 1998; 8: 210–215.
Gozhenko AI, Kuznetsova AS, Kuznetsova EС et al. Endothelial dysfunction in the pathogenesis of diabetes complications Message I. Endothelial dysfunction: etiology, pathogenesis and diagnostic methods. Endokrynologia. 2017; 22 (2): 171–181.
Vanin AF.Nitricoxideisauniversalregulator of biological processes. Sbornik materialov nauch.prakt. konf. « NO-therapy: theoretical aspects, clinical experience and problems of the use of nitric oxide in medicine» Moscow, 2001: 22–21.
Shulutko AM, Antropova NV, Krueger YuA. NO-therapy in patients with diabetes mellitus complicated by purulent-necrotic lesions of the lower extremities. Khirurgiya. 2004; 12: 43–46.
Stallmeyer В, Kampfer H, Kolb N et al. The function of nitric oxide in wound repair: inhibition of inducible NO-synthase severely impairs wound reepitalization. J Invest Dermat. 1999; 6 (133): 1090–1098. DOI: 10.1046/j.1523-1747.1999.00784.x.
Kostyuk VA, Potapovich AI, Kovaleva ZhV. A simple and sensitive method for determining the activity of superoxide dismutase, based on the oxidation reaction of quercetin. Voprosy meditsinskoy khimii. 1990; 36 (2): 88–89.
Guevara I, Iwanejko J, Dembinska-Kiec A et al. Determination of nitrite/nitrate in human biological material by the simple Griess reaction. Clin Chim Acta 1998; 274 (2): 177–188. DOI: 10.1016/s0009-8981(98)00060-6.
Patent Ukrainy na korysnu model №112523, MPK (2016.01): A61K 31/00, A61R 17/02(2006.01). Kompleksnyi antymikrobnyi sorbtsiinyi preparat ornidasyl dlia profilaktyky aerobnoi i anaerobnoi infektsii ta likuvannia hniinykh ran, trofichnykh vyrazok, opikiv / Biliaieva O.O., Holub O.A., Karol I.V., Neshta V.V., Kryzhevskyi Y.Y., Brodska A.P.; zaiavl. 10.05.2016, opubl. 26.12.2016, Biul. № 24.
Bondarenko OH, Galstyan GR, Antsiferov MB et al. The biological role of nitric oxide in diabetes. Sakharnyy diabet.2001; 2: 56–63.
