{"id":159303,"date":"2023-11-30T22:22:07","date_gmt":"2023-11-30T22:22:07","guid":{"rendered":"https:\/\/tecscience.tec.mx\/en\/?post_type=sciencecommunication&p=159303"},"modified":"2023-12-07T23:23:21","modified_gmt":"2023-12-07T23:23:21","slug":"diabetic-foot-treatment","status":"publish","type":"sciencecommunication","link":"https:\/\/tecscience.tec.mx\/en\/science-communication\/diabetic-foot-treatment\/","title":{"rendered":"New and efficient treatment for diabetic foot"},"content":{"rendered":"\n

By Mar\u00eda Isabela Avila Rodr\u00edguez, Mirna Lorena S\u00e1nchez, and Jorge Benavides<\/a><\/strong><\/p>\n\n\n\n

It is well known that diabetes mellitus<\/a> is one of our country\u2019s main health problems. However, did you know that 20-30% of diabetic patients are treated at least once for complications related to foot ulcers? <\/strong>Even more alarming is that if these complications are not treated in a timely and adequate manner, they can lead to the affected limb needing to be amputated.[1] [2]<\/p>\n\n\n\n

In this article, we describe how the use of protease enzymes,<\/strong> such as bromelain, collagenase, and papain, form part of effective strategies for the treatment of diabetic foot ulcers.<\/p>\n\n\n\n

<\/div>\n\n\n\n

Ordinary Reconstruction<\/h2>\n\n\n\n

For the sake of argument, let\u2019s imagine that the skin is a factory of diverse scaffolding such as collagen, which we will call Healthy Skin Inc. In this factory, the different cells give orders to help maintain a healthy and resistant structure (Figure 1). When the factory process is interrupted, such as when we absent-mindedly cut our finger while opening a can of tuna, the cells send an urgent signal to stop the blood flow (called hemostasis<\/strong>) and cover the wound. An inflammation alert is also sent out, in which other groups of cells remove the mess created by the incident (debridement<\/strong>), degrade broken scaffolding, and eliminate invaders (bacteria<\/strong>) that could sneak into the factory through enzymatic tools (proteases<\/strong>).<\/p>\n\n\n\n

Finally, the Healthy Skin Inc. factory resumes its activities, and cell groups such as fibroblasts and keratinocytes <\/strong>generate new scaffolding and build new pathways to close the wound so that everything works properly again.[3] The skin is then repaired.<\/p>\n\n\n\n

<\/div>\n\n\n\n
\"\"
Figure 1.<\/strong> Normal healing process in the Healthy Skin Inc. factory.
WOUND HEALING PROCESS. Healthy Skin Inc.<\/strong>
Re: Interruption due to a cut from a can of tuna
1.     Hemostasis<\/strong> \u2013 stopping of bleeding
coagulation
2.     Inflammation<\/strong> \u2013 eliminates damaged scaffolding and factory intruders (bacteria)
Debridement
3.     Proliferation<\/strong> & Remodeling<\/strong> (closing of wound and healing)
By M. Isabela Avila Rodr\u00edguez<\/figcaption><\/figure>\n\n\n\n
<\/div>\n\n\n\n

Insufficient Reconstruction<\/h2>\n\n\n\n

However, in patients with diabetic foot, the Healthy Skin Inc. factory suffers damage that does not allow for the proper closing of the wound, as in 1. Failure of the factory\u2019s wound detection system due to damage to its main sensors, the nerves of the foot (diabetic neuropathy<\/strong>), and 2. Stagnation in the alarm phase (inflammation<\/strong>) due to excess and prolonged presence of sugar (hyperglycemia<\/strong>) in the area. This leads to damage and low oxygenation (hypoxia<\/strong>) in the circulatory system and abnormal clearance signals (hypercatabolism<\/strong>) of scaffolding that is not defective.[3] [4]<\/p>\n\n\n\n

This in turn means that the factory\u2019s repair system is unaware that there is a wound that needs to be repaired, and it therefore never heals the wound because it is stuck in an inflammatory phase. Over time, a covering called an eschar, composed of semi-degraded scaffolding and dead cells, is generated, which perpetuates the inflammatory state if not removed. Because of this accumulation, the body\u2019s system of enzymatic tools is insufficient<\/strong> so that we need to rely on external tools to remove the eschar through a surgical, physical, or enzymatic method.<\/p>\n\n\n\n

<\/div>\n\n\n\n

Non-invasive Intervention<\/h2>\n\n\n\n

As a first intervention, the patient is normally treated through surgical methods, with the hope that the wound will be able to emerge from stagnation and heal by eliminating the eschar. However, this is not always possible, and we then need a second method to resolve the stagnation.[5] In addition, surgical methods are not suitable for patients with coagulation problems,[3] so other specific and less invasive alternatives such as debridement using proteases<\/strong> (enzymes that break down proteins) are suitable since they act on the wound without requiring incision.<\/p>\n\n\n\n

The enzyme treatment is applied to the surface of the wound. These enzymes function as molecular \u201csculptors,\u201d which enter the wound and target the eschar\u2019s partially degraded and accumulated scaffolding, thereby generating specific removal of the damaged tissue.<\/strong><\/p>\n\n\n\n

Since the technology requires only the ointment containing the protease enzymes and the application materials, it is considered cost-effective for chronic treatment without the need for an operating room <\/strong>when treating small wounds.<\/p>\n\n\n\n

<\/div>\n\n\n\n

Biotechnological Advances<\/h2>\n\n\n\n

The enzymes that have been used in debridement procedures so far are extracted from plant sources, such as papaya or pineapple, and bacterial sources, such as Hathewaya histolytica.<\/em> Part of the current challenges regarding the use of enzymes in debridement processes is finding proteases with a greater resemblance to those present in the wound healing process<\/strong> in humans to allow for more specific and compatible action with our skin.<\/p>\n\n\n\n

Thanks to advances in the understanding of how proteases function in wound healing, the Bioengineering and Medical Devices unit of Tecnol\u00f3gico de Monterrey\u2019s Institute for Obesity Research <\/a>has been able to identify proteases in other animal sources similar to human proteases through computational methods. With modeling and structural comparison, it has been possible to identify enzymes that can be produced through biotechnological means in an economical and standardized way in yeasts such as Pichia pastoris<\/em>. In turn, this will promote the development of formulations that will make it possible to treat a greater number of patients at a lower cost<\/strong> than with current treatments, <\/strong>following much less invasive processes and with quicker results. The research group led by Dr. Jorge Benavides also hopes to design and produce more specific and efficient active molecules through in silico<\/em> \u2013computer simulation\u2013 and protein engineering strategies, thus improving various aspects of current treatments for diseases that have a social impact.<\/p>\n\n\n\n

The application of enzymatic debridement strategies in conjunction with timely diagnosis can prevent severe health complications in diabetic patients with foot ulcers, thereby significantly improving their quality of life.<\/p>\n\n\n\n

<\/div>\n\n\n\n

Authors<\/strong><\/p>\n\n\n\n

Mar\u00eda Isabela Avila Rodr\u00edguez<\/strong><\/a> is a Biotechnology doctoral candidate who has focused on the search for therapeutic molecules from animal sources for the closing of chronic wounds and severe burns through in silico<\/em> and in vitro<\/em> studies.<\/p>\n\n\n\n

Mirna Lorena S\u00e1nchez<\/strong><\/a> is a member of the Molecular Pharmacology Laboratory of the National University of Quilmes, Argentina. Her research is focused on the development of organic and inorganic materials through electrospinning and electrodeposition to promote wound healing and achieve macrophage immunomodulation.<\/p>\n\n\n\n

Jorge Benavides<\/strong><\/a> is a research professor at Tecnol\u00f3gico de Monterrey\u2019s Institute for Obesity Research. His research is focused on the design of biotechnological processes and the development of bioproducts with diverse applications, including the prevention and treatment of diseases.<\/p>\n\n\n\n

<\/div>\n\n\n\n

References<\/strong><\/p>\n\n\n\n

[1] A. V. A. Mariadoss, A. S. Sivakumar, C. H. Lee, y S. J. Kim, \u201cDiabetes mellitus and diabetic foot ulcer: Etiology, biochemical and molecular based treatment strategies via gene and nanotherapy,\u201d Biomedicine & Pharmacotherapy<\/em>, vol. 151, p. 113134, July 2022, doi: 10.1016\/J.BIOPHA.2022.113134.<\/p>\n\n\n\n

[2] G. Garc\u00eda Rodr\u00edguez et al.<\/em>, \u201cInforme Trimestral de Vigilancia Epidemiol\u00f3gica Hospitalaria Diabetes Mellitus Tipo 2 Corte al tercer trimestre 2022 Direcci\u00f3n de Vigilancia Epidemiol\u00f3gica de Enfermedades No Transmisibles,\u201d<\/a> Mexico, oct. 2022. Consulted: Jul. 17, 2023. [Online]. <\/p>\n\n\n\n

[3] M. I. Avila-Rodr\u00edguez, D. Mel\u00e9ndez-Mart\u00ednez, C. Licona-Cassani, J. M. Aguilar-Ya\u00f1ez, J. Benavides, y M. L. S\u00e1nchez, \u201cPractical context of enzymatic treatment for wound healing: A secreted protease approach (Review)\u201d, Biomed Rep<\/em>, Vol. 13, No. 1, p. 3, 2020, doi: 10.3892\/BR.2020.1300.<\/p>\n\n\n\n

[4] S. Jhamb, V. N. Vangaveti, y U. H. Malabu, \u201cGenetic and molecular basis of diabetic foot ulcers: Clinical review,\u201d J Tissue Viability<\/em>, Vol. 25, No. 4, pp. 229\u2013236, Nov. 2016, doi: 10.1016\/J.JTV.2016.06.005.<\/p>\n\n\n\n

[5] J. Paredes y J. Lantis, \u201cPermissive maintenance debridement \u2014 the role of enzymatic debridement in chronic wound care,\u201d<\/a> Wounds International<\/em>, Vol. 8, No. 2, pp. 7\u201313, jun. 2017, [Online]. <\/p>\n","protected":false},"excerpt":{"rendered":"

A simple, non-invasive and low-cost strategy can become the solution to diabetic foot ulcers.<\/p>\n","protected":false},"author":18,"featured_media":159306,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","format":"standard","meta":{"_acf_changed":false,"_eb_attr":"","footnotes":""},"categories":[93],"tags":[165,166,119],"class_list":["post-159303","sciencecommunication","type-sciencecommunication","status-publish","format-standard","has-post-thumbnail","hentry","category-biotechnology","tag-diabetes","tag-institute-for-obesity-research","tag-science-divulgation-thinker"],"acf":[],"yoast_head":"\nDiabetic foot treatment<\/title>\n<meta name=\"description\" content=\"A simple, non-invasive, low-cost strategy can solve diabetic foot ulcers.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/tecscience.tec.mx\/en\/science-communication\/diabetic-foot-treatment\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"New and efficient treatment for diabetic foot\" \/>\n<meta property=\"og:description\" content=\"A simple, non-invasive, low-cost strategy can solve diabetic foot ulcers.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/tecscience.tec.mx\/en\/science-communication\/diabetic-foot-treatment\/\" \/>\n<meta property=\"og:site_name\" content=\"TecScience\" \/>\n<meta property=\"article:modified_time\" content=\"2023-12-07T23:23:21+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/tecscience.tec.mx\/en\/wp-content\/uploads\/sites\/9\/2023\/11\/pie-diabetico.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"750\" \/>\n\t<meta property=\"og:image:height\" content=\"500\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/tecscience.tec.mx\\\/en\\\/science-communication\\\/diabetic-foot-treatment\\\/\",\"url\":\"https:\\\/\\\/tecscience.tec.mx\\\/en\\\/science-communication\\\/diabetic-foot-treatment\\\/\",\"name\":\"Diabetic foot treatment\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/tecscience.tec.mx\\\/en\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/tecscience.tec.mx\\\/en\\\/science-communication\\\/diabetic-foot-treatment\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/tecscience.tec.mx\\\/en\\\/science-communication\\\/diabetic-foot-treatment\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/tecscience.tec.mx\\\/en\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/11\\\/pie-diabetico.webp\",\"datePublished\":\"2023-11-30T22:22:07+00:00\",\"dateModified\":\"2023-12-07T23:23:21+00:00\",\"description\":\"A simple, non-invasive, low-cost strategy can solve diabetic foot ulcers.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/tecscience.tec.mx\\\/en\\\/science-communication\\\/diabetic-foot-treatment\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/tecscience.tec.mx\\\/en\\\/science-communication\\\/diabetic-foot-treatment\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/tecscience.tec.mx\\\/en\\\/science-communication\\\/diabetic-foot-treatment\\\/#primaryimage\",\"url\":\"https:\\\/\\\/tecscience.tec.mx\\\/en\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/11\\\/pie-diabetico.webp\",\"contentUrl\":\"https:\\\/\\\/tecscience.tec.mx\\\/en\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/11\\\/pie-diabetico.webp\",\"width\":750,\"height\":500,\"caption\":\"Proteolytic enzymes enter the wound and remove the damaged tissue. 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