Effects of external application of Chinese medicine on diabetic ulcers and the expressions of β-catenin, c-myc and K6
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To observe the clinical efficacy of Chinese medicine (CM) treatment of Hongyou Ointment (红油膏) and Shengji Powder (生肌散) on diabetic ulcers, and to observe the influence of CM treatment on the expressions of proteins associated with the Wnt signaling pathway, such as β-catenin, c-myc and K6.
sixty-two patients fitting the registration standards were randomly divided into the CM group (31 patients) and the Western medicine (WM) group (31 patients) by a random number table. The patients in the CM group were treated with Hongyou Ointment and Shengji Powder externally. The patients in the WM group were treated with mupirocin ointment, growth factor (bFGF), and Vaseline gauze for external use and with basic therapies. Wound-healing time and four-week healing rate were recorded. The wounds were measured by digital photography and ImageJ software. Skin biopsies were obtained from 24 patients before CM treatment and 20 patients after CM treatment. Immunohistochemical tests and semi-quantitative imaging with NIH ImageJ 1.42 software were used to analyze the changes in protein expression of β-catenin, c-myc, and K6.
Fifty-three patients completed the trial; four patients in the CM treatment group and five patients in the WM group dropped out. Among them, four were dissatisfied with the treatment process, two could not continue because of their jobs, two failed to complete the course of follow-up appointments, and one was diagnosed with squamous cell carcinoma during treatment. The comparison of ulcer healing rates between the two groups showed insignificant differences (P=0.77). The ulcer healing rates were 33.33% (9/27) in the CM group and 26.92% (7/26) in the WM group. However, the effective rate was significantly higher in the CM group (81.48%, 22/27) than in the WM group (57.69%, 15/26, P=0.04). The mean wound healing time was shorter in the CM group (22.71 ±5.46 days) than in the WM group (26.56 ±7.56 days, P=0.04). CM treatment was well tolerated, and there was no withdrawal due to adverse reactions. Immunohistochemical analysis in the refractory wound indicated higher expressions of β-catenin, c-myc and K6 compared with the normal skin. β-catenin was abnormally expressed in the nuclei of the keratinocytes and fibroblasts at the wound margins, and the expressions of c-myc and K6 were highly expressed in the full hyperplastic epidermis, especially in the granular layer (P<0.05). The expressions of these proteins decreased after CM treatment. The expression levels of β-catenin, c-myc, and K6 proteins before and after the treatment were 101.88 ± 10.76 vs. 140.42 ±8.45; 113.27 ± 16.75 vs. 153.79 ±8.32; 90.39 ±11.07 vs. 151.29 ±7.39, respectively.
CM treatment using Hongyou Ointment and Shengji Powder was efficient in the management of diabetic skin ulcers. The mechanism of action might be related to the inhibition of the Wnt signaling pathway.
- Rathmann W, Giani G. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:2568–2569. CrossRef
- Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998;15:539–553. CrossRef
- State Administration of Traditional Chinese Medicine. Vocational criteria for traditional Chinese medicine of People’s Republic of China: diagnostic and therapeutic effect evaluation criteria of diseases and syndromes in traditional Chinese medicine. Nanjing: Nanjing University Press; 1994:142–145.
- Reiber GE, Vileikyte L, Boyko EJ, del Aguila M, Smith DG, Lavery LA, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care 1999;22:157–162. CrossRef
- Fu XB. Attach further importance to studies on mechanism and prevention of chronic dermal ulcers. Chin J Traumatol (Chin) 2004;20:449–451.
- Bowley E, O’Gorman DB, Gan BS. Beta-catenin signaling in fibroproliferative disease. J Surg Res 2007;138:141–150. CrossRef
- Cheon SS, Cheah AY, Turley S, Nadesan P, Poon R, Clevers H, et al. Beta-catenin stabilization dysregulates mesenchymal cell proliferation, motility, and invasiveness and causes aggressive fibromatosis and hyperplastic cutaneous wounds. Proc Natl Acad Sci U S A 2002;99:6973–6978. CrossRef
- Stojadinovic O, Brem H, Vouthounis C, Lee B, Fallon J, Stallcup M, et al. Molecular pathogenesis of chronic wounds: the role of β-catenin and c-myc in the inhibition of epithelialization and wound healing. Am J Pathol 2005;167:59–69. CrossRef
- Ito M, Yang Z, Andl T, Cui C, Kim N, Millar SE, et al. Wnt-dependent de novo hair follicle regeneration in adult mouse skin after wounding. Nature 2007;447:316–320. CrossRef
- Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in diabetes. J Clin Invest 2007;117:1219–1222. CrossRef
- Golinko MS, Joffe R, de Vinck D, Chandrasekaran E, Stojadinovic O, Barrientos S, et al. Surgical pathology to describe the clinical margin of debridement of chronic wounds using a wound electronic medical record. J Am Coll Surg 2009;209:254–260. CrossRef
- Tomic-Canic M, Ayello EA, Stojadinovic O, Golinko MS, Brem H. Using gene transcription patterns (bar coding scans) to guide wound debridement and healing. Adv Skin Wound Care 2008;21:487–492; quiz 493–494. CrossRef
- Brem H, Stojadinovic O, Diegelmann RF, Entero H, Lee B, Pastar I, et al. Molecular markers in patients with chronic wounds to guide surgical debridement. Mol Med 2007;13:30–39. CrossRef
- Saap LJ, Falanga V. Debridement performance index and its correlation with complete closure of diabetic foot ulcers. Wound Repair Regen 2002;10:354–359. CrossRef
- Steed DL, Donohoe D, Webster MW, Lindsley L. Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. Diabetic Ulcer Study Group. J Am Coll Surg 1996;183:61–64.
- Ramundo J, Gray M. Enzymatic wound debridement. J Wound Ostomy Continence Nurs 2008;35:273–280. CrossRef
- Ramundo J, Gray M. Collagenase for enzymatic debridement: a systematic review. J Wound Ostomy Continence Nurs 2009;36(6 Suppl):S4–S11. CrossRef
- Shi L, Carson D. Collagenase Santyl ointment: a selective agent for wound debridement. J Wound Ostomy Continence Nurs 2009;36(6 Suppl):S12–S16. CrossRef
- Hunter S, Langemo D, Thompson P, Hanson D, Anderson J. Maggot therapy for wound management. Adv Skin Wound Care 2009;22:25–27. CrossRef
- Poon R, Nik SA, Ahn J, Slade L, Alman BA. Beta-catenin and transforming growth factor beta have distinct roles regulating fibroblast cell motility and the induction of collagen lattice contraction. BMC Cell Biol 2009;5;10:38. CrossRef
- Xu WB, Li B, Xiao XL, Gu DQ, Fan B, Li FL. Effects of stagnation-resolving and tissue-regenerating method on wound granulation color and wound exudation of chronic lower-limber ulceration. Chin J Surg Integr Tradit West Med (Chin) 2006;12:103–105.
- Xiao XL, Wang ZY, Fan B, Li Fl, Xu WB, Xu R, et al. Clinical observation on stagnation-resolving and tissue-regenerating method in treatment of 50 cases of chronic lower-limb ulceration. Chin J Dermatovenerol Integr Tradit West Med (Chin) 2005;4:48–50.
- Li B, Wang ZY, Xiao XL, Li FL, Fan B. Effects of Shengji Huayu Recipe and its decomposed formulas on synthesis of collagen types I and III in granulation tissue of rats in early wound healing. J Chin Integr Med (Chin) 2005;3:216–219 CrossRef
- Li B, Li FL, Wang ZY, Fan B, Xu WB, Jing W, et al. Effect of stasis-resolving and muscle-regenerating therapy on apoptosis-related gene expression in granulation tissue of diabetic rat wound healing. J Tradit Chin Med (Chin) 2008;49:258–260.
- Effects of external application of Chinese medicine on diabetic ulcers and the expressions of β-catenin, c-myc and K6
Chinese Journal of Integrative Medicine
Volume 17, Issue 4 , pp 261-266
- Cover Date
- Print ISSN
- Online ISSN
- Chinese Association of Traditional and Western Medicine
- Additional Links
- diabetic foot
- Chinese medicine
- external application
- proto-oncogene proteins
- Industry Sectors
- Author Affiliations
- 1. Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
- 2. The Sixth Hospital Affiliated Shanghai Jiaotong University, Shanghai, 200233, China
- 3. Shanghai Skin Diseases and Sexually Transmitled Diseases Hospital, Shanghai, 200050, China