Abstract
Polaprezinc (zinc L-carnosine complex) is a tablet commonly prescribed for gastric ulcers in Japan. Recently, we reported the effects of polaprezinc on pressure ulcer healing at 4-week follow-up. We aimed to further evaluate the efficacy and safety of polaprezinc in 8-week treatment for chronic pressure ulcers. Patients with stage II–IV pressure ulcers for ≥8 weeks received 150 mg/day polaprezinc (containing 116 mg L-carnosine and 34 mg zinc) per os for a maximum of 8 weeks. We measured the severity of pressure ulcers weekly using the Pressure Ulcer Scale for Healing (PUSH) score and monitored blood biochemistry. Fourteen patients (nine men; 68.4 ± 11.8 years) were enrolled. Pressure ulcer stages were II (one patient; 7 %), III (nine; 64 %), and IV (four; 29 %). The PUSH score improved significantly from 8.1 [95 % CI, 6.0–10.3] at baseline to −1.4 [−4.0 to 1.1] after 8 weeks (P < 0.001). Differences from baseline were significant after 1 week (P < 0.05). The mean weekly improvement in PUSH score was 2.0. Eleven patients healed within 8 weeks and none dropped out. Serum zinc levels increased significantly (P < 0.001), whereas serum copper levels (P = 0.001) and copper/zinc ratios (P < 0.001) decreased significantly. In one patient, preexisting copper deficiency deteriorated. These preliminary data suggest that polaprezinc may be effective and well-tolerated in 8-week treatment of pressure ulcers and could be a candidate for their oral treatment.
Similar content being viewed by others
References
Dorner B, Posthauer ME, Thomas D (2009) The role of nutrition in pressure ulcer prevention and treatment: National Pressure Ulcer Advisory Panel white paper. Adv Skin Wound Care 22:212–221
Sanada H, Miyachi Y, Ohura T, Moriguchi T, Tokunaga K, Shido K, Nakagami G (2008) The Japanese pressure ulcer surveillance study: a retrospective cohort study to determine prevalence of pressure ulcers in Japanese hospitals. Wounds 20:176–182
Gunningberg L (2006) EPUAP pressure ulcer prevalence survey in Sweden: a two-year follow-up of quality indicators. J Wound Ostomy Continence Nurs 33:258–266
National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel (2009) Prevention and treatment of pressure ulcers: clinical practice guideline. National Pressure Ulcer Advisory Panel, Washington DC
Whitney J, Phillips L, Aslam R, Barbul A, Gottrup F, Gould L, Robson MC, Rodeheaver G, Thomas D, Stotts N (2006) Guidelines for the treatment of pressure ulcers. Wound Repair Regen 14:663–679
Secretariat MA (2009) Management of chronic pressure ulcers: an evidence-based analysis. Ont Health Technol Assess Ser 9(3)
Sakae K, Agata T, Kamide R, Yanagisawa H (2013) Effects of L-carnosine and its zinc complex (Polaprezinc) on pressure ulcer healing. Nutr Clin Pract 28:609–616
Stechmiller JK (2010) Understanding the role of nutrition and wound healing. Nutr Clin Pract 25:61–68
Jaul E (2010) Assessment and management of pressure ulcers in the elderly: current strategies. Drugs Aging 27:311–325
Rennert R, Golinko M, Yan A, Flattau A, Tomic-Canic M, Brem H (2009) Developing and evaluating outcomes of an evidence-based protocol for the treatment of osteomyelitis in stage IV pressure ulcers: a literature and wound electronic medical record database review. Ostomy Wound Manage 55:42–53
Wilczweski P, Grimm D, Gianakis A, Gill B, Sarver W, McNett M (2012) Risk factors associated with pressure ulcer development in critically ill traumatic spinal cord injury patients. J Trauma Nurs 19:5–10
Peck A, Cohen CE, Mulvihill MN (1990) Long-term enteral feeding of aged demented nursing home patients. J Am Geriatr Soc 38:1195–1198
Mitchell SL, Kiely DK, Lipsitz LA (1997) The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment. Arch Intern Med 157:327–332
Nakao H, Yamazaki M, Tsuboi R, Ogawa H (2006) Mixture of sugar and povidone-iodine stimulates wound healing by activating keratinocytes and fibroblast functions. Arch Dermatol Res 298:175–182
Barnea Y, Weiss J, Gur E (2010) A review of the applications of the hydrofiber dressing with silver (Aquacel Ag) in wound care. Ther Clin Risk Manag 6:21–27
National Pressure Ulcer Advisory Panel (NPUAP) (1998) PUSH tool 3.0. http://www.npuap.org/wp-content/uploads/2012/03/push3.pdf. Accessed 13 Feb 2014
Bergstrom N, Braden BJ, Laguzza A, Holman V (1987) The Braden Scale for predicting pressure sore risk. Nurs Res 36:205–210
Ministry of Education, Culture, Sports, Science and Technology (2010) Standard tables of food composition in Japan—2010
Littell RC, Milliken GA, Stroup WW, Wolfinger RD, Schabenberger O (2006) Chapter 5 Analysis of repeated measures data. In: SAS for mixed models, Second Edition. SAS Institute Inc., Cary, NC, pp 159–203
Bennett G, Dealey C, Posnett J (2004) The cost of pressure ulcers in the UK. Age Ageing 33:230–235
Desneves KJ, Todorovic BE, Cassar A, Crowe TC (2005) Treatment with supplementary arginine, vitamin C and zinc in patients with pressure ulcers: a randomised controlled trial. Clin Nutr 24:979–987
Cereda E, Gini A, Pedrolli C, Vanotti A (2009) Disease-specific, versus standard, nutritional support for the treatment of pressure ulcers in institutionalized older adults: a randomized controlled trial. J Am Geriatr Soc 57:1395–1402
Tomita H, Tanaka M, Ikui A (2007) Clinical standard value for diagnosis of zinc deficiency by the serum zinc value on the basis of evidence [in Japanese]. Biomed Res Trace Elem 18:54–62
Japan Society for Biomedical Research on Trace Elements (2010) The lower cut-off of serum zinc level in healthy persons [in Japanese]. Biomed Res Trace Elem 21:182
Yanagisawa H, Moridaira K, Wada O (2000) Zinc deficiency further increases the enhanced expression of endothelin-1 in glomeruli of the obstructed kidney. Kidney Int 58:575–586
Yanagisawa H (2004) Zinc deficiency and clinical practice. JMAJ 47:359–364
Kawasaki I, Suzuki Y, Yanagisawa H (2013) Zinc deficiency enhances the induction of micronuclei and 8-hydroxy-2′-deoxyguanosine via superoxide radical in bone marrow of zinc-deficient rats. Biol Trace Elem Res 154:120–126
Tomita H (2002) Taste disorder and diet [in Japanese]. Kodansha Ltd, Tokyo
Weismann K, Hoyer H (1985) Serum alkaline phosphatase and serum zinc levels in the diagnosis and exclusion of zinc deficiency in man. Am J Clin Nutr 41:1214–1219
Council NR (2001) Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. The National Academies Press, Washington, DC
Gray M (2003) Does oral zinc supplementation promote healing of chronic wounds? J Wound Ostomy Continence Nurs 30:295–299
Brewer RD Jr, Mihaldzic N, Dietz A (1967) The effect of oral zinc sulfate on the healing of decubitus ulcers in spinal cord injured patients. Proc Annu Clin Spinal Cord Inj Conf 16:70–72
Norris JR, Reynolds RE (1971) The effect of oral zinc sulfate therapy on decubitus ulcers. J Am Geriatr Soc 19:793–797
Matsukura T, Tanaka H (2000) Applicability of zinc complex of L-carnosine for medical use. Biochemistry (Mosc) 65:817–823
Acknowledgments
We thank K. Sekiguchi for supporting assessments of dietary intake, as well as the nurses of Yashio Hospital and Morinoie Yashio for the evaluation of PUs and data collection. This study was not supported by research funds from external sources or by grants.
Conflict of Interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sakae, K., Yanagisawa, H. Oral Treatment of Pressure Ulcers with Polaprezinc (Zinc L-carnosine Complex): 8-Week Open-Label Trial. Biol Trace Elem Res 158, 280–288 (2014). https://doi.org/10.1007/s12011-014-9943-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12011-014-9943-5