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Laser photobiomodulation in pressure ulcer healing of human diabetic patients: gene expression analysis of inflammatory biochemical markers

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Abstract

Pressure ulcers (PU) are wounds located mainly on bone surfaces where the tissue under pressure suffers ischemia leading to cellular lesion and necrosis , its causes and the healing process depend on several factors. The aim of this study was evaluating the gene expression of inflammatory/reparative factors: IL6, TNF, VEGF, and TGF, which take part in the tissue healing process under effects of low-level laser therapy (LLLT). In order to perform lesion area analysis, PUs were photographed and computer analyzed. Biochemical analysis was performed sa.mpling ulcer border tissue obtained through biopsy before and after laser therapy and quantitative real-time PCR (qRT-PCR) analysis. The study comprised eight individuals, mean age sixty-two years old, and sacroiliac and calcaneous PU, classified as degree III and IV according to the National Pressure Ulcer Advisory Panel (NPUAP). PUs were irradiated with low-level laser (InGaAIP, 100 mW, 660 nm), energy density 2 J/cm2, once a day, with intervals of 24 h, totaling 12 applications. The lesion area analysis revealed averaged improvement of the granulation tissue size up to 50% from pre- to post-treatment. qRT-PCR analysis revealed that IL6 values were not significantly different before and after treatment, TNF gene expression was reduced, and VEFG and TGF-β gene expression increased after treatment. After LLLT, wounds presented improvement in gross appearance, with increase in factors VEFG and TGF-β, and reduction of TNF; despite our promising results, they have to be analyzed carefully as this study did not have a control group.

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Author information

Authors and Affiliations

  1. Biological and Health Science, Multidisciplinary Laboratory, State University of Ponta Grossa (UEPG), Av. Gal. Carlos Cavalcanti, 4748, Ponta Grossa, PR, 84030-900, Brazil

    Anelice Calixto Ruh & Giovani Marino Favero

  2. Laser in Dentistry Program, Cruzeiro do Sul University (UNICSUL), Av. Dr. Ussiel Cirilo 225, São Miguel Paulista, SP, 08060-070, Brazil

    Lúcio Frigo & Marcos Fernando Xisto Braga Cavalcanti

  3. Rua Galvão Bueno 868, Liberdade, SP, 01506-000, Brazil

    Lúcio Frigo & Marcos Fernando Xisto Braga Cavalcanti

  4. Faculté de Médecine, UMR 7365 CNRS-Université de Lorraine, 9, avenue de la Forêt de Haye, 54500, Vandoeuvre-lés-Nancy, France

    Marcos Fernando Xisto Braga Cavalcanti & Natalia De Isla

  5. Departamento de Biologia Estrutural, Molecular e Genética, State University of Ponta Grossa (UEPG), Av. Carlos Cavalcanti, 4748, Ponta Grossa, PR, 84030-900, Brazil

    Paulo Svidnicki & Viviane Nogaroto Vicari

  6. Center for Research and Innovation in Laser, Nove de Julho University (UNINOVE), Rua Vergueiro 235, São Paulo, SP, 01504-001, Brazil

    Rodrigo Alvaro Brandão Lopes-Martins & Ernesto Cesar Pinto Leal Junior

  7. Technologycal Innovation Center, Mogi das Cruzes University, Av. Candido Almeida de Xavier e Souza, 200, Mogi das Cruzes, SP, 08780-911, Brazil

    Rodrigo Alvaro Brandão Lopes-Martins

  8. Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University, Chieti-Pescara, 66100, Chieti, Italy

    Francesca Diomede & Oriana Trubiani

Authors
  1. Anelice Calixto Ruh
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  2. Lúcio Frigo
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  3. Marcos Fernando Xisto Braga Cavalcanti
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  4. Paulo Svidnicki
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  5. Viviane Nogaroto Vicari
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  6. Rodrigo Alvaro Brandão Lopes-Martins
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  7. Ernesto Cesar Pinto Leal Junior
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  8. Natalia De Isla
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  9. Francesca Diomede
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  11. Giovani Marino Favero
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Corresponding author

Correspondence to Marcos Fernando Xisto Braga Cavalcanti.

Ethics declarations

The Research Ethics Committee of Ponta Grossa University (COEP-UEPG) approved this study (protocol number 07897/11, decision 48/2011) that was performed in accordance with the ethical standards suggested by the Guidelines and Norms Regulating Research Involving Human Beings according to the Resolution of the National Health Council, n. 466 of 2012. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

Professor Ernesto Cesar Pinto Leal-Junior receives research support from Multi Radiance Medical (Solon, OH-USA), a laser device manufacturer. Multi Radiance Medical had no role in the planning of this study, and the laser device used was not theirs. They had no influence on study design, data collection and analysis, decision to publish, or preparation of the manuscript. The remaining authors declare that they have no conflict of interests.

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Ruh, A.C., Frigo, L., Cavalcanti, M.F.X.B. et al. Laser photobiomodulation in pressure ulcer healing of human diabetic patients: gene expression analysis of inflammatory biochemical markers. Lasers Med Sci 33, 165–171 (2018). https://doi.org/10.1007/s10103-017-2384-6

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  • DOI: https://doi.org/10.1007/s10103-017-2384-6

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