Diabetic Wound Healing in Biomolecular Perspective

THE COMPARATION ROLE OF PROANGIOGENIC GROWTH FACTOR AND CYTOKINE IN NORMAL AND DIABETIC ULCER WOUND HEALING

Adeodatus Yuda Handaya¹⁾, Hendra Susanto^2)
1) General and Laparoscopic Surgeon RSUD Kepanjen Malang

²⁾ Animal Physiology Laboratory Biology Departement Mathematic and Science Faculty State University of Malang

email: yudahandaya@yahoo.com

hendrafaal@yahoo.com

ABSTRAK

Diabetic ulcer is major health problem for diabetic patient. Amputation of lower extremity is the main complication in diabetic ulcer. Fifteen percent of diabetic ulcer patient has amputation risk during their life. Diabetic ulcer is remain become a part of general diabetic complication and also inisiator on the non traumatic lower extremity leg amputation in every country in the world. Neuropathy, decreasing of blood circulation sustainbility to the infection is three important point that have a role to the development of diabetic ulcer and delayed revascularization in diabetic case. Wound healing is  a process that consist of coagulation phase, inflammation, cells proliferation, matrix repaired, epithelialization and remodelling on wound tissue. All of this phase are categorized from cellular component activity, like fibroblast, miofibroblast, visceral muscle cells, endothelial cells, keratinocyte and immune cells, specific cytokine and growth the wound site. Decreasing of the role of growth factor and cytokine inhibit vasculogenesis and causing the delayed wound healing process in diabetic patient. A number of molecular target within cells that become a potent factor to succesing wound healing process included immunomodulator, neuropeptide, growth factor and other molecular agent. In the diabetic ulcer wound healing process , the major problem is delayed angiogenesis in the wound site and make the wound are progress to the chronic diabetic ulcers. This fact is caused by decreasing of growth factor and cytokine expression that contribute in this process. The important process on wound healing are majorly regulated by growth factor such as platelet-derived growth factor (PDGF), insulin-like growth factor-1 (IGF-1), epidermal growth factor (EGF), fibroblast growth factor (FGF), and transforming growth factor-beta (TGF-beta). In other hand role of proinflammatory cytokine (TNF-α, IL-1, IL-2. IL-6, IL-8) and anti-inflammatory cytokine (IL-4, IL-10) is dominant in the wound healing rate. Systemic effect in diabetic case is generally caused by cells dysfunction that stimulate wound healing destruction. This event are important to knowing molecular comparation of between normal and diabetic ulcer wound healing as the first step to developing therapy on clinic. A various diabetic ulcer management should be directed to molecular therapy on every stage of wound healing to prevent delayed healing in diabetic wound site and decreasing the amputation case in diabetic patient.

Key Word : Diabetic ulcer, Wound healing, Growth Factor, Cytokine, Angiogenesis