Explore The Mechanism Of MEBO In Treating DFU By Network Pharmacology And The Experience Summary Of The Therapy Of Different Graded Stage

Objective: 1.To explore the potential mechanism of action of Moist Exppsed Burn Ointment(MEBO)in the treatment of diabetic foot ulcer(DFU).2.Summarizing the clinical experience of using Skin regenerative medical technology(MEBT/MEBO)in the treatment of DFU.Methods: 1.Network pharmacology research and molecular docking : the main pharmaceutical active ingredients(MW<500U and DL≥0.18)of traditional Chinese medicine(Huangqi,Huanglian,Huangbai,Yingsuke)in MEBO were screened out from the TCMSP database.The targets of diabetic foot ulcer were screened out through Gene Cards,Pharm Gkb,and TTD.The targets of MEBO for the treatment of DFU were obtained through target mapping,and using the score of Degree to screen out the core targets of MEBO,and imports the core targets into the STRING database to construct a protein-protein interaction network.The Metascape database was used to perform GO enrichment analysis and KEGG pathway enrichment analysis of core targets to predict the mechanism of MEBO in the treatment of DFU.Molecular docking of core active ingredients of drugs with core targets to validate predictions.2.A retrospective analysis was conducted for DFU inpatients in Peripheral vascular department of wound repair Department of The First Affiliated Hospital of Guangxi University of Chinese Medicine from September 2021 to December 2022,and the effect of using MEBO in the treatment of DFU using the standard for graded staging was discussed and summarized.Results: 1.A total of 131 active ingredients of MEBO,261 related targets,and a total of 2844 DFU-related target proteins were collected through network pharmacology research.There are 165 common target proteins between MEBO and DFU,among which the predicted core targets are HSP90AA1,TP53,AKT1,TNF,IL-6,etc.There are 5274 biological processes,468 cell components and 846 molecular functions were analyzed by GO enrichment.There were 261 pathways through KEGG pathway enrichment.The molecular docking results showed that apigenin and wogonin could stably dock with HSP90AA1(5J80),quercetin and ESR1(7BAA).2.The results showed that there were 1 case of Wagner-II black stage,8 cases of Wagner-II yellow stage,1 case of Wagner-II black stage and yellow stage,5cases of Wagner-III black stage,13 cases of Wagner-III yellow stage,1 case of Wagner-III black stage and yellow stage,7 cases of Wagner-IV black stage and 4 cases of Wagner-IV yellow stage.In the statistics of the number and location of wounds,there were 71 wounds in 40 patients,with the highest proportion(56.34%)of the affected areas being the toes,a total of 40 wounds;The lowest proportion is heel,accounting for 2.82%.In terms of treatment methods,according to the collected case data,40 patients were treated with different kinds of surgery and MEBT/MEBO.Among the 40 patients,only 4cases used MEBO before operation,31 cases used MEBO only after operation,5 cases used MEBO dressing change treatment throughout the course,34 cases changed dressing at home after discharge,5 cases needed to change dressing at the outpatient clinic,and 1 case changed to other methods of treatment.The syndrome score of 35 patients before treatment was(19.71 ±7.87)points,and the syndrome score after treatment was(8.57 ± 5.89)points.The post-average was 11.14 points lower than the pre-average,P<0.01.The results of integral changes before and after treatment at discharge showed that 7 cases were ineffective,17 cases were effective,15 cases were significantly effective,and 1 case was clinically cured,with a total effective rate of 82.50%.Of the 40 DFU inpatients,the minimum length of hospitalization was 7 days,and the longest was 29 days,with an average of17.00 ± 5.63 days.In terms of healing time,there were 38 patients within 6month,and 2 patients without healing more than 6 months.At discharge,there were 8 cases with wound grade of Wagner-I powder stage,13 cases with Wagner-II red stage,12 cases with Wagner-II yellow stage,3 cases with Wagner-III yellow stage,2 cases with Wagner-III red stage,and 1 case with Wagner-IV black stage.The difference was statistically significant(P<0.01).Conclusion(s): 1.Research on the treatment of DFU by MEBO may be through many effective constituent including quercetin,apigenin,baicalein,β-sitosterol,acting on many targets such as AKT1,TNF,IL-6,and effects by regulating the AGEs-RAGE signaling pathway in diabetic complications,PI3K-AKT signaling pathway,IL-17 signaling pathway,TNF signaling pathway and other signaling pathways.2.Normatively using MEBT/MEBO to treat DFU wounds in different Wagner grade and TIME stage can achieve good efficacy,MEBO as a drug,but also need to cooperate with MEBT/MEBO(pioneering cultivation,cannibalization debridement,etc.)to treat the wound,early use of MEBO can liquefy,drain necrotic tissue and protect the wound,postoperative use of MEBO is very critical to the preparation of the wound bed,in addition,pay attention to dry gangrene necrosis level is not determined before MEBO treatment.Patients have high acceptance and easy operation of standardized MEBT/MEBO graded staging for DFU,which is worthy of further promotion in clinical practice.