Effect Of Jiedu Tongmai Decoction On Endothelial Cells In Diabetic Foot Ulcer And Its Mechanism

Background:Diabetic foot ulcer is one of the serious complications of diabetes and a major cause of disability and death in patients with diabetes. Effectively promoting wound healing is the most important part of the treatment. Many factors are involved in wound healing process. Wound tissue angiogenesis plays a key role. EPCs, which can be able to differentiate into endothelial cells, is one kind of precursor cells. EPCs can promote angiogenesis and repair tissue. EPCs locate in the bone marrow at the early stage. When tissue damaged, EPCs can be mobilized to the peripheral blood and move to the injured tissue. However, in the diabetic state, the process is suppressed from the mobilization phase. So, how to repair this process is particularly important. Jiedu tongmai prescription was summed up through a long-term clinical practice. In the clinic, Jiedu tongmai prescription has been widely used in diabetic foot ulcer patients with Yuduzuluo Syndrome. That can promote wound healing and improve symptoms.Objective:To observe the clinical efficacy of Jiedu tongmai prescription. To investigate the impact of Jiedu tongmai prescription for EPCs and its mechanism, and infer the possible mechanisms of Jiedu tongmai prescription in the aspect of promoting wound healing.Method:The study include diabetic foot ulcer patients with Yuduzuluo Syndromes 60 cases, treatment group and control group were 30 cases. Two groups were given the same basic treatment. In addition, the treatment group was treated with Jiedu tongmai prescription. At the time of 0 days,7 days,14 days,21 days, recording the wound area, clinical symptoms and TCM symptom score of two groups of patients, evaluate the clinical efficacy of Jiedu tongmai prescription. At the time of 0 days,7 days,14 days,21 days, respectively drawning blood of two groups, by flow cytometry method to detect the quantity of EPCs, to observe the EPCs mobilization.By elisa method to detect VEGF and SDF-1 a levels of patient serum to explore possible mechanisms of EPCs mobilization. At the time of 0 days,7 days,14 days,21 days, respectively taking the tissue of Ulcers,by elisa method to detect VEGF and bFGF levels of tissue, immunohistochemistry was used to detect the density of ulcers microvessel, to observe the situation of EPCs homing to ulcers organization.Result:1. Clinical efficacy:At the aspect of wound area, pain, cold, TcP02, TCM symptom scores, the treatment group and the control group were different before and after treatment (P<0.05), the treatment group is better than the control group (P<0.05). In 0-7 days,7-14 days,14-21 days, the wound area, pain, cold feeling, TcPO2 of treat group showed a downward trend. In 7-14 days the trend of wound area and TcPO2 was obvious; In 0-14 days pain and cold was evident. In the ABI, the treatment group and the control group after treatment than before treatment were not significantly different (P> 0.05), and no significant difference in the two groups after the treatment (P> 0.05). In terms of total efficiency, total effective rate was 93.33% in the treatment group, the total effective rate was 80% in the control group, but the difference was not significant (P> 0.05).2.Mechanism:In the mobilization of EPCs. At the time of 7 days,14 days,21 days, treatment group and the control group were able to increase the mobilization of EPCs (P<0.05), mobilizing effect of the treatment group than the control group (P<0.05). At the time of 7 days,14 days,21 days, two groups were able to improve the VEGF, SDF-1α levels of peripheral blood (P<0.05), the treatment group was significantly higher than the control group after the treatment (P<0.05). At the time of 7 days,14 days,21 days, two groups were able to improve the VEGF, bFGF content of tissue (P<0.05), the treatment group was significantly higher than the control group after the treatment(P <0.05). In 0-7 days,7-14 days,14-21 days, the mobilization of EPCs, VEGF and SDF-1α levels of blood, VEGF and bFGF levels of tissue showed a upward trend. In 7-21 days,the tread of EPCs mobilization and SDF-1α of peripheral blood content was evident, VEGF levels of peripheral blood was evident in7-14 days, VEGF, bFGF content of tissue was obvious in 14-21 days. Correlation analysis showed:VEGF and SDF-1α levels of blood, VEGF and bFGF levels of tissue, EPCs showed a significant positive correlation (P<0.05). In the density of microvessel, the treatment group and the control group were increased before and after treatment (P< 0.05), the treatment group is better than the control group (P<0.05).Conclusion:1. Jiedu tongmai prescription can effectively alleviate cold, pain of patients with diabetic foot ulcer, improve Tcpao2 and reduce the wound area.2. Jiedu tongmai prescription can promote the mobilization of EPCs, which may be related to improve the content of peripheral blood VEGF and SDF-1a.3. Jiedu tongmai prescription can promote EPCs participate in tissue repair, which may be related to increasing VEGF and bFGF content and microvessel density of ulcers.In summary, Jiedu tongmai prescription can improve the clinical symptoms of patients with diabetic foot ulcer, and promote wound healing. Its possible mechanism is that Jiedu tongmai prescription increased mobilization of EPCs by increasing peripheral blood VEGF and SDF-1α contents, then increase VEGF and bFGF content and microvessel density of ulcers to promote wound healing.