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Angiogenic Effects of Low-Intensity Cathodal Direct Current on Ischemic Diabetic Foot Ulcersa Randomized Controlled Trial Publisher Pubmed



Asadi MR1, 2 ; Torkaman G2 ; Hedayati M3 ; Mohajeritehrani MR4 ; Ahmadi M5 ; Gohardani RF6
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Authors Affiliations
  1. 1. Department of Physical Therapy, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
  2. 2. Physical Therapy Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
  3. 3. Cellular and Molecular Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  4. 4. Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
  6. 6. Hajar Hospital, Tehran, Iran

Source: Diabetes Research and Clinical Practice Published:2017


Abstract

Aims This study investigated the effect of low-intensity cathodal direct current (CDC) of electrical stimulation (ES) on the release of hypoxic inducible factor-1α (HIF-1α), nitric oxide (NO), vascular endothelial growth factor (VEGF), and soluble VEGF receptor-2 (sVEGFR-2) in the wound fluid of ischemic diabetic foot ulcers (DFUs). Methods This study was a randomized, single-blind, placebo-controlled trial. Thirty type 2 diabetes patients with ischemic foot ulcerations were randomly assigned to receive either low-intensity CDC at sensory threshold (ES group, n = 15) or placebo treatment (control group, n = 15) for 1 h/day, 3 days/week, for 4 weeks (12 sessions). After debridement during the first and twelfth treatment sessions, wound fluid was collected before and after ES application to determine the levels of HIF-1α, NO, VEGF, and sVEGFR-2. Wound surface area (WSA) was measured at the first, sixth, and twelfth sessions. Results At the first session, after ES application, wound-fluid levels of HIF-1α were significantly increased (+61.98 pg/mL) compared to the control group (−3.85 pg/mL, P = 0.01). After ES application at the first and twelfth sessions, wound-fluid levels of VEGF were also significantly increased (+36.77 and +39.57 pg/mL, respectively) compared to the control group (+4.15 and +0.15 pg/mL, P = 0.007 and P = 0.019, respectively). There was no significant effect on NO and sVEGFR-2 levels between the groups. Conclusions Low-intensity CDC has positive effects on the release of HIF-1α and VEGF in the wound area of ischemic DFUs. Furthermore, our results suggest that applying ES to ischemic DFUs can be a promising way to promote angiogenesis and to achieve better outcomes in diabetic wound healing. © 2017 Elsevier B.V.
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