Dipeptidyl peptidase 4 inhibition may facilitate healing of diabetic foot ulcers

NewsBot · Dec 1, 2012

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Dipeptidyl peptidase 4 inhibition may facilitate healing of chronic foot ulcers in patients with type 2 diabetes.
Marfella R, Sasso FC, Rizzo MR, Paolisso P, Barbieri M, Padovano V, Carbonara O, Gualdiero P, Petronella P, Ferraraccio F, Petrella A, Canonico R, Campitiello F, Della Corte A, Paolisso G, Canonico S.
Exp Diabetes Res. 2012;2012:

The pathophysiology of chronic diabetic ulcers is complex and still incompletely understood, both micro- and macroangiopathy strongly contribute to the development and delayed healing of diabetic wounds, through an impaired tissue feeding and response to ischemia. With adequate treatment, some ulcers may last only weeks; however, many ulcers are difficult to treat and may last months, in certain cases years; 19-35% of ulcers are reported as nonhealing. As no efficient therapy is available, it is a high priority to develop new strategies for treatment of this devastating complication. Because experimental and pathological studies suggest that incretin hormone glucagon-like peptide-1 may improves VEGF generation and promote the upregulation of HIF-1α through a reduction of oxidative stress, the study evaluated the effect of the augmentation of GLP-1, by inhibitors of the dipeptidyl peptidase-4, such as vildagliptin, on angiogenesis process and wound healing in diabetic chronic ulcers. Although elucidation of the pathophysiologic importance of these aspects awaits further confirmations, the present study evidences an additional aspect of how DPP-4 inhibition might contribute to improved ulcer outcome.
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Admin2 · Dec 1, 2012

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Other thread tagged with diabetic foot ulcer and wound healing

NewsBot · Mar 8, 2015

Evidence based mechanism of Dipeptidyl peptidase IV (DPP4) inihibitors in diabetic foot ulcer healing
Rathnayake, Ayeshmanthe, Saboo, Apoorva, Vangaveti, Venkat N., and Malabu, Usman H.
Annals of the Australasian College of Tropical Medicine, 15 (3). p. 53.

Background/Aims: Diabetic foot wounds are one of the most serious complications of the disease giving rise to 84% of all diabetes-related lower limb amputations. Anti-diabetic drug - dipeptidyl peptidase IV (DPP-4) inhibitors have been reported to improve diabetic foot wound healing. However little is known on how it occurs. The objective of the study was to review DPP-4 inhibitors' mechanism of wound healing in subjects with diabetic foot ulcers.
Methods: Published data on DDP-4 inhibitors in wound healing were sought from Medline, PubMed and Google Scholar search of English language literature from 1994 to 2014 using the key words such as "DPP-4 inhibitors", "endothelial healing" "diabetes" and "chronic ulcers".
Results: DPP-4 inhibitors show a potential benefit in processes of wound healing in diabetic chronic foot ulcers. The enzyme inhibitors promote recruitment of endothelial progenitor cells and allow the final scaffolding of wounds. Furthermore DPP-4 inhibitors augment angiogenesis and have widespread effects on optimising the immune response to persistent hypoxia in chronic diabetes wounds.
Conclusion: DPP-4 inhibitors show promise in the local wound healing of diabetic foot ulcers through multiple mechanisms. In the light of high rate of amputations due to non-healing ulcers with profound psychological and economical liability, more investigations on the new role of DPP-4 inhibitors in treatment of diabetic foot ulcer are needed.
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NewsBot · May 22, 2015

Wound healing effects of dipeptidyl peptidase-4 inhibitors: an emerging concept in management of diabetic foot ulcer –a review
Apoorva Saboo, Ayeshmanthe Rathnayake, Venkat N. Vangaveti, Usman H. Malabu,
Diabetes & Metabolic Syndrome: Clinical Research & Reviews
Available online 25 April 2015

Objective
Dipeptidyl peptidase-4 (DPP-4) inhibitors have a well-known effect on glycaemic control in patients with diabetes but little is known on their wound healing role in this group of population. This paper reviews the effects of DPP-4 inhibitors on wound healing of diabetic foot ulcers.

Methods
Published data on effects and mechanism of DDP-4 inhibitors on wound healing were derived from Medline, PubMed and Google Scholar search of English language literature from 1994 to 2014 using the key words such as “DPP-4 inhibitors”, “endothelial healing” “diabetes” and “chronic ulcers”.

Results
DPP-4 inhibitors show a potential benefit in processes of wound healing in diabetic chronic foot ulcers. The enzyme inhibitors promote recruitment of endothelial progenitor cells and allow the final scaffolding of wounds. Furthermore DPP-4 inhibitors augment angiogenesis and have widespread effects on optimising the immune response to persistent hypoxia in chronic diabetes wounds.

Conclusion
DPP-4 inhibitors show promise in the local wound healing of diabetic foot ulcers in addition to its already established glycaemic control. In the light of high rate of amputations due to non-healing ulcers with profound psychological and economical liability, more investigations on the usefulness of DPP-4 inhibitors in the high risk diabetes population are needed.
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NewsBot · Nov 20, 2018

Incretin-based therapy for diabetic ulcers: from bench to bedside.
Ku HC, Liang YJ
Expert Opin Investig Drugs. 2018 Nov 19

Diabetic foot ulcers are a serious complication of diabetes and are associated with pain, disability and poor quality of life. Incretin-based therapy is available for type-2 diabetes. Aside from glucose control, such treatment can impart numerous beneficial effects. Areas covered: This review summarizes the preclinical and clinical evidence supporting incretin-based treatment approaches for diabetic ulcers. Expert opinion: Incretin-based therapy may have a role in the treatment of diabetic foot ulcers; the benefits of such treatment arise from attenuation of inflammatory response, improvement of keratinocyte migration, induction of angiogenesis and the enhancement of tissue remodeling. Large-scale clinical trials are required to determine the advantages of GLP-1 receptor agonists and DPP4 inhibitors. Future research on the topical application of incretin-based therapy is necessary. Such therapeutic approaches may provide new hope in improving the treatment of impaired diabetic foot ulcers.
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NewsBot · Jul 4, 2022

Role of Dipeptidyl Dipeptidase 4 Inhibitors in the Management of Diabetic Foot
Wen-Hui Yu et al
Int J Low Extrem Wounds. 2022 Feb 28

Background: Patients with diabetes mellitus face difficulties in wound healing. It is important to explore therapeutic options for diabetic complications such as ulcers. This study evaluates the role of dipeptidyl dipeptidase 4 inhibitors (DPP4i) in the management of diabetic foot. Methods: Literature search was conducted in electronic databases (Google Scholar, Ovid, PubMed, Science Direct, and Springer) and studies were selected for inclusion if they reported the incidence rate of diabetic foot ulcer during DPP4i treatment or evaluated the effect of DPP4i on wound healing. Incidence rates of foot ulcer, amputation and peripheral vascular disease were pooled to achieve overall estimates. Meta-analyses of odds ratios were performed to evaluate the risk of foot ulcer, amputation, and peripheral vascular disease with DPP4i, and to examine the effect of DPP4i treatment on ulcer healing. Results: Ten studies (532354 DPP4i and 2092010 non-DPP4i treated diabetes patients) were included. Incidence rates of foot ulcer, amputation, and peripheral vascular disease were 3.80 [95% confidence interval (CI): 0.22, 7.39], 0.82 [95%CI: 0.60, 1.05], and 22.33 [95%CI: 9.14, 35.53] per 1000 person-years respectively in patients treated with DPP4i and 3.60 [95%CI: 1.77, 5.39], 0.76 [95%CI: 0.58, 0.94], and 20.9 [95%CI: 16.04, 25.81] per 1000 person-years respectively in patients treated with non-DPP4i drugs. Risk of ulcer or amputation with DPP4i was not consistent across studies. Odds of non-healing of ulcer were significantly lower with DPP4i in comparison with controls (odds ratio: 0.27 [95%CI: 0.10, 0.71]; p = 0.008). Conclusion: Incidence rates of diabetic foot and amputation are found to be similar with DPP4i and non-DPP4i drugs. DPP4i improved wound healing of diabetic foot in 3-month randomized trials.
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