Chronic wounds, a study

Epidemiology of Chronic Wound Patients and Relation to Serum Levels of Mannan-binding Lectin, by Bitsch, Laursen et al (2009):

“The aim of this study was to describe the epidemiology of chronic wounds in a large cohort of patients from a tertiary hospital out-patient clinic, and examine the significance of serum mannan-binding lectin for the occurrence and clinical presentation of such wounds.The study comprised 489 consecutive patients with chronic foot and leg ulcers. A clinical classification of wound-aetiology was performed, and mannan-binding lectin was measured in the sera of patients and healthy controls. The patients presented with 639 wounds altogether; diabetic foot ulcers (309), venous leg ulcers (188), arterial ulcers (109), and vasculitis (33).”

[The people doing the study are from Copenhagen Wound Healing Center. Notice how many of the patients are diabetic? That’s not a coincidence]

“Mannan-binding lectin (MBL) is an important component of the humoral innate immune system, and MBL possesses several characteristics indicating that it may play an essential role in wound healing; i.e. modulating inflammation and contributing to the clearance of microorganisms and apoptotic cells (3, 4). Deficiency in MBL might therefore contribute to prolonged healing.” […] “Whether MBL plays a direct role in prevention or reduction of the “bio-burden” of chronic wounds is unclear. Chronic wounds colonised with bacteria are often neither infected nor inflamed, and when infection does appear antibiotic treatment will be initiated immediately – or may even have been given prophylactic. This indicates that MBL – shown to be associated with susceptibility and severity of infections – primarily functions upstreams to the manifestation of the chronic leg ulcer as different mechanisms appear to initiate and maintain the leg ulcer.” […] “Like other immune components MBL may act as a double-edged sword; in some clinical contexts MBL deficiency may be advantageous as protection against complement-mediated tissue injury. Studies of patients with type 1 diabetes have shown significantly elevated levels of MBL to be positively correlated with markers of renal complications and nephropathy (26, 27), possibly indicating that MBL may play a pathogenetic role or be a risk factor in type 1 diabetes. Diabetic foot ulcer is most frequently presented by type 2 diabetics, who also constitute the majority of patients in the present study. A follow-up study of Danish type 2 diabetics showed their risk of dying to be significantly correlated to high MBL, indicating an implication in diabetic vascular complication (28). Whether such MBL-associated vascular complications also contribute to the development of chronic foot ulcer in diabetic patients needs further investigation.

In conclusion, in a cohort of chronic foot and leg ulcer patients with different aetiological backgrounds, those with ulcers due to venous insufficiency, alone or in combination with other aetiologies, expressed significantly lower MBL concentrations than the healthy controls. The inverse pattern was seen in diabetic and arterial ulcer patients, who expressed significantly higher MBL levels. This indicates different roles for MBL in the development of ulcers in the different groups of patients; and the significant correlation of MBL deficiency to venous leg ulcer suggests that MBL substitution might be a relevant therapy for this group of patients.”

Basically there seems to still be a lot of work to be done and a lot of stuff ‘we’ (the experts that is, I’m not including myself in that ‘we’…) don’t understand, or at least don’t know for certain if they know yet, but someone are actually doing some of that work right now. As someone who might benefit from this research, all I can say is: Just keep working you guys!


October 25, 2010 - Posted by | Data, Diabetes, Immunology, Medicine, Studies

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