Growth Factors and Cytokines

Colony-stimulating factor (CSF) Epidermal growth factor (EGF) Fibroblast growth factor (FGF) Insulin-like growth factor (IGF) Interleukins (ILs)

Interferon-a (INF-a) and INF-a 2b Platelet-derived growth factor (PDGF) Transforming growth factor-ß (TGF-ß)

Growth factors (GFs), unlike steroids that penetrate the cell, attach to the cell membrane, and their actions are primarily autocrine (action is on the cell that produced the GF), juxtacrine (action is on the adjacent cell), paracrine (action is on the local environment), and, of least importance, endocrine (action is on a distant cell).

Fibroblast GF and GF-a and GF-P have shown to be of little benefit in wound healing; however, platelet-derived GF (AA, AB, and B) and particularly recombinant platelet-derived GF (becaptermin) have been shown to be of value in diabetic foot ulcer healing.

Platelet-rich plasmas (PRPs) are used in a variety of clinical applications, based on the premise that higher growth factor content should promote better healing. PRP supernatants promote strong osteoblast and endothelial cell divisions, supporting the concept that PRPs may be beneficial in wound healing.5-7 There are approximately 6 kg of protein in a 70-kg human. Losing one third of this compartment almost always leads to death. Weight loss and impaired nutritional status are associated with increased complications following injury or surgery. There is a significant reduction in the plasma C-reactive protein response in malnourished patients but no difference from controls in the responses of a-1-antitrypsin, a-1-acid glycoprotein, or in the trace elements iron or zinc, which reflect induction of ferritin and metallothionein, respectively.

There is an early increase in IL-6, soluble receptors of tumor necrosis factor (TNF), and in IL-1 receptor antagonist in both groups, but there is no detectable increase in plasma TNF or IL-1. There is no difference between the well-nourished and malnourished group for any of these markers of cytokine network activation. Weight loss is therefore associated with a reduction in aspects of the acute phase response, but this is due to impaired effectiveness rather than to reduced magnitude of the cytokine response.8

To sum up, in addition to this complex array of wound mediators, appropriate nutrition support, meticulous debridement, and vigilant infection control play important roles in the arena of wound healing. The extent of nutritional repletion and its impact on wound healing continues to deserve aggressive study.

Savvy clinicians would intuitively agree that good nutritional status is key for patient wellbeing and in turn must play an essential role in the wound healing process. Ignoring nutritional status may compromise the patient's ability to heal and subsequently prolong the stages of wound healing.

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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