EVALUATION OF THE EFFECT OF DIFFERENT CONCENTRATIONS OF ALOE VERA ON INFLAMMATION AND REEPITHELIALIZATION IN DIABETIC ULCERS IN A RAT MODEL
Objective: The objective of this research was to evaluate the effect of different concentrations of Aloe vera (AV) on inflammation of diabetic ulcers in a rat model.
Methods: The induction of diabetes was conducted by injection of alloxan monohydrate. This study involved four groups, including 0%, 10%, 30%, and inner leaf AV (ILAV) gel groups. Necrotic tissue, wound size, inflammation, and reepithelialization were evaluated. Wound tissue was collected on days 4 and 8. Histological analysis was performed by hematoxylin and eosin staining. Differences in the intensity of inflammation were analyzed using Kruskalâ€“Wallis test followed by Mannâ€“Whitney U-test.
Results: On day 13, wounds in gels containing AV were almost completely healed, whereas wounds in the 0% gel group (control) were still covered with necrotic tissue. On day 3, the intensity of inflammation in the 30% and ILAV groups was significantly less when compared to the 10% and control groups. On day 8, inflammation was less significant in the 10%, 30%, and ILAV groups when compared with the control group. Moreover, the intensity of inflammation in the 30% and ILAV groups was significantly less compared to the 10% group. In addition, reepithelialization was more advanced in the 10% and 30% ILAV groups compared with the control group, and reepithelialization was most advanced in the 30% and ILAV groups.
Conclusion: Our study indicated that gels containing AV reduced inflammation and improved reepithelialization of diabetic ulcers in a rat model. Therefore, it is highly recommended for clinicians to use AV gels for topical treatment of diabetic ulcers.
2. Armstrong DG, Boulton AJ, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med 2017;376:2367-75.
3. Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care 1990;13:513-21.
4. American Diabetes Association. Consensus development conference on diabetic foot Wound Care. Diabetes Care 1999;22:1354-60.
5. Moulik PK, Mtonga R, Gill GV. Amputation and mortality in new-onset diabetic foot ulcers stratefied by etiology. Diabetes Care 2003;26:491 4.
6. Kaya A, Aydin F, Altay T, Karapinar L, Ozturk H, Karakuz C. Can major amputation rates be decreased in diabetic foot ulcers with hyperbaric oxygen therapy? Int Orthop 2009;33:441-6.
7. Nain PS, Sanjeev K, Uppal SK, Garg R, Bajaj K, Garg S. Role of negative pressure wound therapy in healing of diabetic foot ulcers. J Surg Tech Case Rep 2011;3:17-22.
8. Eshun K, He Q. Aloe vera: A valuable ingredient for the food, pharmaceutical and cosmetic industriesâ€”a review. Crit Rev Food Sci Nutr 2004;44:91-6.
9. Akhoondinasab MR, Akhoondinasab M, Saberi M. Comparison of healing effect of Aloe vera extract and silver sulfadiazine in burn injuries in experimental rat model. World J Plast Surg 2014;3:29-34.
10. SÃ¡nchez-Elsner T, Botella LM, Velasco B, CorbÃ A, Attisano L, BernabÃ©u C. Synergistic cooperation between hypoxia and transforming growth factor-Î² pathways on human vascular endothelial growth factor gene expression. J Biol Chem 2001;276:38527-35.
11. Chithra P, Sajithlal GB, Chandrakasan G. Influence of Aloe vera on the healing of dermal wounds in diabetic rats. J Ethnopharmacol 1998;59:195-201.
12. Daburkar M, Lohar V, Rathore A, Bhutada P, Tangadpaliwar S. An in vivo and in vitro investigation of the effect of Aloe vera gel ethanolic extract using animal model with diabetic foot ulcer. J Pharm Bioallied Sci 2014;6:205-12.
13. Widia W. Formulasi Sediaan gel Ekstrak Etanol Daun Lidah Buaya (Aloe Vera) Sebagai anti Jerawat Dengan Basis Sodium Alginate dan Aktivitas Anti Bakterinya Terhadap Staphylococcus epidermidis. Unpublished; 2015.
14. Sari Y, Saryono S, Purnawan I, Hartono H. Modification of breast pump as a negative pressure wound therapy for accelerating wound healing of diabetic ulcer. J Ners 2014;10. Available from: http://www.ejournal. unair.ac.id/index.php/JNERS/article/view/2037/1499. [Last accessed on 2018 Dec 01].
15. Wright JB, Lam K, Buret AG, Olson ME, Burrell RE. Early healing events in a porcine model of contaminated wounds: Effects of nanocrystalline silver on matrix metalloproteinases, cell apoptosis, and healing. Wound Repair Regen 2002;10:141-51.
16. McLennan S, Yue DK, Twigg SM. Molecular aspects of wound healing in diabetes. Primary Intention 2006;14:8-13.
17. Soneja A, Drews M, Malinski T. Role of nitric oxide, nitroxidative and oxidative stress in wound healing-review. Pharmacol Rep 2005;57:108 19.
18. Liu PH, Chen D, Jie S. Chemical constituents, biological activity and agricultural cultivation of Aloe vera. Asian J Chem 2013;25:6477-85.
19. Fizquez B, Avila G, Segura LD, Escalante B. Antiinflammatory activity of extracts from Aloe vera gel. J Ethnopharmacol 1996;55:69-75.
20. Kudalkar MD, Nayak A, Bhat KS, Nayak RN. Effect of Azadirachta indica (Neem) and Aloe vera as compared to subantimicrobial dose doxycycline on matrix metalloproteinases (MMP)-2 and MMP-9: An in-vitro study. Ayu 2014;35:85-9.
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