Topical application of lyophilized and powdered human amniotic membrane promotes diabetic ulcer healing

Abstract

Background

Amniotic membrane has been widely used in the treatment of several acute and chronic diseases, and surgical reconstructions. Here we report the successful application of a commercial lyophilized, powdered, amniotic membrane (AMX) to a patient with a treatment-refractory diabetic ulcer, with further investigations on AMX angiogenic and anti-inflammatory properties.

Objective

To investigate the topical, continuous, treatment with AMX on a chronic diabetic foot ulcer, along with its angiogenic in vitro properties and proteomic profile.

Methods

A 77-year old woman was treated with AMX 2–3 drops 4–6 times a day for 2 months. Amniotic fluid stem cells were tested for proliferation and angiogenesis potential with or without AMX. ELISA quantification was conducted on NGF, TGF-alpha, NT-3, and IL1-ra. Proteomic analysis was also performed on AMX.

Results

At 2-month follow-up, the ulcer was reduced by 60% and it remained steady after 3-months. At 4-month follow-up, the lesion showed signs of re-epithelization. Cells, with or without AMX, were prone to form endothelial tubules with similar characteristics. Proteomic analysis confirmed that AMX retains proteins involved in anti-inflammatory and angiogenesis pathways.

Conclusions

AMX ameliorated pain and extent of a chronic diabetic ulcer. The effect could be ascribed to angiogenesis and epithelium stimulation that was confirmed in in vitro. Multiple wound healing-involved proteins were detected but further studies are needed to assess their specific role.