Bacteriotherapy with Lactobacillus plantarum in diabetic foot ulcers. New therapy for wound healing

Abstract

Diabetic foot ulcers are caused by vascular and neurological complications in combination with persistent infections lead to an exaggerated inflammatory response and to a deficiency in the process of wound healing. Debridement is the most widely used technique to treat these wounds, but has low effectiveness. This has led to the search for alternative therapies. In previous studies we have shown that topical application of a total culture of Lactobacillus plantarum ( Lp ) favored the healing process of these ulcers . The aim of this work was to study the inflammatory response and cellular mechanisms and parameters related to the wound healing process exercised by Lp .30 type II diabetic patients with ulcers grade 3 as Wagner and more than 3 months duration were randomized into 2 groups: 15 received conventional treatment (debridement) and 15 a daily topical application of a total crop of 105 Lp . Patients were clinically evaluated for 30 days, and the concentration of blood glucose and glycosylated hemoglobin was evaluated serum. Biopsies were taken samples on day 0 , 10 and 30 post- treatment. The following studies were performed: a) Measurement of the wound area ; b ) Bacteriological studies: identification of bacterial strains and antibiograma ; c ) Histological studies : hematoxylin-eosin staining and van Gieson to study collagen deposition ; d ) Immunohistochemistry for identification of macrophage populations ( marking with CD 68) and study the angiogenic process using markers CD31 and CD34 ; e) In situ hybridization technique in biopsies and scraping wounds for identifying Lp . Treatment with L. plantarum was able to produce a significant reduction in wound area 100% in 60% of cases with greater presence of collagen deposition and a significant decrease in UFC / g throughout the entire treatment. 65 bacterial strains were isolated, which were 22% Staphylococcus aureus were isolated. The average percentage of macrophages was higher in the wounds treated with L. plantarum in relation to treatment with debridement. This population of immune cells located at the edges of the wound. The difference was statistically significant (p <0.001). The average percentage of CD34 + CD31 + cells was higher in the group of patients treated with LP in relation to the group of patients with debridement. The presence of live Lp in tissue biopsies up to 72 hours after application of the crop in the wounds was observed. Alternative treatment with L. plantarum favored the appearance of granulation tissue, collagen deposition in wounds and reepithelialization, regulating the inflammation and favoring the angiogenesis.