This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Duckworth, W. C. Articles by Page, J. C. Search for Related Content PubMed PubMed Citation Articles by Duckworth, W. C. Articles by Page, J. C.

Insulin-Degrading Activity in Wound Fluid

Carl T. Hayden Veterans Affairs Medical Center, Phoenix, Arizona 85012

Address all correspondence and requests for reprints to: William C. Duckworth, M.D., Carl T. Hayden Veterans Affairs Medical Center (CS111E), 650 East Indian School Road, Phoenix, Arizona 85012

Patients with diabetes are at great risk of developing lower extremity ulcers. The management of diabetic foot ulcers typically includes early recognition and appropriate clinical care. Recent advances in wound treatment include topical growth factor therapy, which has been successful in diabetic wounds. Growth factors are decreased in wound fluid; this may be due to decreased supply, increased binding, or increased degradation of the naturally occurring growth factors. This study investigates the activity of the insulin-degrading enzyme in wound fluid. Wound fluid was obtained from patients with (n = 17) and without (n = 4) diabetes. Insulin degradation was assayed by incubating [¹²⁵I]insulin with wound fluid and precipitation in trichloroacetic acid. Fluid from nondiabetics degraded 2.22 ± 0.73%, whereas diabetic fluid degraded significantly more (6.13 ± 1.48%; P < 0.05). In patients with diabetes, the degradation of insulin by wound fluid correlated with glucose control (hemoglobin A_1c; r² = 0.5353; P < 0.001), and patients with worse outcomes (i.e. amputation) had higher wound fluid insulin degradation. The biochemical characteristics of insulin degradation in the wound fluid were consistent with the characteristics of insulin-degrading enzyme. These data suggest that glucose control is a critical factor in wound healing, but a reduction in the insulin-degrading activity in the wound fluid is also a potential therapeutic target.

This work was supported in part by a Veterans Affairs Merit Review (to W.C.D.).

Abbreviations: HbA_1c, Hemoglobin A_1c; IDE, insulin-degrading enzyme; NEM, N-ethylmaleimide; PDGF, platelet-derived growth factor; TCA, trichloroacetic acid; V.A.C., Vacuum-Assisted Closure.

This article has been cited by other articles:

				S. M. Bauer, R. J. Bauer, and O. C. Velazquez Angiogenesis, Vasculogenesis, and Induction of Healing in Chronic Wounds Vascular and Endovascular Surgery, July 1, 2005; 39(4): 293 - 306. [Abstract] [PDF]