Therapie chronischer Wunden mit wassergefiltertem Infrarot A (wIRA)

The central portion of chronic wounds is often hypoxic and relatively hypothermic, representing a deficient energy supply of the tissue, which impedes wound healing or even makes it impossible. Water-filtered infrared-A (wIRA) is a special form of heat radiation with a high tissue penetration and a low thermal load to the skin surface. wIRA produces a therapeutically usable field of heat and increases temperature, oxygen partial pressure and perfusion of the tissue. These three factors are decisive for a sufficient tissue supply with energy and oxygen and consequently as well for wound healing, especially in chronic wounds, and infection defense. wIRA acts both by thermal and thermic as well as by non-thermal and non-thermic effects. wIRA can advance wound healing or improve an impaired wound healing process and can especially enable wound healing in non-healing chronic wounds. wIRA can considerably alleviate the pain and diminish wound exudation and inflammation and can show positive immunomodulatory effects. In a prospective, randomized, controlled study of 40 patients with chronic venous stasis ulcers of the lower legs irradiation with wIRA and visible light (VIS) accelerated the wound healing process (on average 18 vs. 42 days until complete wound closure, residual ulcer area after 42 days 0.4 cm² vs. 2.8 cm²) and led to a reduction of the required dose of pain medication in comparison to the control group of patients treated with the same standard care (wound cleansing, wound dressing with antibacterial gauze, and compression garment therapy) without the concomitant irradiation. Another prospective study of 10 patients with non-healing chronic venous stasis ulcers of the lower legs included extensive thermographic investigation. Therapy with wIRA(+VIS) resulted in a complete or almost complete wound healing in 7 patients and a marked reduction of the ulcer size in another 2 of the 10 patients, a clear reduction of pain and required dose of pain medication, and a normalization of the thermographic image. In a current prospective, randomized, controlled, blinded study patients with non-healing chronic venous stasis ulcers of the lower legs are treated with compression garment therapy, wound cleansing, wound dressings and 30 minutes irradiation five times per week over 9 weeks. A preliminary analysis of the first 23 patients of this study has shown in the group with wIRA(+VIS) compared to a control group with VIS an advanced wound healing, an improved granulation and in the later phase of treatment a decrease of the bacterial burden. Some case reports have demonstrated that wIRA can also be used for mixed arterial-venous ulcers or arterial ulcers, if irradiation intensity is chosen appropriately low and if irradiation is monitored carefully. wIRA can be used concerning decubital ulcers both in a preventive and in a therapeutic indication. wIRA can improve the resorption of topically applied substances also on wounds. An irradiation with VIS and wIRA presumably acts with endogenous protoporphyrin IX (or protoporphyrin IX of bacteria) virtually similar as a mild photodynamic therapy (endogenous PDT-like effect). This could lead to improved cell regeneration and wound healing and to antibacterial effects. In conclusion, these results indicate that wIRA generally should be considered for the treatment of chronic wounds.Das Zentrum von chronischen Wunden ist oft hypoxisch und relativ hypotherm. Dies entspricht einer defizitären Energiebereitstellung im Gewebe, die die Wundheilung behindert oder unmöglich macht. Wassergefiltertes Infrarot A (wIRA) ist eine spezielle Form der Wärmestrahlung mit hohem Eindringvermögen in das Gewebe bei geringer thermischer Oberflächenbelastung. wIRA erzeugt ein therapeutisch nutzbares Wärmefeld und steigert Temperatur, Sauerstoffpartialdruck sowie die Durchblutung im Gewebe. Diese drei Faktoren sind entscheidend für eine ausreichende Versorgung des Gewebes mit Energie und Sauerstoff und deshalb auch für die Wundheilung, speziell bei chronischen Wunden, und die Infektionsabwehr. wIRA wirkt sowohl über thermische und temperaturabhängige als auch über nicht-thermische und temperaturunabhängige Effekte. wIRA kann die Wundheilung beschleunigen oder einen stagnierenden Wundheilungsprozess verbessern und insbesondere bei nicht-heilenden chronischen Wunden eine Wundheilung ermöglichen. wIRA vermag Schmerzen deutlich zu mindern und die Wundsekretion sowie Entzündung zu reduzieren sowie positive immunmodulierende Effekte zu zeigen. In einer prospektiven, randomisierten, kontrollierten Studie mit 40 Patienten mit chronischen venösen Unterschenkelulzera führte eine Bestrahlung mit wIRA und sichtbarem Licht (VIS) zu einer schnelleren Wundheilung (im Durchschnitt 18 vs. 42 Tage bis zum kompletten Wundschluss, Restulkusfläche nach 42 Tagen 0,4 cm² vs. 2,8 cm²) und einem geringeren Schmerzmittelverbrauch gegenüber einer in gleicher Form (Wundsäuberung, antibakterielle Wundauflagen und Kompressionstherapie) therapierten, aber nicht bestrahlten Kontrollgruppe. Eine weitere prospektive Studie mit 10 Patienten mit aufwändiger thermographischer Verlaufskontrolle ergab unter Therapie mit wIRA(+VIS) eine vollständige oder fast vollständige Abheilung therapierefraktärer chronischer Unterschenkelulzera bei 7 sowie eine deutliche Ulkusverkleinerung bei 2 weiteren der 10 Patienten, eine ausgeprägte Minderung der Schmerzen und des Schmerzmittelverbrauchs und eine Normalisierung des thermographischen Bildes. In einer laufenden prospektiven, randomisierten, kontrollierten, verblindeten Studie werden Patienten mit nicht-heilenden chronischen venösen Unterschenkelulzera mit Kompressionstherapie, Wundsäuberung und nicht-adhäsiven Wundauflagen sowie 30 Minuten Bestrahlung fünfmal pro Woche über 9 Wochen behandelt. Eine vorläufige Auswertung der ersten 23 Patienten zeigte, dass die Gruppe mit wIRA(+VIS) verglichen mit einer Kontrollgruppe mit VIS eine schnellere Wundheilung, eine bessere Granulation und in der späteren Phase der Behandlung eine Abnahme der bakteriellen Last der Wunden aufwies. Einige Fallberichte haben gezeigt, dass wIRA selbst bei gemischt arteriell-venösen Ulzera oder arteriellen Ulzera eingesetzt werden kann, wenn die Bestrahlungsstärke angemessen niedrig gewählt und die Bestrahlung sorgfältig überwacht wird. wIRA kann bei Dekubitalulzera sowohl präventiv als auch therapeutisch eingesetzt werden. wIRA kann die Resorption topisch applizierter Substanzen auch auf Wunden verbessern. Eine Bestrahlung mit VIS und wIRA wirkt vermutlich in Verbindung mit endogenem Protoporphyrin IX (oder Protoporphyrin IX von Bakterien) quasi ähnlich wie eine milde photodynamische Therapie (endogener PDT-ähnlicher Effekt). Dies kann die Zellregeneration und Wundheilung fördern und antibakteriell wirken. Zusammengefasst zeigen die Ergebnisse, dass wIRA generell für die Behandlung chronischer Wunden erwogen werden sollte

Bericht zum „Hands-on-Lab analog: Bibliotheken auf dem Weg zur ökologischen und sozialen Nachhaltigkeit“ auf dem Deutschen Bibliothekartag in Berlin am 15. Juni 2018

Tagungsberich

Autoantibodies in a Subgroup of Patients with Linear IgA Disease React with the NC16A Domain of BP1801

Linear IgA disease is an autoimmune subepidermal blistering disease characterized by IgA deposits at the cutaneous basement membrane zone. IgA antibodies from linear IgA disease sera react with antigens of 97 kDa (LABD97) and 120 kDa (LAD-1), both of which appear to be fragments of the extracellular domain of bullous pemphigoid 180 (type XVII collagen). The aim of this study was to determine whether linear IgA disease sera react with the immunodominant region of BP180 (NC16A domain), which is a major target of IgG autoanti-bodies produced by patients with bullous pemphigoid. Indeed, 11 of 50 linear IgA disease sera were found to contain IgA autoantibodies that recognized a recombinant form of NC16A by immunoblotting. The same sera also reacted with NC16A by enzyme-linked immunosorbent assay. An epitope mapping analysis uncovered four linear IgA disease-associated epitopes located within the 45 amino acid N-terminal stretch of NC16A, all of which were previously identified as antigenic sites targeted by bullous pemphigoid autoantibodies. Eight of the linear IgA disease sera that were reactive with NC16A also recognized LAD-1 secreted by the SCC-25 cell line, and five sera recognized BP180 extracted from keratinocytes. Linear IgA disease sera depleted of reactivity to NC16A by immunoadsorption continued to react with both the LAD-1 antigen and BP180 by immunoblotting and with the basement membrane zone by indirect immunofluorescence microscopy. Our results demonstrate that IgA autoantibodies from a subset of linear IgA disease patients react with the same sites on BP180 that are targeted by IgG autoantibodies in bullous pemphigoid

Maternal Antibiotic-Induced Early Changes in Microbial Colonization Selectively Modulate Colonic Permeability and Inducible Heat Shock Proteins, and Digesta Concentrations of Alkaline Phosphatase and TLR-Stimulants in Swine Offspring

Elevated intake of high energy diets is a risk factor for the development of metabolic diseases and obesity. High fat diets cause alterations in colonic microbiota composition and increase gut permeability to bacterial lipopolysaccharide, and subsequent low-grade chronic inflammation in mice. Chronic inflammatory bowel diseases are increasing worldwide and may involve alterations in microbiota-host dialog. Metabolic disorders appearing in later life are also suspected to reflect changes in early programming. However, how the latter affects the colon remains poorly studied. Here, we hypothesized that various components of colonic physiology, including permeability, ion exchange and protective inducible heat shock proteins (HSP) are influenced in the short- and long-terms by early disturbances in microbial colonization. The hypothesis was tested in a swine model. Offspring were born to control mothers (n = 12) or mothers treated with the antibiotic (ATB) amoxicillin around parturition (n = 11). Offspring were slaughtered between 14 and 42 days of age to study short-term effects. For long-term effects, young adult offspring from the same litters consumed a normal or a palm oil-enriched diet for 4 weeks between 140 and 169 days of age. ATB treatment transiently modified maternal fecal microbiota although the minor differences observed for offspring colonic microbiota were nonsignificant. In the short-term, consistently higher HSP27 and HSP70 levels and transiently increased horseradish peroxidase permeability in ATB offspring colon were observed. Importantly, long-term consequences included reduced colonic horseradish peroxidase permeability, and increased colonic digesta alkaline phosphatase (AP) and TLR2- and TLR4-stimulant concentrations in rectal digesta in adult ATB offspring. Inducible HSP27 and HSP70 did not change. Interactions between early ATB treatment and later diet were noted for paracellular permeability and concentrations of colonic digesta AP. In conclusion, our data suggest that early ATB-induced changes in bacterial colonization modulate important aspects of colonic physiology in the short- and longterms

Betulin-based oleogel to improve wound healing in dystrophic epidermolysis bullosa: a prospective controlled proof-of-concept study

INTRODUCTION: Skin fragility and recurrent wounds are hallmarks of hereditary epidermolysis bullosa (EB). Treatment options to accelerate wound healing are urgently needed. Oleogel-S10 contains a betulin-rich triterpene extract from birch bark. In this study, we tested the wound healing properties of topical Oleogel-S10 in patients with dystrophic EB. METHODS: We conducted an open, blindly evaluated, controlled, prospective phase II pilot trial in patients with dystrophic EB (EudraCT number 2010-019945-24). Healing of wounds treated with and without topical Oleogel-S10 was compared. Primary efficacy variable was faster reepithelialization as determined by 2 blinded experts. The main secondary outcome variable of the study was percentage of wound epithelialization. RESULTS: Twelve wound pairs of 10 patients with dystrophic EB were evaluated. In 5 of 12 cases, both blinded reviewers considered epithelialization of the intervention wounds as superior. In 3 cases, only one reviewer considered Oleogel-S10 as superior and the other one as equal to control. Measurements of wound size showed a trend towards accelerated wound healing with the intervention but without reaching statistical significance. CONCLUSION: Our results indicate a potential for faster reepithelialization of wounds in patients with dystrophic EB when treated with Oleogel-S10 but larger studies are needed to confirm significance

Species-sorting and mass-transfer paradigms control managed natural metacommunities

A complex microbial system consisting of six different interconnected localities was thoroughly investigated at full scale for over a year. The metacommunity concept originating from macro-ecology was used to uncover mechanisms of community assembly by observing microbial interrelationships in and between the different localities via correlation and network analysis. The individual based observation approach (IBO) was applied using high-throughput microbial community cytometry in addition to next generation sequencing (NGS). We found robust α-diversity values for each of the six localities and high β-diversity values despite directed connectivity between localities, classifying for endpoint assembly of organisms in each locality. Endpoint characteristics were based on subcommunities with high cell numbers whereas those with lower cell numbers were involved in dispersal. Perturbation caused abiotic parameters to alter local community assembly with especially the rare cells announcing community restructuration processes. The mass-effect paradigm as part of the metacommunity concept was identified by an increase in inter-locality biotic correlations under perturbation which, however, did not unbalance the predominant species-sorting paradigm in the studied full scale metacommunity. Data as generated in this study might contribute to the development of individual based models for controlling managed multi-species natural systems in future. This article is protected by copyright. All rights reserved.status: publishe

Therapy of chronic wounds with water-filtered infrared-A (wIRA)

The central portion of chronic wounds is often hypoxic and relatively hypothermic, representing a deficient energy supply of the tissue, which impedes wound healing or even makes it impossible. Water-filtered infrared-A (wIRA) is a special form of heat radiation with a high tissue penetration and a low thermal load to the skin surface. wIRA produces a therapeutically usable field of heat and increases temperature, oxygen partial pressure and perfusion of the tissue. These three factors are decisive for a sufficient tissue supply with energy and oxygen and consequently as well for wound healing, especially in chronic wounds, and infection defense. wIRA acts both by thermal and thermic as well as by non-thermal and non-thermic effects. wIRA can advance wound healing or improve an impaired wound healing process and can especially enable wound healing in non-healing chronic wounds. wIRA can considerably alleviate the pain and diminish wound exudation and inflammation and can show positive immunomodulatory effects. In a prospective, randomized, controlled study of 40 patients with chronic venous stasis ulcers of the lower legs irradiation with wIRA and visible light (VIS) accelerated the wound healing process (on average 18 vs. 42 days until complete wound closure, residual ulcer area after 42 days 0.4 cm² vs. 2.8 cm²) and led to a reduction of the required dose of pain medication in comparison to the control group of patients treated with the same standard care (wound cleansing, wound dressing with antibacterial gauze, and compression garment therapy) without the concomitant irradiation. Another prospective study of 10 patients with non-healing chronic venous stasis ulcers of the lower legs included extensive thermographic investigation. Therapy with wIRA(+VIS) resulted in a complete or almost complete wound healing in 7 patients and a marked reduction of the ulcer size in another 2 of the 10 patients, a clear reduction of pain and required dose of pain medication, and a normalization of the thermographic image. In a current prospective, randomized, controlled, blinded study patients with non-healing chronic venous stasis ulcers of the lower legs are treated with compression garment therapy, wound cleansing, wound dressings and 30 minutes irradiation five times per week over 9 weeks. A preliminary analysis of the first 23 patients of this study has shown in the group with wIRA(+VIS) compared to a control group with VIS an advanced wound healing, an improved granulation and in the later phase of treatment a decrease of the bacterial burden. Some case reports have demonstrated that wIRA can also be used for mixed arterial-venous ulcers or arterial ulcers, if irradiation intensity is chosen appropriately low and if irradiation is monitored carefully. wIRA can be used concerning decubital ulcers both in a preventive and in a therapeutic indication. wIRA can improve the resorption of topically applied substances also on wounds. An irradiation with VIS and wIRA presumably acts with endogenous protoporphyrin IX (or protoporphyrin IX of bacteria) virtually similar as a mild photodynamic therapy (endogenous PDT-like effect). This could lead to improved cell regeneration and wound healing and to antibacterial effects. In conclusion, these results indicate that wIRA generally should be considered for the treatment of chronic wounds