Abstract
Background: Diabetes is a disease that affects people worldwide, including in Indonesia. The prevalence of diabetes in Indonesia is increasing from year to year. One of the most devastating complications of diabetes mellitus is diabetic ulcers, which is a limb-threatening complication. Over the past few decades, ozone generated using plasma medical technology has been investigated as an agent that helps wound healing. This study aims to evaluate the effects of topical ozonated virgin coconut oil (VCO) in a diabetic wound mouse model. Methods: This study was an experimental study with a post-test control design. An ulcer wound model was made in 50 diabetic male Wistar mice, divided into five groups, and a control group of 10 non-diabetic mice. The control groups were given conventional therapy only and the treatment groups were also given topical ozonated VCO with different flow durations (0 min, 90 min, 7 h, 14 h). Macroscopic appearance and wound contraction were observed. HSP90β, VEGF-A, EGF, bFGF, and CD34 levels were measured from the immunostained slices of wound margins. Results: The reduction of wound length was proportionally related to the duration of ozone flow. Ozonated VCO with a longer duration of ozone flow healed the wound more quickly and had the shortest wound length. VCO with ozone flow for 14 hours (16837.10 µm) had the biggest reduction in wound length compared to other groups. The wounds treated with ozonated VCO showed an increase in HSP90β, VEGF-A, EGF, bFGF, and CD34 levels that correlated to improved wound healing. A longer period of treatment resulted in higher levels of wound healing biomarkers compared to shorter therapeutic durations. Conclusions: Topical ozonated VCO improved the wound healing process in a diabetic ulcer mouse model by improving macroscopic wound appearance and increasing levels of wound healing biomarkers.
Highlights
Diabetes is a non-communicable disease that has become a worldwide burden
The reduction of wound length is directly proportional to the duration of ozone flow
The greatest to smallest wound length reduction is found in the virgin coconut oil (VCO) with ozone flow for 14 hours group (P4), followed by the 7 hours ozonated VCO group (P3), 90 minutes ozonated VCO group (P2), non-ozonated VCO group (P1), and the diabetic wound without VCO group (C-)
Summary
Diabetes is a non-communicable disease that has become a worldwide burden. In 2014, the number of people with diabetes in the world reached 8.5% of the total world population. In line with the WHO report, the International Diabetes Federation found that in 2017, the prevalence of diabetes mellitus among adults in Indonesia had increased to 6.7%. Diabetes is a risk factor and cause of several other diseases, including blindness, kidney failure, diabetic neuropathy, diabetic vasculopathy, and diabetic ulcers. Of those diabetic patients, 15% of them will develop a diabetic ulcer. An ulcer wound model was made in 50 diabetic male Wistar mice, divided into five groups, and a control group of 10 nondiabetic mice. The control groups were given conventional therapy only and the treatment groups were given topical ozonated VCO with different flow durations (0 min, 90 min, 7 h, 14 h). Ozonated VCO with a longer duration of ozone flow healed the wound more quickly and had the shortest version 3 (revision)
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