A natural approach to manage diabetes associated wounds

Diabetes mellitus, which is a morbid condition associated with various connective tissue (mainly collagen tissue) abnormalities, is generally associated with delayed wound healing. Delayed wound healing is producing high economic burden on the society. Diabetic foot ulcer is severe most case of delayed wound healing which afflicts 15% of diabetic patients and among these 84% undergo lower-leg amputations. Delay in wound healing, specifically to diabetic patients, is due to ill function/metabolic behavior/chemotaxis of leucocytes resulting in non availability of neutrophils and macrophages to the wound. Basic principle of wound healing is to reduce tissue damage by providing adequate blood supply, oxygenation, proper nutrition and moist environment for healing of the wound It involves the organized and coordinated interaction between extracellular matrix, different types of cells (leukocytes, fibroblasts etc.) and various growth factors such as platelet derived growth factor, epidermal growth factor, fibroblast growth factor etc. Herbal treatment has been targeted in the study, as of their greater demand in market now-a-days.

Amree Plus, a poly-herbal formulation already available in the market, is effective in controlling blood glucose by delaying glucose absorption and other complications related to diabetes. Apart from anti-diabetic action, it also provides toning effect, nutrient supplementation, anti-oxidant, immuno-modulator, anti-ageing, cardio-protection and renal protection. Amree plus exert its effect by activating islets of pancreas and mimicking insulin effect. Phytochemical examination of Amree Plus revealed the presence of flavonoids, tri-terpenoids, saponins, tannins, steroids, proteins, amino acids etc. It consists of many plants reported to have wound healing activity such as Gymnema sylvestre (Gudmar), Pterocarpus marsupium (Vijaysaar), Eclipta alba (Bhringraj), Azadirachta indica (Neem patr), Coccinia indica (Kundru), Nigella sativa (Kalonji), Tinospora cordifolia (Giloe), Aegle marmelos (Bilv patr) etc.

The secondary metabolites of these plants promotes wound healing through different components such as saponins (anti-oxidant and anti-microbial activity), tannins and flavonoids (astringent, anti-microbial property and free radical scavengers), sterols & poly phenols (free radical scavengers, anti-oxidant and reduce lipid peroxidation), tri-terpenoids (promotes wound contraction and rate of epithelialization). This formulation shows good antidiabetic activity and has herbal constituents active as wound healer thus it may heal wound or lessen the duration of delayed wound healing in diabetics.

The effect of polyherbal formulation Amree plus on wound healing has been studied in diabetic and normal animals and compared with standard (Chymoral Forte) using excision wound model. Diabetes was induced by administration of single dose of Streptozotocin 55 mg/kg i.p. The biochemical parameters i.e. hydroxyl proline content, total protein content, glutathione and superoxide dismutase (SOD) were also estimated. Exp animals were treated with Amree Plus at both doses i.e. 1200 and 5400 mg/kg dose per day had significantly high wound contraction both in diabetic and normal rats (88.91 & 95.05 %, respectively) in comparison to respective control. Hydroxyproline content of the granulation tissue and anti-oxidants (glutathione and SOD) level were also showing same pattern in Amree Plus 5400 mg/kg treatment group with respect to controls.

Wound contraction and other biochemical indicators results with animals Amree Plus (1200 mg/kg) treated were found to be statistically equivalent to standard Chymoral forte dose (36 kAU/kg) while Amree Plus 5400 mg/kg dose showed statistically higher results than standard. Amree Plus, an established antidiabetic formulation, was also showing healing of the wound in normal animals along with diabetic animals. So this finding should be confirmed further for more precision with large number of animals and small progression of doses.

Reference : The Journal of Phytopharmacology 2017;6(1):1-10