Skin Disease

Wound & Skin Ulcer Healing

Skin Transplantation

The prevalence of many inflammatory skin conditions has increased since the beginning of the twentieth century: atopic dermatitis, for instance, now affects 15-30% of children and 2-10% of adults in developed countries and in the US, it has nearly tripled in the last 30-40 years. Over 15 million American adults and children suffer from atopic dermatitis, which has no known cure.

 

“Diabetic foot” is the designation for any pathologic condition that results from peripheral arterial disease (PAD) and/or sensory neuropathy affecting the feet of diabetic individuals: diabetic foot pathologies include infection, foot ulcer and neuropathic osteoarthropathy. In the US, 15% of diabetes patients develop a foot ulcer, and about 20% of individuals with a foot ulcer eventually require amputation.

  • Diabetic skin ulcers

  • Acute pruritus

  • Burn injuries

  • Androgenic

  • Skin flap transplantation

Image by National Cancer Institute

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The feet of diabetes patients have a reduced ability to feel pain due to peripheral nerve dysfunction; therefore, minor injuries — which take a long time to heal — may progress to a fully developed diabetic foot ulcer. In diabetes, peripheral nerve dysfunction may concur with PAD, causing poor blood circulation to the extremities: about half of patients with diabetic foot ulcer also present with PAD. 

 

Pressure ulcers are commonly known as bedsores; they occur due to pressure applied to soft tissue that results in complete or partial obstruction of blood flow to tissue (leading to ischemic damage) and to the reperfusion damage that sets in when blood flow is restored upon relief of pressure.

 

They are common among persons with impaired mobility (confined to bed or using wheelchairs); their prevalence in European hospitals ranges from 8 to 23% and is about 26% in Canadian healthcare settings. In 2013 there were 29,000 documented deaths from pressure ulcers globally, up from 14,000 in 1990. Each year, more than 2.5 million people develop pressure ulcers in the USA; incidence is especially high in intensive care units, with 8 to 40% of patients developing pressure ulcers.

 

The expression “free autologous tissue transfer “or “free flap” describes the transplantation of tissue from one site of the body to another. “Free” implies that the tissue is completely detached from its blood supply. Blood circulation through the tissue must be re-established by anastomosis of arteries and veins. There are several indications for “free flap skin transplant” skin transplants, including aesthetic reconstruction, post-traumatic reconstruction and reconstruction of a defect following tumor removal. Importantly, free flap tissue damage by ischemia-reperfusion injury (IRI) is a common occurrence.

 

Abundant evidence obtained by studying both in vitro and in vivo systems indicates that:

  • Exogenous H2S may be used to treat atopic dermatitis (Coavoy-Sanchez 2020) and acute pruritus (Coavoy-Sanchez 2016, Rodrigues 2016);

  • Exogenous H2S protects against development of IRI in a pressure ulcer rat model (Xiaoqin 2015);

  • Hydrogen sulfide donors are able to accelerate wound healing in animal models of scald burns (Pyiochou 2008) and refractory skin wounds (Zhao 2020);

  • Exogenous hydrogen sulfide accelerates wound healing/ulcer healing in animal models of diabetes (Zhou 2015, Zhao 2017, Wang 2015, Lingxu 2007, Liu 2014).

 

All of these effects of exogenous H2S have been attributed to:

  • Its ability to restore the function of endothelial progenitor cells (Liu 2014);

  • Activation of angiopoietin-1/ angiogenesis upregulation (Liu 2014);

  • Its ability to increase the bioavailability of nitric oxide (Duda 2004), to promote keratinocyte autophagy, proliferation and differentiation (Xie 2016) and to protect keratinocytes against methylglyoxal-induced injury (Yang 2014);

  • Its Nrf2-mediated antioxidant effect (Panich 2018). 

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