Hypoxia Inducible Factor 1 & Wound healing in Diabetics
It seems and age since we shared anything not related to the unfortunate Charity Commission news and the seemingly odd choice of the health authorities to ignore outright the scientific community. As they say though, onward and upward.
Accordingly, albeit a short snippet, today’s discussion revisits wound healing briefly, with further support from the aforementioned science fraternity in the form a paper detailing the role of the heterodimeric transcription factor Hypoxia Inducible Factor 1 (HIF1), Which consists of 2 subunits, HIF1a and HIF1b.
In our own article on hypoxia , and also the one on wound healing, we discuss fairly extensively the mechanism involved in how wounds heal and how cells proliferate in the wound bed. Ultimately this all comes down to the hypoxia response in tissues when they become diseased or injured. Lower oxygen saturation and transport into cells and tissues following some or other compromise of the vasculature results in localised hypoxia which triggers the HIF1a response. Being a master regulator, HIF1a then upregulates up to 100 other hypoxia induced responses including the vascular endothelial growth factor (VEGF) responsible for endothelial growth, the release of endothelial progenitor cells (EPC’s), and collagen release into the wound bed which stimulates fibroblast growth and development . This accelerates scaffold development improving the rate and level of success with which a wound heals. There is also further information on the hyperoxia hypoxia paradox in our article similarly titled.
In an attempt to not ‘reinvent the wheel’ and simply rewrite our previous articles, we rather link the subject of today’s discussion here for further reading:
Something we would disagree on though is the opening comment which states: “Hyperbaric oxygen (HBO) therapy has been used as an adjunctive therapy for diabetic foot ulcers, although its mechanism of action is not completely understood.”
The mechanism is rather better understood than that comment eludes to. Our reference and links page contains a number of relevant sources which go into fairly detailed explanations of how this mechanism works.
The paper concludes however that:
“In conclusion, we provide evidence that HBO stabilizes and activates HIF-1, which contributes to increased cellular proliferation.”
What is of particular interest to us in this. As the passage time often provides for and facilitates, interest is growing, and more and more evidence is coming to the fore as to the efficacy of hyperbaric oxygen therapy and hyperbaric oxygenation. Indeed there is a wealth of information out there for those with the inclination to seek it out despite the authorities apparent inability to find it and then jump to premature conclusions. Specifically in this case as it relates to diabetic wound healing. Far too many people become candidates for amputation when they simply do not need to be. Not only is this very obviously a curtailment of quality of life, but it is an increasingly unmanageable cost to national health authorities. Coupled with that is population growth and the established increase in incidences of type 2 diabetes (T2D) in the population with huge increases expected in coming years. T2D complications can be treatment intensive requiring extended hospitalisation which costs. HBOT has been shown over and over again to reduce incidence of amputation and improve overall outcomes for diabetic ulceration despite the prevailing opinion in state health and other authorities. All of this has been shown to deliver benefit and solutions in a cost effective way. HBOT is not an expensive therapy to deliver and it can be medically indirectly supervised with trained technicians operating the equipment much like X-Ray technicians do.
The question we need to ask is why this still not being seriously considered by parliament and the appropriate select committees, and added to the physician toolbox available under the NHS? They simply cannot continue to deny the efficacy of this modality forever.
Although related to blood glucose levels rather than wound healing, the below graphic is included out of interest.
In other news…, it’s pantomime time in Cumbria once more as it is up and down the country and there is a fairly long tradition now of our involvement in this with this year being no different. Accordingly articles may be fewer as we approach Christmas. We will however be active on social media and continue to contribute with short articles of interest as we move forward with fundraising which will hopefully carry us toward our goals of acquiring a chamber for the benefit of our Cumbrian and wider community.