effect of aloe gel in enhancing diabetic wound healing djanggan sargowo, yudha handaya, askandar...
TRANSCRIPT
![Page 1: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/1.jpg)
EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING
Djanggan Sargowo, Yudha Handaya,
Askandar Tjokroprawiro
Brawijaya Medical School
Malang11
![Page 2: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/2.jpg)
BACKGROUNDS
22
![Page 3: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/3.jpg)
33
Grade 0 pre-ulcerative lesion, healed ulcers, presence of bony deformity
Grade 1 superficial ulcer without subcutaneous tissue involvement
Grade 2 penetration through the subcutaneous tissue (may expose bone, tendon, ligament or joint capsule)
Grade 3 osteitis, abscess, or osteomyelitis
Grade 4 gangrene on the forefootGrade 5 gangrene on the entire foot
Grade 0 pre-ulcerative lesion, healed ulcers, presence of bony deformity
Grade 1 superficial ulcer without subcutaneous tissue involvement
Grade 2 penetration through the subcutaneous tissue (may expose bone, tendon, ligament or joint capsule)
Grade 3 osteitis, abscess, or osteomyelitis
Grade 4 gangrene on the forefootGrade 5 gangrene on the entire foot
WAGNER CLASSIFICATION
![Page 4: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/4.jpg)
44 WOUND HEALING DISORDERS
![Page 5: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/5.jpg)
DMHyperglycemia↑ ROS ↑ apoptosis angiogenesis dysfunction (#tube formation)
↓ WH ↑ diabetic foot ulcers (DFU) progression amputation
(David et al 2002, Hesham et al 2006 ,Beem 2007, Tjokropawiro 2010)
DM↓ VEGF ↓ Ca cytosolic activity + ↓eNOS ↓Homing EPC ↓ Angiogensis # WH ulkus DM
(Costanza et al 2002, Pradhan et al 2007,Singhan et al 2007)
DFU proper management Herbal therapy enhance angiogenesis (Larijani et al 2008)
55
![Page 6: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/6.jpg)
HIPERGLIKEMIA (DM)
b↑AGE>1 week ↑HEKSOSAMINE PATWAY (H) ↑AR ↑PKC↑ROS
↑TNF↑NFκB↓NO ↑NFκB, ↓eNO, ↑TGFβ
↑NAD(P)H OXIDASE↑ET-1, ↑PAI-1, ↑VEGF
↑TGFβ,↑MMPs↓CELL PROLIFERATION
↑SORBITOL↓GSH↑TNFα
↑OH+↑TNFα
GFATP A H A
STRESS OXIDATIVE STRESS OXIDATIVE INSULIN SENSITIVITY -CELL FUNCTIONΒ
“PAHAM”:PKC,AGE,HEKSOSAMINE,AR,MITOCONDRIAL DYSFUNCTION
MIKROANGIOPATI & MAKROANGIOPATI
TRAUMA VASCULOPATHYNEUROPATHY
MOTORIC SENSORY AUTONOM MICROPATHY MACROPATHY
WEAKNESSATROPHYDEFORMITY↑PLANTAR PRESSURE CLAVUS
↓PROTECTION↓SENSATION
ANHIDROSISDRY SKINFISSURE↑SYMPATHY PRESSURE
ATEROSCLEROSISISCHEMIA
BM CAPILLARY THICKENNINGA-V SHUNT↑BLOOD FLOWEDEMA NEUROPATHY
OSTEOARTHROPATHY ↓RESPONSE TO INFECTION↓NUTRITION ↓CAPILLARY BLOOD FLOW
HEMOSTASIS 1 HOUR #INFLAMMATION 2-7 DAYS #PROLIFERATIOM 2-20 DAYS #REMODELLING 6WEEK-3 MONTHS
GAMGGUAN PENYEMBUHAN ULKUS KAKI DMAMPUTASI AMPUTASI
#INFLAMMATION↓NEUTROPHIL↓MONOCYTE
ENDOTHELIAL DYSFUNCTION# ANGIOGENESIS↓KERATINOCYTES↓PROLIFERATION
↓FIBROBLAST↓GF↓CITOKINES
SCHIFF BASE <1 day
AMADORI 1-7 days
Gambaran Kegagalan Patofisiologi Ulkus diabetes dan Patologi Penyembuhan ulkus diabetes (Robert et al 2006, Gugliucci 2007, Pradhan et al 2007, Tjokroprawiro 2010). 66
HYPERGLYCEMIA
MACRO-MICROANGIOPATHY
# WOUND HEALING
OXIDATIVE STRESS OXIDATIVE STRESS
AMPUTATIONAMPUTATION
![Page 7: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/7.jpg)
77
![Page 8: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/8.jpg)
88
![Page 9: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/9.jpg)
99
![Page 10: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/10.jpg)
1010
![Page 11: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/11.jpg)
1111
ERK-1/2ERK-1/2
ALOE GEL
VEGF
eNOS
EPC CEC
ANGIOGENESIS
DIABETIC WOUND HEALING
Cellular proliferation
CONCEPTUAL THEORY
![Page 12: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/12.jpg)
Aloe gelAloe gel
Dose of Dose of 30,60,12030,60,120(mg/day)(mg/day)
Diabetic wound Diabetic wound healinghealing
wound wound diameterdiameter
Angiogenesis
VEGF, VEGF, eNOS eNOS ,,EPCEPC,,CEC , CEC ,
Rasio EPC/CECRasio EPC/CEC
Expression and Expression and amountamount
Hipotesis
1212
![Page 13: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/13.jpg)
MATERIALS AND METHODSMATERIALS AND METHODS
1313
![Page 14: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/14.jpg)
SCHEME OF STUDY PROTOCOL (ROCKET SYSTEM MODIFICATION, TJOKROPRAWIRO,
1978)
1414
REPORT
WOUND + ALOE GEL 120 MG
WOUND + ALOE GEL 60 MG
ANALISIS
DATA
DAY0 1
4
DM 0
DM120
DM 60
B0RANDOM
STRAIN
WISTAR+ALOE
GEL
VEGF,eNOS, EPC,CEC Ø WOUND
PRA PENELITIAN
A : NORMAL RATSB : UNTREATED RATSC : DIABETIC RATS+TREATMENTD : DIABETIC RATS+TREATMENTE : DIABETIC RATS+TREATMENTPRE-STUDY: 0-14 days bedore treatmentSTUDY : 0-14 hari after treatmentAle gel : glycoprotein and polysacchaarides aloe vera
VEGF :Vascular Endothelial Growth Factor
eNOS :endothelial Nitric Oxide Synthase
EPC :Endothelial Progenitor CellsCEC :Circulating Endothelial Cells
VEGF : immunohistochemistryeNOS : immunohistochemistryEPC : CD34 (Flowcitometri)CECs : CD45(FITC)+CD146(PE)
(Flowcitometri)Ø wound : wound dimeter
Injection of STZ 60mg/kg (IP)for 14 days (2 weeks)Diabetes if blood glucose level >200mg/dl
NON DM
WOUND
WOUND + ALOE GEL 30 MG
D14
PENELITIAN
14
0
28
0 14
N:15N:15
n:3n:3
n:3n:3
MAIN PARAMETERMAIN PARAMETER
ketamin (10mg/kg/iv)Wound diameter 2,5 cm depth 0,2 cmWash the wound with Nacl 0,9%
n:3n:3
n:3n:3
A0
D0
E0
VEGF,eNOS,EPC,CEC Ø WOUND
HASILHASILDATADATA
DATADATA
DATADATA
DATADATAA14
PRE- STUDY STUDY
DAY
MAKING OF DIABETIC RATS
MAKING OF WOUND
PARAMETER DATA ANALYSIS
C14
E14
SAMPLE POPULATIONp(t-1)(r-1)≥ 15
t=±treatmentr=±repetition
DM 30C0
WOUND B14 DATADATAn:3n:3
Linear Regression
Anova (simple anova)
PRE- STUDY STUDY
DATA
ANALYSIS
RESULTRESULT
![Page 15: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/15.jpg)
STUDY TIMELINE
1515
![Page 16: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/16.jpg)
RESULTS
14th Day, measurement of :•Wound diameter
•Immunohistochemistry of dermal tissue•Blood for Flowcitometry
1616
![Page 17: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/17.jpg)
Measurement of Wound Diameter
Treatment n Mean SD (p ≤ 0,05)
Normal Rats 3 1,100,14 (a
Diabetic Rats 3 1,190,12(a
Diabetic rats + 30 mg aloe gel
3 0,320,01(b
Diabetic rats + 60 mg aloe gel
3 0,270,02(b
Diabetic rats + 120 mg aloe gel
3 0,410,02(b
1717p = 0.000
Normal Rats DM + 120 mgDiabetic rats DM + 30 mg DM + 60 mg
![Page 18: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/18.jpg)
Vascular Endothelial Growth Factor (VEGF) Expression
treatment n Mean SD (p ≤ 0,05)
Normal Rats 3 24,672,00 (a
Diabetic Rats 3 25,334,51(a
Diabetic rats + 30 mg aloe gel
3 28,335,86(a
Diabetic rats + 30 mg aloe gel
3 34,675,03(a
Diabetic rats + 30 mg aloe gel
3 25,674,73(a
1188
p = 0.676
Normal Rats Diabetic Rats DM+30mg DM+60mg DM+120mg
![Page 19: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/19.jpg)
Endothelial Nitric Oxide Synthase (eNOS) Expression
Treatment n Mean SD (p ≤ 0,05)
Normal Rats 3 24,671,73 (b
Diabetic Rats 3 30,672,08(a
Diabetic rats + 30 mg aloe gel
3 30,001,00(a
Diabetic rats + 60 mg aloe gel
3 34,332,08(a
Diabetic rats + 120 mg aloe gel
3 42,001,00(b
1919p = 0.000
Normal RatsDM + 120
mgDiabetic rats DM + 30 mg DM + 60 mg
![Page 20: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/20.jpg)
Amount of Endothelial Progenitor Cells (EPCs) CD 34
Treatment n Mean SD (p ≤ 0,05)
Normal Rats 3 16,880,59 (a
Diabetic Rats 3 10,471,14(a
Diabetic rats + 30 mg aloe gel
3 10,649,34(a
Diabetic rats + 60 mg aloe gel
3 12,111,16(a
Diabetic rats + 120 mg aloe gel
3 13,751,63(a
p = 0.457
n kelompok = 3
2200
Normal RatsDM + 120
mgDiabetic rats DM + 30 mg DM + 60 mg
![Page 21: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/21.jpg)
Amount of Circulating Endothelial Cells (CECs) CD 45
2121p = 0.000
Normal Rats DM + 120 mgDiabetic rats DM + 30 mg DM + 60 mg
Treatment n Mean SD (p ≤ 0,05)
Normal Rats 3 3,161,68(bc
Diabetic Rats 3 14,762,28(a
Diabetic rats + 30 mg aloe gel
3 7,361,22(b
Diabetic rats + 60 mg aloe gel
3 4,890,83(bc
Diabetic rats + 120 mg aloe gel
3 2,200,74(c
![Page 22: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/22.jpg)
PATH ANALYSIS
2222
![Page 23: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/23.jpg)
2323
DISCUSSION
![Page 24: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/24.jpg)
Aloe gelAloe gel
DosisDosis(mg/day)(mg/day)
Diabetic Diabetic wound healingwound healing
Wound Wound diameterdiameter
↑ wound contraction
Effect administration of Aloe gel on wound diameter
Effect administration of Aloe gel on wound diameter
2424
• Anti inflammatory• fibroblast
proliferation• collagen dan
glycosaminoglikan synthesis
(Heggers 1993; Jia et al 2008;Kwack et al 2009 ,;Liu et al., 2010; Fernanda et al., 2009;Jettanacheawchankit et al 2009)
![Page 25: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/25.jpg)
Aloe gelAloe gelDosisDosis
(mg/day)(mg/day) Diabetic Diabetic
wound healingwound healing
Wound Wound diameterdiameter
↑ Angiogenesis
Effect administration of Aloe gel on Expression of VEGF and eNOS Dermal Tissue
Effect administration of Aloe gel on Expression of VEGF and eNOS Dermal Tissue
(Heggers 1993; Choi et al 2002; Tanimoto et al 2002;Duda et al 2004; Young et al 2004;Kim et al
2007;Pradhan et al. 2007; Beem et al. 2007; Singhan et al 2007; Chen et al 2007).
2525
VEGF eNOS
EPC mobilization
![Page 26: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/26.jpg)
Aloe gelAloe gel
DosisDosis(mg/day)(mg/day)
Diabetic Diabetic wound healingwound healing
Wound Wound diameterdiameter
↑ Angiogenesis
Effect administration of Aloe gel on amount of EPCs and CECs circulation
Spinetti et al. 2008;Albiero et al., 2011;Oren et al., 2010;McClung et al 2005;Fiorina et al. 2010;Sibal et al 2009;Spinetti et al 2008;Nababan
et al., 2007;Boos et al 2006
2266
migration/Homing EPC
CECs
![Page 27: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/27.jpg)
2727
EPC/CEC RATIO AFTER ADMINISTRATION OF ALOE GELEPC/CEC RATIO AFTER ADMINISTRATION OF ALOE GEL
aloe gel herbal pro-angiogenic keep survival
EPCs during mobilization and homing into
wound increase amount of EPCs to damage
endothelial cells from vascular wall (CECs).
aloe gel herbal pro-angiogenic keep survival
EPCs during mobilization and homing into
wound increase amount of EPCs to damage
endothelial cells from vascular wall (CECs).
![Page 28: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/28.jpg)
Aloe gelAloe gelDose Dose
120(mg)120(mg)
wound healingwound healingwound healingwound healing
wound wound diameter diameter
cmcm22
Angiogenesis
VEGF, VEGF, eNOS eNOS ,,EPCEPC
,,CEC CEC
Exresion (ng/ml) Exresion (ng/ml) and amountand amount
2288
Ratio Ratio EPC/CECEPC/CEC
Ratio Ratio EPC/CECEPC/CEC
• Hipotesis statistically proved (P<0,05)
• Hipotesis statistically proved (P<0,05)
EPC/CEC ratio Novel (new)Base of therapyPrognostic factor
EPC/CEC ratio Novel (new)Base of therapyPrognostic factor
![Page 29: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/29.jpg)
2929
![Page 30: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/30.jpg)
3030
![Page 31: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/31.jpg)
3131
![Page 32: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/32.jpg)
Mekanisme Penyembuhan luka Normal dibanding Diabetes (Beem et al 2007, Tjokropawiro 2011)•
DM WITH 5 DYSFUNCTION : KERATINOCYTE, PLATELET, ENDOTHELIUM, MACROPHAGE, MYOFIBROBLAST
DM WITH 5 DYSFUNCTION : KERATINOCYTE, PLATELET, ENDOTHELIUM, MACROPHAGE, MYOFIBROBLAST
3232
Blood Glukose Should be <
200
Blood Glukose Should be <
200
HEALTHY WOUND DIABETIC WOUNDTHE ROLES OF HSP 70 / HSP 72
on Wound HealingTHE ROLES OF HSP 70 / HSP 72
on Wound Healing
-catenin-catenin
c-mycc-myc
LIMITEDEPC HOMING
IMPROVED BY LOCAL SDF-1
INJECTION
IMPROVED BY LOCAL SDF-1
INJECTION
LIMITED NEOVASCULOGENESIS AND WOUND HEALING
IMPROVED BY HBO THERAPY
IMPROVED BY HBO THERAPY
DecreasedeNOS Activation
VEGF
![Page 33: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/33.jpg)
Conceptual TheoryConceptual Theory
33
![Page 34: EFFECT OF ALOE GEL IN ENHANCING DIABETIC WOUND HEALING Djanggan Sargowo, Yudha Handaya, Askandar Tjokroprawiro Brawijaya Medical School Malang 1](https://reader038.vdocuments.us/reader038/viewer/2022110209/56649e4b5503460f94b3f3bc/html5/thumbnails/34.jpg)
Active Compound of Aloe Gel (Hamman, 2008)
34