Original Articles

The effect of hyaluronic acid on the changes in Matrix Metalloproteinase-1 (MMP-1), leukocytes level, and bacteriocide effects among patients with Wagner 3 and 4 diabetic foot ulcer

Ida Bagus Anangga Kharisma , I Nyoman Semadi, I Gede Raka Widiana

Ida Bagus Anangga Kharisma
General Surgery Specialist Program, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia. Email: anangga.kharisma@yahoo.com

I Nyoman Semadi
Department of General Surgery, Thorax Cardiovascular Division, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia

I Gede Raka Widiana
Department of Internal Medicine, Kidney-Hypertension Division, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia
Online First: June 04, 2019 | Cite this Article
Kharisma, I., Semadi, I., Widiana, I. 2019. The effect of hyaluronic acid on the changes in Matrix Metalloproteinase-1 (MMP-1), leukocytes level, and bacteriocide effects among patients with Wagner 3 and 4 diabetic foot ulcer. Indonesia Journal of Biomedical Science 13(2). DOI:10.15562/ijbs.v13i2.195


Background: Diabetes Mellitus (DM) has become a major public health problem. A significant complication of Diabetes Mellitus is the emergence of diabetic foot ulcers that require special treatment in healing. Hyaluronic Acid plays a role in cell proliferation and cell movement and is needed in the process of wound healing. The main goal of treatment of diabetic ulcers in the foot is to achieve wound closure as quickly as possible, prevent recurrence and amputation.

Methods: A true experimental study with pre and post-test design has been conducted among 32 diabetic foot patients at Sanglah General Hospital which divided into 2 groups: Hyaluronic acid and NaCl 0.9% using consecutive techniques. The hyaluronic acid compared to NaCl 0.9% on MMP-1, leukocyte levels, and bacteriocide effects in patients with Wagner's diabetic foot 3 and 4 were assessed. Data were analyzed using SPSS version 20 software for Windows.

Results: The results showed that Hyaluronic Acid increased MMP-1 levels while NaCl 0.9% reduced MMP-1 levels significantly (P<0.05). Hyaluronic Acid was able to reduce leukocyte level significantly compared to NaCl 0.9% (P=0.006). A positive bacterial culture was also found markedly lesser in Hyaluronic Acid groups compared with NaCl 0.9% (P<0.001). Multivariate analysis using logistic and linear regression also showed significant differences in the MMP-1 and leukocyte level (P<0.001) and positive culture results using hyaluronic acids (OR: 0.020; 95% CI 0.003-0.166; P<0.001)

Conclusion: These results suggest that MMP-1 levels and leukocyte levels differed significantly between Hyaluronic Acid and NaCl 0.9% used. Hyaluronic Acid can increase MMP-1 levels in Wagner 3 and 4 diabetic care. The results of positive culture with Hyaluronic Acid used are less than NaCl 0.9%.

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