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Clinical Research
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Treatment of chronic wounds with topical substance P Randall Wolcott, MD, Ted W. Reid, PhD Although Substance P was discovered over 70 years ago, many of its functions are just now coming to light. Substance P is an 11 amino acid neuropeptide, which is involved in cutaneous inflammation, resulting vasodilation and permeability of the capillaries. A direct growth promoting effect of Substance P has been reported in smooth muscle cells, human skin fibroblasts, keratinocytes and endothelial cells. Substance P also enhances the proliferation of human blood T-lymphocytes, and affect apparently mediated by specific receptors for this peptide. These findings parallel other evidence, which indirectly suggests that tachykinins release from sensory nerves in the skin, joints and other peripheral tissues, functions as mediators of local inflammatory and subsequent wound healing responses. These are positive functions for wound healing, which make Substance P a very proactive substance for wound healing especially in diabetics. Case histories were used to assess efficacy of topical Substance P. Case histories have the advantage of being able to provide insights as to whether treatment is clinically effective. A disadvantage of a case history approach is the possible bias of the observer in evaluating results and comparing them to ÒstandardÓ therapies. Therefore, a large number of case histories showing good results are necessary to overcome this bias. With this in mind, five cases of improved outcomes with diabetic foot ulcers treated with Substance P are presented as a representative sample of a large number of patients that have showed this improved outcome from the use of Substance P. Delgado AV, McManus AT, Chambers JP. Exogenous administration of Substance P enhances wound healing in a novel skin-injury model. Exp Biol Med. 2005;230(4):271Ð280 Nakamura M, Nishida T, Ofuji K, Reid TW, Mannis MJ, Murphy CJ. Synergistic effect of substance P with epidermal growth factor on epithelial migration in rabbit cornea. Exp Eye Res. 1997;65(3):321Ð329 Nakamura M, Kawahara M, Morishige N, Chikama T, Nakata K, Nishida T. Promotion of corneal epithelial wound healing in diabetic rats by the combination of a substance P-derived peptide (FGLM-NH2) and insulin-like growth factor-1. Diabetologia. 2003;46(6):839Ð842 Antezana M, Sullivan S, Usui M, et al. Neutral endopeptidase activity is increased in the skin of subjects with diabetic ulcers. J Invest Dermatol. 2002;119(6):1400Ð1404 Spenny ML, Muangman P, Sullivan SR, et al. Neutral endopeptidase inhibition in diabetic wound repair. Wound Repair Regen. 2002;10(5):295Ð301 |
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