The University of Johannesburg Laser Research Centre (LRC) is joining the World Health Organisation (WHO) and millions of concerned people around the world this Thursday, 7 April 2016, to recognize World Diabetes Day, the primary global awareness campaign for diabetes.
This year’s World Diabetes Day theme is “Beat Diabetes”: Scale up prevention, strengthen care and enhance surveillance’.
The Laser Research Centre (LRC), a research centre within the Faculty of Health Sciences at the University of Johannesburg, under the directorship of Prof Heidi Abrahamse (NRF SARChI Chair: Laser Applications in Health), has a group of researchers’ working on the underlying mechanisms of action of Photobiomodulation (PBM) for application in diabetic wound healing,” says Dr Nicolette Houreld, UJ’s Senior Lecturer: Laser Research Centre.
“We conduct in vitro studies in artificial cell culture (growth of cells in an artificial environment outside a living organism) where diabetic wounded fibroblast cells are exposed to low-powered laser light (either visible red or near infra-red (NIR) laser light) and various biochemical pathways involved in wound healing are studied, for example collagen synthesis.”
Dr Houreld explains that their results have shown that exposure to such light is directly absorbed by the cells, which in turn increases various cellular processes necessary for wound healing such as cell migration and collagen production.
“We have also conducted a small pilot study on humans with lower limb diabetic ulcers. This study showed favorable results; ulcers irradiated with the LED light (combination of red and NIR) healed faster than those exposed to placebo irradiation, there was also no side-effects reported. In fact, some patients regained feeling in areas of the feet where they had lost all sensation (Ntelei et al., 2016).This is an ongoing study,” says Dr Houreld.
“Diabetes Mellitus (DM) has been declared as a global burden, with 415 million cases (adults aged 20-79) worldwide in 2015, and a further estimated 193 million undiagnosed cases. The estimated number of people with DM on the African continent in 2015 was at 14.2 million, and is thought to increase to 140.2 million by 2040 (International Diabetes Federation, IDF, 2015). It was also estimated that at the end of 2015 there would be 5 million deaths worldwide related to DM at a cost of between USD673 billion and USD1,197 billion in healthcare.”
“To put this into perspective, there was only 1.5 million deaths related to HIV/AIDS, 1.5 million related to tuberculosis and 0.6 million related to malaria (IDF, 2015). Patients with DM commonly develop a number of life threatening health conditions, and repeatedly suffer from non-healing, chronic and frequently debilitating lower limb ulcers, which often necessitate amputation.”
“A number of underlying pathologies contributes to the impaired wound healing seen in diabetes. These include, but not limited to, increased oxidative stress, advanced glycation end products, inflammation, and infection, and decreased immunity, angiogenesis (growth of blood vessels), circulation and fibroblast migration, as well as a disruption in the extracellular matrix (ECM, non-cellular component present within all tissues and organs and provides essential physical support), hypoxia (decreased oxygen levels), ischemia (restriction in blood supply to tissues, causing a shortage of oxygen and glucose) and neuropathy (damage or dysfunction of nerves typically causing numbness or weakness).”
In diabetic wound healing there is a disruption in the formation and synthesis of the ECM, including collagen, an essential component in wound healing. The decrease in collagen seen in diabetes may be as a result of decreased synthesis/production and/or enhanced metabolism/breakdown.
“Photobiomodulation (PBM), commonly also known as laser therapy, phototherapy, and low level laser therapy (LLLT) is a non-invasive, non-ablative and non-thermal therapy which involves the application of low powered light (typically from a laser or light emitting diode, LED) to stimulate cellular processes. It is used to treat a wide variety of conditions, including chronic diabetic ulcers. Light absorbing structures within the cell, or chromophores, absorb this light (photon energy) which is then converted to chemical energy. This stimulates the cells to repair themselves and produce essential cellular components, including collagen, required for wound healing,” she says.
“The type of lasers and light instruments used in PBM should not be confused with the high powered ablative lasers commonly used in aesthetics and dermatology. Ablative lasers are dependent on the thermal damage of the target tissue, thereby forcing it to repair itself and hence make more collagen. These types of instruments are typically used for skin resurfacing and rejuvenation. The light sources used in PBM are low-powered, and their effects do not rely on thermal damage, and commonly makes use of light in the visible red and near infra-red spectrum of light. This treatment calms down inflammation, speeds up the formation of new blood vessels and speeds up healing, when applied correctly to wounds and painful areas.”