Diyabetik Ayak Yaraları Üzerine İmmunohistokimyasal Bir Çalışma; MMP-2 ve TNF- α Ekspresyonlarının İncelenmesi

Year 2019, Volume: 16 Issue: 2, 394 - 398, 29.08.2019

Murat Baloğlu , Ebru Gökalp Özkorkmaz

https://doi.org/10.35440/hutfd.540551

Cited By: 1

Abstract

Amaç: Diyabetik ayak, diyabetin önemli ve uzun süreli komplikasyonlarından biridir. Bilindiği üzere diyabetik bireylerde yara iyileşmesi yavaş olmaktadır ve bu duruma bakteriyel invazyonun eklenmesi sonucu uzun süreli inflamasyon eşliğinde iyileşmeyen diyabetik ayak yaraları ortaya çıkmaktadır. Söz konusu çalışmanın amacı, diyabetik ayak yara dokusunda proinflamatuvar sitokinlerden TNF-α ve kollajenin parçalanmasında rol oynayarak dokunun yeniden şekillenmesini sağlayan matriks metaloprotein MMP-2 ekspresyonunu immunohistokimyasal yöntemlerle tespit etmektir.

Materyal ve metod: Bu çalışmaya 30 erkek ve 30 kadın olmak üzere, diyabetik ayak tanısı almış, ve ayaklarında açık yara bulunan 60 birey dahil olmuştur. Çalışmaya alınacak ayak, izotonik çözelti ile yıkandıktan sonra yaralar kesilip çıkarılmış ve dokular %10’luk formaldehit solüsyonunda tespit edilmiştir. Rutin histolojik takip sonrası kesitler parafine gömülmüş ve yarı-ince kesitleri alınarak histopatolojik incelemeleri yapılmıştır. İmmunohistokimyasal analiz için, doku örnekleri, MMP-2 ve TNF-α primer antikorları ile boyanarak mikroskop altında incelenmiştir. 

Bulgular: Çalışmamızın
sonuçlarına göre diyabetik ayak yara dokusunda, ligamenter dokunun içinde
lökositler,  lenfositler ve monositlerin
yoğun olduğu izlenmiştir.  Kollajen
liflerde dejenerasyon ve kan damarlarında dilatasyon,  konjesyon ve ödem görülmüştür. İnflamatuvar
hücrelerde ve nekroze olan alanlarda TNF-α ekspresyonunda artış izlenmiştir.
Damar çevresinde görülen yoğun inflamasyonunun arasında, dejenere kollajen lif
ve fibroblast hücreleri ve ekstrasellüler matrikste MMP-2 ekspresyonu pozitif
olarak gözlenmiştir.

Sonuç: Diyabetik
ayak yarası tedavisinde MMP ekspresyonu yönünde düzenleme yapılarak, her geçen
gün genişleyen diyabetik popülasyonda iyileşmeyen ayak yaralarına karşı bir
yaklaşım geliştirilebilir düşüncesindeyiz.

Keywords

Diyabetik ayak, MMP-2, TNF- α, histopatoloji, immunohistokimya

An immunohistochemical study on diabetic foot wounds; examination of MMP-2 and TNF- α expressions

Abstract

Objectives: Diabetic
foot is one of the major and long-term complications of diabetes. As known,
wound healing is slow in diabetic individuals and as a result of inclusion of
bacterial invasion to this condition, non-healing diabetic foot wounds occur
with prolonged inflammation. The aim of this study was to determine the
expressions of TNF-α, a proinflammatory cytokine and matrix metalloprotein
MMP-2, involved in tissue remodeling via collagen degradation by
immunohistochemical methods in diabetic foot wound tissues.

Materials and Methods: This study included 30 males and 30 females,  a total of 60 patients diagnosed with
diabetic foot having open wounds. After washing the foot with isotonic
solution, the hole wounds were cut and tissues were fixed in 10% formaldehyde
solution. After routine histological follow-up, the sections were embedded in
paraffin and semi-thin sections were cut and histopathological examinations
were performed. For immunohistochemical analysis, tissue samples were stained
with MMP-2 and TNF-α primary antibodies and examined under a microscope.

Results: In our study, leukocytes, lymphocytes and monocytes
were observed in the diabetic foot wound tissue. Degeneration of collagen
fibers and dilatation of blood vessels, congestion and edema were observed.
TNF-α expression was increased in inflammatory cells and necrosis areas. MMP-2
expression was found to be positive in degenerated collagen fibers, fibroblasts
and extracellular matrix among the intense inflammation around the vein.

Conclusion: Regarding
the MMP expression in diabetic foot wound treatment, we think that an approach
to the healing of non-healing foot wounds may be developed in the diabetic population.

Keywords

Diabetic foot, MMP-2, TNF- α, histopathology, immunohistochemistry

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