Hyaluronic Acid Accelerates VEGF and PDGF Release from Advance Platelet Rich Fibrin in Diabetic Foot Ulcer

Ronald Winardi Kartika (Doctoral Program in Medical Science, Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No.6, Jakarta)
Idrus Alwi (Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Jakarta)
Franciscus Dhyanagiri Suyatna (Department of Clinical Pharmacology, Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No.6, Jakarta)
Ferry Sandra (Department of Biochemistry and Molecular Biology, Division of Oral Biology, Faculty of Dentistry, Universitas Trisakti, Jl. Kyai Tapa No. 260, Jakarta)
Em Yunir (Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Jakarta)
Sarwono Waspadji (Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Jakarta)
Suzzana Immanuel (Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Jakarta)
Todung Silalahi (Department of Internal Medicine, Faculty of Medicine, Krida Wacana Christian University, Jl. Tanjung Duren Raya No.4, Jakarta)
Saleha Sungkar (Department of Clinical Parasitology, Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No.6, Jakarta)
Jusuf Rachmat (Department of Thoracic, Cardiac and Vascular Surgery, Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No.6, Jakarta)
Saptawati Bardosono (Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No.6, Jakarta)
Mirta Hediyati Reksodiputro (Facial Plastic Reconstructive Division, Department of Otorhinolaryngology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Jakarta)

The Indonesian Biomedical Journal
Vol 13, No 3 (2021)

BACKGROUND: Hyaluronic acid (HA) is an essential component of extracellular matrix and mediates signaling in wound healing. HA could induce growth factor release from Advanced Platelet Rich Fibrin (A-PRF), including Vascular Endothelial Growth Factor (VEGF) and Platelet-derived Growth Factor (PDGF). However, concentrations of the released-VEGF and PDGF have not been clearly disclosed. Therefore, current study was conducted to measure the release of these growth factors in HA + A-PRF gel of diabetic foot ulcer (DFU) subjects.METHODS: Twenty DFU subjects were included in the study and treated with A-PRF or HA+A-PRF. A-PRF was derived from autologous peripheral blood and processed with low-speed centrifugation. HA was added with a ratio of 1:0.6. A-PRF or HA + A-PRF was applied topically on DFU. Upper tips of A-PRF or HA + A-PRF gels were collected on day 0, 3 and 7 for measurements of VEGF and PDGF concentrations with Enzyme-linked Immune-sorbent Assay (ELISA) methods.RESULTS: On day-3, both VEGF and PDGF concentrations of HA + A-PRF group were significantly higher than the VEGF (p=0.000) and PDGF (p=0.019) concentrations of A-PRF group. The VEGF and PDGF concentrations were continuously and significantly increased on day-7 of HA + A-PRF group, compared to the VEGF (p=0.000) and PDGF (p=0.004) concentrations of A-PRF group.CONCLUSION: Combination HA+A-PRF induces VEGF and PDGF release from A-PRF. A mixture of A-PRF and HA could be more effective than A-PRF alone for treatment of DFU.KEYWORDS: hyaluronic acid, advanced platelet rich fibrin, PRF, growth factor, VEGF, PDGF, diabetic foot ulcer