ALA-PDT exerts beneficial effects on chronic venous ulcers by inducing changes in inflammatory microenvironment, especially through increased TGF-beta release: a pilot clinical and translational study

Publication date: Available online 22 December 2017
Source:Photodiagnosis and Photodynamic Therapy
Author(s): Vieri Grandi, Stefano Bacci, Alessandro Corsi, Maurizio Sessa, Elisa Puliti, Nicoletta Murciano, Francesca Scavone, Pietro Cappugi, Nicola Pimpinelli
A cohort of 19 patients affected by chronic venous ulcers was recruited from our centre. A 4-mm punch biopsy from wound bed was taken before application of ALA 20% gel and repeated one hour after the first PDT irradiation. We observed a significant and progressive reduction of wounds mean volumes right after three ALA-PDT sessions (once per week; 4479.9 +/− 345.5 mm³ vs 34599 +/− 190.3 mm³, p < 0.01). On immunofluorescence staining from biopsy specimens, we observed a change in all tested stains of post treatment specimens compared to pre-treatment ones. An increase of plasmacytoid dendritic cells (from 699 +/− 22 cells/0.018 mm² to 1369 +/− 27 cells/0.018 mm², p < 0.0001); MHC-II expression (260.39 +/− 99.7 Red, Green, Blue [RGB 0-255] to 370.2 +/− 162.6 RGB (0-255), p < 0.01), TNF-alpha positive mast cells expression (49 +/− 0.3 cells/0.018 mm² to 69 +/− 0.4 cells/0.018 mm², p < 0.001), TGF-beta expression (59.89 +/− 23.2 RGB (0-255)/cell vs 137.39 +/− 56.6 RGB (0-255)/cell, p < 0,01) and CD4+/CD25+ Treg cells (39 +/− 1 cells/0.018 mm² vs 209 +/− 10 cells/0.018 mm², p < 0.001) was observed. An increase of TGF-beta was correlated in a statistical significant manner with a reduction of wounds' mean volumes.



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