Berberine improves diabetic foot ulcer healing after tibial transverse osteotomy by inhibiting the PDGF-B/PDGFRβ signaling pathway .
Rudong Zhang, Huanzhe Jiang
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In 30 seconds
This prospective, single-centre, randomized, placebo-controlled trial evaluated local berberine injections added to tibial transverse osteotomy (TTO) in patients with Wagner grade 2–4 diabetic foot ulcers. Among 96 randomized participants followed for 3 months, the total effective rate of ulcer healing was higher with berberine plus TTO than with TTO plus saline (87.5% vs. 68.8%; risk difference, 18.7%; 95% CI, 1.2% to 36.2%; P < 0.05). Berberine was also associated with greater improvements in ABI and ulcer healing, and with reduced inflammatory markers and fibroblast apoptosis. The proposed PDGF-B/PDGFRβ pathway link remains correlative.
Key findings
- At 3 months, total effective ulcer-healing rates were 87.5% with berberine plus TTO and 68.8% with TTO plus saline (risk difference, 18.7%; 95% CI, 1.2% to 36.2%; P < 0.05).
- ABI improved more with berberine (mean difference, 0.13; 95% CI, 0.08 to 0.18; P < 0.01), as did ulcer healing rate (mean difference, 16.7%; 95% CI, 9.5% to 23.9%; P < 0.01).
- Berberine was associated with reduced wound-tissue fibroblast apoptosis (mean difference, -1.10%; 95% CI, -1.56% to -0.64%; P = 0.001) and lower PDGF-B and PDGFRβ protein expression.
- No severe adverse events related to berberine injections were reported during the 3-month follow-up.
Why it matters
Diabetic foot ulcers can remain difficult to heal, and this trial suggests that local berberine may add benefit when used alongside TTO. The findings include clinical healing outcomes as well as changes in perfusion and inflammatory or tissue markers. The pathway observations may help guide further investigation, but they do not establish that PDGF-B/PDGFRβ changes caused the improvement.
What to keep in mind
The trial was single-centre, included 96 randomized participants, and followed them for 3 months. The proposed pathway mechanism is correlative and requires further validation; the authors call for larger multicentre trials.