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Comparison of the Hydroxylase Inhibitor Dimethyloxalylglycine and the Iron Chelator Deferoxamine in Diabetic and Aged Wound Healing

Duscher, Dominik M.D.; Januszyk, Michael M.D., Ph.D.; Maan, Zeshaan N. M.B.B.S., M.S.; Whittam, Alexander J. B.A.; Hu, Michael S. M.D., M.P.H., M.S.; Walmsley, Graham G. M.D., Ph.D.; Dong, Yixiao Ph.D.; Khong, Sacha M. Ph.D.; Longaker, Michael T. M.D., M.B.A.; Gurtner, Geoffrey C. M.D.

Plastic & Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 695e–706e
doi: 10.1097/PRS.0000000000003072
Experimental: Original Articles

Background: A hallmark of diabetes mellitus is the breakdown of almost every reparative process in the human body, leading to critical impairments of wound healing. Stabilization and activity of the transcription factor hypoxia-inducible factor (HIF)-1α is impaired in diabetes, leading to deficits in new blood vessel formation in response to injury. In this article, the authors compare the effectiveness of two promising small-molecule therapeutics, the hydroxylase inhibitor dimethyloxalylglycine and the iron chelator deferoxamine, for attenuating diabetes-associated deficits in cutaneous wound healing by enhancing HIF-1α activation.

Methods: HIF-1α stabilization, phosphorylation, and transactivation were measured in murine fibroblasts cultured under normoxic or hypoxic and low-glucose or high-glucose conditions following treatment with deferoxamine or dimethyloxalylglycine. In addition, diabetic wound healing and neovascularization were evaluated in db/db mice treated with topical solutions of either deferoxamine or dimethyloxalylglycine, and the efficacy of these molecules was also compared in aged mice.

Results: The authors show that deferoxamine stabilizes HIF-1α expression and improves HIF-1α transactivity in hypoxic and hyperglycemic states in vitro, whereas the effects of dimethyloxalylglycine are significantly blunted under hyperglycemic hypoxic conditions. In vivo, both dimethyloxalylglycine and deferoxamine enhance wound healing and vascularity in aged mice, but only deferoxamine universally augmented wound healing and neovascularization in the setting of both advanced age and diabetes.

Conclusion: This first direct comparison of deferoxamine and dimethyloxalylglycine in the treatment of impaired wound healing suggests significant therapeutic potential for topical deferoxamine treatment in ischemic and diabetic disease.

Stanford, Calif.; Linz, Austria; and Munich, Germany

From the Hagey Laboratory, Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine; the Section of Plastic Surgery, Department of Surgery, Johannes Kepler University; and the Department of Plastic Surgery and Hand Surgery, Technical University Munich.

Received for publication February 9, 2016; accepted June 22, 2016.

Disclosure: The content of this article was expressly written by the authors listed. GCG is listed on the following patent assigned to Stanford University: Topical and Transdermal Delivery of HIF-1 Modulators to Prevent and Treat Chronic Wounds (No: 20100092546). DD, MJ, ZNM, AJW, MSH, GGW, YD, SMK, and MTL have no potential conflicts of interest, affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed herein.

Geoffrey C. Gurtner, M.D., Stanford University School of Medicine, 257 Campus Drive, GK-201, Stanford, Calif. 94305-5148, ggurtner@stanford.edu

©2017American Society of Plastic Surgeons