In vitro and clinical evaluation of platelet-rich plasma combined with angioplasty in diabetic foot treatment

BACKGROUND Diabetic foot ulcers (DFUs) affect approximately 18.6 million people worldwide every year. Patients with DFU often present with symptoms such as lower limb infections, ulcers, and deep tissue damage. Platelet-rich plasma (PRP) is a concentrated platelet product that can trigger the release of growth factors and cytokines, which stimulate tissue healing and regeneration and thus alleviates DFU. At present, no comprehensive study has been conducted to verify the effect of PRP in both in vitro and clinical settings for treating DFUs. AIM To perform the in vitro and clinical evaluation of PRP combined with endovascular angioplasty in treating diabetic foot. METHODS This study focused on both in vitro and clinical settings. In the in vitro study, human umbilical vein endothelial cells (HUVECs), human dermal fibroblasts (HSFs), and human immortalized keratinocytes (HaCaTs) were treated with PRP. Experiments involving proliferation, migration, tubule formation, and angiogenesis signaling pathways were conducted. In this clinical study, patients who visited the Affiliated Panyu Central Hospital of Guangzhou Medical University from 2020 to 2024 and met enrollment criteria were randomly assigned to 2 groups using prospective block randomization. In the control group, the DFU was treated with endovascular angioplasty and wound debridement. In the PRP + endovascular angioplasty group, PRP was evenly used on the surface of superficial ulcers, followed by endovascular angioplasty to treat vascular occlusion. The key outcomes were measured, including the Rutherford scale, Wagner scale, foot skin temperature, and ulcer repair area before and after treatment. RESULTS In the in vitro study, 6% PRP could promote the proliferation and migration of HUVECs, HSFs, and HaCaTs in a high-glucose environment. Additionally, it promoted tubule formation in HUVECs by activating signaling proteins such as Ak strain transforming and extracellular regulated protein kinases 1/2. In the clinical study, a total of 208 patients participated. After 12 months of treatment, the ulcer repair area (14.95 ± 0.16 cm2) and ulcer healing rate were improved in the PRP + endovascular angioplasty group than in the control group (P < 0.05). CONCLUSION The combination of 6% activated PRP and endovascular angioplasty may improve the microcirculation and tissue repair in DFUs. This study offers a novel treatment option for patients with diabetic foot.