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From Buenos Aires Conference, additional findings on apitherapy

The international beekeeping organization, Apimondia, promotes scientific, technical, ecological, sociological, and economic apiculture development around the world.  Apimondia comprises seven standing commissions, including on eon apitherapy. Its 2011 congress, held in October in Buenos Aires, Argentina, featured three symposia on apitherapy.  Edited versions of five of the presentations were published in our January-March 2012 issue; two more appear here. 

Topical treatment with propolis dressings for poor-healing foot ulcers in diabetic patients.
by Drs. P. Temesio (in memorian), N. Ross, and R. Alvarez

Foot ulcers that heal poorly affect 15% of diabetic patients and precede 84% of all diabetes-related lower leg amputations. Compared with diabetic patients without ulcers, the mortality at 3 years is 15% higher. Foot ulcers do not follow an orderly and reliable wound healing process.

Although propolis has been used since anceitn times to cure wounds, few clinical experiences have been documented or published. We therefore present the results of the small historic observational study performed in 1983 among 23 ambulatory diabetic patients (13 type I, 10 type II) with foot ulcers.  All recieved topical treatment with 8% propolis of Uruguayan origin in hydro-soluble vehicle dressings.

Quantitative analysis of polyphenols in Uruguayan propolis (ethanol extracts) using high performance liquid chromatography-mass spectrometry showed a mean value of 457 mg/g, with a high content of flavonoids. On the sixth day of treatment, 2 patients who had developed a peri-lesional allergic reaction (which cleared after treatment with topical corticosteroids) were withdrawn from the study.

A 1997 study comparing the efficiacy and safety of the treatment with 8% versus 2% propolis dressings from Uruguay in patients with burns (n=76), wounds (n=122) or ulcers (n=31) showed similar effectiveness but a significant reduction in local allergic events.

Characteristics of the 21 patients before treatment were as follows: mean age 48+-18.7 years (range 17-77); mean diabetes duration 13.5+-7.5 (range 30-33); mean wound duration 77+- 27.7 days (range 30 – 120). A total of 11 patients had neuropathic ulcers (2 with underlying lipoidic necrobiosis, 4 with bilateral ulcers; 5 had neuroischemic ulcers, 3 had traumatic wounds, and 2 had venous ulcers.  For treatment purposes, wounds were fully covered with propolis occlusive dressings (plus a 8% propolis solution in four deep wounds) and replaced every 3 days; surgical debridement was performed as required.  A total of 15 patients recieved were simultaneously given antibiotics.

After a mean treatment time of 40.5+-16 days (range 18-75), wounds healed completely in 20 patients and significantly improved in one.  Propolis dressings which provided for a moist wound environment, facilitated autolytic debridement and healthy granulation tissue formation.  They were painless and easy to use and to remove without trauma to the wound.

In chronic wounds, the reestablishment of a normal repair pattern by topical propolis is apparently related mainly to the ability of its polyphenols to down regulate the activation of NF-kB – the master key of the genetic regulation of immunity and inflammation – induced by bacterial molecules, inflammatory mediators, and oxygen/nitrogen reactive species; and with its iron chelating capability.

References

1. BREM H and TOMIC-CANIC M. Cellular and moecular basis of wound healing in diabetes. J Clin INvest 117:1219-1222; 2007
2. RAMSEY SD et al. Incidence, outcomes, and costs of foot ulcers in patients with diabetes. Diabetes care 22:382-387; 1999
3. HARTOCH RS et al. Emergency management of chronic wounds. Emerg Med Clin N Am 25:203-221; 2007
4. FALANGA V. Wound healing and its impairment in the diabetic foot. Lancet 366: 1736-1743; 2005.
5. KUMAZAWA S et al. Antioxidant activity of propolis of various geographic regions. Food Chemistry 84:329-339; 2004
6. FIERRO MORALES and LOPEZ GARBARINO J. Clinical Evulation of a new hypoallergenic formula of propolis in dressings. In: Bee products. Properties, applications and apitherapy Mizrahi and Y Lensky Eds), pp 101-105. Plenum Press, New York, 1996
7. DRIVER VR et al. The costs of diabetic foot: the economic case for the limb salvage team. J Vasc Surg 52 (3Suppl): 17S-22S; 2010
8. GHOSH S and HAYDEN MS. New regulations of NF-kB in inflammation. Nat Rev Immunol 8:837-848; 2008
9. KOSTYUK V et al. The promise of plant polyphenols as the golden standard skin anti-inflammatory agents. Curr Drug Metab 11:415-424; 2010.

 

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