New treatment with granulocyte-colony stimulating factor in diabetic foot ulceration

Several pathogenetic factors such as peripheral neuropathy, vasculopathy an d infection are responsible for the development of diabetic foot ulceration s. An important factor contributing to the high infection risk in diabetic patients is a defect in neutrophil granulocytes. Deficencies in neutrophil chemotaxis, phagocytosis and respiratory burst activity with the decrease o f the super- and peroxids are known to be associated with diabetes. Granulo cyte-colony stimulating factor(G-CSF) increases the release of neutrophils from the bone marrow and improves neutrophil function. A 78-year old patien t with non-insulin-dependent diabetes presented with ulcerations of both bi g toes and a malum perforans on the right sole. He also had generalized art eriosclerosis as well as a polyneuropathy with a dry foot and typical foot deformation as well as decreased in sensitivity. Intensive local care for 3 5 days led to no improvement of the ulcerations. Then G-CSF (Neupogen((R))) was adminstered in a total dose of 165 million IU over 11 days;the daily d ose varied between 15-30 million IU depending on the absolute leucocyte cou nt. In addition 500 mg of oral ciprofloxacin (Ciproxin((R))) was given b.i. d. This treatment led to a significant improvement of the lesions. Within 1 1 days cost analysis suggests G-CSF may be a cost-effective addition to ant imicrobial therapy in diabetic foot infection.