Publication: Obtención, caracterización y evaluación de nitroderivados de heparina y heparinas de bajo peso molecular para el tratamiento de úlceras
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2018-03-01
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Universidad Complutense de Madrid
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Abstract
La ulceración de las extremidades inferiores representa una patología con una alta incidencia y prevalencia, que afecta al 1-3% de la población en los países desarrollados. A la problemática social derivada de la invalidez, se suma el elevado coste sanitario generado por el tratamiento de estos pacientes. Cuando los afectados son jóvenes, a las implicaciones negativas en la calidad de vida, debe agregarse la pérdida de jornadas laborales, incrementándose así el coste social que esta afección genera. La etiología de la mayor parte de las úlceras es vascular, fundamentalmente debidas a insuficiencia venosa (80-90%), aunque también pueden ser de origen arterial. Otra patología altamente vinculada a este tipo de ulceraciones es la diabetes, con una incidencia del 50% en pacientes, siendo un 15% los que sufren complicaciones ulcerosas que derivan en el llamado síndrome de pie diabético. El 90% de las amputaciones no traumáticas son atribuidas a esta causa, lo cual incrementa la morbilidad en dicha patología, ya que se estima que el 50% de los pacientes diabéticos que sufren una amputación requieren una segunda en los siguientes 5 años, reduciendo su supervivencia al 40%. No obstante, ciertas úlceras también responden a causas particulares como enfermedad oclusiva arterial o diabetes, así como a enfermedades tumorales, causas hematológicas, infecciones específicas o procesos traumáticos. A pesar de que se puede realizar un tratamiento etiológico correcto y existe una gran variedad de apósitos disponibles en la actualidad, el porcentaje y la velocidad de cicatrización siguen siendo bajos. De modo que no existe tratamiento farmacológico eficaz para las úlceras de pie diabético. Los productos empleados consisten en vendajes, apósitos y geles para hidratar la herida. Por otra parte, la retinopatía periférica es otra patología frecuentemente asociada a la diabetes, tanto la de tipo I como la de tipo II, la cual puede derivar en afectaciones a nivel no sólo de la retina, sino también de la córnea y nervios craneales. Los pacientes diabéticos con retinopatía diabética presentan un riesgo elevado de desarrollar desórdenes a nivel corneal, como defectos epiteliales, susceptibilidad y ulceraciones...
Ulceration of the lower limbs represents a pathology with a high incidence and prevalence, affecting 1-3% of the population in developed countries. To the social problems derived from the disability, the high health cost generated by the treatment of these patients is added. When the patients affected are young, the negative implications in the quality of life, must be added to the loss of working days, thus increasing the social cost that this condition generates. The etiology of most ulcers is vascular, mainly due to venous insufficiency (80-90%), although they may also be of arterial origin. Another pathology highly associated with this type of ulceration is diabetes, with a 50% incidence in patients, with 15% suffering from ulcer complications that result in the so-called diabetic foot syndrome. 90% of nontraumatic amputations are attributed to this cause, which increases morbidity in this pathology, since it is estimated that 50% of diabetic patients suffering from amputation require a second amputation in the following 5 years, reducing their survival to 40%. However, certain ulcers also respond to particular causes such as arterial occlusive disease or diabetes, as well as to tumor diseases, haematological causes, specific infections or traumatic processes. Although a correct etiological treatment can be performed and there is a wide variety of dressings available today, the percentage and speed of healing remain low. So there is no effective pharmacological treatment for diabetic foot ulcers. The products used consist of bandages, dressings and gels to hydrate the wound. On the other hand, peripheral retinopathy is another pathology frequently associated with diabetes, both type I and type II, which can lead to affectations not only to the retina but also to the cornea and cranial nerves. Diabetic patients with diabetic retinopathy have a high risk of developing corneal disorders such as epithelial defects, susceptibility and ulcerations. This is associated with alterations in the composition of the basement membrane of the corneal epithelium, such as the decrease in entactin, laminin-1 and laminin- 10, integrins α3β1 (VLA-3)...
Ulceration of the lower limbs represents a pathology with a high incidence and prevalence, affecting 1-3% of the population in developed countries. To the social problems derived from the disability, the high health cost generated by the treatment of these patients is added. When the patients affected are young, the negative implications in the quality of life, must be added to the loss of working days, thus increasing the social cost that this condition generates. The etiology of most ulcers is vascular, mainly due to venous insufficiency (80-90%), although they may also be of arterial origin. Another pathology highly associated with this type of ulceration is diabetes, with a 50% incidence in patients, with 15% suffering from ulcer complications that result in the so-called diabetic foot syndrome. 90% of nontraumatic amputations are attributed to this cause, which increases morbidity in this pathology, since it is estimated that 50% of diabetic patients suffering from amputation require a second amputation in the following 5 years, reducing their survival to 40%. However, certain ulcers also respond to particular causes such as arterial occlusive disease or diabetes, as well as to tumor diseases, haematological causes, specific infections or traumatic processes. Although a correct etiological treatment can be performed and there is a wide variety of dressings available today, the percentage and speed of healing remain low. So there is no effective pharmacological treatment for diabetic foot ulcers. The products used consist of bandages, dressings and gels to hydrate the wound. On the other hand, peripheral retinopathy is another pathology frequently associated with diabetes, both type I and type II, which can lead to affectations not only to the retina but also to the cornea and cranial nerves. Diabetic patients with diabetic retinopathy have a high risk of developing corneal disorders such as epithelial defects, susceptibility and ulcerations. This is associated with alterations in the composition of the basement membrane of the corneal epithelium, such as the decrease in entactin, laminin-1 and laminin- 10, integrins α3β1 (VLA-3)...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Farmacia, Departamento de Química Orgánica y Farmacéutica, leída el 10-07-2017