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

doi:10.4239/wjd.v16.i10.110631

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Clinical Trials Study

World J Diabetes. Oct 15, 2025; 16(10): 110631
Published online Oct 15, 2025. doi: 10.4239/wjd.v16.i10.110631

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

Chen Huang, He-Zhu Liu, Jia-Bin Liang, Wei Zhao, Yan-Sheng Wang, Li-Fen Ruan, Wei-Zhao Zhuang, Yong-Sheng Li, Qian Wang, Yu-Kuan Tang

Chen Huang, Li-Fen Ruan, Wei-Zhao Zhuang, Qian Wang, Yu-Kuan Tang, Department of Minimally Invasive Interventional Radiology, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou 511400, Guangdong Province, China

He-Zhu Liu, Wei Zhao, Yan-Sheng Wang, School of Life Sciences, South China Normal University, Guangzhou 511400, Guangdong Province, China

Jia-Bin Liang, Lab Center, Guangzhou University of Chinese Medicine, Guangzhou 511400, Guangdong Province, China

Yong-Sheng Li, Institution of Guangdong Cord Blood Bank, Guangdong Women and Children Hospital, Guangzhou 510010, Guangdong Province, China

Co-first authors: Chen Huang and He-Zhu Liu.

Co-corresponding authors: Qian Wang and Yu-Kuan Tang.

Author contributions: Huang C and Liu HZ designed the research; Huang C, Liu HZ, Li YS, Zhao W, Wang YS, and Liang JB performed the research; Huang C, Liu HZ, Ruan LF, Zhuang WZ, and Wang Q analyzed and interpreted data; and Huang C, Liu HZ, and Tang YK wrote the manuscript. All authors approved the final version of the manuscript. Huang C proposed and designed the research, patient screening, enrollment, collection of clinical data, performed data analysis and prepared the first draft of the manuscript. Liu HZ designed and conducted PRP analysis, performed data analysis and prepared the first draft of the manuscript. Both authors have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper. Both Wang Q and Tang YK have played important and indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-corresponding authors. Wang Q conceptualized, designed and supervised the whole process of the project. Wang Q was instrumental and responsible for data re-analysis and re-interpretation, figure plotting, comprehensive literature search, preparation. Tang YK applied for and obtained the funds for this research project and revised the manuscript. This collaboration between Wang Q and Tang YK is crucial for the publication of this manuscript.

Supported by the Medical Science and Technology Foundation of Guangdong Province, No. A2024625; the Guangzhou Municipal Science and Technology Program Key Projects, No. 202103000002; and the Panyu Science and Technology Planning Project, No. 2023-Z04-019.

Institutional review board statement: Ethical approval was obtained from the Medical Ethics Committee of the Affiliated Panyu Central Hospital of Guangzhou Medical University (No.[2019] 59) in the study.

Clinical trial registration statement: The study has been registered in the clinical trial registry at http://www.chictr.org.cn, No. ChiCTR1900023986.

Informed consent statement: Informed consent was obtained from all enrolled patients.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: The datasets analyzed for the present study are available from the corresponding author on request.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Yu-Kuan Tang, MD, Director, Department of Minimally Invasive Interventional Radiology, The Affiliated Panyu Central Hospital of Guangzhou Medical University, No. 8 East Fuyu Road Qiaonan Street, Panyu District, Guangzhou 511400, Guangdong Province, China. tyk20126@126.com

Received: June 11, 2025
Revised: July 17, 2025
Accepted: September 8, 2025
Published online: October 15, 2025
Processing time: 126 Days and 17.9 Hours

Abstract

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.

Keywords: Angiogenesis; Diabetic foot; Endovascular angioplasty; Platelet-rich plasma; Wound healing

Core Tip: This study investigated the effect of platelet-rich plasma (PRP) combined with endovascular angioplasty on diabetic foot ulcers (DFUs). The findings revealed that PRP improved the proliferation and migration of human umbilical vein endothelial cells, human dermal fibroblasts, and human immortalized keratinocytes. It also activated p38, Ak strain transforming and extracellular regulated protein kinases 1/2, and upregulated vascular endothelial growth factor receptor 2 to promote angiogenesis. PRP combined with endovascular angioplasty improved microcirculation, especially in the lower limb ischemic area, and promoted tissue repair in DFU conditions. The combination of 6% activated PRP and endovascular angioplasty demonstrated a notable effect in improving DFU conditions, providing a novel treatment option for patients with DFUs.