Background: L-carnosine (CAR) is an endogenous dipeptide. We aimed to determine the effects of CAR and its zinc complex polaprezinc (PLZ) on pressure ulcer healing in institutionalized long-term care patients. Methods: This study was a nonrandomized controlled trial with a maximum 4-week follow-up. Forty-two patients with stage II–IV pressure ulcers for 4 or more weeks were allocated to 1 of 3 groups in order of recruitment: the control group (n = 14) was untreated, the PLZ group (n = 10) orally received 150 mg/d PLZ (containing 116 mg CAR and 34 mg zinc), and the CAR group (n = 18) orally received 116 mg/d CAR. Pressure ulcer severity was measured weekly using the Pressure Ulcer Scale for Healing (PUSH) score. Results: At baseline, no significant differences were found among groups in demographic and nutrition parameters and pressure ulcer characteristics (severity, size, and staging). After 4 weeks, the rate of pressure ulcer healing, assessed by the mean weekly improvement in PUSH score, was significantly greater in the CAR (1.6 ± 0.2, P = .02) and PLZ groups (1.8 ± 0.2, P = .009) than in the control group (0.8 ± 0.2). The difference between the CAR and PLZ groups was not significant (P = .73). Actual dietary intakes over this period did not differ significantly among groups. Conclusions: Our results suggest that CAR and PLZ may almost equally accelerate pressure ulcer healing during 4 weeks. The results need confirmation by randomized controlled trials with larger sample sizes.
DornerBPosthauerMEThomasD. The role of nutrition in pressure ulcer prevention and treatment: National Pressure Ulcer Advisory Panel white paper. Adv Skin Wound Care. 2009;22:212-221.
2.
SanadaHMiyachiYOhuraT. The Japanese Pressure Ulcer Surveillance Study: a retrospective cohort study to determine prevalence of pressure ulcers in Japanese hospitals. WOUNDS. 2008;20:176-182.
3.
GunningbergL. EPUAP pressure ulcer prevalence survey in Sweden: a two-year follow-up of quality indicators. J Wound Ostomy Continence Nurs. 2006;33:258-266.
4.
National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Washington, DC: National Pressure Ulcer Advisory Panel; 2009.
5.
JaulE. Assessment and management of pressure ulcers in the elderly: current strategies. Drugs Aging. 2010;27:311-325.
6.
HipkissAR. Carnosine and its possible roles in nutrition and health. Adv Food Nutr Res. 2009;57:87-154.
7.
RobertsPRBlackKWSantamauroJTZalogaGP. Dietary peptides improve wound healing following surgery. Nutrition. 1998;14:266-269.
8.
HollidayRMcFarlandGA. A role for carnosine in cellular maintenance. Biochemistry (Mosc). 2000;65:843-848.
9.
TakahashiSNakashimaYTodaK. Carnosine facilitates nitric oxide production in endothelial f-2 cells. Biol Pharm Bull. 2009;32:1836-1839.
10.
SchaferMWernerS. Oxidative stress in normal and impaired wound repair. Pharmacol Res. 2008;58:165-171.
11.
ValleeBLFalchukKH. The biochemical basis of zinc physiology. Physiol Rev. 1993;73:79-118.
12.
LansdownABMirastschijskiUStubbsNScanlonEAgrenMS. Zinc in wound healing: theoretical, experimental, and clinical aspects. Wound Repair Regen. 2007;15:2-16.
13.
RinkLGabrielP. Zinc and the immune system. Proc Nutr Soc. 2000;59:541-552.
14.
GrayM. Does oral zinc supplementation promote healing of chronic wounds?J Wound Ostomy Continence Nurs. 2003;30:295-299.
15.
YanagisawaHMiyakoshiYKobayashiK. Long-term intake of a high zinc diet causes iron deficiency anemia accompanied by reticulocytosis and extra-medullary erythropoiesis. Toxicol Lett. 2009;191:15-19.
16.
MatsukuraTTakahashiTNishimuraYOhtaniTSawadaMShibataK. Characterization of crystalline L-carnosine Zn(II) complex (Z-103), a novel anti-gastric ulcer agent: tautomeric change of imidazole moiety upon complexation. Chem Pharm Bull (Tokyo). 1990;38:3140-3146.
17.
SeikiMAitaHUekiS. Effect of Z-103 on wound healing by dermal incision in guinea pigs [in Japanese]. Nihon Yakurigaku Zasshi. 1992;100:165-172.
18.
MatsukuraTTanakaH. Applicability of zinc complex of L-carnosine for medical use. Biochemistry (Mosc). 2000;65:817-823.
19.
European Food Safety Authority Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific opinion on the substantiation of health claims related to L-carnosine and increase in muscle power (ID 1824), increase in endurance capacity (ID 1824), “skin” (ID 1825) and maintenance of normal cardiac function (ID 1826) pursuant to Article 13(1) of Regulation (EC) NO 1924/2006. EFSA J. 2011;9:2038.
RennertRGolinkoMYanAFlattauATomic-CanicMBremH. Developing and evaluating outcomes of an evidence-based protocol for the treatment of osteomyelitis in stage IV pressure ulcers: a literature and wound electronic medical record database review. Ostomy Wound Manage. 2009;55:42-53.
22.
WilczweskiPGrimmDGianakisAGillBSarverWMcNettM. Risk factors associated with pressure ulcer development in critically ill traumatic spinal cord injury patients. J Trauma Nurs. 2012;19:5-10.
23.
NakaoHYamazakiMTsuboiROgawaH. Mixture of sugar and povidone—iodine stimulates wound healing by activating keratinocytes and fibroblast functions. Arch Dermatol Res. 2006;298:175-182.
24.
BarneaYWeissJGurE. A review of the applications of the hydrofiber dressing with silver (Aquacel Ag) in wound care. Ther Clin Risk Manag. 2010;6:21-27.
BergstromNBradenBJLaguzzaAHolmanV. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res. 1987;36:205-210.
27.
Ministry of Education, Culture, Sports, Science and Technology. Standard Tables of Food Composition in Japan—2010. Tokyo, Japan: Ministry of Education, Culture, Sports, Science and Technology; 2010.
28.
LittellRCMillikenGAStroupWWWolfingerRDSchabenbergerO. Analysis of repeated measures data. In: SAS for Mixed Models. 2nd ed.Cary, NC: SAS Institute; 2006:159-203.
29.
BrewerRDJrMihaldzicNDietzA. The effect of oral zinc sulfate on the healing of decubitus ulcers in spinal cord injured patients. Proc Annu Clin Spinal Cord Inj Conf. 1967;16:70-72.
30.
NorrisJRReynoldsRE. The effect of oral zinc sulfate therapy on decubitus ulcers. J Am Geriatr Soc. 1971;19:793-797.
31.
WoodRJ. Assessment of marginal zinc status in humans. J Nutr. 2000;130:1350S-1354S.
32.
GibsonRS. Principles of Nutritional Assessment. 2nd ed.New York, NY: Oxford University Press; 2005.
33.
YanagisawaH. Zinc deficiency and clinical practice. JMAJ. 2004;47:359-364.
34.
TomitaHTanakaMIkuiA. Clinical standard value for diagnosis of zinc deficiency by the serum zinc value on the basis of evidence [in Japanese]. Biomed Res Trace Elem. 2007;18:54-62.
35.
KogirimaMKurasawaRKuboriS. Ratio of low serum zinc levels in elderly Japanese people living in the central part of Japan. Eur J Clin Nutr. 2007;61:375-381.
36.
YanikMKocyigitATutkunHVuralHHerkenH. Plasma manganese, selenium, zinc, copper, and iron concentrations in patients with schizophrenia. Biol Trace Elem Res. 2004;98:109-117.
37.
Food and Nutrition Board, Institute of Medicine of The National Academies. Dietary reference intakes. 2001. http://www.nap.edu. Accessed May 12, 2013.
38.
MillerBJBuckleyPSeaboltWMellorAKirkpatrickB. Meta-analysis of cytokine alterations in schizophrenia: clinical status and antipsychotic effects. Biol Psychiatry. 2011;70:663-671.
39.
DoleyJ. Nutrition management of pressure ulcers. Nutr Clin Pract. 2010;25:50-60.
