Changes in ZO-1 expression as an early indicator of treatment effectiveness in patients with chronic diabetic foot wounds

Abstract

Chronic diabetic foot wounds represent a persistent surgical challenge due to delayed healing, frequent complications, and high socioeconomic burden. Chronic hyperglycemia is known to impair epidermal barrier integrity, in part by altering the expression of tight junction proteins, including zonula occludens‑1 (ZO‑1).

Objective – to evaluate changes in ZO‑1 expression in chronic diabetic foot wounds following combined local therapy and to assess the potential role of ZO‑1 as an early molecular marker of epithelial barrier restoration.

Materials and methods. A prospective randomized study included 28 patients with chronic diabetic foot wounds. Patients were divided into an intervention group (n=14) treated with a combined spray–and–gel regimen containing collagen, hyaluronate, amino acids, trace elements (Zn, Cu), and antiseptic components, and a control group (n=14), receiving standard chlorhexidine dressings. Epidermal biopsy samples were obtained at baseline (Day 0) and after 10 days of treatment. ZO‑1 expression was assessed using Western blot analysis, followed by densitometric quantification.

Results. Patients receiving combined local therapy demonstrated a marked increase in ZO‑1 expression by Day 10 compared with baseline values, indicating restoration of intercellular junction integrity. No comparable changes were observed in the control group.

Conclusions. Combined local therapy promotes molecular recovery of the epidermal barrier in chronic diabetic foot wounds, as evidenced by increased ZO‑1 expression. These findings support the clinical relevance of ZO‑1 as an objective biomarker for treatment response in the surgical management of chronic diabetic wounds.