143 urn:lsid:arphahub.com:pub:892805cc-c5d0-571f-8841-3ba335035073 Review of Clinical Pharmacology and Pharmacokinetics – International Edition RCPP 1011-6583 2945-1922 PHARMAKON-Press 10.61873/ONPK3289 34778 Research Article Assessment of the CO 2 water bath therapy effectiveness on diabetic foot ulcers through VEGF and TNF-α levels Abdulhamza Ghazwan Riyad 1 Mohammed Najeeb Hassan 2 Department of Physiology, College of Medicine, University of Kerbala, Kerbala, Iraq Department of Physiology, College of Medicine, University of Kerbala Kerbala Iraq Department of Physiology, College of Medicine, University of Baghdad, Baghdad, Iraq Department of Physiology, College of Medicine, University of Baghdad Baghdad Iraq

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2024 05 05 2024 38 s2 43 46 F4E8A4B5-6B86-5E64-9AC6-67A71496452C Ghazwan Riyad Abdulhamza, Najeeb Hassan Mohammed This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Vasculopathy is typically seen in diabetic patients, and can lead to foot ulcerations. Carbon dioxide (CO 2 ) therapy was found to improve chronic wound healing in patients with vascular impairment. This type of therapy refers to the transcutaneous and subcutaneous application of CO 2 as well as CO 2 water baths for therapeutic purposes. In the method used herein, artificial CO 2 -containing water for foot bathing was generated by dissolving Carbothera® (MRE-SPA-MD; Mitsubishi Rayon Engineering, Tokyo, Japan) and generating CO 2 (free CO 2 concentration: 1,000–1,200 mg/L; pH 4.6). The foot of each patient was immersed in CO 2 -enriched water (depth of 20–30 cm, 37–38°C, 30-min duration) three times per week, for the next three months. Dramatic clinical improvement was observed in the CO 2 water bath therapy group before and after the treatment, while both the blood levels of the vascular endothelial growth factor and of the tumour necrosis factor-alpha in these patients exhibited significant changes. The advantages of this method are the absence of pain and the protection against infection, while the improved angiogenesis and oxygenation can result in healing of the chronic wound.