Can Copper Help Prevent Lower Extremity Complications In Patients With Diabetes?
The wound care arena of the 21st century offers the practicing clinician a wide array of products and technologies to utilize in the management of diabetic foot ulcerations. Our patients are benefitting from the explosion of emerging technologies and evidence-based algorithms are helpful in guiding treatment interventions. Some technologies are innovative and a reflection of modern discoveries while others like medicinal applications for copper were in use in ancient times.
Copper has been used for centuries as a disinfectant of fluids, solids and tissues. It is known to have both natural antibacterial and antifungal properties. Constant exposure to high copper concentrations is toxic to microorganisms yet resistance is extremely rare. There are several theories given for the potent biocidal activity of copper. These theories include: alteration of proteins and inhibition of their biological assembly and activity; plasma membrane permeabilization; and membrane lipid peroxidation.1
As a vital trace element, copper is known to be safe and tolerated by humans. The United States National Academy of Sciences Committee recommends a daily allowance of 0.9 mg of copper for normal adults. Common naturally occurring dietary resources of copper include vegetables, legumes, nuts, grains and fruits, as well as shellfish, avocado and beef. Given that copper is present in the earth’s crust, most of the world’s surface water and ground water used for drinking purposes contains small amounts of copper.
Copper is required for the normal function of many human tissues including skin and is postulated as an important cofactor in angiogenesis and wound repair. Copper is necessary (along with iron) for the formation of hemoglobin. It also plays a role in keeping bones, blood vessels and nerves healthy. Copper is involved in numerous biochemical reactions in human cells. Copper is a component of multiple enzymes. It is involved with the regulation of gene expression, mitochondrial function/cellular metabolism and connective tissue formation as well as the absorption, storage and metabolism of iron.2 Copper levels are tightly regulated in the body.
Copper toxicity is extremely rare in the general population. Wilson’s disease is a genetic disorder in which the body cannot rid itself of copper. This results in copper deposition in organs and serious consequences such as liver failure and neurologic damage.
While there is a lack of concrete evidence to prove the efficacy of copper for several conditions, there is substantial anecdotal experience that warrants further research. The use of copper bracelets in the treatment of arthritis has a long history. There are research reports suggesting that copper salicylate may reduce arthritis symptoms more effectively than either copper or aspirin alone.3
Other medical conditions possibly associated with the therapeutic use of copper include macular degeneration, Alzheimer’s disease, schizophrenia, osteoporosis and even cosmetically in skin rejuvenation. However, copper has been used for years. It is well tolerated for prolonged and widespread human use as exemplified by female use of copper intrauterine devices (IUDs).
Assessing The Potential Of Copper In Wound Dressings
In an animal model, Borkow and colleagues studied the safety and biocidal properties of a non-stick dressing containing copper oxide particles.4 Recognizing the potent antimicrobial activity of copper, its role in the wound healing cascade and demonstrated low skin irritation, the authors hypothesized that Band-Aids containing copper would not only prevent wound contamination, but also promote wound healing.