Background: Pressure ulcer remains as a common problem, especially developed
in disabled patients and hence, subjected to continuous pressure for prolonged periods
of time. Most of the studies investigating the preventive and therapeutic approaches
have focused on wound cleansing, dressing and supportive strategies, as well as pharmacological
therapy including zinc sulphate, vitamin A or phenytoin. Despite such efforts,
pressure ulcer continues to impair the life quality and expectancy. Thus involving in the
paradigm shift in biomedical studies, the recent ones focus on biological signaling pathways
involving nitric oxide (NO)- soluble guanylatecyclase (sGC)- cyclic guanosine
monophosphate (cGMP) contributing in vasodilation, reperfusion and oxygen delivery.
Methods: Literatures review focusing on NO/sGC/cGMP pathway was performed as well as
seeking themolecular biology aspects inKyoto Encyclopedia of genes and genomes (KEGG).
Results: NO is an important signaling molecule activating sGC and cGMP production,
which is a mediator of vasodilation and platelet inhibition. Considering the subject, it
could be hypothesized that the application of sGC stimulators and activators is a very curious
strategy for pressure ulcer healing. It is well known that pressure and shear forces
usually produce the blood vessel obstruction, inducing ischemia and tissue necrosis and in
pathologic states, damaged endothelium leads to a reduced synthesis of NO and inadequate
oxygen supply contributing to delayed wound healing. Riociguat is the first FDA
approved agent of new class of sGC stimulators, involving in activation of sGC both in
presence and absence of NO.
Conclusion: The findings of this review confirm that Riociguat could start a new therapeutic
approach for pressure ulcer treatment even with dysfunctional endothelium.