Everyone of us consider honey as a natural remedy to treat numerous illnesses and infections. It is used by people as one of the best natural ingredients for wound healing since ancient times. With countless varieties of honey available in the market, Manuka honey offers the greatest therapeutic benefits than any other variety. However, inadequate trials and experimental data have made it a bit hard to accept that Manuka honey is an effective ingredient in wound care. Recent researches have shown that the prominent antibacterial activity of Manuka honey is due to reactive methylglyoxal (MGO).
What is MGO (Methylglyoxal)?
(MGO) Methylglyoxal is a powerful protein-glycating agent and a significant precursor of advanced glycation end products (AGEs). MG and AGEs assume a part in the pathogenesis of disabled diabetic wound healing and can adjust the construction and capacity of target particles. But the major concern is whether MGO in Manuka honey delays wound healing in diabetic patients or not.
Methylglyoxal (MGO) is perceived similar to the bioactive component liable for the antibacterial movement of Manuka honey. MGO content was explored by superior fluid chromatography (HPLC-UV), in isocratic elution, to evaluate the occurrence of this compound in mono-and multi-flower honey samples illustrative of various herbal and geographic origins. The measure of MGO found in various kinds of nectar ranges from 0.4 to 24.1 mg/kg.
Nectar source is definitive in honey MGO concentration in light of the fact that methylglyoxal is a flagging atom in plants exposed to abiotic stress. Without a doubt, many examinations have shown that the arrangement and volume of nectar are impacted by ecological factors (water pressure, temperatures, soil supplements) or plant-explicit components (bloom age, sex and genotypic changeability). Subsequently, MGO concentrations in honey fluctuate from one year to another, yet additionally starting with one country then onto the next, given that the composition of honey, even from a similar cultivar, is completely connected to its space of production, and its organoleptic qualities reflect the vegetational variety of the environment of origin. The presence of MGO in honey has been ascribed to the phenomenon of sugar degradation throughout caramelization, yet progressive investigations have shown that the undeniable levels of this compound in Manuka honey are an outcome of the presence of dihydroxyacetone (DHA), recognized as an immediate antecedent for MGO development. DHA is delivered by the plant or by microorganisms present in the flower, and is contained in Manuka honey; DHA lack of hydration builds the MGO levels during honey maturation.
Does MGO in Manuka Honey Help in Treating Diabetic Ulcers?
The prevalence of diabetes is quickly expanding around the world. The occurrence of diabetic foot ulcers is a genuine intricacy which contrarily influences patients' personal quality of life. Among people diagnosed to have diabetes mellitus, the commonness of foot ulcers is 4%–10%. Therapy of foot ulcers is extended and escalated and associated with significant expenses. Different methodologies have been produced for the treatment of diabetic ulcers including topical wound-care therapies.
Silver sulfadiazine, hydrogel, hydrocolloid and alginate dressings impregnated with silver, are some of the most commonly used therapeutic products which are accepted as beneficial ifor control of bacterial contaminations. Expanded utilization of ionic silver in wound care has made some worry with respect to the advancement of bacterial resistance. With expanding recurrence, present day medication focuses on normal items with antimicrobial action and their utilization in clinical practice. The significant contentions for carrying out regular items like honey, aloe vera or curcumin are the minimal expense and nonappearance of antimicrobial obstruction hazard in correlation with ordinary wound care items. Additionally, a portion of the regular treatments, for example, worm debridement treatment and phage treatment have as of late been rethought for their likely helpfulness in the treatment of wounds that are hard to heal.
Evidence of Honey Usage in Managing Chronic Wounds
Several animal studies have given convincing proof that honey can speed up injury healing. Then again, the nature of revealed preliminaries is variable and proof to date upholds honey just as a treatment of mild-to-moderate shallow and incomplete thickness burns. However, there is inadequate proof to direct clinical practice for other injury types. Honey impregnated dressings didn't altogether further develop venous ulcer healing at 12 weeks contrasted with usual care. Also, these dressings didn't essentially further develop time to heal, change in ulcer region, and frequency of disease. Then again, two extremely late clinical preliminaries recommend that healing times and occurrence of infection after treatment with honey are diminished compared with traditional treatment, and the outcomes are of clinical importance.
What is the Concentration of Methylglyoxal in Honey?
MG in Manuka honey is obtained from the non-enzymatic change of dihydroxyacetone which happens at undeniable levels in the nectar. Newly delivered Manuka honey contained low degrees of MG (139–491 mg kg−1) yet during storage at 37°C its substance expanded. The degrees of MG in multi-botanical honey varieties are low, going from 0.4 to 5.4 mg kg−1 . In two examinations, significant degrees of MG were accounted for in Manuka honey going from 48 to 743 mg kg−1  and 189 to 835 mg kg−1 , individually. It has been proposed that convergences of MG above 150 mg kg−1 are straightforwardly answerable for the characteristic antibacterial properties of Manuka honey.
What Are the Roles of MG and AGEs in Impairment of Diabetic Wound Healing?
The extent of MG damage in diabetes is tremendous, on the grounds that MG can shape adducts on protein, lipoproteins and DNAs at any site where its focus is high. It has likewise been recommended that MG glycation could be a connection among diabetes and disease vulnerability. MG-incited immune damage may give a connection among hyperglycemia and diabetes-related disease hazard.
Information from ongoing trial examines demonstrate that MG as well as AGEs might assume a part in the pathogenesis of debilitated diabetic injury mending and may have separate ramifications for resistance. Expanded AGE accumulation, alongside articulation of their receptors, are related with arrangement of diabetic atheromatous sores, setting off their destabilization, disabling ischemia-prompted neovascularization and and disrupting the expression of endothelial nitrous oxide synthase.
The accumulation of AGEs in the extracellular matrix causes abnormal cross-connecting, bringing about diminished vessel versatility. It has likewise been shown that keratinocyte movement is repressed by AGEs amassing under high-glucose conditions. In diabetes, AGEs can upgrade the action of neutrophils, with change in cell natural practices which may be one of the principle reasons answerable for constant aggravation. The supported provocative reaction happens following connection of AGEs with their receptors and arrival of favorable to fiery go-betweens, for example, tumor necrosis factor α and production of destructive matrix metalloproteinases which limit wound closure . In addition, Goova et al.  have demonstrated that blocking receptors for AGEs restores impaired wound healing in diabetic mice.
Various randomized clinical preliminaries recommend that clinical trials advances wound recuperating; however a large portion of them have excluded diabetic patients with constant leg ulcers and almost 3/4 of clinical preliminaries have zeroed in on the utilization of honey for intense injuries, specifically consumed. As a rule, fix of tissue harm in diabetic foot illness is done with a few pathophysiological instruments. Since Manuka honey contains significant degrees of MG, we conjecture that patients with diabetes might be in danger because of either the immediate adverse consequence of MG on cells and segments in the injury or the circuitous development of AGEs, which could weaken the injury recuperating measure.
According to Mr. Basem Barry, CEO and founder of Geohoney, honey is a viable elective dressing for therapy of many kinds of ongoing injuries. In any case, MG might detrimentally affect diabetic ulcers. Further examination is expected to completely clarify the impact of honey inferred MG in the treatment of diabetic ulcers.