What is the Future of Diabetic Wound Care?

Abstract

With diabetes affecting 5% to 10% of the US population, development of a more effective treatment for chronic diabetic wounds is imperative. Clinically, the current treatment in topical wound management includes debridement, topical antibiotics, and a state-of-the-art topical dressing. State-of-the-art dressings are a multi-layer system that can include a collagen cellulose substrate, neonatal foreskin fibroblasts, growth factor containing cream, and a silicone sheet covering for moisture control. Wound healing time can be up to 20 weeks. The future of diabetic wound healing lies in the development of more effective artificial "smart" matrix skin substitutes. This review article will highlight the need for novel smart matrix therapies. These smart matrices will release a multitude of growth factors, cytokines, and bioactive peptide fragments in a temporally and spatially specific, event-driven manner. This timed and focal release of cytokines, enzymes, and pharmacological agents should promote optimal tissue regeneration and repair of full-thickness wounds. Development of these kinds of therapies will require multidisciplinary translational research teams. This review article outlines how current advances in proteomics and genomics can be incorporated into a multidisciplinary translational research approach for developing novel smart matrix dressings for ulcer treatment. With the recognition that the research approach will require both time and money, the best treatment approach is the prevention of diabetic ulcers through better foot care, education, and glycemic control.

Conventional treatment versus vacuum therapy for diabetic foot ulcers treatment

“…Blisters and sores appear on numb areas of the feet and legs such as metatarsi-phalangeal joints, heel region and as a result pressure or injury goes unnoticed and eventually become portal of entry for bacteria and infection. 5 Assessment of diabetic foot ulcer includes identifying risk factors such as diabetic peripheral neuropathy, noting that 50 percent of people are asymptomatic, and ruling out other causes of peripheral neuropathy such as alcohol abuse and spinal injury.…”

The molecular signature of impaired diabetic wound healing identifies serpinB3 as a healing biomarker

“…Proteomic analysis of human diabetic wounds has been previously shown to yield reliable and biologically sound information on the molecular mechanisms that might be involved in delayed healing [10,11]. However, though proteomics is considered to be the way forward in diabetic foot research [12], none of the studies have developed a rigorous validation strategy. In fact, hypothesis-generating omics approaches have been criticised for being burdened by excess rates of false-positive results [18,19], thus limiting the chances of finding true biomarkers or pathogenic factors.…”

“…Such approaches are used to generate hypotheses that need to be verified in animal models and in humans [9]. So far, proteomics has been rarely used to discover new aspects of the delayed diabetic wound healing process, and the resulting pathways have never been validated [10][11][12]. Furthermore, cross-sectional comparisons of diabetic vs non-diabetic wound tissues have been biased by patients' differences and underlying conditions [10,11].…”

A Pilot Study to Evaluate the Efficacy of IZN 6D4 for the Treatment of Diabetic Foot Ulcers

“…The treatment of diabetic foot ulcers remains a major unmet medical need [1]. DFU has an incidence rate of 15% among all diabetic patients, and is more common in those with long-standing diabetes and poor glycemic control [2].…”

“…A significant amount of research has been devoted to determine the specific etiology of DFU and to answer the question of why there is impaired healing of skin ulcers in diabetes [1,8,9]. The impaired healing may result from numerous factors including changes in growth factor milieu, impaired fibroblast function, decreased immunologic function, and defects in the extracellular matrix (ECM) environment in the region of the wound.…”