Effect of matrix metalloproteinases on the healing of diabetic foot ulcer: A systematic review

Tri-Layered Bioactive Cutaneous Scaffold with Integrated Bioactive Metal Organic Frameworks to Promote Full-Thickness Infected Diabetic Wound Healing: Multifaceted Therapeutic Strategies

Chronic infected diabetic wounds are complex and often lead to severe clinical outcomes such as sepsis, gangrene, and amputation. To address these challenges, herein we developed a novel tri-layered scaffold to provide multi-functional therapeutic support. The bottom poly (lactic-co-glycolic acid) (PLGA) fibrous layer contains doxycycline loaded CuBDC nanosheets for rapid antibacterial action. The porous PLGA/gelatin middle layer offers mechanical support and γ-tocotrienol loaded ZIF-8 nanocrystals mitigates oxidative stress in the wound. The PLGA top sealing fibrous layer delivers insulin and Transforming growth factor beta (TGF-β1) from Zeolitic Imidazolate Framework-8 (ZIF-8) nanocrystals to promote epithelialization and modulate inflammation. Comprehensive in vitro and in vivo evaluations demonstrated that the scaffold effectively filled deep wounds, reduced bacterial load, controlled inflammation, and accelerated the tissue regeneration. Histopathological analyses showed enhanced epithelialization and partial granulation tissue remodeling. Biochemical assays indicated an increase in glutathione peroxidase (GPx) activity and a reduction in lipid peroxidation. Gene expression analysis revealed decreased levels of the pro-inflammatory TNF-α and increased levels of the anti-inflammatory IL-10, facilitating the transition to the proliferative phase. This multi-layered composite scaffold, with its antimicrobial, antioxidant, and anti-inflammatory activities, controlled release capabilities, presents a promising solution the healing process of deep, infected diabetic wounds.

A Smart MMP-9-responsive Hydrogel Releasing M2 Macrophage-derived Exosomes for Diabetic Wound Healing

Chronic diabetic wounds are characterized by prolonged inflammation and excessive accumulation of M1 macrophages, which impede the healing process. Therefore, resolving inflammation promptly and transitioning to the proliferative phase are critical steps for effective diabetic wound healing. Exosomes have emerged as a promising therapeutic strategy. In this study, a smart hydrogel capable of responding to pathological cues in the inflammatory microenvironment to promote the transition from inflammation to proliferation by delivering M2 macrophage-derived exosomes (M2-Exos) is developed. The smart hydrogel is synthesized through the cross-linking of oxidized dextran, a matrix metalloproteinase (MMP)-9-sensitive peptide, and carboxymethyl chitosan containing M2-Exos. In response to elevated MMP-9 concentrations in the inflammatory microenvironment, the hydrogel demonstrates diagnostic logic, adjusting the release kinetics of M2-Exos accordingly. The on-demand release of M2-Exos facilitated macrophage polarization from the M1 to the M2 phenotype, thereby promoting the transition from the inflammatory to the proliferative phase and accelerating diabetic wound healing. The transcriptomic analysis further reveals that the MMP-9-responsive hydrogel with M2-Exos delivery exerts anti-inflammatory and regenerative effects by downregulating inflammation-related pathways. This study introduces an innovative, microenvironment-responsive exosome delivery system that enables precise control of therapeutic agent release, offering a personalized approach for the treatment of chronic diabetic wounds.

Enhancing patient outcomes: the role of octenidine-based irrigation solutions in managing sore and irritated peristomal skin

This article explores the potential benefits of cleansing damaged peristomal skin with an octenidine-based antimicrobial irrigation solution.

Targeting Epigenetic Plasticity to Reduce Periodontitis-Related Inflammation in Diabetes: CBD, Metformin, and Other Natural Products as Potential Synergistic Candidates for Regulation? A Narrative Review

Periodontitis is unanimously accepted to be the sixth complication of diabetes mellitus (DM), while the inverse relationship of causality is still to be deciphered. Among the proposed mechanisms is gut dysbiosis, which is responsible for the systemic release of proinflammatory mediators. In this process, Gram-negative bacteria from the oral cavity enter the general circulation, leading to the emergence of bi-hormonal beta-pancreatic cells that lack the ability to secrete insulin. Additionally, epigenetic and adaptive mechanisms in affected cells may play a role in reducing inflammation. The release of reactive oxygen species, proinflammatory cytokines, and adipokines, such as interleukins, tumor necrosis factor alpha, leptin, prostaglandin E2, C-reactive protein, or matrix metalloproteinases, determine epigenetic changes, such as the methylation of DNA nucleotides or changes in the activity of histone acetylases/deacetylases. The management of periodontitis involves targeting inflammation, and its potential connection to epigenetic modulation observed in other chronic conditions may help to explain its role in preventing DM in affected patients. This review focuses on the key epigenetic changes in periodontitis that might contribute to DM development, and explores the mechanisms and novel multi-drug therapies that could help to prevent these effects.

Lyopreservation and Nonionic Decellularization of Human Amnion Scaffolds for Enhancing Regeneration in Chronic Nonhealing Ulcers

Chronic nonhealing ulcers are responsible for considerable morbidity, given the increasing prevalence of type II diabetes and other comorbid conditions that further worsen healing. This study introduced shelf-stable decellularized and lyopreserved human amnion grafts for treating difficult-to-heal wounds. The processing approach (comprising a unique combination of nonionic surfactants and trehalose lyopreservation) applied to develop these bioscaffolds maximized the retention of sulfated glycosaminoglycans while enhancing both tensile property and hydrophilicity. Postprocessing, the tensile properties were found to be similar to human skin (5.33 ± 2.45 MPa). Additionally, the surface hydrophilicity of the lyopreserved grafts was increased. It also exhibited optimum moisture transmissibility (evaluated as per BS EN 13726-2 standards), similar to moist wound dressing (1625 ± 375 g/m2/day). Biochemical attributes including total acid-soluble proteins (481.140 ± 14.95 μg/mL) and collagen (9.01 ± 0.15 mg/mL) were well retained as compared to the fresh membrane. Notably, the sulfated glycosaminoglycan content of the processed grafts was well conserved (there was only a 21.14% reduction, which was substantially lower than the reduction achieved by conventionally used surfactants for processing biological tissues). The regenerative efficacy of these bioactive scaffolds was evaluated through preclinical testing in a diabetic rodent wound model. It showed a 50% reduction in time to heal compared to the standard of care dressings, supported by increased vascular endothelial growth factor (VEGF) expression in the healed tissues. This can be collectively attributed to the conservation of sulfated glycosaminoglycans (GAGs) and the enhanced scaffold tensile quality, which play key roles in promoting angiogenesis, and tissue regeneration in diabetic wound beds. As a result, these grafts are well suited for a variety of soft tissue reconstruction applications and can also serve as bioactive scaffolds for culturing autologous cells, making them versatile tools in regenerative medicine.

Cratylia mollis lectin reduces inflammatory burden induced by multidrug-resistant Staphylococcus aureus in diabetic wounds

In diabetes, tissue repair is impaired, increasing susceptibility to Staphylococcus aureus infections, a pathogen commonly found in wounds. The emergence of S. aureus strains that are highly resistant to antimicrobial agents highlights the urgent need for alternative therapeutic options. One promising candidate is Cramoll (Cratylia mollis seed lectin), known for its immunomodulatory, mitogenic, and healing properties. However, its efficacy in infected diabetic wounds remains unexplored. This study evaluated the effects of topical Cramoll treatment on diabetic wounds infected by S. aureus. Diabetic Swiss mice (induced by streptozotocin) were subjected to an 8-mm wound on the back and subsequently infected with a suspension of multidrug-resistant S. aureus. During the treatment period, the wounds were clinically evaluated for inflammation and the area of injury. After seven days, samples were collected from the wounds to quantify the bacterial load and histopathological and immunological analyses. Wounds infected by S. aureus exhibited more pronounced areas and severity indices, which were significantly reduced by Cramoll treatment (p < 0.05). Histopathological analysis revealed a reduction in inflammatory cells and an increase in revascularization with Cramoll treatment (p < 0.05). Cramoll also promoted greater collagen production compared to controls (p < 0.05). Furthermore, Cramoll treatment significantly reduced the S. aureus load in wounds (p < 0.0001), decreased TNF-α and IL-6 levels in infected wounds, and increased ERK pathway activation (p < 0.05). In conclusion, Cramoll lectin improves the healing of diabetic wounds, and these results contribute to the understanding of Cramoll healing mechanisms, reinforcing its potential as a healing agent in various clinical conditions.

Porous silicon-based sensing and delivery platforms for wound management applications

Wound management remains a great challenge for clinicians due to the complex physiological process of wound healing. Porous silicon (PSi) with controlled pore morphology, abundant surface chemistry, unique photonic properties, good biocompatibility, easy biodegradation and potential bioactivity represent an exciting class of materials for various biomedical applications. In this review, we focus on the recent progress of PSi in the design of advanced sensing and delivery systems for wound management applications. Firstly, we comprehensively introduce the common type, normal healing process, delaying factors and therapeutic drugs of wound healing. Subsequently, the typical fabrication, functionalization and key characteristics of PSi have been summarized because they provide the basis for further use as biosensing and delivery materials in wound management. Depending on these properties, the rise of PSi materials is evidenced by the examples in literature in recent years, which has emphasized the robust potential of PSi for wound monitoring, treatment and theranostics. Finally, challenges and opportunities for the future development of PSi-based sensors and delivery systems for wound management applications are proposed and summarized. We hope that this review will help readers to better understand current achievements and future prospects on PSi-based sensing and delivery systems for advanced wound management.

Alcaligenes faecalis corrects aberrant matrix metalloproteinase expression to promote reepithelialization of diabetic wounds

Chronic wounds are a common and costly complication of diabetes, where multifactorial defects contribute to dysregulated skin repair, inflammation, tissue damage, and infection. We previously showed that aspects of the diabetic foot ulcer microbiota were correlated with poor healing outcomes, but many microbial species recovered remain uninvestigated with respect to wound healing. Here, we focused on Alcaligenes faecalis, a Gram-negative bacterium that is frequently recovered from chronic wounds but rarely causes infection. Treatment of diabetic wounds with A. faecalis accelerated healing during early stages. We investigated the underlying mechanisms and found that A. faecalis treatment promotes reepithelialization of diabetic keratinocytes, a process that is necessary for healing but deficient in chronic wounds. Overexpression of matrix metalloproteinases in diabetes contributes to failed epithelialization, and we found that A. faecalis treatment balances this overexpression to allow proper healing. This work uncovers a mechanism of bacterial-driven wound repair and provides a foundation for the development of microbiota-based wound interventions.

Metalloproteinases as Biomarkers and Sociomarkers in Human Health and Disease

Metalloproteinases (MPs) are zinc-dependent enzymes with proteolytic activity and a variety of functions in the pathophysiology of human diseases. The main objectives of this review are to analyze a specific family of MPs, the matrix metalloproteinases (MMPs), in the most common chronic and complex diseases that affect patients' social lives and to better understand the nature of the associations between MMPs and the psychosocial environment. In accordance with the PRISMA extension for a scoping review, an examination was carried out. A collection of 24 studies was analyzed, focusing on the molecular mechanisms of MMP and their connection to the manifestation of social aspects in human disease. The complexity of the relationship between MMP and social problems is presented via an interdisciplinary approach based on complexity paradigm as a new approach for conceptualizing knowledge in health research. Finally, two implications emerge from the study: first, the psychosocial states of individuals have a profound impact on their overall health and disease conditions, which implies the importance of adopting a holistic perspective on human well-being, encompassing both physical and psychosocial aspects. Second, the use of MPs as biomarkers may provide physicians with valuable tools for a better understanding of disease when used in conjunction with "sociomarkers" to develop mathematical predictive models.

Wound microbiota-mediated correction of matrix metalloproteinase expression promotes re-epithelialization of diabetic wounds

Chronic wounds are a common and costly complication of diabetes, where multifactorial defects contribute to dysregulated skin repair, inflammation, tissue damage, and infection. We previously showed that aspects of the diabetic foot ulcer microbiota were correlated with poor healing outcomes, but many microbial species recovered remain uninvestigated with respect to wound healing. Here we focused on Alcaligenes faecalis , a Gram-negative bacterium that is frequently recovered from chronic wounds but rarely causes infection. Treatment of diabetic wounds with A. faecalis accelerated healing during early stages. We investigated the underlying mechanisms and found that A. faecalis treatment promotes re-epithelialization of diabetic keratinocytes, a process which is necessary for healing but deficient in chronic wounds. Overexpression of matrix metalloproteinases in diabetes contributes to failed epithelialization, and we found that A. faecalis treatment balances this overexpression to allow proper healing. This work uncovers a mechanism of bacterial-driven wound repair and provides a foundation for the development of microbiota-based wound interventions.