Diabetic Wound-Healing Science

A glycopeptide-based pH-responsive hydrogel promotes diabetic wound healing via antimicrobial and remodeling microenvironment

Treating bacterium-infected diabetic wounds remains a major medical challenge. Antimicrobial activity, remodeling of oxidative stress-heavy and angiogenesis-impaired microenvironments are critical factors for effective wound healing. Hydrogels can function as drug delivery systems that encompass all these capabilities to enhance wound healing. In this study, we developed a glycopeptide-based hydrogel (DA/bF@OD-PL) composed of oxidized dextran (OD), polylysine (PL), dopamine (DA), and basic fibroblast growth factor (bF). This hydrogel exhibits excellent structural integrity, injectability, adhesion properties, swelling capacity, and degradability. Notably, the hydrogel is responsive to acidic conditions due to the presence of Schiff base bonds, enabling it to respond to the acidic environment characteristic of bacterium-infected wounds and release its encapsulated drugs accordingly. Among these components, PL has a strong antibacterial effect and can easily kill S. aureus and E. coli. DA effectively scavenges multiple reactive oxygen species (ROS) and induces macrophage polarization to M2 macrophages to alleviate oxidative stress. bF upregulates the expression of CD31 and vascular endothelial growth factor (VEGF) to promote angiogenesis. Finally, we validated the ability of this hydrogel to promote rapid wound healing in an S. aureus-infected diabetic mouse wound model.

Lipoic acid improves wound healing through its immunomodulatory and anti-inflammatory effects in a diabetic mouse model

Objectives

Diabetes mellitus is a chronic disease that has become more prevalent worldwide because of lifestyle changes. It leads to serious complications, including increased atherosclerosis, protein glycosylation, endothelial dysfunction, and vascular denervation. These complications impair neovascularization and wound healing, resulting in delayed recovery from injuries and an elevated risk of infections. The present study aimed to investigate the effect of lipoic acid (LA) on the key mediators involved in the wound healing process, specifically CD4 + CD25 + T cell subsets, CD4 + CD25 + Foxp3 + regulatory T (Treg) cells, T-helper-17 (Th17) cells that generate IL-17 A, glucocorticoid-induced tumor necrosis factor receptor (GITR) expressing cells, as well as cytokines such as IL-2, IL-1β, IL-6, and TNF-α and IFN-γ. These mediators play crucial roles in epidermal and dermal proliferation, hypertrophy, and cell migration.

Methods

We divided mice into 5 groups: the non-diabetic (normal control; NC), wounded non-diabetic mice (N + W), wounded diabetic mice (D + W), wounded diabetic mice treated with 50 mg/kg lipoic acid (D + W + L50) for 14 days, and wounded diabetic mice treated with 100 mg/kg lipoic acid (D + W + L100) for 14 days.

Results

Flow cytometric analysis indicated that lipoic acid-treated mice exhibited a significant decrease in the frequency of intracellular cytokines (IL-17 A, TNF-α and IFN-γ) in CD4 + T cells, as well as a reduction in the number of GITR-expressing cells. Conversely, a significant upregulation in the number CD4+, CD25+, FOXp3 + and CD4 + CD25 + Foxp3 + regulatory T (Treg) cells was observed in this group compared to both the normal + wounded (N + W) and diabetic + wounded (D + W) groups. Additionally, the mRNA Levels of inflammatory mediators (IL-2, IL-1β, IL-6, and TNF-α) were downregulated in lipoic acid-treated mice compared to other groups. T thereby he histological findings of diabetic skin wounds treated with lipoic acid showed well-healed surgical wounds.

Conclusions

These findings support the beneficial role of lipoic acid in fine-tuning the balance between anti-inflammatory and pro-inflammatory cytokines, influencing both their release and gene expression.

Combined metabolomics and network pharmacology to elucidate the mechanisms of Huiyang Shengji decoction in treating diabetic skin ulcer mice

BACKGROUND

Diabetic skin ulcer is a clinical disorder of glucose metabolism that has a long treatment period and is prone to recurrent episodes. Huiyang Shengji decoction (HYSJD) is an effective traditional Chinese medicine for its clinical treatment, but its metabolic effects in patients with diabetic skin ulcers have not been well studied.

PURPOSE

Our study aimed to investigate the mechanism of pharmacological treatment of HYSJD in treating diabetic skin ulcers.

METHODS

The potential mechanism underlying diabetic wound treatment by HYSJD was screened using network pharmacology. Ultra-high performance liquid chromatography-MS/MS metabolomics analysis and correlation analysis were performed to investigate potential target pathways and genes. Furthermore, the db/db diabetic wound tissues and RAW264.7 macrophage inflammation model verified the mechanism using molecular biology experiments.

RESULTS

In network pharmacology, HYSJD played a mainly therapeutic effect by regulating PI3K/AKT signaling pathway, EGFR tyrosine kinase inhibitor resistance, metabolic pathway, and other related metabolic-related pathways. Metabolomics analysis disclosed that L-lysine content increased, while those of linoleic and deoxycholic acids decreased in plasma between the HYSJD-treated group and the control group, participating in biotin metabolism. Among them, PPARγ played an important role. The experiments conducted in db/db mice indicated that HYSJD facilitates VEGF secretion and PPARγ expression. In vitro experiments have revealed that HYSJD inhibits macrophage ROS production, augments mitochondrial ATP production, elevates mitochondrial membrane potential, and diminishes the mitochondrial ECAR rate. Furthermore, these effects culminate in promoting M2 macrophage polarization through PPARγ activation. The molecular docking results revealed that the active compounds from HYSJD were capable of binding to PPARγ protein primarily through hydrogen bonding interactions. Notably, all binding energies were found to be lower than -3 kcal/mol, indicating strong and favorable interactions between the active compounds and the target receptor.

CONCLUSIONS

The findings suggested that HYSJD regulates biotin metabolism by reducing excess levels of linoleic and deoxycholic acids and increasing levels of L-lysine, which in turn promotes diabetic wound healing by promoting M2 macrophage polarization through PPARγ up-regulation. These findings indicated that HYSJD is a decoction that can effectively treat diabetic skin ulcers.

Diabetic wounds and short-chain fatty acids

Diabetes mellitus is a debilitating and worrisome chronic disease with many complications such as cardiovascular disease, kidney damage, blindness and diabetic wounds. Despite advances in the treatment of diabetic wounds, there are still concerns regarding the management of diabetic wound healing, particularly the inflammatory phase. In addition to many treatments with successful effects on wound healing in diabetic patients, short-chain fatty acids (SCFA) acetate, propionate, butyrate, valproate and valerate and their by-products have recently been proposed as new treatments for wound healing in diabetic patients. We provide an overview of the most recent studies on the effectiveness of the above-mentioned SCFAs in the treatment of diabetic wounds as well as possible effects on cytokines in this area of ​​study.

PTEN/PI3K/AKT pathway activation with hypoxia-induced human umbilical vein endothelial cell exosome for angiogenesis-based diabetic skin reconstruction

Diabetic skin, a major clinical challenge due to impaired wound healing, is often exacerbated by a hypoxic microenvironment at the wound site. Exosomes have been proven to have excellent biological activities and applied to solve many bioengineering problems. However, the wide application of exosomes is still limited by their short in vitro lifetime and low yield. To overcome these application limitations, this study specifically enhances the pro-angiogenic biological efficacy of exosomes through hypoxic treatment and achieves sustained release using hydrogel loading. In vitro, hypoxia-induced exosomes (Hp-Exo) significantly enhanced endothelial cell migration, proliferation, and angiogenic capacity. In vivo, Gelman hydrogels loaded with Hp-Exo accelerated wound closure, promoted collagen deposition, and increased vascularization in diabetic mice. miRNA sequencing of Hp-Exo revealed that exosomes induced under hypoxic conditions contain various miRNAs, which enhance vascular endothelial cell proliferation, migration, and angiogenesis through the PTEN/PI3K/AKT pathway. These results highlight that hypoxia-induced exosomes, when delivered through a biocompatible hydrogel platform, provide potential therapeutic approach to improve diabetic wound healing by stimulating angiogenesis and tissue regeneration.

Plasma vitamin D status and its association with biochemical, clinical and humanistic outcomes in diabetic foot infection patients: a prospective observational study in a tertiary healthcare facility

BACKGROUND

The study aimed to determine the association of vitamin D3 status with biochemical, clinical, and quality of life (QoL) in diabetic foot infection (DFI) patients.

RESEARCH DESIGN AND METHODS

A longitudinal study was conducted in a tertiary care hospital. Baseline biochemical (glycemic, renal, plasma vitamin D3), clinical, and QoL data of the DFI patients were collected. Patients were followed up with over the telephone for four months to assess clinical outcomes (healed/not healed). A subgroup analysis was performed to investigate the effect of vitamin D3 supplementation.

RESULTS

Eighty-nine DFI patients were enrolled, with a median age of 55 years and a male predominance (89.9%). A significant association between vitamin D3 levels and clinical outcome was not observed (p = 0.66). A moderate correlation was observed with the neutrophil-lymphocyte ratio (r = 0.24, p = 0.02). Regarding QoL, emotions (domain) were significantly associated with vitamin D3 levels (p < 0.01). The subgroup analysis showed that vitamin D3 supplements did not affect the clinical outcome.

CONCLUSION

The plasma vitamin D3 levels and vitamin D3 supplements do not significantly affect the biochemical, clinical, and humanistic outcomes, indicating vitamin D3 did not have a positive effect on DFI patients.

Injectable polypeptide/chitosan hydrogel with loaded stem cells and rapid gelation promoting angiogenesis for diabetic wound healing

Diabetic wounds face challenges like infection, prolonged inflammation, and poor vascularization. To address these, we developed an injectable hydrogel for diabetic wound dressing by grafting palmitoyl tetrapeptide-7 (Pal-7) onto chitosan (CS) to form CS/Pal-7 (CP7). Glutaraldehyde (GA) was used to enhance crosslinking between CS, creating the CP7 hydrogel. The hydrogel showed rapid gelation, good mechanical properties, biocompatibility, and strong antibacterial effects. Additionally, stem cells derived from human deciduous teeth (SHED) were loaded into the CP7 hydrogel to form SHED@CP7. This complex promoted human umbilical vein endothelial cell (HUVEC) migration and tube formation, aiding angiogenesis, and induced macrophage polarization toward the M2 phenotype, exerting anti-inflammatory effects. In streptozotocin-induced diabetic mouse wounds, SHED@CP7 significantly improved wound healing with over 95 % wound closure, increased collagen deposition, and reduced tumor necrosis factor-α (TNF-α) expression by approximately 75 % and Interleukin-6 (IL-6) expression by around 81 %. It also increased Interleukin-10 (IL-10) expression by approximately 58 %, modulating the inflammatory microenvironment for regeneration. Moreover, SHED@CP7 enhanced angiogenesis, as shown by a 69 % increase in endothelial cell marker CD31 staining, supporting faster wound healing. These results highlight the potential of SHED@CP7 as an effective treatment for diabetic wounds.

Anisotropic structure of nanofiber hydrogel accelerates diabetic wound healing via triadic synergy of immune-angiogenic-neurogenic microenvironments

Wound healing in chronic diabetic patients remains challenging due to the multiple types of cellular dysfunction and the impairment of multidimensional microenvironments. The physical signals of structural anisotropy offer significant potential for orchestrating multicellular regulation through physical contact and cellular mechanosensing pathways, irrespective of cell type. In this study, we developed a highly oriented anisotropic nanofiber hydrogel designed to provide directional guidance for cellular extension and cytoskeletal organization, thereby achieving pronounced multicellular modulation, including shape-induced polarization of macrophages, morphogenetic maturation of Schwann cells, oriented extracellular matrix (ECM) deposition by fibroblasts, and enhanced vascularization by endothelial cells. Additionally, we incorporated a VEGF-mimicking peptide to further reinforce angiogenesis, a pivotal phase that interlocks with immune regulation, neurogenesis, and tissue regeneration, ultimately contributing to optimized inter-microenvironmental crosstalk. In vivo studies validated that the anisotropic bioactive nanofiber hydrogel effectively accelerated diabetic wound healing by harnessing the triadic synergy of the immune-angiogenic-neurogenic microenvironments. Our findings highlight the promising potential of combining physical and bioactive signals for the modulation of various cell types and the refinement of the multidimensional microenvironment, offering a novel strategy for diabetic wound healing.

Electrical hydrogel: electrophysiological-based strategy for wound healing

Wound healing remains a significant challenge in clinical practice, driving ongoing exploration of innovative therapeutic approaches. In recent years, electrophysiological-based wound healing strategies have gained considerable attention. Specifically, electrical hydrogels combine the synergistic effects of electrical stimulation and hydrogel properties, offering a range of functional benefits for wound healing, including antibacterial activity, real-time wound monitoring, controlled drug release, and electrical treatment. Despite significant progress made in electrical hydrogel research for wound healing, there is a lack of comprehensive, systematic reviews summarizing this field. In this review, we survey the latest advancements in electrical hydrogel technology. After analyzing the mechanisms of electrical stimulation in promoting wound healing, we establish a novel classification framework for electrical hydrogels based on their operational principles. The review further provides an in-depth evaluation of the therapeutic efficacy of these hydrogels in various types of wounds. Finally, we propose future directions and challenges for the development of electrical hydrogels for wound healing.

Thioredoxin-loaded nanocomposite wound dressing for the delivery of adipose derived stem cells for wound healing applications

In the current research, Thioredoxin was loaded into chitosan nanoparticles and then loaded into the matrix of collagen hydrogel containing adipose-derived stem cells (ASCs). In vitro studies including Scanning electron microscopy imaging, cell viability assay, cell migration assay, swelling assay, release assay, radical scavenging assay were performed in order to characterize the dressings. Then, the wound healing activity of these scaffolds were studied in a rat model of wound healing. Our findings indicate that the scaffolds markedly accelerated wound closure, enhanced epithelial regeneration, and increased collagen deposition. The wound closure values for the developed dressings were 60.507 ± 2.287% on Day 7 and 95.270 ± 2.600% on Day 14. ELISA results demonstrated an upregulation of VEGF, b-FGF, and TGF-β expression, while TNF-α and IL-6 levels were significantly reduced. For our developed dressings, VEGF levels were 661.307 ± 80.195 pg/mL, while bFGF was detected at 524.410 ± 81.040 pg/mL. The concentration of TGF-β was 315.357 ± 54.783 pg/mL, and TNF-α was measured at 176.093 ± 43.934 pg/mL. Additionally, IL-6 levels were found to be 187.577 ± 40.860 pg/mL. Our results suggest that our developed hydrogel system has improved wound healing via improving angiogenesis and modulating inflammation. These mechanisms can be attributed to the proangiogenic and immunomodulatory activities of ASCs and the antioxidative properties of Thioredoxin.

Advancements in polymer-based approaches in diabetic wound healing: a comprehensive review

Diabetes, both Type 1 and Type 2, often leads to chronic wounds due to impaired healing processes, marked by prolonged inflammation, delayed blood vessel formation, and abnormal collagen production. These issues disrupt normal tissue regeneration, slowing healing. To address these challenges, polymer-based wound dressings are being explored as a promising solution. Natural polymers like alginate, chitosan, and hyaluronic acid, as well as synthetic ones like PCL, PLA, and PLGA, offer potential for more effective healing. These materials can be used in advanced delivery systems, such as nanofibrous scaffolds, nanoparticles, and hydrogels, which help deliver medications, maintain a moist healing environment, and stimulate cell growth. By improving the wound environment, polymer-based systems provide new hope for diabetic patients with slow-to-heal wounds, enhancing therapeutic outcomes and accelerating healing. These innovations could significantly improve the management of chronic wounds in diabetes.

An Injectable Ibuprofen Sustained-Release Composite Hydrogel System Effectively Accelerates Diabetic Wound Healing via Anti-Inflammatory Effects and Angiogenesis

Purpose

Excessive inflammation in diabetic wounds, driven by hyperglycemia, prolongs healing, increases the risk of non-healing ulcers, and can lead to severe complications such as amputation or life-threatening infections. Recurrent wound infections and prolonged treatment impose significant economic and psychological burdens, drastically reducing patients' quality of life. Modulating the inflammatory response is a promising strategy to accelerate diabetic wound healing. Ibuprofen (IBU), a widely used anti-inflammatory and analgesic agent, has the potential to promote healing by mitigating excessive inflammation and alleviating wound-associated pain. However, its clinical application is hindered by poor water solubility and a short half-life. Therefore, a controlled and sustained-release system for IBU could enhance its therapeutic efficacy in diabetic wound management.

Materials and Methods

Here, we present an in situ multi-crosslinked composite hydrogel system that integrates oxidized alginate (OSA), methacryloylated gelatin (GelMA), and an ibuprofen/amino-modified β-cyclodextrin inclusion complex (IBU/CD-NH2) via ion crosslinking, photocrosslinking, and Schiff-base reactions.

Results

The optimized hydrogel formulation was synthesized at 35°C, with a P/A molar ratio of 2 and an methacrylamide(MA) volume fraction of 20%. Physicochemical and biocompatibility analyses demonstrated that the IBU-loaded composite hydrogel exhibits enhanced mechanical strength, favorable biocompatibility, tunable degradation, and injectability. This system effectively addresses IBU's solubility and absorption challenges while conforming to wounds of varying shapes and sizes, enabling controlled and sustained drug release. Cellular and animal studies confirmed that the hydrogel continuously and uniformly releases IBU, exerting anti-inflammatory effects while promoting angiogenesis and fibroblast migration. This leads to enhanced granulation tissue formation, collagen deposition, and epidermal regeneration, significantly accelerating wound closure within 14 days.

Conclusion

By simultaneously suppressing inflammation and stimulating tissue regeneration through controlled IBU release, this hydrogel system offers a highly effective strategy for diabetic wound healing and holds strong potential for clinical application.

TOpClass Class 4 Perineal Crohn's Disease: A Systematic Review and Meta-analysis of Perineal Wound Complication After Proctectomy in Crohn's Patients

BACKGROUND

Nonhealing perineal wounds have been reported to be common after proctectomy for Crohn's disease (CD). We performed a systematic review and meta-analysis of perineal wound healing after proctectomy for CD and assessed the risk factors for nonhealing.

METHODS

A comprehensive literature search was conducted in PubMed, Embase, and Scopus databases from 2010 to 2023, and articles reporting perineal wound healing rates after proctectomy for CD were included. Data on study characteristics and proportion of healed wounds, and risk factors, were extracted. Random-effects meta-analysis was performed to estimate the pooled proportion and 95% CIs using the "meta" package in R. Heterogeneity was assessed using the I2 statistic.

RESULTS

We identified 501 articles, of which 252 remained after de-duplication. After screening, 4 retrospective cohort studies involving 333 patients were included. Across the 4 studies, the pooled proportion of completely healed perineal wounds at 6 months was 65% (95% CI 52%-80%), and 70% (95% CI 60%-83%) at 12 months. Significant heterogeneity was found between studies (I2 = 86% at 6 months). Three studies examined risk factors for impaired healing after proctectomy. One study identified preoperative perineal sepsis as the only independent factor associated with impaired healing (P = .001) on multivariable analysis. In 1 study, male sex, shorter time from diversion to proctectomy, and higher preoperative C-reactive protein levels were all associated with delayed healing in univariate analysis. Another study found that close rectal dissection was associated with significantly lower healing rates than total mesorectal excision (P = .01). Prior use of tumor necrosis factor inhibitors was not associated with wound healing outcomes.

CONCLUSIONS

This meta-analysis revealed complete perineal healing in only 70% of patients 12 months after proctectomy for CD. This highlights knowledge gaps, including the identification of modifiable risk factors and methods for preventing or as rescue therapy, such as vacuum-assisted closure and flap reconstruction, for nonhealing perineal wounds after proctectomy for CD. Poor perineal wound healing outcomes are likely related to imperfectly understood underlying inflammatory dysregulation and systemically impaired wound healing in patients with CD.

Mechanisms underlying the wound healing and tissue regeneration properties of a novel gauze dressing impregnated with traditional herbal medicine (Ya-Samarn-Phlae) in type 2 diabetic Goto-Kakizaki (GK) rats

Ethnopharmacological relevance

A traditional preparation of Ya-Samarn-Phlae (T-YaSP) consists of Garcinia mangostana L., Oryza sativa L., Curcuma longa L., and Areca catechu L. and has been used in Thai medicine as an infused oil for treating chronic and diabetic wounds. It is reputed for its antibacterial, antioxidant, and wound-healing properties. Despite its traditional use, scientific validation of the mechanisms underlying diabetic wound healing remains limited.

Aim

This study aims to develop a novel gauze dressing impregnated with an ointment containing T-YaSP (YaSP) to enhance its practical application and elucidate the mechanisms of action in promoting wound healing in both non-diabetic and type 2 diabetic wounds of this ointment.

Materials and methods

YaSP was developed and tested for stability and dermal irritation. Changes in chemical markers during storage were measured both qualitatively and quantitatively. Its anti-inflammatory activity was assessed using the carrageenan-induced rat paw edema model. The effect of YaSP on levels of nitric oxide (NO), myeloperoxidase (MPO), malondialdehyde (MDA), inflammatory cytokines (TNF-α, IL-1β, and PGE2), and pro-inflammatory enzymes (iNOS and COX-2) was measured. The wound-healing effects of YaSP were assessed using full-thickness (6 mm diameter) wound models in both non-diabetic Wistar rats and type 2 diabetic Goto-Kakizaki rats. In addition to evaluating wound closure on days 0, 3, 5, 7, 9, and 11, the influence on TGF-β1, VEGF, and the production of collagen types I and III, which indicate the inflammatory, proliferative, and remodeling phases, was measured.

Results

During the 6-month storage period, the α-mangostin content measured in YaSP did not decrease; however, the curcumin level showed a significant reduction. Topical treatment with YaSP demonstrated strong anti-inflammatory activity and alleviated oxidative stress and inflammatory markers. YaSP improved wound closure rates in both diabetic and non-diabetic models. Levels of TGF-β1 and VEGF increased, indicating the promotion of angiogenesis and granulation tissue formation during the proliferation phase on the seventh day. Additionally, TGF-β1 levels dropped on the 11th day, aligning with diminished inflammation and enhanced remodeling. The treatment balanced collagen synthesis, increasing type III collagen in the early stages and type I collagen in the later stages of wound healing. Histological analysis confirmed reduced inflammation, enhanced neovascularization, and increased collagen production.

Conclusion

A gauze dressing impregnated with YaSP provides a practical solution for diabetic wound management and demonstrates strong wound-healing properties by modulating excess inflammation, promoting angiogenesis during the proliferation phase, and regulating collagen synthesis throughout the remodeling phase. This discovery reveals, for the first time, the underlying mechanisms of action of this traditional formulation, highlighting its potential as a cost-effective alternative for managing chronic wounds in resource-limited settings.

Injectable dual-cross-linked microalgae-silk gel ameliorates diabetic wound healing by promoting oxygenation and ROS clearance and lessening inflammation

Hypoxia, excessive reactive oxygen species (ROS), and an impaired inflammatory microenvironment are key barriers to diabetic wound healing, collectively hindering cell migration, proliferation, and neovascularization, ultimately leading to failure in the healing process. Therefore, developing an effective therapeutic strategy capable of simultaneously addressing these challenges remains a critical clinical need. In this study, we developed CeS-Gel, an advanced hydrogel dressing integrating live microalgae and CeO₂ nanoparticles within a dual-crosslinked silk hydrogel network. By harnessing photosynthesis, CeS-Gel provided a continuous and reliable oxygen supply, significantly enhancing cell migration and proliferation. Additionally, CeS-Gel exhibited potent ROS-scavenging properties, effectively mitigating oxidative stress-induced cellular damage while directly promoting M2 macrophage polarization, thereby modulating the inflammatory response. In vivo experiments demonstrated that CeS-Gel markedly accelerated wound healing in diabetic mice, achieving a 93.2 % wound closure rate. Furthermore, CeS-Gel effectively alleviated hypoxia, promoted neovascularization, and exhibited anti-inflammatory and immunoregulatory effects. This living microalgae-silk gel represents a promising approach for improving chronic diabetic wound healing with great potential for clinical application.

A dual-action strategy: Wound microenvironment responsive hydrogel and exosome-mediated glucose regulation enhance inside-out diabetic wound repair

Sustained hyperglycemia induces complex pathological microenvironment in diabetic wounds, significantly hindering wound healing. Most current therapeutic approaches (e.g., hydrogel dressings) have paid little attention to the effect of blood glucose levels on diabetic wound healing. In this study, a synergetic therapeutic strategy including a wound microenvironment responsive, multifunctional hydrogel and the exosome-mediated glucose regulation is developed for diabetic wound treatment. First, a gelatin-dopamine (Gel-DA) crosslinked hyaluronic acid-phenylboronic acid (HA-PBA) hydrogel (GDHP) is constructed with good injectable, self-healing, and adhesive abilities. Such GDHP hydrogel not only can effectively relieve oxidative stress and reduce inflammation, but also promote keratinocyte migration. Then, ciprofloxacin hydrochloride (CIP·H) is loaded to prepare the GDHPC hydrogel that may respond to diabetic wound microenvironment (e.g., low pH, high glucose and reactive oxygen species) and degrade for controlled release of CIP·H, showing on-demand antibacterial properties. Exosomes derived from human umbilical cord mesenchymal stem cells (hucMSC-exos) are administered via tail vein injection in diabetic mice, which may repair injured pancreatic islets by modulating the pancreatic immune microenvironment, thus promoting insulin secretion and further reducing blood glucose levels. By applying this synergetic therapeutic strategy, the full-thickness cutaneous wounds in type 1 diabetic mice heal well and quickly compared to that treated with the GDHPC hydrogel and the hucMSC-exos alone. This promotion effect on wound healing may associate with reducing inflammation and promoting angiogenesis. This study sheds new light on the development of a dual-action strategy that can effectively maintain glucose homeostasis, improve the wound microenvironment, and consequently promote inside-out repair of diabetic wounds, offering a promising therapeutic avenue for future diabetic wound treatment.

Paeonol regulates the DDIT4-mTOR signaling pathway in macrophages to promote diabetic wound healing

BACKGROUND

Diabetic foot ulcers are a common complication in people with diabetes, and patients with severe disease are at risk of amputation. Current studies have found that one of the reasons for the difficulty in healing diabetic foot ulcers is the Abnormal polarization of the M1/M2 phenotype of macrophages, which leads to a prolonged inflammatory period of the wound. The aim of this study was to investigate whether paeonol can promote the polarization of macrophages towards the M2 type and whether M2 type macrophages can regulate the DDIT4-mTOR signaling pathway and slow down the inflammatory response of diabetic foot ulcers.

METHODS

C57BL/6 mice were used to establish an animal model of diabetic foot ulcers and the effect of paeonol on wound healing was investigated. The effects of paeonol on wound healing of foot ulcer in diabetic mice were evaluated using histological staining and immunohistochemistry. The molecular mechanism of refractory healing of foot ulcers was speculated through network pharmacology. The effects of Paeonol on phenotypic polarization of macrophages and the mechanism of inhibiting inflammation were studied by q-PCR, ELISA, immunofluorescence and Western.

RESULTS

Paeonol can effectively promote wound healing in diabetic mice. HE staining showed that paeonol could improve the inflammatory infiltration in the ulcer wound of diabetic mice; Masson trichromatic staining showed that paeonol could increase the increase of muscle fibers and collagen in the wound tissue of diabetic mice; immunofluorescence results showed that paeonol could increase the angiogenesis in the wound tissue of diabetic mice. Network pharmacological analysis showed that the molecular mechanism of paeonol in treating diabetic wound healing may be through DDIT4-mTOR signaling pathway. q-PCR, ELISA, immunofluorescence and Western blot showed that paeonol could reduce the expression of the signature protein CD86 and inflammatory factors in M1 macrophages, and promote the phenotypic polarization of M2 macrophages, which is the mechanism of inhibiting inflammation by activating DDIT4-mTOR signaling pathway.

CONCLUSION

Paeonol can promote the polarization of macrophages towards M2 type, reduce inflammatory response and accelerate wound surface healing through DDIT4-mTOR signaling pathway, providing a new therapeutic strategy for the treatment of diabetic foot ulcers.

The Prognostic Value of Transcutaneous Oxygen Pressure (TcPO2) in Diabetic Foot Ulcer Healing: A Protocol for a Systematic Review

Background/Objectives: Due to poor perfusion, diabetic foot ulcers (DFUs) create hypoxic environments, and their chronicity represents a negative factor in wound healing. Transcutaneous oxygen pressure (TcPO2) is a non-invasive method that provides information on oxygen supply to microvascular circulation, useful for determining the severity and progression of peripheral arterial disease (PAD) as well as potentially predicting DFU healing. However, the current literature does not provide strong support for the use of TcPO2 as an independent predictive tool. Methods: This protocol aims to systematically review the available evidence according to PRISMA (2020) guidelines, registered with the International Prospective Register of Systematic Reviews (registration number: CRD42024505907). The following databases will be used: Cochrane Library, EMBASE, Ovid Medline, PubMed, and Web of Science. Additionally, a manual search will be conducted through the references of the included articles. Results: The systematic review will summarize the current evidence on the prognostic value of TcPO2 in DFU healing, identifying gaps in knowledge and potential areas for future research. Conclusions: The findings of this study may clarify the prognostic value of TcPO2 in DFU healing, which could ultimately facilitate clinical management, decision-making, patient care, and potentially reduce treatment costs.

Smart self-healing hydrogel wound dressings for diabetic wound treatment

Diabetic wounds are difficult to treat clinically because they heal poorly, often leading to severe complications such as infections and amputations. Hydrogels with smart self-healing properties show great promise for treating diabetic wounds. These hydrogels are capable of continuously and dynamically responding to changes in the wound environment, feature improved mechanical qualities and the capacity to self-heal damage. We explore the latest developments in smart self-healing hydrogels for diabetic wound healing in this review. First, we systematically summarize the obstacles in treating diabetic wounds. We then highlighted the significance of smart self-healing hydrogels, explaining their stimulus-responsive mechanisms and self-healing design approaches, along with their applications in addressing these challenges. Finally, we discussed the unresolved obstacles and potential avenues for future research. We anticipate that this review will facilitate the continued refinement of smart self-healing hydrogels for diabetic wound dressings, aiming for broader clinical adoption.

pH- and glucose-responsive antioxidant hydrogel promotes diabetic wound healing

Excessive oxidative stress and persistent inflammation are key factors contributing to the formation of diabetic chronic wounds. Delivering antioxidants through a microenvironment-responsive hydrogel system can effectively enhance wound healing and tissue regeneration. In this study, we developed a novel pH- and glucose-responsive hydrogel using Schiff base reaction and phenyl borate group for intelligent antioxidant release. Hyaluronic acid (HA) modified with phenylboronic acid (PBA) (HA-PBA) was oxidized to form OHA-PBA, which was then crosslinked with carboxymethyl chitosan (CMCS) and incorporated Proanthocyanidins (PA) to create an OHA-PBA/CMCS/PA (OPCP) hydrogel. The reversible nature of imine and borate groups enabled the responsive release of PA from OPCP hydrogels under acidic and high glucose conditions. The OPCP hydrogel exhibited excellent biocompatibility, suitable mechanical properties, and biodegradability. Both in vitro and in vivo results demonstrated that the OPCP hydrogel effectively reduced reactive oxygen species (ROS), suppressed inflammation, promoted vascularization, accelerated collagen deposition, and facilitated diabetic wound healing. This strategy offers novel insights into microenvironment-responsive scaffolds, highlighting the potential application of this responsive antioxidant hydrogel scaffold for chronic diabetic wound treatment.

Collagen-based hydrogel derived from amniotic membrane loaded with quercetin accelerates wound healing by improving stereological parameters and reducing inflammation in a diabetic rat model

In clinical practice, there is a demand for innovative wound healing methods to tackle full thickness skin injuries, especially in those with diabetes. In this study, we examined if collagen-based hydrogel from amniotic membrane (CHAM) loaded with quercetin could enhance healing in diabetic rats. Sixty diabetic rats were randomly divided into the control group, CHAM group, quercetin group, and CHAM+Quercetin group. Sampling took place on days 4 and 8 for additional evaluations. Our findings showed that the rates of wound contraction, volumes of new epidermis and dermis, fibroblast and blood vessel counts, collagen deposition, and concentrations of TGF-β1 and VEGF cytokines were significantly higher in the treatment groups compared to the control group, with these changes being more pronounced in the CHAM+Quercetin group. This is while the counts of neutrophils and macrophages, along with the concentration levels of IL-6, IL-1β, and TNF-α cytokines dropped more noticeably in the CHAM+Quercetin group in comparison to the other groups. In summary, it was determined that the combination of CHAM and quercetin significantly enhances diabetic wound healing.

Peptide-Based Functional Amyloid Hydrogel Enhances Wound Healing in Normal and Diabetic Rat Models

The inability to heal on time is a key component of chronic wounds, which can result in economic, psychological, and physiological burdens. Hydrogels based on amyloid can imitate the extracellular matrix and function as scaffolds for healing wounds. In this direction, a wound dressing inspired by peptide-based amyloid hydrogel is fabricated here. The results demonstrate that the amyloid hydrogel improves the three essential components of skin tissue regeneration: cell migration, proliferation, and collagen remodeling, both in vitro and in vivo. Furthermore, the amyloid hydrogel accelerates wound healing and promotes wound closure within 9 and 15 d in normal and diabetic rats, respectively. Microscopic evaluation of the wound region demonstrates the ultimate stages of regeneration and skin reformation toward normal skin compared to the untreated wound. Hematoxylin and eosin-stained hydrogel-treated wound sites reveal faster dermal bridging, angiogenesis, and epidermal repair in both acute and chronic conditions. The hydrogel creates an environment that encourages the growth of dermal fibroblasts and the release of cytokines, decreasing inflammation with concomitant enhancement of collagen production at the site of injury. Thus, these findings suggest that amyloid-based hydrogel can be a promising candidate for application in acute and chronic wound healing.

Extracellular Vesicle-Associated miR-ERIA Exerts the Antiangiogenic Effect of Macrophages in Diabetic Wound Healing

ARTICLE HIGHLIGHTS

An understanding of cell interactions is needed to identify therapeutic targets for diabetic cutaneous ulcers. We explored extracellular vesicles after treatment with advanced glycation end products (AGEs-EVs) derived from macrophages that can suppress diabetic cutaneous wound healing. We found that a novel miRNA enriched in AGEs-EVs (miR-ERIA) suppresses the migration and tube formation of vascular endothelial cells by targeting helicase with zinc finger 2. miR-ERIA offers a potential therapeutic target for diabetic cutaneous ulcers.

Reassessing Glycemic Control: A Novel Method for 90-Day Major Complication Stratification Based on Hemoglobin A1c and Same-Day Glucose Levels for Patients Undergoing Total Knee Arthroplasty

BACKGROUND

Glucose levels obtained on the day of surgery may be predictive of complications following total knee arthroplasty (TKA). Established glucose thresholds for TKA are either nonspecific or have low predictive power. Therefore, the purpose of this study was to create data-driven hemoglobin A1c (HbA1c) and same-day glucose thresholds associated with varying risks of 90-day major and surgical site infection (SSI) complications following TKA.

METHODS

Stratum-specific likelihood ratio analysis was conducted to determine data-driven HbA1c and glucose strata associated with varying risks of 90-day major and SSI complications. Each strata was then propensity score matched to the lowest strata based on age, sex, hypertension, heart failure, chronic obstructive pulmonary disorder, and obesity. The risk ratio (RR) for complications in each stratum with respect to the lowest matched stratum was analyzed.

RESULTS

Four data-driven HbA1c (%) strata (4.5 to 5.9, 6.0 to 6.4, 6.5 to 7.9, and 8.0+) and two same-day glucose (mg/dL) strata (60 to 189 and 190+) were identified that predicted 90-day major complications. When compared to the propensity-matched lowest strata (4.5 to 5.9%), the risk of 90-day major complications sequentially increased as the HbA1c (%) strata increased: 6.0 to 6.4 (RR: 1.23; P = 0.024), 6.5 to 7.9 (RR: 1.38; P < 0.001), and 8.0+ (RR: 2.0; P < 0.001). When compared to the propensity-matched lowest strata (60 to 189 mg/dL), the 190+ mg/dL strata had a higher risk of 90-day major complications (RR: 1.18; P = 0.016). No HbA1c or same-day glucose strata had significantly different risks of 90-day SSI.

CONCLUSIONS

The multiple strata identified for HbA1c demonstrate that a single HbA1c cutoff as identified in prior literature may be missing a larger picture for risk stratification. The threshold identified for same-day glucose can be utilized in day-of-surgery glycemic control guidelines to further reduce the risk of 90-day major complications.

Fabrication and characterization of a multifunctional hyaluronic acid-based microneedle system for diabetic wound healing

Diabetes mellitus (DM)-associated wounds, characterized by chronic bacterial infections and elevated glucose levels, present significant challenges to effective healing. To overcome these issues, a novel transdermal drug delivery system was developed, integrating microneedles (MNs) with biofilm-penetrating capability, the wound-healing properties of hyaluronic acid (HA), the antibacterial effects of silver nanoparticles (AgNPs), and the glucose-lowering action of insulin (Ins). Named HAMNs@AgNPs-Ins, this system demonstrated optimal morphological characteristics, robust mechanical strength, and 100 % skin penetration efficiency. It exhibited sustained antibacterial activity in vitro, ensured skin safety, and provided controlled, steady blood glucose reductions, achieving a 72.29 % reduction at 8 h, compared to the sharp decline seen with subcutaneous injection. Additionally, wound healing experiments showed a significant improvement in the healing rate of 89.66 ± 1.34 % in the HAMNs@AgNPs-Ins group, compared to 48.19 ± 9.03 % in the control group. These results underscore the potential of HAMNs@AgNPs-Ins as an effective treatment for DM-associated wounds.

Pinitol Improves Lipopolysaccharide-Induced Cellular Damage in Human Dermal Microvascular Endothelial Cells

3-O-Methyl-D-chiro-inositol (pinitol) has been reported to possess insulin-like effects and is known as one of the anti-diabetic agents for improving muscle and liver function. However, the beneficial effects of pinitol on human dermal microvascular endothelial cells (HDMECs) are not well understood. In this study, we investigated whether pinitol could protect HDMECs from damage induced by lipopolysaccharides (LPSs), which cause various cell defects. We observed that pinitol enhanced wound healing for LPS-damaged HDMECs. We found that pinitol significantly downregulated the LPS-induced upregulation of reactive oxygen species (ROS). Pinitol also significantly restored the mitochondrial membrane potential in these cells. Immunofluorescence analysis revealed that pinitol notably reduced the nuclear localization of NF-κB in LPS-damaged HDMECs. Furthermore, we demonstrated that pinitol decreased the phosphorylation levels of the MAPK family in LPS-damaged HDMECs. Interestingly, we observed that pinitol improved tube formation in LPS-damaged HDMECs. Taken together, we suggest that pinitol exerts several beneficial effects on LPS-damaged HDMECs and may be a promising therapeutic agent for improving vascular-related skin diseases.

Melatonin promotes diabetic wound healing by mediating mitochondrial function in endothelial cells through the AMPK/SIRT1/HIF-1α pathway

OBJECTIVE

Diabetic wounds are open lesions that can develop on any part of the body of diabetic patients. Importantly, melatonin (Mel) exerts promotional effects on wound healing. Accordingly, this study explored the mechanism of Mel in diabetic wound healing by mediating mitochondrial function in endothelial cells.

METHODS

Human umbilical vein vascular endothelial cells (HUVECs) were exposed to high glucose (HG) to mimic a diabetic environment in vitro, followed by Mel treatment. Cell viability, invasion and angiogenic capacity were evaluated with CCK-8, Transwell, and tube formation assays, respectively. CD31 protein expression was determined with Western blot. Wound healing ability was evaluated in vitro, and the levels of adenosine triphosphate (ATP), reactive oxygen species (ROS), mitochondrial membrane potential (MMP), and apoptosis-related proteins (Bcl-2/Bax/CytC) were also detected. To verify the role of the AMPK/SIRT1/HIF-1α pathway in diabetic wound healing, HG-induced HUVECs treated with Mel were subjected to treatment with sh-HIF-1α, AMPK inhibitor (compound c), or SIRT1 inhibitor (Nicotinamide).

RESULTS

HG impaired the proliferation, invasion, angiogenesis, and wound healing ability of HUVEC, increased ROS, Bax, and CytC levels, and decreased MMP and the levels of ATP and Bcl-2. Mel facilitated viability, angiogenesis, and wound healing ability while ameliorating mitochondrial dysfunction in HG-treated HUVECs. Mel activated the AMPK/SIRT1 pathway to upregulate HIF-1α in HG-treated HUVECs. HIF-1α knockdown, CC, or Nicotinamide negated the effect of Mel on HG-treated HUVECs.

CONCLUSIONS

Mel fosters angiogenesis and represses mitochondrial dysfunction in endothelial cells by activating the AMPK/SIRT1/HIF-1α pathway, thereby promoting diabetic wound healing.

A dual-network hydrogel patch fabricated by alginate/sulfobetaine methacrylate enriched with Dictyophora indusiata β-glucans promotes diabetic wound repair

This study developed a dual-network hydrogel patch loaded with Dictyophora indusiata β-glucans to enhance diabetic wound healing. The hydrogel combines a flexible primary network formed by polymerized sulfobetaine methacrylate with a rigid secondary alginate network crosslinked via metal ions. The resulting material demonstrates favorable mechanical properties for wound care, achieving 600 % elongation at break, 3.12 MPa compressive strength, and 1.5 kPa tissue adhesion strength. These characteristics meet with the physical requirements necessary for effective diabetic wound management. Furthermore, the β-glucans derived from Dictyophora indusiata, which serve as the main bioactive component, endowed the hydrogel patch with significant antioxidant and anti-inflammatory properties. Cellular experiments have demonstrated that the hydrogel patch significantly reduces reactive oxygen species levels in cells and inhibits inflammatory responses. In animal wound model, diabetic wound treated with a hydrogel patch achieved a closure rate of 98.26 % by the second week. Additionally, histological analyses revealed that the hydrogel patch significantly facilitates angiogenesis, collagen deposition, and re-epithelialization in diabetic wound. Consequently, the hydrogel patch based on β-glucans from Dictyophora indusiata appears to be an effective agent for promoting wound healing, thereby offering a novel therapeutic strategy for the repair of diabetic wound.

Chlorella-encapsulated living hydrogel based on gelatin and carrageenan with oxygen production, hemostatic and antibacterial capacity for promoting wound healing

Hypoxia can prolong the healing time of wounds and oxygen delivery to the hypoxic tissue has been reported an effective strategy for promoting wound regeneration. Bacterial infections can interfere with the wound healing process, leading to poor skin regeneration and even more serious complications, which is also an urgent issue to be solved during the process of wound healing. To address the problem of delayed wound healing caused by hypoxia and bacterial infections, we fabricated a series of Chlorella-loaded hydrogels (CK) using gelatin, κ-carrageenan and I-carrageenan as matrixes, which introduced Chlorella and ampicillin conferred oxygen-producing and antimicrobial capacity to the hydrogel. The CK hydrogels possessed good mechanical and adhesive properties, as well as the capability of efficient and sustained oxygen release. The hydrogels possessed outstanding hemostatic ability, excellent blood and cell compatibility, which also owned excellent antibacterial capacity against E. coli and S. aureus. More notably, the in vivo evaluation revealed that the hydrogel can accelerate wound healing by promoting collagen deposition, which may as a promising potential wound dressing for hypoxic wound healing.

Collagen-based hydrogel encapsulated with SDF-1α microspheres accelerate diabetic wound healing in rats

Diabetic wounds are a common complication in diabetic patients, often characterized by impaired healing and tissue repair processes. The use of advanced biomaterials such as collagen-based hydrogels as carriers for therapeutic agents has gained significant attention in accelerating wound healing. In this regard, stromal cell-derived factor (SDF)-1α microspheres, a chemotactic factor that attracts stem cells, can effectively direct regenerative cells to the wound site, enhancing the healing process. This study investigates the potential of collagen-based hydrogels derived from amniotic membrane (AMCh) encapsulated with SDF-1α microspheres in promoting the healing of diabetic wounds in rats. Sixty rats were randomly assigned. In addition to non-diabetic rats (control group), the diabetic rats were randomly divided into non-treated (diabetic) group, AMCh treated group, and AMCh encapsulated with SDF-1α microspheres (AMCh + SM) group. Sampling was done on days 7, 14, and 21 for further evaluations. The results demonstrated significant improvements in wound closure, fibroblast and blood vessel counts, collagen density, and the gene expression of TGF-β and VEGF, as well as tensiometrical parameters in the treatment groups compared to the diabetic group, with more pronounced effects observed in the AMCh + SM group (p < 0.05). The AMCh + SM group showed the most notable effects, including a larger reduction in neutrophil and mast cell counts, as well as lower expression levels of TNF-α and IL-1β genes (p < 0.05). In conclusion, AMCh encapsulated with SDF-1α microspheres had the most pronounced effect in promoting the healing of diabetic wounds.

The Extracellular Matrix Promotes Diabetic Oral Wound Healing by Modulating the Microenvironment

Oral wounds in diabetes mellitus (DM) often delay healing due to reduced angiogenesis and increased inflammatory response in the local microenvironment, even leading to graft necrosis and implant failure. Therefore, developing an effective program to promote healing is of great clinical value. Much of the current research is focused on promoting wound healing through surface adhesive materials that exert a pro-angiogenic, anti-inflammatory effect. However, the application of surface bonding materials in the oral cavity is very limited due to the humid and friction-prone environment. Decellularized extracellular adipose tissue (DAT) is an easily accessible and biocompatible material derived from adipose tissue. To further explore the potential of DAT, we used multi-omics to analyze its composition and possible mechanisms. Proteomic studies revealed that DAT contains anti-inflammatory, pro-angiogenic proteins that promote DM tissue regeneration. To adapt to the moist and chewing friction environment of the mouth, we modified DAT into a temperature-sensitive hydrogel material that can be injected intramucosally. DAT hydrogel has been verified to promote angiogenesis and exert anti-inflammatory effects through macrophage phenotypic transformation. Meanwhile, transcriptome analysis suggested that the inhibitory effect of DAT on the interleukin 17 signaling pathway might be a key factor in promoting DM oral wound healing. In conclusion, after multi-omic analysis, DAT hydrogel can exert good pro-angiogenic and anti-inflammatory effects through the interleukin 17 signaling pathway and can be adapted to the specific environment of the oral cavity. This provides a potential way to promote DM oral wound healing in a clinical setting.

Evaluation of topical vitamin k cream on repair of full thickness wound in diabetic rat

BACKGROUND

diabetic Wound is one of the most common complications throughout the world. .This experiment was conducted in order to study the effects of vitamin k cream on repair of full thickness wound in diabetic rat.

METHODS

75 adult Male Wistar rats were randomly divided into five groups of equal numbers; each group consists of 15 animals. After diabetes induction, full thickness wound in the shape of 2.25 CM2 square was created on the back of the rats. Group one was not treated and served as control. The woud areas in the second, third and fourth groups were covered twice a day with phenytoin (PHT) cream,0.05 and 1 % vitamin k creams, respectively. Group five treated with eucerin(vichel group) The size of wound area were measured in the 1, 4, 7, 10, 14, 18 and 21 days after wound induction. and histopathological observation and tissue parameters (hydroxyprolin(HP), collagen, glutation(GSH), malondialdeid (MDA), superoxiddesmutase(SOD), glutation peroxidase(GPX), catalase(CAT),tumor necrosis factor alpha (TNF-α), interlukin 1 bata(IL-1β)) were analysed as onther indicators of wound healing on days of 7, 14 and 21.

RESULTS

the findings indicated that PHT and 1 % vitamin k creams significantly elevated HP and collagen in contrast with control group. furthermore, in all time points, the average wound size in PHT and 1 % vitamin k groups was significantly greater than other groups (P < 0.05). Also, PHT and vitamin K 1 % creams improved oxidative and inflammatory stress parameters at all times courses. Theses findings were confirmed by histological examination.

CONCLUSION

The findings showed that 1 % vitamin k creams have potential effects on wound healing. Vitamin K exerts this effect through its antioxidant and anti-inflammatory properties, as well as stimulating collagen synthesis.

Fabrication of curcumin‑incorporated poly glycerol sebacate/poly lactide acid (PGS/PLA) hydrogel to enhance full‑thickness wound healing in diabetic rats

New wound dressings with therapeutic benefits are consistently being developed to enhance the wound healing process. In present study, a biocompatible wound dressing was fabricated using curcumin- incorporated poly glycerol sebacate/poly lactide acid (PGS/PLA) hydrogel to promote diabetic wound healing in rats. A total of 60 diabetic rats were randomly planned to four groups: the control group, PGS/PLA group, curcumin group, and PGS/PLA+Curcumin group. Sampling occurred on days 7 and 14 for further evaluations. Our findings revealed that the rates of wound healing, dimensions and thickness of newly created epidermis, counts of blood vessels, collagen accumulation, levels of TGF-β and VEGF cytokines, and wound robustness were notably greater in the treated groups versus the control group, with these effects being more significant in the PGS/PLA+Curcumin group. In contrast to the other groups, the PGS/PLA+Curcumin group exhibited a more significant reduction in the inflammatory and apoptotic cell counts, and concentration levels of IL-1β and TNF-α cytokines. In conclusion, it was established that the partnership of PGS/PLA and curcumin greatly improves healing of diabetic wounds.

Conductive Hybrid Hydrogel of Carbon Nanotubes-Protein-Cellulose: In Vivo Treatment of Diabetic Wound via Photothermal Therapy and Tracking Real-Time Wound Assessment via Photoacoustic Imaging

Diabetic wounds pose significant challenges in healthcare due to their slow healing rates and susceptibility to infections, leading to severe complications. In this study, we developed a carbon nanotube-based conductive protein-cellulose hydrogel designed to enhance wound healing through photothermal therapy. The hydrogel's unique properties, including high electrical conductivity and biocompatibility, were assessed in vitro for cell viability, hemolysis, and histological evaluations. In vivo studies on diabetic rats revealed that the hydrogel significantly improved wound healing, with faster wound closure rates. These results were supported by noticeable reductions in inflammatory markers and enhanced blood vessel formation, as observed through immunohistochemical analysis. Additionally, photoacoustic imaging offered real-time data on blood flow and tissue oxygen levels, showing positive trends in the healing process. Overall, these findings point to the potential of this conductive hydrogel, especially when paired with photothermal therapy, to serve as an effective treatment for diabetic wounds, offering promising possibilities in wound care strategies.

Advancement of Nanomaterials- and Biomaterials-Based Technologies for Wound Healing and Tissue Regenerative Applications

Patients and healthcare systems face significant social and financial challenges due to the increasing number of individuals with chronic external and internal wounds that fail to heal. The complexity of the healing process remains a serious health concern, despite the effectiveness of conventional wound dressings in promoting healing. Recent advancements in materials science and fabrication techniques have led to the development of innovative dressings that enhance wound healing. To further expedite the healing process, novel approaches such as nanoparticles, 3D-printed wound dressings, and biomolecule-infused dressings have emerged, along with cell-based methods. Additionally, gene therapy technologies are being harnessed to generate stem cell derivatives that are more functional, selective, and responsive than their natural counterparts. This review highlights the significant potential of biomaterials, nanoparticles, 3D bioprinting, and gene- and cell-based therapies in wound healing. However, it also underscores the necessity for further research to address the existing challenges and integrate these strategies into standard clinical practice.

Synthesis of Yttria Nanoparticle-Loaded Electrospun Nanofibers for Enhanced Antimicrobial Activity, Biofilm Inhibition, and Alleviation of Diabetic Wounds

Diabetes-related sores and ulcers are quite common around the world and can cause complicated disruptions to both patient compliance and socioeconomic structure. Diabetic wounds take longer to heal due to pathophysiological causes, persistent infections, and increasingly severe medical problems. Nanoparticles (NPs) derived from nanotechnology have drawn interest due to their revolutionary potential in understanding the biological milieu and offering therapeutic strategies for wound healing. In this regard, the potential of yttrium oxide nanoparticles (YNPs) has been studied extensively to understand their efficacy in diabetic wound healing. Yttrium oxide nanoparticles having size in the range of 2-10 nm were prepared and incorporated into nanofibrous mats consisting of polyurethane as the matrix polymer, and leaf extract of Azadirachta indica and clindamycin hydrochloride as additive conventional antidiabetic and antibacterial agents to form S3. Physicochemical characterization tests confirmed the formation of nanofibers having average diameters in the range of 320-470 nm, respectively. The study demonstrated that S3 shows an enhanced zone of inhibition against E. coli (29 mm), S. aureus (32 mm), and P. aeruginosa (30 mm). Moreover, the nanofibrous mats also prevented microbial penetration and biofilm formation, as observed from MTT, CV, and confocal microscopy images. In vivo wound healing study conducted on diabetic mice revealed that S3 exhibited high wound contraction after 9 days of treatment. Additionally, the fabricated mat lowered plasma glucose levels, hepatotoxicity, and oxidative stress biomarkers. Therefore, it can be concluded that YNP-loaded nanofibrous composite mats have a strong potential in alleviating diabetic wounds.

Factors influencing the choice of urethral slings over artificial sphincter for male stress urinary incontinence

OBJECTIVE

To examine the factors influencing urologists' decision to offer slings instead of AUS for managing male stress urinary incontinence.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database 2006-2021 was used to identify patients undergoing surgical procedures for male urinary incontinence using current procedural terminology (CPT) codes. The Current procedural terminology (CPT) codes for AUS (53,445) and male slings (53,440) were used to analyze the data appropriately. The cases with incomplete demographic data were excluded. Patient characteristics of interest were race, age, smoking status, obesity, HTN, COPD, ASA classification, use of glucocorticoids, history of cancer, and diabetes mellitus. Chi square and multivariate logistic regressions were used to identify significant predictors of outcomes. Significance was defined as p<0.05.

RESULTS

Among 4098 patients, 2407 underwent AUS implantation, and 1691 received a sling for male SUI. African American males were significantly more likely than Caucasian males to receive a sling (OR = 5.566, p < 0.05). The patients with comorbidities such as diabetes mellitus, hypertension, use of glucocorticoids, cancer, increased ASA, and history of DVTs are significantly more likely to undergo sling placement. COPD, congestive heart failure, and dialysis had no impact on the choice of male urinary incontinence management.

CONCLUSION

Male patients who are African American or have comorbidities such as history of diabetes, hypertension, cancer, DVT, and glucocorticoid use were more likely to be offered slings for stress urinary incontinence. These findings suggest a preference among urologists to recommend slings for patients with higher surgical risk profiles.

Advancements in Injectable Hydrogels for Controlled Insulin Delivery: A Comprehensive Review of the Design, Properties and Therapeutic Applications for Diabetes and Its Complications

Glycemic management in diabetes patients remains heavily reliant on multiple daily insulin injections, which often leads to poor patient compliance and an elevated risk of hypoglycemia. To overcome these limitations, injectable hydrogels capable of encapsulating insulin within polymeric networks have emerged as a promising alternative. Ideally, a single injection can form an in situ depot that allows prolonged glycemic control and lower injection frequency. This review summarizes recent advances in injectable hydrogels for controlled insulin delivery, focusing on the polymer sources, crosslinking strategies, and stimuli-responsive release mechanisms. Synthetic polymers such as PEG, PNIPAM, and Pluronics dominate the current research due to their highly tunable properties, whereas naturally derived polysaccharides and proteins generally require further modifications for enhanced functionality. The crosslinking types, ranging from relatively weak physical interactions (hydrogen bonds, hydrophobic interactions, etc.) to dynamic covalent bonds with higher binding strength (e.g., Schiff base, phenylboronate ester), significantly influence the shear-thinning behavior and stimuli-responsiveness of hydrogel systems. Hydrogels' responsiveness to temperature, glucose, pH, and reactive oxygen species has enabled more precise insulin release, offering new options for improved diabetic management. Beyond glycemic regulation, this review also explores insulin-loaded hydrogels for treating complications. Despite the progress, challenges such as burst release, long-term biocompatibility, and scalability remain. Future research should focus on optimizing hydrogel design, supported by robust and comprehensive data.

Nanomanaging Chronic Wounds with Targeted Exosome Therapeutics

Chronic wounds pose a significant healthcare challenge, impacting millions of patients worldwide and burdening healthcare systems substantially. These wounds often occur as comorbidities and are prone to infections. Such infections hinder the healing process, complicating clinical management and proving recalcitrant to therapy. The environment within the wound itself poses challenges such as lack of oxygen, restricted blood flow, oxidative stress, ongoing inflammation, and bacterial presence. Traditional systemic treatment for such chronic peripheral wounds may not be effective due to inadequate blood supply, resulting in unintended side effects. Furthermore, topical applications are often impervious to persistent biofilm infections. A growing clinical concern is the lack of effective therapeutic modalities for treating chronic wounds. Additionally, the chemically harsh wound microenvironment can reduce the effectiveness of treatments, highlighting the need for drug delivery systems that can deliver therapies precisely where needed with optimal dosages. Compared to cell-based therapies, exosome-based therapies offer distinct advantages as a cell-free approach for chronic wound treatment. Exosomes are of endosomal origin and enable cell-to-cell communications, and they possess benefits, including biocompatibility and decreased immunogenicity, making them ideal vehicles for efficient targeting and minimizing off-target damage. However, exosomes are rapidly cleared from the body, making it difficult to maintain optimal therapeutic concentrations at wound sites. The hydrogel-based approach and development of biocompatible scaffolds for exosome-based therapies can be beneficial for sustained release and prolong the presence of these therapeutic exosomes at chronic wound sites. Engineered exosomes have been shown to possess stability and effectiveness in promoting wound healing compared to their unmodified counterparts. Significant progress has been made in this field, but further research is essential to unlock their clinical potential. This review seeks to explore the benefits and opportunities of exosome-based therapies in chronic wounds, ensuring sustained efficacy and precise delivery despite the obstacles posed by the wound environment.

Network Pharmacology, Molecular Docking and Experimental Validation on Potential Application of Diabetic Wound Healing of Cinnamomum zeylanicum Through Matrix Metalloproteinases-8 And 9 (MMP-8 And MMP-9)

Background

Diabetic wounds are a significant clinical challenge due to impaired healing processes often exacerbated by elevated matrix metalloproteinases (MMPs). Cinnamomum zeylanicum, known for its anti-inflammatory and antioxidant properties, has shown potential in promoting wound healing. This study investigates the molecular docking and experimental validation of Cinnamomum zeylanicum's effects on diabetic wound healing, focusing on its interaction with matrix metalloproteinases-8 (MMP-8) and 9 (MMP-9).

Methods

Molecular docking studies were performed to predict the binding affinity of Cinnamomum zeylanicum compounds to MMP-8 and MMP-9. Diabetic wound healing was evaluated using in vivo models where wounds were induced and treated with Cinnamomum zeylanicum extract. Various parameters were measured, including wound contraction, hydroxyproline content, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and malondialdehyde (MDA) levels. Biochemical analyses included glucose levels, fasting blood glucose (FBG), oral glucose tolerance test (OGTT), and histomorphological examination of skin tissues.

Results

Molecular docking results indicated a high binding affinity of Cinnamomum zeylanicum's bioactive compounds with MMP-8 and MMP-9, suggesting potential inhibition. Experimental validation showed significant improvement in wound contraction and increased hydroxyproline content, indicating enhanced collagen synthesis. Antioxidant enzyme activities (SOD, GPx, CAT) were significantly elevated, while MDA levels were reduced, reflecting decreased oxidative stress. Biochemical analysis demonstrated improved glucose homeostasis with reduced FBG and enhanced OGTT responses. Histomorphological studies revealed improved tissue architecture and re-epithelialization in treated wounds.

Conclusion

Cinnamomum zeylanicum exhibits promising potential in diabetic wound healing by modulating MMP-8 and MMP-9 activities, enhancing antioxidant defenses, and improving glucose regulation. These findings support its therapeutic application for diabetic wounds, providing a foundation for further clinical investigations.

Conditioned medium of engineering macrophages combined with soluble microneedles promote diabetic wound healing

Diabetic wounds have a profound effect on both the physical and psychological health of patients, highlighting the urgent necessity for novel treatment strategies and materials. Macrophages are vital contributors to tissue repair mechanisms. Macrophage conditioned medium contains various proteins and cytokines related to wound healing, indicating its potential to improve recovery from diabetic wound. Engineering macrophages may enable a further improvement in their tissue repair capacity. Fibroblast growth factor 2 (FGF2) is a crucial growth factor that plays an integral role in wound healing process. And in this study, a stable macrophage cell line (engineered macrophages) overexpressing FGF2 was successfully established by engineering modification of macrophages. Proteomic analysis indicated that conditioned medium derived from FGF2 overexpressed macrophages may promote wound healing by enhancing the level of vascularization. Additionally, cellular assays demonstrated that this conditioned medium promotes endothelial cell migration in vitro. For the convenience of drug delivery and wound application, we prepared soluble hyaluronic acid microneedles to load the conditioned medium. These soluble microneedles exhibited excellent mechanical properties and biocompatibility while effectively releasing their contents in vivo. The microneedles significantly accelerated wound healing, leading to a marked increase in vascular proliferation and improved collagen deposition within a full thickness skin defect diabetic mouse model. In summary, we developed a type of hyaluronic acid microneedle loaded with conditioned medium of engineered macrophages. These microneedles have been demonstrated to enhance tissue vascularization and facilitate diabetic wound healing. This might potentially serve as a highly promising therapeutic approach for diabetic wounds.

Catalase-like Nanozyme-Hybrid Hydrogels Utilizing Endogenous ROS as an Oxygen Source To Synergically Regulate Oxidative Stress and Hypoxia for Enhanced Diabetic Wound Healing

High levels of reactive oxygen species (ROS) and hypoxia in diabetic wounds significantly hinder the healing process. In this work, a kind of catalase-like nanozyme-hybrid hydrogel was developed to explore the potential of harnessing endogenous excessive ROS as an oxygen source to synergistically regulate oxidative stress and hypoxia, thereby enhancing diabetic wound healing. The hydrogels exhibited rapid degradation and controlled release of ferrihydrite nanozymes in response to oxidative stress, which continuously catalyzed the decomposition of H2O2 to generate oxygen, effectively scavenging ROS and reducing the risk of local oxygen toxicity. The hydrogels relieved intracellular oxidative stress and the hypoxic microenvironment simultaneously in vitro. The hydrogel dressings effectively inhibited oxidative damage at wound sites, promoted epidermis formation and collagen deposition, and significantly accelerated wound healing in db/db mice. Therefore, the catalase-like nanozyme-hybrid hydrogels represent a promising strategy for diabetic wound dressings, addressing both oxidative stress and hypoxia to improve healing outcomes.

Curcumin nanoparticles loaded in a bioengineering and biodegradable silk-hyaluronan scaffold triggered wound healing by regulating inflammation and accelerating proliferation in a diabetic rat model

The complex causes of diabetic wounds require a combined strategy for effective treatment. Herein we investigated whether bioengineering and biodegradable silk-hyaluronan (SH) scaffold incorporated with curcumin nanoparticles (CN) could promote wound repairing in diabetic rats. Forty-five diabetic animals were randomly divided into the control group, SH group, and CN-incorporated SH (SCN) group. Sampling took place on days 4 and 8 for additional evaluations. Evaluations indicated that the parameters related to regeneration, including wound closure, fibroblasts and blood vessel counts, collagen density, and tensile strength, as well as concentration levels of TGF-β and VEGF in both treatment groups were considerably greater than those of the control group, and these changes were more obvious in the SCN ones. This is while the number of neutrophils and macrophages, and the concentration levels of TNF-α and IL-1β decreased more notably in the SCN group than the other groups. In general, these results indicated that using the complementary or synergistic impacts of curcumin nanoparticles and SH could be a promising approach to accelerate diabetic wound healing.

Polyethylene Glycol Loxenatide Accelerates Diabetic Wound Healing by Downregulating Systemic Inflammation and Improving Endothelial Progenitor Cell Functions

Diabetes wound healing presents several significant challenges, which can complicate recovery and lead to severe consequences. Polyethylene glycol loxenatide (PEG-loxe), a long-acting glucagon-like peptide-1 receptor agonist (GLP-1RA), shows cardiovascular benefits, yet its role in diabetic wound healing remains unclear. Diabetic mice received PEG-loxe (0.03 mg/kg/week, i.p.) for three months. Glucose metabolism was evaluated using the insulin tolerance test (ITT) and oral glucose tolerance test (OGTT). Wound closure rates and angiogenesis-related proteins were analyzed. Serum proteomics was performed using the Olink assay to evaluate systemic inflammation. In vitro, human endothelial progenitor cells (EPCs) were exposed to high glucose and palmitic acid, with or without PEG-loxe treatment. EPC tube formation and migratory capacity were evaluated using the tube formation assay and migration assay, respectively. Levels of nitric oxide (NO) and phosphorylated endothelial nitric oxide synthase (p-eNOS) were quantified. Mitochondrial reactive oxygen species (ROS) production and mitochondrial membrane potential were assessed using MitoSOX and JC-1 staining. Cellular respiratory function was analyzed via the Seahorse XF assay. Autophagy was evaluated by examining the expression of autophagy-related proteins and the colocalization of mitochondria with lysosomes. PEG-loxe improved glucose tolerance, accelerated wound closure, and upregulated the hypoxia-inducible factor-1α/vascular endothelial growth factor/stromal cell-derived factor-1 axis (HIF-1α/VEGF/SDF-1) in diabetic mice. Serum proteomics revealed reduced pro-inflammatory markers and elevated anti-inflammatory IL-5. In vitro, PEG-loxe restored EPC function by enhancing NO production, reducing mitochondrial ROS, improving cellular respiratory function, and restoring autophagic flux. These findings suggest that PEG-loxe offers therapeutic benefits for diabetic wound healing by downregulating systemic inflammation, enhancing angiogenesis, and improving mitochondrial quality control in EPCs, highlighting GLP-1RAs as potential therapies for diabetic vascular complications.

Inhibition of cytokine-like protein 1 transcription hinders wound-healing process in diabetic rats

AIM

This study explored the function and mechanism of cytokine-like protein 1 (CYTL1) in regulating the wound-healing process of rats with diabetes mellitus (DM).

METHODS

A wound was made in diabetic rats, in which CYTL1 overexpression or HDAC1 expression-interfering adenovirus was injected. The wound area on day 0, 7, 14 and 21 was observed and photographed to calculate the wound-healing rate. The wound tissues were collected for H&E, Masson staining and CD31 immunohistochemistry. The HDAC1 and CYTL1 mRNA and protein expressions in wound tissues were detected by RT-qPCR and western blot. The regulation of HDAC1 on CYTL1 was predicted by hTFtarget and AnimalTFDB database. The H3K27Ac level in the CYTL1 promoter was detected by chromatin immunoprecipitation (ChIP).

RESULTS

Diabetic rats with CYTL1 overexpression or interfered HDAC1 expression had accelerated the wound-healing rate, in which massive fibroblasts, attenuated inflammatory infiltration and increased collagen and microvessel density were observed. Further experiments found that HDAC1 can inhibit CYTL1 transcription and expression by inhibiting H3K27Ac expression in CYTL1 promoter.

CONCLUSION

Collected evidence showed HDAC1 can inhibit CYTL1 transcription by down-regulating the H3K27Ac level in CYTL1 promoter to slow down the wound-healing process in diabetic ulcer rats.

Versatile conductive hydrogel orchestrating neuro-immune microenvironment for rapid diabetic wound healing through peripheral nerve regeneration

Diabetic wound (DW), notorious for prolonged healing processes due to the unregulated immune response, neuropathy, and persistent infection, poses a significant challenge to clinical management. Current strategies for treating DW primarily focus on alleviating the inflammatory milieu or promoting angiogenesis, while limited attention has been given to modulating the neuro-immune microenvironment. Thus, we present an electrically conductive hydrogel dressing and identify its neurogenesis influence in a nerve injury animal model initially by encouraging the proliferation and migration of Schwann cells. Further, endowed with the synergizing effect of near-infrared responsive release of curcumin and nature-inspired artificial heterogeneous melanin nanoparticles, it can harmonize the immune microenvironment by restoring the macrophage phenotype and scavenging excessive reactive oxygen species. This in-situ formed hydrogel also exhibits mild photothermal therapy antibacterial efficacy. In the infected DW model, this hydrogel effectively supports nerve regeneration and mitigates the immune microenvironment, thereby expediting the healing progress. The versatile hydrogel exhibits significant therapeutic potential for application in DW healing through fine-tuning the neuro-immune microenvironment.

Lauric acid-loaded biomimetic, biocompatible, and antioxidant jelly fig (Ficus awkeotsang Makino) pectin hydrogel accelerates wound healing in diabetic rats

Herein, we have presented a lauric acid (LA)-loaded jelly fig pectin (JFP)-based biocompatible hydrogel, which possesses strong antioxidant and antibacterial properties to treat diabetic wounds. The antioxidant and antibacterial activity of the JFP + LA hydrogels were beneficial in eliminating the reactive oxygen species (ROS) and bacterial infection in the wound bed, thereby protecting the wound surface and accelerating the tissue repair process. The in vivo diabetic wound healing studies demonstrated that applying JFP + LA hydrogels improved the rate of wound contraction and reduced the epithelialization time significantly. The epithelialization period of the control, JFP, JFP + LA 0.5 %, and JFP + LA 1 % hydrogels were 28 ± 1.5 days, 24 ± 1 days, 18.5 ± 1 days, and 19 ± 1 days, respectively. JFP also enhanced the neovascularization and collagen synthesis during wound healing. The incorporation of LA reduced the inflammation and helped recruit macrophages to proceed to other phases of wound healing in rats treated with JFP + LA hydrogels. The results presented provide insight into the clinical management of infected diabetic wounds. Overall, the results demonstrated that the JFP + LA hydrogels were an inexpensive dressing material that accelerated the healing of diabetic wounds.

Multifunctional Hydrogel with Photothermal ROS Scavenging and Antibacterial Activity Accelerates Diabetic Wound Healing

Poor diabetic wound healing poses a critical threat to human health. Excessive oxidative stress and increased susceptibility to bacterial infection are key issues that impede diabetic wound healing. Cerium oxide nanoparticles (CeO2 NPs) have attracted increasing attention because of their unique antioxidant and antimicrobial properties. Here, this work designs a near-infrared (NIR) light-responsive gelatin methacryloyl (GelMA)/CeO2/polydopamine (PDA) hydrogel with antibacterial and antioxidant effects. The hydrogel exhibits a stable, efficient, and controllable photothermal conversion capacity under NIR stimulation. The hydrogel can be used to construct a local microenvironment conducive to chronic diabetic wound healing. Significant antibacterial effects of the NIR-responsive GelMA/CeO2/PDA hydrogel on both Escherichia coli (E.coli) and methicillin-resistant Staphylococcus aureus (MRSA) are demonstrated by counting colony-forming units (CFUs) and in bacterial live/dead staining experiments. The strong antioxidant activity of hydrogels is demonstrated by measuring the level of reactive oxygen species (ROS). The effect of the NIR-responsive GelMA/CeO2/PDA hydrogel in terms of promoting diabetic wound healing is validated in full-thickness cutaneous wounds of diabetic rat models. Additionally, this work describes the mechanism by which the NIR-responsive GelMA/CeO2/PDA hydrogel promotes diabetic wound healing; the hydrogel inhibits the interleukin (IL)-17 signaling pathway. This NIR-responsive, multifunctional hydrogel dressing provides a targeted approach to diabetic wound healing.

Beneficial effects of resveratrol on diabetes mellitus and its complications: focus on mechanisms of action

Diabetes mellitus (DM) is a significant global health issue, associated with various microvascular and macrovascular complications that significantly impair patients' quality of life as well as healthspan and lifespan. Despite the availability of several anti-diabetic medications with different mechanisms of action, there remains no definite curative treatment. Hence, discovering new efficient complementary therapies is essential. Natural products have received significant attention due to their advantages in various pathological conditions. Resveratrol is a natural polyphenol that possesses antioxidant and anti-inflammatory properties, and its efficacy has been previously investigated in several diseases, including DM. Herein, we aimed to provide a holistic view of the signaling pathways and mechanisms of action through which resveratrol exerts its effects against DM and its complications.

Bone Morphogenetic Protein 7 Improves Wound Healing in Diabetes by Decreasing Inflammation and Promoting M2 Macrophage Polarization

Diabetic foot ulcers (DFUs) are a devastating complication of diabetes, presenting limited treatment success rates due to their complex pathophysiology. Bone morphogenetic protein 7 (BMP7) confers tissue protective and regenerative functions, but its potential role in diabetic wound healing is unknown. The aim of this study was to investigate the effects of topical BMP7 treatment in wound healing using a streptozotocin-induced diabetic mouse model. The expression of markers of wound healing progression were detected using RT-PCR or immunohistochemistry. Overall, BMP7 improved wound closure, as well as maturation of granulation tissue and collagen deposition, as evidenced by hematoxylin and eosin and Masson's trichrome histological analysis. The expression of inflammatory markers (IL-6, TNF-α) and matrix metalloproteinase-9 were decreased in BMP7-treated wounds, together with the number of pro-inflammatory M1 macrophages and T lymphocytes. The number of anti-inflammatory M2 macrophages was increased in BMP7-treated wounds. Moreover, BMP7 decreased oxidative stress and increased Ki67+ cells and CD31+ cells, indicating induced proliferation and angiogenesis in the wound bed compared to the control wounds. Finally, BMP7 activated the ERK pathway and suppressed the p38 pathway in diabetic wounds. Together, our data suggest that BMP7 enhanced skin wound healing in diabetes by decreasing local inflammation and oxidative stress, which promoted a regenerative environment for collagen deposition, wound maturation, cell proliferation, and angiogenesis. These findings underline BMP7 as a potential therapeutic agent for the treatment of skin wounds in diabetes.