Tissue Engineering-Based Strategies for Diabetic Foot Ulcer Management
Abstract
Significance: Diabetic foot ulcers (DFU) are a mounting problem with the increasingly frail population. Injuries that would otherwise heal are kept open by risk factors such as diabetes, obesity, and age-related conditions, which interferes with the natural wound healing processes.
Recent Advances: This review summarizes recent advancements in the field of tissue engineering for the treatment of DFUs. FDA-approved approaches, including signaling-based therapies, stem cell therapies, and skin substitutes are summarized and cutting-edge experimental technologies that have the potential to manage chronic wounds, such as skin printing, skin organogenesis, skin self-assembly, and prevascularization, are discussed.
Critical Issues: The standard of care for chronic wounds involves wound debridement, wound dressings, and resolving the underlying cause such as lowering the glycemic index and reducing wound pressure. Current DFU treatments are limited by low wound closure rates and poor regrown skin quality. New adjuvant therapies that facilitate wound closure in place of or in conjunction with standard care are critically needed.
Future Directions: Tissue engineering strategies are limited by the plasticity of adult human cells. In addition to traditional techniques, genetic modification, although currently an emerging technology, has the potential to unlock human regeneration and can be incorporated in future therapeutics.
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ABOUT THE AUTHORS
Alvis Chiu received his bachelor's degree from the Department of Biology at Truman State University. He is currently a PhD student under Dr. Zhao's supervision in the Department of Biomedical Engineering at Texas A&M University. His research interests include regenerative medicine and de novo lymphatic valve organogenesis.
Feng Zhao, PhD, is an associate professor in the Department of Biomedical Engineering at Texas A&M University. Dr. Zhao's research interests are focused mainly on stem cell and tissue engineering. She also develops synthetic and naturally derived biomaterials for cardiovascular bioengineering, lymphatic regeneration, and skin wound healing.
Dhavan Sharma received his master's degree from the Department of Biomedical Engineering at Michigan Technological University. He is currently a PhD candidate under Dr. Zhao's supervision in the Department of Biomedical Engineering at Texas A&M University. His research interests include prevascularization of 3D tissues for chronic wound repair and modulating macrophage activation.
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Copyright © 2023 by Mary Ann Liebert, Inc., publishers.
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Published in print: March 2023
Published online: 19 December 2022
Published ahead of print: 22 December 2021
Accepted: 26 October 2021
Received: 19 May 2021
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A.C. contributed to every section, except section 4 of the article. D.S. contributed to section 4. Dr. F.Z. was responsible for editing, proofreading, and corresponding. All authors have reviewed and approved of this article. This work is original and has not been submitted to or published elsewhere.
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This article was expressly written by the authors listed. No ghostwriters were used. No competing financial interest exists.
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This study was supported by the National Institutes of Health (R01HL146652) and the National Science Foundation (1703570, 2106048) to Feng Zhao, PhD.
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