Biomaterials for Promoting Wound Healing in Diabetes

Impaired wound healing is the leading cause of non-traumatic lower limb amputation in people with diabetes mellitus. Skin substitutes engineered from biomaterials currently play an important role in the healing process of diabetic wounds, especially those wounds that fail to show progress after standard wound care. This article summarizes current developments of biomaterials used for promoting the wound healing process in either diabetic animal models or patients with diabetes mellitus. Those biomaterials can be categories into tissue-derived scaffolds, hydrogel-based biomaterials and biomaterials with controlled-release of signaling molecules. Tissue-derived scaffolds maintain perfect extracellular matrix architectures for three-dimensional cell growth and rebuilding of multi-layer tissue structures within scaffolds after implantation. Hydrogel-based biomaterials are engineered to resemble the natural extracellular matrix for cell invasion and capillary growth. Biomaterials processed with cells or controlled-release of signaling molecules (growth factors, cytokines) can induce angiogenesis, re-epithelialization, cell recruitment and migration as well as inhibit consistent inflammation, thereby accelerating the wound healing process. Better understanding of the mechanism of diabetic wound healing will lead to the development of even better biomaterials possibly with inclusion of engineered patient derived cells or factors which will aid in vivo vascularization and consistent release of tissue-inductive signals. By reviewing the recent literature, we draw future perspectives on new strategies for further improvement of the individualized therapy of diabetic wounds.