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Prospective, Randomized, and Controlled Study of a Human Umbilical Cord Mesenchymal Stem Cell Injection for Treating Diabetic Foot Ulcers
Published on: March 3, 2023
Emerging drugs for diabetic foot ulcers
Nina Petrova1, Michael Edmonds
1Research Fellow, King's College Hospital, Diabetic Foot Clinic, London SE5 9RS, UK.
Abstract:
Diabetic foot ulceration results from factors extrinsic to the foot such as repeated trauma, ischaemia and infection, as well as intrinsic factors that lead to impairment of wound healing. Intrinsic factors are less well understood, but include deficiency of growth factors, changes in extracellular matrix components with excess proteases, reduced fibroblast activity, cellular abnormalities, deficiencies of angiogenesis, nitric oxide abnormalities and hyperglycaemia. The scientific rationale of therapy is to correct both the external factors that cause diabetic foot ulcers and the internal factors that lead to impairment of wound healing. Current research is leading to new therapies that can be divided into the following classes: growth factors, skin substitutes, extracellular matrix proteins, stem cell therapy, gene therapy, protease inhibitors, angiogenesis stimulants, nitric oxide-releasing agents, adenosine agonists, immunostimulants, vasoactive compounds and granulating agents. These therapies should be considered when existing treatments to correct extrinsic factors have failed to heal ulceration in the diabetic foot.
Insights
Diabetic foot ulcers stem from external trauma and internal healing issues. New therapies target these factors, offering hope when standard treatments fail for diabetic wound healing.
Area of Science:
- Podiatry
- Wound Healing
- Diabetology
Background:
- Diabetic foot ulceration arises from extrinsic factors like trauma and ischemia, and intrinsic factors impairing wound healing.
- Intrinsic factors include growth factor deficiency, extracellular matrix changes, reduced fibroblast activity, and hyperglycemia.
- Understanding these intrinsic factors is crucial for effective treatment strategies.
Purpose of the Study:
- To outline the scientific rationale for treating diabetic foot ulcers by addressing both extrinsic and intrinsic factors.
- To review emerging therapeutic approaches for diabetic foot ulceration.
- To guide the consideration of novel therapies when conventional treatments are insufficient.
Main Methods:
- Literature review of current research on diabetic foot ulceration and its management.
- Categorization of novel therapies based on their proposed mechanisms of action.
- Analysis of the scientific basis for each therapeutic class.
Main Results:
- Identified extrinsic factors (trauma, ischemia, infection) and intrinsic factors (growth factors, ECM, angiogenesis, hyperglycemia) contributing to diabetic foot ulcers.
- Classified new therapies into categories including growth factors, skin substitutes, stem cells, gene therapy, and others.
- Highlighted that these advanced therapies are indicated when extrinsic factor correction fails.
Conclusions:
- Effective management of diabetic foot ulcers requires addressing both external causes and internal healing impairments.
- A diverse range of novel therapies are under investigation to improve wound healing in diabetic patients.
- These advanced treatments represent a critical option for recalcitrant diabetic foot ulcers.
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