Novel biological therapies for the treatment of diabetic foot ulcers

ABSTRACT

Introduction: The number of people with diabetes mellitus (DM) is estimated to exceed 640 million by the year 2040. Diabetic foot ulcer (DFU) is a debilitating illness that affects more than 2% of DM patients. DFU is caused by DM-induced neural and vascular lesions leading to a reduced sensation and microcirculation. The increase in the prevalence of DFU has prompted researchers to find new therapies for the management of DFU.

Areas covered: This review presents the current status of novel biological therapies used in the treatment of DFU. Literature information and data analysis were collected from PubMed, the website of the American Diabetes Association, and ClinicalTrials.gov. The keywords used in the search were: DM, DFU, complications of DM.

Expert opinion: Many biological agents have been investigated in a bid to find an effective therapy for DFU. These include growth factors (platelet-derived growth factor, vascular endothelial growth factor etc), stem cells (epithelial progenitor-, adipose-derived stem cells etc), anti-diabetic drugs (insulin, exendin-4), herbs, urokinase, dalteparin, statins and bio-agents such as acid peptide matrix. Biological agents that can reduce hyperglycaemia, increase sensation, microcirculation and oxygenation and repair lost tissue are the most ideal for the treatment of DFU.

KEYWORDS:

• Diabetes mellitus
• long-term complications
• ulcer
• therapy
• hyperglycemia
• diabetic foot
• diabetic neuropathy
• diabetic angiopathy

Article highlights

• Diabetic Foot Ulcer (DFU) is a common complication of diabetes mellitus (DM).

• More than 25 million USD is spent yearly on the treatment of DFU.

• Risk factors for DFU include age > 60 years, male gender, poor socioeconomic background, and the presence of peripheral vascular disease, neuropathy, pedal deformities, and systemic disease.

• Wound care (reduction of tissue hypoxia, debridement of necrotic tissue) is important in facilitating wound healing.

• Biological therapies tested on DFUs include growth factors, stem cells, anti-diabetic drugs, herbs, enzymes, and biological agents like arginine-glycine-aspartic acid peptide matrix, oxidized regenerated cellulose/collagen bio-material, and decellularized human tissue.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in, or financial conflict with, the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This manuscript was funded by United Arab Emirates University Grant# ZCHS-7-2014.