The joint impact of elevated homocysteine and type 2 diabetes on non-healing wounds and all-cause mortality: integrated clinical and multi-omics analyses

T2D and HHcy synergistically worsen non-healing wounds, but not all-cause mortality. In diabetic males, Hcy levels displayed a J-shaped relationship with non-healing wound risk. Mechanistically, Hcy amplified systemic inflammation and drove stromal-immune crosstalk via the MIF-CD74/CXCR4 axis, reshaping the diabetic wound microenvironment.