Biomaterials for diabetic wound-healing therapies

Diabetes mellitus is a chronic metabolic disorder that negatively impacts patient's health and results in significant economic burden healthcare around the globe. Chronic diabetic ulcers represent a major complication of diabetes and are characterized by dysregulated molecular and cellular wound microenvironment and persistent inflammation. Biomaterials such as films, foams, hydrogels, antimicrobials, and different types of dressings have been used in a variety of therapeutic applications for wound treatment. However, despite tremendous amount of research efforts, there is still no "ideal" treatment that is able to directly address the complexity of nonhealing diabetic ulcers. This chapter focuses on the recent advances and existing challenges in the development of biomaterials for the management and treatment of diabetic wounds, including major classes of biomaterials used in wound dressings and skin substitutes, their physiochemical properties, critical aspects of biomaterial processing, as well as emerging therapies for diabetic wound treatment that incorporate biomaterials as an key component. The discussion includes synthetic, natural and combined polymers and composites, self-assembling peptides, hydrogels and nanoparticles, microRNA-based materials, alternative biophysical therapies, cell- and drug-delivery therapies. Given the multitude of approaches being investigated, along with the current explosive pace of the biomaterial technology development, the analysis warrants cautious optimism for a breakthrough in the near future that would enable the regenerative healing of a diabetic wound and provide much-needed cure for chronic diabetic ulcers.