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Pioneering Hydrogel May Save Diabetic Foot from Amputation

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ACS Biomaterials Science and Engineering journal published this week a new invention that can change the way diabetic foot ulcers are managed and treated. Rice University introduced injectable hydrogel which speeds up healing of diabetes-related wounds.


According to Jeffrey Hartgerink chemist and bio-engineer at Rice lab, the tests on genetically diabetic rodent models unraveled faster wound healing compared to the hydrogels used in clinics today. The multidomain peptide (MDP)  hydrogel showed closure of wounds in just two weeks, dense growth of blood vessels and nerve cells and regeneration of hair follicles.

MDP hydrogel, known by its amino acid sequence, K2(SL)6K2, demonstrated its ability to encourage healing on its own.  MDP was also highlighted in the recent study published as effective in time-released immunotherapy drugs.

The MDP performance is very promising particularly to people suffering from diabetes mellitus by which wound infection is a major complication. These people developed chronic wounds in their lower appendages take longer  time to heal compared to ordinary wounds .

Hartgerink  shared, "This is particularly exciting because the study shows our material has an effect that's positive and better than things that are already out there. This has been a long time coming."

 

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Diabetic Foot Ulcers Explained

When a person has diabetes, foot infections are common occurrence.  Immunity is reduced and healing is slowed. Changes in the blood and nerve vessels of the feet coupled with conditions ranging from diabetic neuropathy, diabetic angiopathy, and foot infections are collectively called diabetic foot or diabetic foot syndrome. The recurring high blood sugar levels impairs the blood vessels, nerves, muscles, and skin of the feet. The feet carries all body weight, therefore, if simple to severe foot ulcers are left untreated, a diabetic food has no other recourse but amputation.


 

Classification

Diabetic food infection is mild when there’s inflammation, tenderness, pain, a feeling of warmth on the affected area. Moderate foot infection, the infection has spread to the skin and soft tissue.

In severe foot infection, fever is present, heartbeat is fast, sugar blood levels are high, blood pressure is reduced and vomiting occurs. The infection has spread to the bloodstream and organs of the body at this point and will require medical attention.

 

Causes of Infection

A bacteria or fungi caused diabetic foot infections. Infections start from a simple cut, or cracks in the skin due to hot, humid of the feet when wearing shoes and even bad hygiene. The infection when ignored can lead to secondary infections which are carried by the blood streams and caused tissue decay inside the body.

 

Management of Diabetic Foot Ulcers

Treatment of diabetic foot is holistic in approach and management wound depend upon the stages of the ulcer. Usually it demands frequent foot examinations, weight management, strict blood sugar control and treatment of concurring diseases like high cholesterol or high blood pressure.

In addition, diabetic foot requires proper foot or wound care, use of prescribed diabetes footwear and appropriate medications. Patients are usually advised to lessen the pressure on the feet affected and most importantly, prevent infection. Prevention of further damage is always the goal  of the treatment.

However, these approaches to treat and manage diabetic foot ulcer have not changed significantly in the last century. Nicole Carrejo, lead author of the paper and Rice graduate student described the current treatment of diabetic foot ulcers. "The current gold standard of treatment is to debride the wound which means to remove necrotic tissue. The wound is washed, bandaged and patients are told to keep pressure off the foot. "Various treatments and materials may be tried, but oftentimes, everything fails, which can lead to amputation."

The paper explained the process by comparing the results of a control group using commercial hydrogels and administered twice a day until the wound appeared with some degree of closure. The MDP hrdrogel proved that it can penetrate the cells which these commercial hydrogels do not. "Although the control results in the healing of wounds, we believe cellular infiltration of our MDP helps lead to the acceleration of wound healing" Carrejo stressed.

Hartgerink hopes to move the hydrogel toward clinical trials as a material rather than a drug to ease the federal approval process. "That would make it much more practical to do a clinical trial," he said. "These preclinical experiments have been exciting enough to warrant that thought process."

 

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In Vivo Experiment

Diabetic foot ulcer is often an exposed wound and takes a long time to heal. The skin does not appear to grow back because of diabetes which is manifested by poor blood flow. As such, diabetic foot ulcers are seen as open area with the tissue visible.

In the experiment, MDP hydrogels underwent cell aggression and revealed mild inflammation that actually promote angiogenesis or the development of new blood cells. The nanofibers are then degenerated which produced natural collagen-based extracellular matrix. This resulted in a remodelled artificial material into natural tissue. As such, MDPs showed fitting in regeneration.

MDP hydrogels regenerative potentials were tested in a diabetic wound. Results showed that when applied to fully thick dermal wounds of genetically diabetic mice models, MDP hydrogel notably hastened healing of the wound. MDP hydrogel treatment revealed wound closure in 14 days. The thick granulation tissue formation included improved blood supply and nerves to the organ and regenerate hair follicle. Conclusion of the experiment pointed to MDP hydrogel as winning treatment option of wounds in diabetic patients.