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Review
. 2023 Apr 15;14(4):364-395.
doi: 10.4239/wjd.v14.i4.364.

Therapeutic role of growth factors in treating diabetic wound

Shen-Yuan Zheng  1   2 , Xin-Xing Wan  3 , Piniel Alphayo Kambey  4 , Yan Luo  5 , Xi-Min Hu  1   2 , Yi-Fan Liu  5 , Jia-Qi Shan  5 , Yu-Wei Chen  5 , Kun Xiong  2   6   7
Affiliations
Review

Therapeutic role of growth factors in treating diabetic wound

Shen-Yuan Zheng et al. World J Diabetes. .

Abstract

Wounds in diabetic patients, especially diabetic foot ulcers, are more difficult to heal compared with normal wounds and can easily deteriorate, leading to amputation. Common treatments cannot heal diabetic wounds or control their many complications. Growth factors are found to play important roles in regulating complex diabetic wound healing. Different growth factors such as transforming growth factor beta 1, insulin-like growth factor, and vascular endothelial growth factor play different roles in diabetic wound healing. This implies that a therapeutic modality modulating different growth factors to suit wound healing can significantly improve the treatment of diabetic wounds. Further, some current treatments have been shown to promote the healing of diabetic wounds by modulating specific growth factors. The purpose of this study was to discuss the role played by each growth factor in therapeutic approaches so as to stimulate further therapeutic thinking.

Keywords: Biomaterial; Delivery system; Diabetic wound; Growth factor; Skin; Therapy.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
The wound healing process is generally divided into four stages: Hemostasis, inflammation, hyperplasia and reconstruction. During the hemostatic stage, platelets will come into contact with collagen, resulting in platelet activation and aggregation; central thrombin triggers the formation of a fibrin network; the fibrin network strengthens platelet aggregation into a stable clot, effectively preventing bleeding. During the inflammatory phase, neutrophils and macrophages enter the wound to destroy bacteria and remove debris, and secrete growth factors, inflammatory factors, and chemokines that attract immune system cells to the wound to promote tissue repair. During the hyperplastic phase, granulation tissue grows and fills the wound, new blood vessels form, the wound shrinks, and epithelial cells gradually cover the surface of the wound. Finally, it enters the reconstruction stage, the fibrin of the granulation tissue gradually arranges regularly under the action of the pulling force, the epidermis gradually matures, M1 macrophages gradually transform into M2 macrophages, and inflammation and collagen synthesis are gradually inhibited.
Figure 2
Figure 2
Hyperglycemia and hyperinsulinemia are often the core causes of numerous problems in diabetic individuals. These consequences add to the wound's aberrant features, like prolonged inflammation, poor tissue regeneration, slowed angiogenesis, etc. Moreover, the persistent breakdown of the skin barrier makes such wounds extremely susceptible to infection, which further hinders the healing process. Mφ: Macrophages; ECM: Extracellular matrix; ROS: Reactive oxygen species.
Figure 3
Figure 3
In the direct delivery system, growth factors are fully exposed to the wound environment and are easily proteolyzed. In the delivery system built by biomaterials, growth factors can persist in the wound to promote healing. GFs: Growth factors.
See this image and copyright information in PMC

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