Abstract
Diabetic foot ulcers (DFUs), the most serious complication of diabetes mellitus, can induce high morbidity, the need to amputate lower extremities, and even death. Although many adjunctive strategies have been applied for the treatment of DFUs, the low treatment efficiency, potential side effects, and high cost are still huge challenges. Recently, nanomaterial-based drug delivery systems (NDDSs) have achieved targeted drug delivery and controlled drug release, offering great promises in various therapeutics for diverse disorders. Additionally, the radial extracorporeal shock wave (rESW) has been shown to function as a robust trigger source for the NDDS to release its contents, as the rESW harbors a potent capability in generating pressure waves and in creating the cavitation effect. Here, we explored the performance of oxygen-loaded nanoperfluorocarbon (Nano-PFC) combined with the rESW as a treatment for DFUs. Prior to in vivo assessment, we first demonstrated the high oxygen affinity in vitro and great biocompatibility of Nano-PFC. Moreover, the rESW-responsive oxygen release behavior from oxygen-saturated Nano-PFC was also successfully verified in vitro and in vivo. Importantly, the wound healing of DFUs was significantly accelerated due to improved blood microcirculation, which was a result of rESW therapy (rESWT), and the targeted release of oxygen into the wound from oxygen-loaded Nano-PFC, which was triggered by the rESW. Collectively, the oxygen-saturated Nano-PFC and rESW provide a completely new approach to treat DFUs, and this study highlights the advantages of combining nanotechnology with rESW in therapeutics.
Highlights
Diabetic foot ulcers (DFUs), the most common complication of diabetes mellitus, are caused by peripheral neuropathy, small vessel occlusion, and secondary infection or trauma, and they may lead to lower extremity amputation [1,2,3,4]
The size of Nano-PFC changed negligibly after radial extracorporeal shock wave (rESW) treatment, which proved that Nano-PFC had great stability (Figure 2(b))
Burst-like oxygen release in a dose-dependent manner was observed under rESW treatment with different frequencies (2, 4, 6, 8, and 10 Hz)
Summary
Diabetic foot ulcers (DFUs), the most common complication of diabetes mellitus, are caused by peripheral neuropathy, small vessel occlusion, and secondary infection or trauma, and they may lead to lower extremity amputation [1,2,3,4]. Many adjunctive strategies have been developed for the treatment of DFUs in the clinical practice, including negative pressure wound therapy, ultrasound, recombinant human platelet-derived growth factor-BB, and acellular matrix products [5,6,7]. Hypoxia is a key inhibiting factor for wound healing of DFUs, which can block fibroblast proliferation, collagen production, and capillary angiogenesis and enhance the risk of infection [8,9,10]. Hyperbaric oxygen therapy (HBOT) is the most commonly utilized adjunctive therapy for improving wound tissue hypoxia in DFU treatment [11,12,13], but this method has not achieved universal success in many studies and is costly [14, 15].
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