Abstract
Abstract Introduction Diabetic foot ulceration is a devasting complication of diabetes contributing to significant morbidity. Delayed wound healing leads to limb loss and associated stress, anxiety and depression. Apart from systemic inflammatory markers and qualitative assessment of the ulcers, there is no molecular biomarker that can help prognosticate the fate of a diabetic foot ulcer. Metabonomics is a powerful toolset employed to describe metabolic signatures of diabetes in various biological systems. The aim of this systematic review is to summarise the existing evidence on the subject. Methods A systematic review was performed following a predefined protocol. Searches of Embase and MEDLINE by two independent authors, retrieved 292 articles, of which two were included in this study. A qualitative synthesis was performed due to heterogeneity between the studies. Result Two articles pertaining to metabonomics in diabetic foot ulcers were included. One study found that phospholipids (phosphatidylcholine, phosphatidylethanolamine and lysophosphatidylethanolamine) were associated with the development of diabetic foot ulcers. In the second study, amino acids such as arginine, isoleucine, leucine and threonine were found to be in greater concentration in the healed ulcer group as compared to the non-healed ulcer group. Conclusion The studies have highlighted disruption in the phospholipid pathway. They also suggest that specific amino acids are indeed deficient in non-healing ulcers. There is limited published literature on the application of metabolic phenotyping platforms in DFU. The methodology is heterogeneous and hence not directly comparable. Further studies are needed that utilize a biological approach, standardized design and additionally have translational application. Take-home message Diabetic foot ulcer healing is not fully understood. More study designs using metabolic phenotyping should be developed as they provide the most patient specific phenotype.
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