Innovations in gene and growth factor delivery systems for diabetic wound healing

Alginate hydrogel dressings for advanced wound management

Wound healing is a complicated and continuous process affected by several factors, and it needs an appropriate surrounding to achieve accelerated healing. At present, various wound dressings are used for wound management, such as fiber, sponge, hydrogel, foam, hydrocolloid and so on. Hydrogels can provide mechanical support and moist environment for wounds, and are widely used in biomedical field. Alginate is a natural linear polysaccharide derived from brown algae or bacteria, consisting of repeating units of β-1,4-linked D-mannuronic acid (M) and L-guluronic acid (G) in different ratios. It is widely used in biomedical and engineering fields due to its good biocompatibility and liquid absorption capacity. Alginate-based hydrogels have been used in wound dressing, tissue engineering, and drug delivery applications for decades. In this review, we summarize the recent approaches in the chemical and physical preparation and the application of alginate hydrogels in wound dressings.

Enhanced wound healing via collagen-turnover-driven transfer of PDGF-BB gene in a murine wound model

Wound healing is a complex biological process that requires coordinated cell proliferation, migration, and extracellular matrix production/remodeling, all of which are inhibited/delayed in chronic wounds. In this study, a formulation was developed that marries a fibrin-based, provisional-like matrix with collagen mimetic peptide (CMP)/PDGF gene-modified collagens, leading to the formation of robust gels that supported temporally controlled PDGF expression and facile application within the wound bed. Analysis employing in vitro co-gel scaffolds confirmed sustained and temporally controlled gene release based on matrix metalloproteinase (MMP) activity, with ~30% higher PDGF expression in MMP producing fibroblasts as-compared with non-MMP-expressing cells. The integration of fibrin with the gene-modified collagens resulted in co-gels that strongly supported both fibroblast cell recruitment/invasion as well as multiple aspects of the longer-term healing process. The excisional wound healing studies in mice established faster wound closure using CMP-modified PDGF polyplex-loaded co-gels, which exhibited up to 24% more wound closure (achieved with ~2 orders of magnitude lower growth factor dosing) after 9 days as compared to PDGF-loaded co-gels, and 19% more wound closure after 9 days as compared to CMP-free polyplex loaded co-gels. Moreover, minimal scar formation as well as improved collagen production, myofibroblast activity, and collagen orientation was observed following CMP-modified PDGF polyplex-loaded co-gel application on wounds. Taken together, the combined properties of the co-gels, including their stability and capacity to control both cell recruitment and cell phenotype within the murine wound bed, strongly supports the potential of the co-gel scaffolds for improved treatment of chronic non-healing wounds.

Collagen/GAG scaffolds activated by RALA-siMMP-9 complexes with potential for improved diabetic foot ulcer healing

Impaired wound healing of diabetic foot ulcers has been linked to high MMP-9 levels at the wound site. Strategies aimed at the simultaneous downregulation of the MMP-9 level in situ and the regeneration of impaired tissue are critical for improved diabetic foot ulcer (DFU) healing. To fulfil this aim, collagen/GAG (Col/GAG) scaffolds activated by MMP-9-targeting siRNA (siMMP-9) were developed in this study. The siMMP-9 complexes were successfully formed by mixing the RALA cell penetrating peptide with siMMP-9. The complexes formulated at N:P ratios of 6 to 15 had a diameter around 100 nm and a positive zeta potential about 40 mV, making them ideal for cellular uptake. In 2 dimensional (2D) culture of human fibroblasts, the cellular uptake of the complexes surpassed 60% and corresponded to a 60% reduction in MMP-9 gene expression in low glucose culture. In high glucose culture, which induces over-expression of MMP-9 and therefore serves as an in vitro model mimicking conditions in DFU, the MMP-9 gene could be downregulated by around 90%. In the 3D culture of fibroblasts, the siMMP-9 activated Col/GAG scaffolds displayed excellent cytocompatibility and ~60% and 40% MMP-9 gene downregulation in low and high glucose culture, respectively. When the siMMP-9 complexes were applied to THP-1 macrophages, the primary cell type producing MMP-9 in DFU, MMP-9 gene expression was significantly reduced by 70% and 50% for M0 and M1 subsets, in 2D culture. In the scaffolds, the MMP-9 gene and protein level of M1 macrophages decreased by around 50% and 30% respectively. Taken together, this study demonstrates that the RALA-siMMP-9 activated Col/GAG scaffolds possess high potential as a promising regenerative platform for improved DFU healing.

The Treatment of Impaired Wound Healing in Diabetes: Looking among Old Drugs

Chronic wounds often occur in patients with diabetes mellitus due to the impairment of wound healing. This has negative consequences for both the patient and the medical system and considering the growing prevalence of diabetes, it will be a significant medical, social, and economic burden in the near future. Hence, the need for therapeutic alternatives to the current available treatments that, although various, do not guarantee a rapid and definite reparative process, appears necessary. We here analyzed current treatments for wound healing, but mainly focused the attention on few classes of drugs that are already in the market with different indications, but that have shown in preclinical and few clinical trials the potentiality to be used in the treatment of impaired wound healing. In particular, repurposing of the antiglycemic agents dipeptidylpeptidase 4 (DPP4) inhibitors and metformin, but also, statins and phenyotin have been analyzed. All show encouraging results in the treatment of chronic wounds, but additional, well designed studies are needed to allow these drugs access to the clinics in the therapy of impaired wound healing.

Bioactive antibacterial silica-based nanocomposites hydrogel scaffolds with high angiogenesis for promoting diabetic wound healing and skin repair

Diabetic wound repair and skin regeneration remains a worldwide challenge due to the impaired functionality of re-vascularization. Methods: This study reports a bioactive self-healing antibacterial injectable dual-network silica-based nanocomposite hydrogel scaffolds that can significantly enhance the diabetic wound healing/skin tissue formation through promoting early angiogenesis without adding any bioactive factors. The nanocomposite scaffold comprises a main network of polyethylene glycol diacrylate (PEGDA) forming scaffolds, with an auxiliary dynamic network formed between bioactive glass nanoparticles containing copper (BGNC) and sodium alginate (ALG) (PABC scaffolds). Results: PABC scaffolds exhibit the biomimetic elastomeric mechanical properties, excellent injectabilities, self-healing behavior, as well as the robust broad-spectrum antibacterial activity. Importantly, PABC hydrogel significantly promoted the viability, proliferation and angiogenic ability of endothelial progenitor cells (EPCs) in vitro. In vivo, PABC hydrogel could efficiently restore blood vessels networks through enhancing HIF-1α/VEGF expression and collagen matrix deposition in the full-thickness diabetic wound, and significantly accelerate wound healing and skin tissue regeneration. Conclusion: The prominent multifunctional properties and angiogenic capacity of PABC hydrogel scaffolds enable their promising applications in angiogenesis-related regenerative medicine.

Prospects for the application of growth factors in wound healing

As the largest organ of the body, human skin is multifunctional and enjoys two layers, the epidermis and the dermis, the separation of which is performed by a basement membrane zone. Skin protects the body against mechanical forces and infections. Skin wounds represent large and growing challenges to the healthcare systems globally. Skin wound healing, as a protective shield for the body against the external environment, includes interactions among cell types, the neurovascular system, cytokines, and matrix remodeling. Growth factors (GFs) affect the microenvironment of the wound, and cause rises in cell differentiation, proliferation, and migration. Administrating exogenous GFs has revealed potential in enhancing wound healing outcomes. The use of human GFs in the field of wound healing is becoming gradually more interesting, because of the low-invasive techniques required for their use. Reviewed here are the literatures on the healing of skin wounds with emphasize on the role of GFs and their future prospects, containing profits, and probable long-standing side effects accompanied with their use.

A review of accelerated wound healing approaches: biomaterial- assisted tissue remodeling

Nowadays, due to a growing number of tissue injuries, in particular, skin wounds, induction and promotion of tissue healing responses can be considered as a crucial step towards a complete regeneration. Recently, biomaterial design has been oriented towards promoting a powerful, effective, and successful healing. Biomaterials with wound management abilities have been developed for different applications such as providing a native microenvironment and supportive matrices that induce the growth of tissue, creating physical obstacles against microbial contamination, and to be used as delivery systems for therapeutic reagents. Until now, numerous strategies aiming to accelerate the wound healing process have been utilized and studied with their own pros and cons. In this review, tissue remodeling phenomena, wound healing mechanisms, and their related factors will be discussed. In addition, different methods for induction and acceleration of healing via cell therapy, bioactive therapeutic delivery, and/or biomaterial-based approaches will be reviewed.

Adhesive thermosensitive gels for local delivery of viral vectors

Local delivery of viral vectors can enhance the efficacy of therapies by selectively affecting necessary tissues and reducing the required vector dose. Pluronic F127 is a thermosensitive polymer that undergoes a solution-gelation (sol-gel) transition as temperature increases and can deliver vectors without damaging them. While pluronics can be spread over large areas, such as the surface of an organ, before gelation, they lack sufficient adhesivity to remain attached to some tissues, such as the surface of the heart or mucosal surfaces. Here, we utilized blends of pluronic F127 and polycarbophil (PCB), a mucoadhesive agent, to provide the necessary adhesivity for local delivery of viral vectors to the cardiac muscle. The effects of PCB concentration on adhesive properties, sol-gel temperature transition and cytocompatibility were evaluated. Rheological studies showed that PCB decreased the sol-gel transition temperature at concentrations >1% and increased the adhesive properties of the gel. Furthermore, these gels were able to deliver viral vectors and transduce cells in vitro and in vivo in a neonatal mouse apical resection model. These gels could be a useful platform for delivering viral vectors over the surface of organs where increased adhesivity is required.

Silk fibroin scaffolds loaded with angiogenic genes in adenovirus vectors for tissue regeneration

Vascularization remains a critical challenge in dermal tissue regeneration. In this study, a vascular endothelial growth factor (VEGF165) and angiopoietin-1 (Ang-1) dual gene coexpression vector that encoded green fluorescent protein (GFP) was constructed from an arginine-glycine-aspartic acid-modified adenovirus. Silk fibroin (SF) scaffolds loaded with adenovirus vectors were fabricated by freeze-drying method. In vitro, the human endothelial-derived cell line EA.hy926 was infected with adenovirus vectors and then expressed GFP, secreted VEGF165 and Ang-1, and promoted cell proliferation effectively. The VEGF165 and Ang-1 genes loaded in the SF scaffolds significantly promoted the formation of abundant microvascular networks in the chick embryo chorioallantoic membrane. In vivo, angiogenic genes loaded in the scaffolds promoted vascularization and collagen deposition in scaffolds, thus effectively accelerating dermal tissue regeneration in a dorsal full-thickness skin defect wound model in Sprague-Dawley rats. In conclusion, SF scaffolds loaded with arginine-glycine-aspartic acid-modified adenovirus vectors encoding VEGF165 and Ang-1 could stimulate the formation of vascular networks through the effective expression of target genes in vascular endothelial cells, thereby accelerating the regeneration of dermal tissue.

Review: Multimodal bioactive material approaches for wound healing

Wound healing is a highly complex process of tissue repair that relies on the synergistic effect of a number of different cells, cytokines, enzymes, and growth factors. A deregulation in this process can lead to the formation of a non-healing chronic ulcer. Current treatment options, such as collagen wound dressings, are unable to meet the demand set by the wound environment. Therefore, a multifaceted bioactive dressing is needed to elicit a targeted affect. Wound healing strategies seek to develop a targeted effect through the delivery of a bioactive molecule to the wound by a hydrogel or a polymeric scaffold. This review examines current biomaterial and small molecule-based approaches that seek to develop a bioactive material for targeted wound therapy and accepted wound healing models for testing material efficacy.

Experimental study of epidermal growth factor and acidic fibroblast growth factor in the treatment of diabetic foot wounds

The aim of the present study was to investigate the effect of epidermal growth factor (EGF) and acidic fibroblast growth factor (aFGF) on the healing of diabetic foot wounds. A total of 199 patients with diabetic foot ulcers were recruited and randomly divided into four groups: A recombinant human EGF group (n=50), an aFGF group (n=50), a combined EGF and aFGF group (n=50) and a normal saline control group (n=49). Patients in all groups received a daily dressing change and growth factor reagents were applied topically when dressing. To observe the time required for each stage of wound healing, the epidermal healing rate and granulation tissue growth were recorded. Following 3-4 days of treatment, the wound healing stage was similar in all groups. Later stages (following 4 days) of wound healing were achieved significantly faster in the combined group compared with the control group (P<0.05). The rate of wound healing in the EGF group was similar to that observed in the combination group. No significant difference was observed between the EGF and aFGF groups during the initial period of wound healing. However, in the later stage (following 4 days), the combined use of recombinant human EGF and aFGF had a marked positive effect on wound healing when compared with the control group. Growth factors have extensive biological activities with functions including promoting cell proliferation as well as rehabilitating and regenerating tissues, which serve important roles in wound healing.

[Construction and bioactivity evaluation of hepatocyte growth factor-loaded poly (lactic-co-glycolic acid) nanoparticles]

OBJECTIVE

To explore the optimum conditions for preparing poly(lactic-co-glycolic) acid (PLGA) nanoparticles and evaluate the bioactivity of hepatocyte growth factor (HGF)-loaded PLGA nanoparticles.

METHODS

Bovine serum albumin (BSA)-loaded PLGA nanoparticles were prepared using a double emulsion-solvent evaporation method. The preparation process of nanoparticles was optimized by orthogonal test with the particle size, encapsulation efficiency (EE), drug loading (DD), and recovery as the indexes. HGF-loaded nanoparticles were then prepared under the optimized conditions. The EE, DD and release characteristics of BSA?loaded nanoparticles and HGF-loaded nanoparticles were evaluated using a BCA kit and HGF ELISA kit. The bioactivity of HGF-loaded nanoparticles was evaluated using CCK8 proliferation assay.

RESULTS

The HGF-loaded nanoparticles prepared under the optimized conditions had a uniform size with a mean diameter of 234.4∓4.8 nm, an EE of (77.75∓3.04)% and a recovery rate of (49.33∓9.34)%. The in vitro release curve highlighted an initial burst drug release followed by sustained release from the nanoparticles. HGF-loaded nanoparticles obviously promoted the proliferation of Hacat keratinocytes in vitro.

CONCLUSION

HGF-loaded nanoparticles prepared using double emulsion?solvent evaporation method under optimized conditions possesses a high EE with a good sustained drug release profile and a good bioactivity.

[Construction and bioactivity evaluation of hepatocyte growth factor-loaded poly (lactic-co-glycolic acid) nanoparticles]

OBJECTIVE

To explore the optimum conditions for preparing poly(lactic-co-glycolic) acid (PLGA) nanoparticles and evaluate the bioactivity of hepatocyte growth factor (HGF)-loaded PLGA nanoparticles.

METHODS

Bovine serum albumin (BSA)-loaded PLGA nanoparticles were prepared using a double emulsion-solvent evaporation method. The preparation process of nanoparticles was optimized by orthogonal test with the particle size, encapsulation efficiency (EE), drug loading (DD), and recovery as the indexes. HGF-loaded nanoparticles were then prepared under the optimized conditions. The EE, DD and release characteristics of BSA?loaded nanoparticles and HGF-loaded nanoparticles were evaluated using a BCA kit and HGF ELISA kit. The bioactivity of HGF-loaded nanoparticles was evaluated using CCK8 proliferation assay.

RESULTS

The HGF-loaded nanoparticles prepared under the optimized conditions had a uniform size with a mean diameter of 234.4∓4.8 nm, an EE of (77.75∓3.04)% and a recovery rate of (49.33∓9.34)%. The in vitro release curve highlighted an initial burst drug release followed by sustained release from the nanoparticles. HGF-loaded nanoparticles obviously promoted the proliferation of Hacat keratinocytes in vitro.

CONCLUSION

HGF-loaded nanoparticles prepared using double emulsion?solvent evaporation method under optimized conditions possesses a high EE with a good sustained drug release profile and a good bioactivity.

Advanced Growth Factor Delivery Systems in Wound Management and Skin Regeneration

Growth factors are endogenous signaling molecules that regulate cellular responses required for wound healing processes such as migration, proliferation, and differentiation. However, exogenous application of growth factors has limited effectiveness in clinical settings due to their low in vivo stability, restricted absorption through skin around wound lesions, elimination by exudation prior to reaching the wound area, and other unwanted side effects. Sophisticated systems to control the spatio-temporal delivery of growth factors are required for the effective and safe use of growth factors as regenerative treatments in clinical practice, such as biomaterial-based drug delivery systems (DDSs). The current review describes the roles of growth factors in wound healing, their clinical applications for the treatment of chronic wounds, and advances in growth factor-loaded DDSs for enhanced wound healing, focusing on micro- and nano-particulate systems, scaffolds, hydrogels, and other miscellaneous systems.