Department of Pharmaceutics, Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam Campus, Bandar Puncak Alam 42300, Selangor, Malaysia.
Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak 56000 Cheras, Kuala Lumpur, Malaysia.
Curr Drug Targets. 2018;19(5):527-550. doi: 10.2174/1389450118666170704132523.
BACKGROUND: Diabetic foot ulcers (DFUs) are the chronic, non-healing complications of diabetic mellitus which compels a significant burden to the patients and the healthcare system. Peripheral vascular disease, diabetic neuropathy, and abnormal cellular and cytokine/chemokine activity are among the prime players which exacerbate the severity and prevent wound repair. Unlike acute wounds, DFUs impose a substantial challenge to the conventional wound dressings and demand the development of novel and advanced wound healing modalities. In general, an ideal wound dressing should provide a moist wound environment, offer protection from secondary infections, eliminate wound exudate and stimulate tissue regeneration. OBJECTIVE: To date, numerous conventional wound dressings are employed for the management of DFUs but there is a lack of absolute and versatile choice. The current review was therefore aimed to summarize and critically discuss the available evidences related to pharmaceutical and therapeutic viability of polymer-based dressings for the treatment of DFUs. RESULTS: A versatile range of naturally-originated polymers including chitosan (CS), hyaluronic acid (HA), cellulose, alginate, dextran, collagen, gelatin, elastin, fibrin and silk fibroin have been utilized for the treatment of DFUs. These polymers have been used in the form of hydrogels, films, hydrocolloids, foams, membranes, scaffolds, microparticles, and nanoparticles. Moreover, the wound healing viability and clinical applicability of various mutually modified, semi-synthetic or synthetic polymers have also been critically discussed. CONCLUSION: In summary, this review enlightens the most recent developments in polymer-based wound dressings with special emphasis on advanced polymeric biomaterials, innovative therapeutic strategies and delivery approaches for the treatment of DFUs.
背景:糖尿病足溃疡(DFUs)是糖尿病的慢性、不愈合的并发症,给患者和医疗保健系统带来了巨大的负担。周围血管疾病、糖尿病神经病变和异常的细胞和细胞因子/趋化因子活性是加重病情和阻碍伤口愈合的主要因素。与急性伤口不同,DFUs 对传统伤口敷料构成了重大挑战,需要开发新型和先进的伤口愈合方式。一般来说,理想的伤口敷料应提供湿润的伤口环境,提供免受二次感染的保护,清除伤口渗出物并刺激组织再生。
目的:迄今为止,有许多传统的伤口敷料用于治疗 DFUs,但缺乏绝对和通用的选择。因此,本次综述旨在总结和批判性讨论与聚合物基敷料治疗 DFUs 的药物和治疗可行性相关的现有证据。
结果:各种各样的天然来源聚合物,包括壳聚糖(CS)、透明质酸(HA)、纤维素、藻酸盐、葡聚糖、胶原、明胶、弹性蛋白、纤维蛋白和丝素纤维,已被用于治疗 DFUs。这些聚合物已以水凝胶、薄膜、水胶体、泡沫、膜、支架、微球和纳米颗粒的形式使用。此外,还批判性地讨论了各种相互修饰、半合成或合成聚合物的伤口愈合可行性和临床适用性。
结论:总之,本综述阐述了聚合物基伤口敷料的最新进展,特别强调了先进的聚合物生物材料、创新的治疗策略和用于治疗 DFUs 的给药方法。
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