Sun Dan, Chang Qiang, Lu Feng
Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
J Tissue Eng. 2024 Jul 27;15:20417314241265202. doi: 10.1177/20417314241265202. eCollection 2024 Jan-Dec.
Diabetic wound healing presents a significant clinical challenge due to the interplay of systemic metabolic disturbances and local inflammation, which hinder the healing process. Macrophages undergo a phenotypic shift from M1 to M2 during wound healing, a transition pivotal for effective tissue repair. However, in diabetic wounds, the microenvironment disrupts this phenotypic polarization, perpetuating inflammation, and impeding healing. Reprograming macrophages to restore their M2 phenotype offers a potential avenue for modulating the wound immune microenvironment and promoting healing. This review elucidates the mechanisms underlying impaired macrophage polarization toward the M2 phenotype in diabetic wounds and discusses novel strategies, including epigenetic and metabolic interventions, to promote macrophage conversion to M2. Hydrogels, with their hydrated 3D cross-linked structure, closely resemble the physiological extracellular matrix and offer advantageous properties such as biocompatibility, tunability, and versatility. These characteristics make hydrogels promising candidates for developing immunomodulatory materials aimed at addressing diabetic wounds. Understanding the role of hydrogels in immunotherapy, particularly in the context of macrophage reprograming, is essential for the development of advanced wound care solutions. This review also highlights recent advancements in immunotherapeutic hydrogels as a step toward precise and effective treatments for diabetic wounds.
由于全身代谢紊乱和局部炎症的相互作用阻碍了愈合过程，糖尿病伤口愈合面临着重大的临床挑战。在伤口愈合过程中，巨噬细胞会经历从M1到M2的表型转变，这一转变对有效的组织修复至关重要。然而，在糖尿病伤口中，微环境会破坏这种表型极化，使炎症持续存在，并阻碍愈合。重新编程巨噬细胞以恢复其M2表型为调节伤口免疫微环境和促进愈合提供了一条潜在途径。本综述阐明了糖尿病伤口中巨噬细胞向M2表型极化受损的潜在机制，并讨论了包括表观遗传和代谢干预在内的新策略，以促进巨噬细胞向M2转化。水凝胶具有水合的三维交联结构，与生理细胞外基质非常相似，并具有生物相容性、可调节性和多功能性等优势特性。这些特性使水凝胶成为开发针对糖尿病伤口的免疫调节材料的有前途的候选材料。了解水凝胶在免疫治疗中的作用，特别是在巨噬细胞重编程的背景下，对于开发先进的伤口护理解决方案至关重要。本综述还强调了免疫治疗水凝胶的最新进展，作为迈向糖尿病伤口精确有效治疗的一步。
