Treatment for diabetic foot ulcer (DFU), a common manifestation of diabetes mellitus, will get easier with a simplified treatment involving 3D bioprinted scaffolds loaded with antibiotics. This is what a proof of concept study by researchers from Queen’s University, Belfast, suggests.
The proof-of-concept study, published in January, involved studying the effects of loading antibiotic Levofloxacin on scaffolds with different designs, fabricated using bioprinting technologies. The impact of geometry and design of the scaffold on change in mechanical properties was looked at. It was seen that modifying the geometry and design of the scaffold resulted in change of mechanical properties displayed, with the square design, exhibiting the lowest stiffness, being the most preferred.
The study also looked at the effect of drug concentration on the mechanical properties of the scaffolds. The nature of drug release too was studied in-vitro for various concentrations of the antibiotic, which showed an initial burst of release followed by achieving a steady-state release.
Bioprinting provides for producing flexible scaffolds while retaining mechanical characteristics — durability with a degree of flexibility while providing support to the wound — and loading these scaffolds with drug, provides for sustained drug delivery, such as an antibiotic in this case. The bioprinting technique wields an upper hand as it allows for the use of a wide variety of biodegradable polymers, and is capable of producing composite scaffolds, composed of both synthetic and natural polymers, to combine the benefits of each polymer type and alleviate the respective limitations. Moreover, the proof-of-concept study also demonstrated that no major drug-polymer interaction occurred. Bioprinting also allows for production of scaffolds of various geometries and sizes and using bioinks containing cells. The sustained drug delivery at the target site through the scaffold reduces the potential for side effects, including drug toxicity, is non-invasive and requires no hospitalisation for administration of the drug. As the study’s authors note, in clinical practice, the scaffold could be applied to the skin using an adherent dressing that would aid the retention of the scaffold in direct contact with the skin over the desired application time.
DFU affects nearly 25 per cent of diabetic patients and may lead to lower limb amputation in a majority of DFU cases.
Standard practices in DFU management include surgical debridement, dressings to facilitate a moist wound environment, wound off-loading, vascular assessment, and infection and glycaemic control. However, these are often unsuccessful alone. Advanced therapies, such as hydrogel wound dressings, further increases treatment costs and requires hospitalisation. Such limitations thus affect the patient’s quality of life, along with increasing the costs and clinical burden in treating DFU.
Treatment of DFUs accounts for approximately one-third the total cost of diabetic care, and even after wound resolution, subsequent DFUs are common, with a recurrence rate of roughly 40 per cent of patients within a year. Some of the common reasons seen in failure of wound healing include damage of peripheral nerves, lack of resistance to infection, and absence of a suitable protein matrix on the dermis, that is the middle layer of the skin. In fact, more rapid migration of epidermal cells across the wound base is one of the key goals for wound dressing. Wound dressing is crucial to create a beneficial environment for the open wound to achieve a better and faster wound closure. However, conventional wound dressings like gauze possess limited basic function for their defective material properties. Moreover, different phases of the diabetic wound healing have different pathology features and hence multifunctional wound dressing with specific material becomes important. Infection, particularly biofilm formation witnessed in the later stages of DFU progression, is another major contributing factor to poor wound-healing outcomes in diabetic patients.
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Sohini GhoshSohini is a senior correspondent based in Gujarat, primarily covering … read more
Diabeets
11/10/2022