A Closer Look At The Efficacy Of Bioengineered Alternative Tissues For DFUs
In 2003, Marston and colleagues published an article detailing their findings on the efficacy and safety of Dermagraft in comparison to conventional wound therapy.21 Their level 1 therapeutic study evaluated the healing rate of 314 patients suffering with chronic diabetic ulcerations over a 12-week period. The results indicated that Dermagraft is an effective agent for treating recalcitrant diabetic wounds as 30 percent of Dermagraft patients went on to closure versus the 18.3 percent of control patients. Adverse events were similar for both groups, supporting the belief that this bioengineered alternative tissue is safe for use.
The issue of cell binding is unique to products like Dermagraft that contain polymers or non-biological molecules. Although the synthetic polyglactin mesh offers locations for fibroblasts to adhere, the cells need to be told where to migrate. Chemotactic signals direct this activity as well as other cell functions. Since the interaction of fibroblasts with synthetic materials is different than what occurs with native extracellular matrix, manufacturers of these tissue substitutes must integrate protein recognition sequences into the matrices in order to facilitate cell-matrix contact.22 Advances in tissue engineering such as this make it seem as if there is no limit to future technologies and product creations that will solve the ever present problem of chronic non-healing wounds.
While there is a gamut of treatment options currently available for recalcitrant diabetic neuropathic ulcerations, physicians must employ appropriate discretion when selecting a modality. Knowledge of product characteristics and limitations, wound type and depth, and associated patient comorbidities will allow one to make an educated decision, which will result in a favorable outcome.
Bioengineered alternative tissues can play a role in the healing of many chronic diabetic ulcers. However, achieving successful incorporation of these products relies heavily on proper wound preparation and a stable wound environment. Clinicians should not forget this concept.
The preponderance of research presented in this article supports the effectiveness of bioengineered alternative tissues yet these products are not the panacea as complete wound closure occurred in about 30 to 56 percent of patients, a far cry from 100 percent ulcer epithelialization and resolution. Perhaps the key to improving the effectiveness of bioengineered alternative tissues lies in recognizing when standard treatment modalities are just not cutting it. Earlier identification of these non-healing ulcerations may lead to quicker implementation and initiation of bioengineered tissues that could ultimately reduce the time to heal.
It goes without saying that further research is needed to gain a more detailed understanding of the biochemical mechanisms at work within these advanced wound care products. If we can unmask the intricacies of these cellular processes, we can modify products to enhance healing and prevent recurrence.
Dr. Skratsky is an Assistant Professor in the Department of Podiatric Medicine and Radiology at Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University in Chicago.
Dr. Wu is the Director of the Center for Lower Extremity Ambulatory (CLEAR) at the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science in Chicago. She is an Associate Professor for the Center for Stem Cell and Regenerative Medicine at the School of Graduate and Postdoctoral Studies at the Rosalind Franklin University of Medicine and Science. She is also an Associate Professor in the Surgery Department and the Associate Dean of Research at the aforementioned Scholl College of Podiatric Medicine.