A Multi-targeted Approach for the Impaired Healing of Diabetic Foot Ulcers Through Combined Electric Field Stimulation and Nitric Oxide Therapy
openNIDDK - National Institute of Diabetes and Digestive and Kidney Diseases
Project Summary
Diabetic Foot Ulcer (DFU) is a major complication of diabetes, often leading to lower extremity amputations.
DFUs are characterized by a complex pathology resulting from peripheral vascular disease, neuropathy, and
infections, all exacerbated by prolonged hyperglycemia, which collectively impede normal wound healing. Standard
DFU treatments, such as surgical debridement, wound dressing, and infection management, primarily address
individual aspects of the pathology, leading to only about 25% of cases achieving complete healing within 12
weeks. This highlights the limitations of current treatments and the need for innovative solutions that
comprehensively address multiple aspects of DFU. Diabetes impairs mitochondrial activity, reducing cellular
energy and hindering wound healing and closure. Our previous research showed that electric field stimulation
significantly enhanced mitochondrial activity, ATP production, and the proliferation of human dermal fibroblasts.
Additionally, nitric oxide (NO) has been shown to promote angiogenesis, prevents ischemia, and reduces
inflammation and infection, as also demonstrated in our study with a NO releasing prohealing peptide amphiphile
(PA) nanomatrix. However, in diabetic conditions, decreased endothelial NO synthase (eNOS) activity lowers NO
levels. Thus, as a multi-targeted strategy, combining electric field stimulation with NO therapy may enhance DFU
healing by stimulating cellular energy for wound closure and tissue regeneration, while also reducing complications,
such as vascular disease, inflammation, and infection in hyperglycemic conditions.
In this study, we will evaluate the therapeutic effects of electric field stimulation and NO therapy, investigating
the healing mechanisms of diabetic wounds. To conduct this evaluation, we will develop a bio-engineered cell
culture platform that mimics a 3D human skin extracellular matrix (ECM) environment, integrating electric
stimulation and NO delivery. This platform will be designed using a peptide amphiphile (PA)-based NO-releasing
nanomatrix coating on a highly porous 3D electrospun nanofiber scaffold with two-electrode arrangement (semi-
capacitive coupling) for electric stimulation, as proposed in Specific Aim 1. In Specific Aim 2, we will evaluate the
effects of combined treatments, particularly electric field stimulation, on behaviors related to wound healing, such
as cell proliferation and ECM production, in diabetic skin cells derived from DFU patients under hyperglycemia
using the platform. This evaluation will focus on the ATP binding purinergic (P2) receptor-mediated pathway. We
will also test the combined treatment, particularly NO, to enhance diabetic endothelial activities, reduce
inflammation, and inhibit DFU related bacterial growth under hyperglycemia using the platform in Specific Aim 3.
Successful completion of this study will offer a novel DFU treatment strategy by delivering electric field
stimulation and NO, validated with an innovative wound healing cell culture platform, enhancing current treatment
methods. Additionally, it will enhance Rowan University's biomedical research capabilities and provide valuable
hands-on research opportunities for undergraduate students, fostering their development as future scientists.
Up to $562K
health research