Expanding arsenal against diabetic wounds using nanomedicines and nanomaterials: Success so far and bottlenecks

Diabetic wound (DW) is disease that occurs as a secondary complication of diabetes. The use of current therapies being employed to treat DW is associated with a number of limitations. However, the advancement in novel drug delivery system (NDDS) and nanomaterials in recent years has provided new options in the field of tissue rejuvenation. This review discusses the pathogenesis of DW, role of GFs and nucleic acids in DW healing, conventional treatments and need for NDDS. Various NDDS and nanomaterials reported for the treatment of DWs include liposomes, niosomes, transfersomes, exosomes, nanoemulsion, nano hydrogel, SLNs, NLCs, metallic NPs, polymeric NPs, dendrimers, wafers, hydrogel nanotubes, scaffolds, nanofibers and nanocomposites. Delving deeper, the clinical trials of NDDS based formulations and patents on treatment strategies of DW are also enlisted. The article has shown the potential of the aforementioned NDDS in treating DW, however, their clinical translation is hindered by certain issues such as their physicomechanical and storage instability, toxicity, poor drug loading and yield, poor site specificity and expensive manufacturing procedures. It is important to work on these bottlenecks to achieve better in vivo performance of formulation. This can be possible by the joint efforts of formulation scientists, biomaterial engineers, clinicians as well as regulatory officials. They have to understand the key areas that require more attention and that should be addressed for their better clinical translation.