A new magnetic gel could speed healing of diabetic wounds, reduce the rates of recurrence, and in turn, lower the incidents of limb amputations, researchers report.
Diabetic patients, whose natural wound-healing capabilities are compromised, often develop chronic wounds that are slow to heal. Such non-healing wounds could cause serious infections resulting in painful outcomes such as limb amputation.
The new treatment involves the application of a bandage pre-loaded with a hydrogel containing skin cells for healing and magnetic particles. To maximize therapeutic results, a wireless external magnetic device is used to activate skin cells and accelerate the wound healing process. The ideal duration of magnetic stimulation is about one to two hours.
Lab tests showed the treatment coupled with magnetic stimulation healed diabetic wounds about three times faster than current conventional approaches. Furthermore, while the research has focused on healing diabetic foot ulcers, the technology has potential for treating a wide range of complex wounds such as burns.
“Conventional dressings do not play an active role in healing wounds,” says Andy Tay, assistant professor who leads the team comprising researchers from the biomedical engineering department at NUS College of Design and Engineering as well as the NUS Institute for Health Innovation & Technology. “They merely prevent the wound from worsening and patients need to be scheduled for dressing change every two or three days. It is a huge cost to our healthcare system and an inconvenience to patients.”
In contrast, the new invention takes a comprehensive all-in-one approach to wound healing, accelerating the process on several fronts.
“Our technology addresses multiple critical factors associated with diabetic wounds, simultaneously managing elevated glucose levels in the wound area, activating dormant skin cells near the wound, restoring damaged blood vessels, and repairing the disrupted vascular network within the wound,” Tay says.
The researchers describe the gel in a paper published in Advanced Materials.
Sweet spot for treating diabetic wounds
Currently, more than half a billion people globally are living with diabetes and this number is expected to rise significantly. Chronic diabetic wounds such as foot ulcers (one of the most common and hardest to treat wounds) have therefore become a major global healthcare challenge.
Traditional treatments for these wounds are often unsatisfactory, leading to recurring and persistent health issues and—in a high number of cases—limb amputation.
Every year, there are around 9.1 to 26.1 million cases of diabetic foot ulcer worldwide, and around 15 to 25% of patients with diabetes will develop a diabetic foot ulcer during their lifetime. Singapore has one of the highest rates of lower limb amputation due to diabetes globally, averaging around four per day.
Skin cells experience mechanical forces continuously from normal daily activities. However, patients with wounds are usually advised not to carry out rigorous activities, such as walking, and this could kill the remaining cells essential for healing.
“What our team has achieved is to identify a sweet spot by applying gentle mechanical stimulation,” Tay says. “The result is that the remaining skin cells get to ‘work-out’ to heal wounds, but not to the extent that it kills them.”
The specially designed wound-healing gel is loaded with two types of FDA-approved skin cells—keratinocytes (essential for skin repair) and fibroblast (for formation of connective tissue)—and tiny magnetic particles. When combined with a dynamic magnetic field generated by an external device, the mechanical stimulation of the gel encourages dermal fibroblasts to become more active.
Lab tests showed that the increased fibroblast activity generated by the magnetic wound-healing gel increases the cells’ growth rate by approximately 240% and more than doubles their production of collagen—a crucial protein for wound healing. It also improves communication with keratinocytes to promote the formation of new blood vessels.
“The approach we are taking not only accelerates wound healing but also promotes overall wound health and reduces the chances of recurrence,” Tay says.
Chronic wounds and burns
While the magnetic wound-healing gel has shown great promise in improving diabetic wound healing, it could also revolutionize the treatment of other complex wound types.
“The magneto-responsive hydrogel, combined with wireless magneto-induced dynamic mechanical stimulation, addresses fundamental challenges in wound healing, such as creating a conducive microenvironment and promoting tissue regeneration,” says co-first author Shou Yufeng, research fellow from the biomedical engineering department at NUS College of Design and Engineering.
“These principles and our technology’s adaptability, as well as its general ease of use for patients, means that it can be applied to improve wound healing in various situations beyond diabetes, including burns and chronic non-diabetic ulcers.”
The researchers are conducting more tests to further refine the magnetic wound-healing gel to improve its effectiveness. They are also collaborating with a clinical partner to test the effectiveness of the gel using diabetic human tissues.
“This is major step forward in active wound care,” Tay says. “Our goal is to provide an effective and convenient wound-healing solution that improves outcomes for millions around the world.”
“Wound healing, especially in the field of diabetic foot ulcers, has always been a challenging arena. Diabetic foot patients do not heal as well as normal patients and their healing journey is often prolonged,” says Francis Wong Keng Lin, assistant professor and a consultant in the orthopaedic surgery department at Sengkang General Hospital, who was not involved with the study.
“Advancements in wound healing technologies will reduce the duration of the patient journey and would allow them to return to their lives as quickly as possible, hence improving productivity and quality of life.”
The researchers have filed a patent for this innovation. Additional researchers from the Agency for Science, Technology and Research; Nanyang Technological University; Sun Yat-sen University; and Wuhan University of Technology collaborated on the work.