1465-P: Diatom-Loaded Pressure Sensor: Combining Real-Time Monitoring and Oxygen Therapy for Diabetic Pressure Injury

Introduction and Objective: Diabetic pressure ulcers are hard-to-heal chronic wounds characterized by sustained mechanical stress and local hypoxia. Here we report a pressure-sensitive, oxygengenerating bilayer hydrogel (APAD) dressing, which can accelerates wound closure, enhances neovascularization and collagen remodeling, and activates cell cycle and Wnt signaling pathways. This integrated platform offers a clinically relevant strategy for real-time monitoring and effective treatment of diabetic pressure injuries. Methods: We designed, fabricated, and systematically evaluated the APAD hydrogel in terms of structural optimization, mechanical performance, electromechanical sensitivity, and oxygenrelease behavior. Furthermore, we assessed its biocompatibility and pro-healing efficacy both in vitro and in vivo using diabetic mouse and miniature pig models, and explored the underlying molecular mechanisms through transcriptomic analyses. Results: The APAD hydrogel is structurally reinforced by the silica exoskeletons of diatoms. Meanwhile, the embedded diatoms maintain robust metabolic activity under low-light and moist wound conditions, producing oxygen in a controllable and cyclic manner that counteracts local hypoxia. Transcriptomic profiling and immunohistochemistry of APAD-treated tissue revealed upregulation of epidermal development and cell cycle pathways, along with suppression of muscle contraction-related signatures, indicating a shift toward regenerative rather than fibrotic wound remodeling, supporting the notion that oxygen microenvironment modulation directly orchestrates cellular regenerative responses at the wound site. Conclusion: The diatom-integrated APAD hydrogel offers a biologically intelligent strategy for addressing the dual pathological barriers of pressure overload and hypoxia in diabetic pressure ulcers. This system enables real-time feedback and actively promotes tissue regeneration.