Biotechnological advances in biomaterial-based strategies for diabetic foot ulcers: drug delivery-based approaches for enhanced angiogenesis and regeneration

Diabetic Foot Ulcers (DFU) are a debilitating consequence of diabetes mellitus and are associated with chronic inflammation, reduced angiogenesis, oxidative stress, and bacterial infection that impede wound healing. Current treatment modalities offer palliative care rather than targeting the molecular and cellular pathologies of DFU. It is in this scenario that biomaterials and biotechnology have gained momentum as viable treatment options, providing an active mechanism to modulate the wound milieu. In this regard, the current review highlights recent developments in various types of biomaterials, including those fabricated from natural, synthetic, and combinations of both sources, with an emphasis on smart and responsive formulations that could be used for delivering therapies for diabetic wounds. However, despite emerging preclinical and early clinical data, the translation of biomaterial based therapies into regular clinical practice remains limited due to large scale manufacturing challenges, regulatory pathways and cost-effectiveness. The focus of the review will be on nanoparticles and other nanocarriers, gene activators, growth factor carriers, cells and exosomes that target critical biological processes such as inflammation, angiogenesis, and immune dysfunction. Moreover, some innovative technologies like biosensor-based bandages and intelligent systems are analysed in terms of their ability to provide personalised wound care solutions.