Tissue biomarkers for diabetic foot ulcer healing identified

In a significant step toward addressing the persistent challenge of diabetic foot ulcers (DFUs), the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Diabetic Foot Consortium (DFC) assessed the potential of two biomarkers—c-myc and phosphorylated-glucocorticoid receptor (p-GR)—in wound tissue to forecast healing in patients with active DFUs. The report, published in Wound Repair and Regeneration, is the first major study evaluating tissue biomarkers for predicting DFU outcomes.

DFUs are an important clinical issue, and are associated with high morbidity, disability, amputation, and mortality rates. Despite extensive investigation, reliable biomarkers to predict healing or recurrence have yet to be determined.

The study included wound tissue collected at baseline from 107 participants with active DFUs. Investigators employed immunohistochemistry to assess the nuclear presence of c-myc and p-GR. While mean biomarker levels did not differ significantly between ulcers that healed and those that remained unhealed, p-GR levels showed a trend consistent with the investigators’ hypothesis, suggesting a potential avenue for further exploration.

The findings underscore the complexity of managing DFUs and highlight the importance of continued biomarker discovery. Importantly, the study successfully demonstrated the feasibility of integrating tissue biomarker analysis into prospective DFU research. It also established a comprehensive biorepository of wound tissue samples linked to detailed clinical data, which is expected to serve as a foundational resource for future investigations.

“This study lays the groundwork for further biomarker discovery and advancing DFU science and clinical practice,” said Dr. Marjana Tomic-Canic in a press release. “Although there is still work to be done to develop biomarkers that are strong predictors of healing, the established infrastructure of the DFC is leading the way and will be crucial for supporting research focused on DFU healing.” She is Professor of Dermatology at the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Director of the Wound Healing and Regenerative Medicine Research Program, and lead investigator of the DFC’s University of Miami Biomarker Analyses Unit.

The DFC’s commitment to DFU research is evidenced by its ongoing efforts to expand the biorepository and incorporate advanced technologies such as spatial transcriptomics and proteomics. These initiatives offer new opportunities to identify novel biomarkers and refine DFU management strategies. The consortium’s master protocol, “No DFU Patient Goes Unstudied,” ensures that research findings are broadly applicable to all individuals affected by DFUs.

“This effort represents a critical resource for continued biomarker exploration. We are now in a stronger position to further investigate other molecules and technologies that may lead to reliable, predictive tests for DFU healing,” Dr. Tomic-Canic said. “This study is just the beginning, and the resources generated will continue to drive the advancement of DFU research for years to come.”

The NIDDK Diabetic Foot Consortium is a collaborative initiative among leading academic institutions and healthcare centres, working in partnership with the U.S. NIH/NIDDK to enhance the understanding and treatment of diabetic foot ulcers. Through innovative clinical studies, biomarker discovery, and patient-centred research, the DFC aims to improve outcomes and reduce the burden of this chronic, debilitating condition.