Healing Diabetic Wounds: Four Studies, One Question
For people with diabetes, a small blister can become a wound that won’t close for months. Over the past few years, I’ve contributed the proteomics to four studies asking the same question from different angles: why?
Chronic wounds are one of the most serious complications of diabetes, and a leading cause of amputation. High blood sugar, ongoing inflammation, oxidative stress and poor circulation all disrupt the normal sequence of healing. All four studies below come from Dr Mari van de Vyver’s wound healing research group at Stellenbosch University, and all four use proteomics to look at what is happening at the molecular level.
1. The First Days Matter Most
In Dysregulated healing responses in diabetic wounds occur in the early stages postinjury (2021), led by Kiara Boodhoo, we compared wounds in obese diabetic mice with wounds in healthy mice on day 2 and day 7 after injury.
By day 7, the healthy wounds had closed and started rebuilding tissue. The diabetic wounds showed no signs of healing. Of 906 proteins identified, 23 differed significantly on day 2 but only 6 on day 7. Most of the disruption, in other words, happened early. The takeaway: treatment may need to start in the first days after injury, before a wound gets stuck.
2. Cord Blood Serum and Amniotic Membrane
In Combined therapeutic use of umbilical cord blood serum and amniotic membrane in diabetic wounds (2024), we tested two biological products together: cord blood serum to prime the wound, followed by an amniotic membrane scaffold. In the wounds that responded, the combination produced the most complete tissue regeneration. I wrote about this one at 2am with a newborn in my arms: From the Cord to the Clinic.
3. Putting Macrophages to Work
Macrophages are immune cells that clear debris and help direct repair. In diabetes, they tend to get stuck in an inflammatory mode. In A macrophage-based cell therapy approach promotes collagen deposition in diabetic wounds (2025), again led by Kiara Boodhoo, a macrophage-based cell therapy increased collagen deposition in diabetic wounds. Collagen is the structural protein that gives healed skin its strength.
4. Keeping Stem Cells Alive Isn’t Enough
Bone marrow stem cells are a promising wound therapy, but diabetes damages them too. In Antioxidants improve the viability of diabetic bone marrow MSCs without rescuing their pro-regenerative secretome function (2025), led by Michelle Maartens, antioxidant treatment helped more of these cells survive, but did not restore the healing signals they release. A cell that survives is not necessarily a cell that helps.
What Ties Them Together
Read together, these studies point in the same direction. Diabetic wounds go wrong early; several processes fail at once; and fixing one problem, whether cell survival or a single growth signal, is rarely enough on its own. That is exactly where proteomics earns its place: it measures thousands of proteins at once, so it can show whether a treatment has actually moved a wound towards healing, not just changed one marker.
My role in this work covered the proteomics: developing the methods, training the students on sample preparation, setting up the instruments, acquiring and processing the data, writing the data reports, and reviewing the manuscript before publication.