Peptides in chronic wound healing: Fighting infections and facilitating diabetic wound management

Diabetes mellitus is a global health challenge with increasing prevalence and devastating complications. Impaired wound healing, leading to chronic non-healing wounds, significantly affects patients' quality of life and burdens healthcare systems. Diabetic wounds are highly susceptible to pathogens, particularly bacteria, due to immunocompromised patients. The threat of antimicrobial resistance has fueled the search for novel, effective antimicrobial agents. Peptides have emerged as promising therapeutic candidates for addressing antimicrobial resistance and impaired wound healing in diabetic patients. This review aims to provide a comprehensive analysis of the current progress and future perspectives regarding the utilization of peptides for their dual antimicrobial and wound-healing activities in diabetes. We begin by discussing the pathophysiological mechanisms underlying impaired wound healing in diabetes and the growing challenges associated with antimicrobial resistance. Subsequently, we delve into the diverse classes of peptides that have demonstrated potent antimicrobial activity against various multidrug-resistant pathogens. Furthermore, we explore the multifaceted roles of peptides in promoting wound healing in diabetes. These roles encompass enhanced angiogenesis, accelerated cell proliferation, increased extracellular matrix synthesis, and modulation of inflammatory responses, all crucial in wound repair processes. Throughout the review, we critically evaluate the results of in-vitro, in-vivo, and clinical studies investigating peptides' antimicrobial and wound-healing properties in diabetic and non-diabetic wounds. We highlight the advantages and limitations of various peptide-based therapeutic strategies, shedding light on potential challenges that need to be addressed for successful translation into clinical applications. In addition, we discuss cutting-edge advances in peptide modification and delivery systems that aim to enhance peptide stability, bioavailability, and tissue specificity, thereby improving their therapeutic potential. Overall, this review serves as a comprehensive resource for researchers, clinicians, and healthcare professionals interested in understanding the current landscape of peptides as antimicrobial agents and wound healing promoters in diabetes. By identifying knowledge gaps and proposing future research directions, we hope to accelerate the development of peptide-based therapeutics for combating antimicrobial resistance and facilitating wound healing in diabetic patients.