Diabetes research and clinical practice · 2026
Distinct microRNA signatures in Platelet-Rich Plasma-Derived extracellular vesicles predict healing outcomes in chronic diabetic foot ulcers.
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Tsai Yu-Chi, Wu Shu-Yu, Wu Chien-Ju, Chiao Hao-Yu, Tseng Hsu-Ping, He Yu-Min, Chen Tim-Mo, Tu Min-Yu, Tzeng Yuan-Sheng
Аннотация
BACKGROUND: Diabetic foot ulcers (DFUs) present a major challenge due to impaired angiogenesis and chronic inflammation. Autologous platelet-rich plasma (PRP) is a widely used therapy, but clinical outcomes remain inconsistent. We hypothesized that the microRNA (miRNA) cargo of platelet-derived extracellular vesicles (PRP-EVs) drives this therapeutic variability.
METHODS: Ten patients with refractory DFUs were enrolled. Autologous PRP-EVs were isolated, and wound healing-associated miRNAs were quantified via qRT-PCR. Clinical wound closure was monitored weekly, with the primary efficacy endpoint assessed at 6 weeks. The biological effects of patient-specific PRP-EVs on keratinocyte migration were evaluated in vitro.
RESULTS: PRP treatment resulted in significant wound area reduction, achieving an average closure rate of approximately 90% by week 6. However, miRNA expression exhibited substantial heterogeneity. High levels of miR-20a-5p and miR-21-5p in PRP-EVs were significantly associated with delayed clinical healing and impaired keratinocyte migration. Conversely, elevated miR-223-3p correlated with accelerated wound closure.
CONCLUSION: The intrinsic miRNA composition of PRP-EVs is a critical determinant of PRP therapeutic efficacy. miR-20a-5p and miR-21-5p serve as negative predictive biomarkers, whereas miR-223-3p indicates a favorable prognosis. Profiling these miRNAs offers a novel approach for PRP quality control and personalized regenerative strategies.
METHODS: Ten patients with refractory DFUs were enrolled. Autologous PRP-EVs were isolated, and wound healing-associated miRNAs were quantified via qRT-PCR. Clinical wound closure was monitored weekly, with the primary efficacy endpoint assessed at 6 weeks. The biological effects of patient-specific PRP-EVs on keratinocyte migration were evaluated in vitro.
RESULTS: PRP treatment resulted in significant wound area reduction, achieving an average closure rate of approximately 90% by week 6. However, miRNA expression exhibited substantial heterogeneity. High levels of miR-20a-5p and miR-21-5p in PRP-EVs were significantly associated with delayed clinical healing and impaired keratinocyte migration. Conversely, elevated miR-223-3p correlated with accelerated wound closure.
CONCLUSION: The intrinsic miRNA composition of PRP-EVs is a critical determinant of PRP therapeutic efficacy. miR-20a-5p and miR-21-5p serve as negative predictive biomarkers, whereas miR-223-3p indicates a favorable prognosis. Profiling these miRNAs offers a novel approach for PRP quality control and personalized regenerative strategies.