Preface

I decided to bring up a multidisciplinary volume concerning wound healing, since in my everyday activity, as a surgeon, I am constantly confronted to impressive complexity of tis‐ sue regeneration process, singular yet multifaceted for each given patient. Wound regenera‐ tion unceasingly staggers scientists and clinicians in revealing its intricacy and constant unfolding, as life's movement itself. Tissue repair seems to bear thousands of overlapping molecular and macroscopic processes, all capable to target specific dysfunctions also parallel remedies, only partially revealed to our knowledge.

My main goal in building this work is to try to uplift the reader's awareness on the latest genetic, molecular, pharmaceutical, medical, surgical, and physiotherapeutic approaches for tissue regeneration, at this moment of soaring technologies and bursting medical informa‐ tion. Many of yesterday's "hopeless foot wounds" reveal nowadays unanticipated limb preservation longings and new expectation for survival. The chapters of this book are con‐ ventionally gathered in four main groups of interest, although largely overlapping by indis‐ putable entangled content. As technology evolves, parallel new challenges in cell and tissue engineering, gene, or nanotechnologies (part I), clinical diagnostic, drugs, surgical or endo‐ vascular novel approaches (part II), pharmacological research, serviceable dressings (part III), or traditional medications (part IV) become highly indispensable in daily medical prac‐ tice. Therefore, it is with particular admiration that I greet all participant authors for kindly sharing their erudition and compiling each dedicated chapter at highest scientific level, al‐ though influential building blocks of this volume.

I long for that this book may enable the eager clinician or researcher to overcome part of undeniable challenges in his or her current practice and partake with their teams and pa‐ tients a greater diligence in wound treatment and tissue healing. I would like to express my real gratitude to all remarkable scientists, medical colleagues, specialized nurses, physio‐ therapists, and statisticians and all those who contributed in fulfilling this work and for ev‐ ery step forward that they eventually enhanced throughout this publication.

### **Vlad-Adrian Alexandrescu, MD**

Department of Vascular, Endovascular and Thoracic Surgery Princess Paola Hospital, Marche-en-Famenne, IFAC/Vivalia CHU Sart Tilman Hospital, University of Medicine, Liège, Belgium

**Molecular and Cellular Aspects for Tissue Regeneration**

### **The Role of MicroRNAs in Impaired Diabetic Wound Healing The Role of MicroRNAs in Impaired Diabetic Wound Healing**

Maggie M. Hodges, Carlos Zgheib, Junwang Xu and Kenneth W. Liechty Maggie M. Hodges, Carlos Zgheib, Junwang Xu and Kenneth W. Liechty

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/63637

### **Abstract**

Diabetes mellitus is a worldwide pandemic, affecting 29 million Americans, resulting in substantial morbidity and mortality, and accounting for an annual healthcare expenditure exceeding \$176 billion in the US alone. This burden of disease is the result of a progressive disease associated with numerous complications and the development of chronic wounds, which remain the leading cause of hospital admissions and nontraumatic lower extremity amputations in diabetic patients. Despite clinical strategies aimed at prevention and early detection, patients with diabetes continue to remain at risk of developing chronic diabetic wounds due to poor patient compliance and progression of the diabetic phenotype. Development of the diabetic phenotype and wound healing impairment is associated with dysregulation of microRNAs that regulate inflammation, extracellular matrix composition, and angiogenesis; here we present evidence from the studies that demonstrate correction of microRNA dysregu‐ lation expedites wound healing and reverses the diabetic skin phenotype.

**Keywords:** microRNA, diabetic wound healing, inflammation, angiogenesis, extracel‐ lular matrix
