The role of extracellular matrix in the pathophysiology of diabetic wounds

Impaired healing leading to the formation of ulcerated wounds is a critical concern in patients with diabetes. Abnormalities in extracellular matrix (ECM) production and remodeling contribute to tissue dysfunction and delayed healing. Specifically, diabetes-induced changes in the expression and/or activity of structural proteins, ECM-modifying enzymes, proteoglycans, and matricellular proteins have been reported. In this review, we provide a summary of the key ECM molecules and associated changes in skin and diabetic wounds. Such information should allow for new insights in the understanding of impaired wound healing and lead to the development of ECM-based therapeutic strategies. •Wound healing is largely impaired in diabetes due, in part, to dysfunction and dysregulation of extracellular matrix.•This review gives a brief summary of the alterations of key ECM molecules in diabetes.•We also try to elucidate how hyperglycemia impacts ECM and anticipate how these changes contribute to the pathological state of diabetic wounds.