Aging, biofilms, and diabetic foot ulcers: disrupting chronic infections with super-oxidized solutions and addressing age-related vulnerabilities

Diabetic Foot Ulcers (DFUs) are a serious complication of diabetes, often leading to chronic infections, prolonged hospitalization, and, in severe cases, amputations. A major challenge in DFU treatment is the presence of polymicrobial biofilms, complex bacterial communities encased in a protective extracellular matrix, which enhances their survival, evade immune responses, and contributes to antimicrobial resistance (AMR). Conventional treatments, such as systemic antibiotics, antiseptics, and mechanical debridement, often fail to fully eliminate biofilms, highlighting the need for more effective therapeutic strategies. Considering the existing ineffective anti-biofilm treatments, super-oxidized solution (SOS) has emerged as a promising non-antibiotic alternative for DFU infections. As a reactive oxygen species (ROS)-based therapy, SOS effectively disrupts biofilm integrity, enhances bacterial eradication, and promotes wound healing by reducing inflammation and supporting tissue regeneration. Additionally, its mechanism of action could significantly minimize the risk of AMR, making it a valuable adjunct to conventional therapies. The purpose of this review is to explore the mechanisms of biofilm formation in DFUs, evaluate the limitations of current treatment approaches, and highlight the therapeutic potential of SOS. Integrating SOS into DFU treatment protocols could improve infection control, reduce chronic wound burden, and enhance patient outcomes. By advancing non-antibiotic solutions like SOS, DFU management can shift toward more effective and sustainable wound care strategies, ultimately reducing the need for surgical interventions and improving the quality of life for diabetic patients.