PROJECT SUMMARYApproximately 25% of diabetic patients experience diabetic foot ulcers (DFUs). This is a significant clinicalproblem since there are no effective biomarkers for predicting outcomes no drug candidates that have recentlybeen FDA-approved and no therapies that are widely effective in treatment. Additionally the prevalence ofdiabetes and non-healing DFUs are highest among minorities such as in Native American and Hispanicpopulations and associated with social deprivation and high mortality.The University of Arizona (UArizona) is the leading public research university in the American Southwest and anideal transdisciplinary research community for studying DFU healing. The partnership between UArizona andBanner Health provided service to 5680 patients with open wounds last year. Ranging from trauma to podiatryBanner Health saw 3770 individuals with diabetic foot ulcers (DFUs) in the past 3 years. Dr. Geoffrey Gurtnerhas an established history in studying both late-stage biomarker validation through clinical trials and alsomechanistic and early-stage biomarkers identification through the collection of many high-quality biosamplesand longitudinal data (Aim 1). This is supported by both the large patient population at UArizona as well as Dr.Gurtners history in identifying rate cell subpopulations in DFU samples collected from human patients.Next we aim to create a unified Standard of Care through the execution of high-quality clinical trials for DFUswhich historically have been difficult to recruit and also by collecting high-quality data to address theheterogeneity of DFUs with complex pathologies co-morbidities and social factors. At UArizona Dr. Gurtnerand Dr. Zhou conduct high-quality clinical trials and have access to a wide distribution of patients and a range oftechniques to make sure that No DFU Patient Goes Unstudied (Aim 2). Next our diverse patient pool will allowus to specifically understand how social and environmental contextual factors (social determinants of health;SDH) may affect diabetic healing and biomarkers specifically be recruiting over a diverse and expansive patientpool (Aim 3). Finally we have access to not just the entire Banner Health Network (BHN) but also to the IndianHealth Network and outreach programs for Latino communities. Through this expansive network thatincorporates people of all demographics and socio-economic statuses we will establish effective collaborationsbetween the CRU and new clinical sites to generate cooperative problem-solving and high-level training withshared resources and values (Aim 4).