Inflammation and neuropeptides: the connection in diabetic wound healing.
Abnormal wound healing is a major complication of both type 1 and type 2 diabetes, with nonhealing foot ulcerations leading in the worst cases to lower-limb amputation. Wound healing requires the integration of complex cellular and molecular events in successive phases of inflammation, cell proliferation, cell migration, angiogenesis and re-epithelialisation. A link between wound healing and the nervous system is clinically apparent as peripheral neuropathy is reported in 30-50% of diabetic patients and is the most common and sensitive predictor of foot ulceration. Indeed, a bidirectional connection between the nervous and the immune systems and its role in wound repair has emerged as one of the focal features of the wound-healing dogma. This review provides a broad overview of the mediators of this connection, which include neuropeptides and cytokines released from nerve fibres, immune cells and cutaneous cells. In-depth understanding of the signalling pathways in the neuroimmune axis in diabetic wound healing is vital to the development of successful wound-healing therapies.
Pradhan
Leena
L
Department of Surgery, Division of Vascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Nabzdyk
Christoph
C
Andersen
Nicholas D
ND
LoGerfo
Frank W
FW
Veves
Aristidis
A
D000818:Animals; D003920:Diabetes Mellitus / Q000473:pathology*; D003929:Diabetic Neuropathies / Q000150:complications; D006801:Humans; D007249:Inflammation / Q000150:complications* / Q000378:metabolism*; D018836:Inflammation Mediators / Q000378:metabolism; D009479:Neuropeptides / Q000378:metabolism*; D014945:Wound Healing
D018836:Inflammation Mediators; D009479:Neuropeptides