Diabetic neuropathy: therapies on the horizon.
OBJECTIVE
This is a review of emerging interventions from the recent preclinical and clinical literature that demonstrate the potential for effectiveness in the therapy of diabetic neuropathy (DN). DN is the most common complication of diabetes mellitus and up to 50% of patients with type 1 and type 2 forms have some or other form of neuropathy. The pathology of DN is characterized by progressive nerve fibre loss that gives rise to positive and negative clinical signs and symptoms such as pain, paraesthesiae and loss of sensation.


RESULTS
There are very few drugs available to directly treat DN. Those that are clinically indicated provide symptomatic relief but do not repair or reverse underlying nerve damage. However, some agents are in clinical development that may support adult neurons and direct reparative processes after injury stages. Several disease modifying drugs such as aldose reductase inhibitors and protein kinase C inhibitors are in phase III development. Agents on the horizon include neurotrophic factors, growth factors, gene therapy, immunotherapy, poly(ADP-ribose) polymerase inhibitors and non-immunosuppressive immunophilin ligands.


CONCLUSIONS
Progress has been made toward understanding the biochemical mechanisms leading to diabetic neuropathy, and as a result, new treatment modalities are being explored. The pathogenesis, types and approaches for treating DN together with the newer therapeutic interventions on the horizon are discussed.
Mahmood
Danish
D
Department of Pharmacology, Hamdard University, Hamdard Nagar, New Delhi 110062, India.
Singh
Bhulan Kumar
BK
Akhtar
Mohammad
M
D000818:Animals; D000975:Antioxidants / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003929:Diabetic Neuropathies / Q000145:classification / Q000188:drug therapy* / Q000209:etiology; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D015316:Genetic Therapy; D006801:Humans; D020104:Immunophilins / Q000627:therapeutic use; D007167:Immunotherapy; D036341:Intercellular Signaling Peptides and Proteins / Q000627:therapeutic use; D008954:Models, Biological
D000975:Antioxidants; D004791:Enzyme Inhibitors; D036341:Intercellular Signaling Peptides and Proteins; D020104:Immunophilins