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The pro-inflammatory environment in recalcitrant diabetic foot wounds

Int Wound J. 2008 Oct;5(4):530-9. doi: 10.1111/j.1742-481X.2008.00457.x.

Abstract

Lower extremity ulceration is one of the serious and long-term diabetic complications rendering a significant social burden in terms of amputation and quality-of-life reduction. Diabetic patients experience a substantial wound-healing deficit. These lesions are featured by an exaggerated and prolonged inflammatory reaction with a significant impairment in local bacterial invasion control. Experimental and clinical evidences document the deleterious consequences of the wound's pro-inflammatory phenotype for the repair process. From a biochemical standpoint, hyperinflammation favours wound matrix degradation, thus, amplifying a pre-existing granulation tissue productive cells' invasiveness and recruitment deficit. Tumour necrosis factor perpetuates homing of inflammatory cells, triggers pro-apoptotic genes and impairs reepithelialisation. Advanced glycation end-products act in concert with inflammatory mediators and commit fibroblasts and vascular cells to apoptosis, contributing to granulation tissue demise. Therapeutic approaches aimed to downregulate hyperinflammation and/or attenuate glucolipotoxicity may assist in diabetic wound healing by dismantling downstream effectors. These medical interventions are demanded to reduce amputations in an expanding diabetic population.

Publication types

  • Review

MeSH terms

  • Apoptosis / immunology
  • Apoptosis Regulatory Proteins / immunology
  • Diabetic Foot / immunology*
  • Diabetic Foot / prevention & control
  • Down-Regulation / drug effects
  • Down-Regulation / immunology
  • Fibroblasts / immunology
  • Glycation End Products, Advanced / antagonists & inhibitors
  • Glycation End Products, Advanced / immunology*
  • Granulation Tissue / immunology
  • Humans
  • Inflammation
  • Matrix Metalloproteinases / immunology*
  • Tumor Necrosis Factor Inhibitors
  • Tumor Necrosis Factors / immunology*
  • Wound Healing / drug effects
  • Wound Healing / immunology*

Substances

  • Apoptosis Regulatory Proteins
  • Glycation End Products, Advanced
  • Tumor Necrosis Factor Inhibitors
  • Tumor Necrosis Factors
  • Matrix Metalloproteinases