Inflammation and neuropeptides: the connection in diabetic wound healing

Expert Rev Mol Med. 2009 Jan 13:11:e2. doi: 10.1017/S1462399409000945.

Abstract

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Diabetes Mellitus / pathology*
  • Diabetic Neuropathies / complications
  • Humans
  • Inflammation / complications*
  • Inflammation / metabolism*
  • Inflammation Mediators / metabolism
  • Neuropeptides / metabolism*
  • Wound Healing*

Substances

  • Inflammation Mediators
  • Neuropeptides