Pereira Sónia G, Moura João, Carvalho Eugénia, Empadinhas Nuno
Center for Neuroscience and Cell Biology, University of CoimbraCoimbra, Portugal.
Polytechnic Institute of LeiriaLeiria, Portugal.
Front Microbiol. 2017 Sep 21;8:1791. doi: 10.3389/fmicb.2017.01791. eCollection 2017.
World Health Organization considered diabetes as one of the 20th century epidemics, estimating that over 10% of the world population is diabetic or at high risk. Self-assessment studies indicate that diabetic patients consider chronic wounds to affect their quality of life more dramatically than vision loss or renal failure. In addition to being the main reason for diabetic patients' hospitalization, the economic burden of diabetic chronic wounds is close to 1% of United Kingdom and United States health systems budgets, which exceeds the funds allocated to the treatment of some types of cancer in both countries. Among the factors preceding the emergence of chronic diabetic wounds, also designated diabetic foot ulcers (DFUs), hygiene and pressure in specific areas are under patient control, while others are still far from being understood. A triple impairment in the innervation, immune responses, and vascularization associated to DFU has been extensively studied by the scientific community. However, the skin natural microbiota has only recently emerged as having a tremendous impact on DFU emergence and evolution to chronicity. Despite the great inter- and intra-variability of microbial colonizers, ongoing efforts are now focused on deciphering the impact of commensal and pathogenic microbiota on DFU etiology, as well as the mechanisms of interkingdom microbial-host communication. This review summarizes recent work in this context and offers new microbiological perspectives that may hold potential in the prevention and treatment of chronic diabetic wounds.
世界卫生组织将糖尿病视为20世纪的流行病之一，估计全球超过10%的人口患有糖尿病或处于高风险状态。自我评估研究表明，糖尿病患者认为慢性伤口对其生活质量的影响比视力丧失或肾衰竭更为显著。除了是糖尿病患者住院的主要原因外，糖尿病慢性伤口的经济负担接近英国和美国卫生系统预算的1%，这超过了两国分配给某些类型癌症治疗的资金。在慢性糖尿病伤口（也称为糖尿病足溃疡，DFUs）出现之前的因素中，特定部位的卫生和压力受患者控制，而其他因素仍远未被了解。科学界广泛研究了与DFU相关的神经支配、免疫反应和血管形成的三重损伤。然而，皮肤天然微生物群直到最近才被发现对DFU的出现和向慢性发展具有巨大影响。尽管微生物定植者存在很大的个体间和个体内差异，但目前正在进行的努力集中在解读共生和致病微生物群对DFU病因的影响，以及微生物与宿主跨界交流的机制。本综述总结了这方面的最新研究工作，并提供了可能在慢性糖尿病伤口预防和治疗中具有潜力的新微生物学观点。
