Pandey Shricharan, Anshu Tushar, Maharana Krushna Ch, Sinha Suhani
Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India.
Department of Pharmaceutical sciences and drug research, Punjabi University Patiala, India.
Cytokine. 2025 Jul;191:156957. doi: 10.1016/j.cyto.2025.156957. Epub 2025 May 13.
Diabetic wounds manifest significant clinical challenge with approximately 50-70 % reporting non-traumatic lower limb amputations annually. This review examines the intricate relationship between impaired wound healing in diabetes mellitus and two crucial signaling pathways: Wnt/β-catenin and MAPK/ERK. Chronic hyperglycemia in diabetes mellitus leads to peripheral neuropathy, vascular dysfunction, and compromised immune responses, resulting in delayed wound healing. The Wnt/β-catenin pathway, which is essential for cellular proliferation, differentiation, and tissue homeostasis, shows altered activity in diabetic wounds, particularly through decreased R-spondin 3 protein expression. Similarly, the MAPK/ERK pathway, which regulates cellular proliferation and differentiation through hierarchical kinase cascades, exhibits dysregulation under diabetic conditions. This review describes the current understanding of normal wound healing processes, diabetic wound pathophysiology, and the molecular mechanisms of both signaling pathways. Evidence suggests that targeting these pathways, either individually or synergistically offer promising therapeutic approaches for diabetic wound management. Future directions include, developing targeted delivery systems, exploring pathway cross-talk, and investigating dual-pathway modulators to enhance wound healing outcomes in diabetic patients. This comprehensive analysis provides insights into potential therapeutic strategies and emphasizes the necessity of research in this crucial area of diabetes treatment. (Graphical Abstract).
糖尿病伤口带来了重大的临床挑战,每年约有50%-70%的患者因非创伤性下肢截肢。本综述探讨了糖尿病伤口愈合受损与两个关键信号通路:Wnt/β-连环蛋白和MAPK/ERK之间的复杂关系。糖尿病中的慢性高血糖会导致周围神经病变、血管功能障碍和免疫反应受损,从而导致伤口愈合延迟。Wnt/β-连环蛋白通路对细胞增殖、分化和组织稳态至关重要,在糖尿病伤口中其活性发生改变,尤其是通过R-spondin 3蛋白表达降低。同样,通过分级激酶级联调节细胞增殖和分化的MAPK/ERK通路在糖尿病条件下也表现出失调。本综述描述了目前对正常伤口愈合过程、糖尿病伤口病理生理学以及这两个信号通路分子机制的理解。有证据表明,单独或协同靶向这些通路为糖尿病伤口管理提供了有前景的治疗方法。未来的方向包括开发靶向递送系统、探索通路间相互作用以及研究双通路调节剂,以改善糖尿病患者的伤口愈合结果。这一全面分析为潜在治疗策略提供了见解,并强调了在糖尿病治疗这一关键领域进行研究的必要性。(图形摘要)
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