Qin Yuqi, Deng Shan
Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Cardiovascular Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Endocrinol (Lausanne). 2025 Oct 7;16:1676621. doi: 10.3389/fendo.2025.1676621. eCollection 2025.
Diabetic foot, one of the most severe chronic complications of diabetes mellitus, arises from complex interactions among neuropathy, vascular ischemia, and inflammatory dysregulation. This review systematically explores the inflammatory regulatory network centered on NF-κB and the interleukin (IL) family in the diabetic foot microenvironment and examines their roles in promoting tissue damage. Under hyperglycemic conditions, the AGE-RAGE axis potently activates the NF-κB signaling pathway, leading to upregulation of pro-inflammatory factors and suppression of anti-inflammatory mediators, thereby forming a vicious cycle of "inflammation-oxidative stress-tissue damage." Charcot foot, a distinct subtype characterized by neurogenic osteoarthropathy, is strongly linked to abnormal IL-6/RANKL pathway activation and impaired anti-inflammatory neuropeptide signaling. We further assess the diagnostic utility of inflammatory biomarkers, including procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), and the neutrophil-to-lymphocyte ratio (NLR), and summarize current therapeutic challenges along with emerging targeted strategies, such as NF-κB inhibition via salicylates. This review underscores the importance of spatiotemporal heterogeneity and dynamic equilibrium within inflammatory networks for clinical stratification and proposes that integrating multi-omics data with artificial intelligence models holds promise for developing personalized interventions. This approach offers novel theoretical insights to overcome therapeutic bottlenecks in diabetic foot management.
糖尿病足是糖尿病最严重的慢性并发症之一,由神经病变、血管缺血和炎症调节异常之间的复杂相互作用引起。本综述系统地探讨了糖尿病足微环境中以核因子κB(NF-κB)和白细胞介素(IL)家族为中心的炎症调节网络,并研究了它们在促进组织损伤中的作用。在高血糖条件下,晚期糖基化终末产物-受体(AGE-RAGE)轴强力激活NF-κB信号通路,导致促炎因子上调和抗炎介质抑制,从而形成“炎症-氧化应激-组织损伤”的恶性循环。夏科氏足是一种以神经源性骨关节病为特征的独特亚型,与IL-6/核因子κB受体活化因子配体(RANKL)通路异常激活和抗炎神经肽信号受损密切相关。我们进一步评估了炎症生物标志物的诊断效用,包括降钙素原(PCT)、高敏C反应蛋白(hs-CRP)和中性粒细胞与淋巴细胞比值(NLR),并总结了当前的治疗挑战以及新兴的靶向策略,如通过水杨酸盐抑制NF-κB。本综述强调了炎症网络内时空异质性和动态平衡对临床分层的重要性,并提出将多组学数据与人工智能模型相结合有望开发个性化干预措施。这种方法为克服糖尿病足管理中的治疗瓶颈提供了新的理论见解。