Abstract

Diabetic foot ulcer (DFU) is a kind of common and disabling complication of Diabetes Mellitus (DM). Emerging studies have demonstrated that tendon fibroblasts play a crucial role in remodeling phase of wound healing. However, little is known about the mechanism underlying high glucose (HG)-induced decrease in tendon fibroblasts viability. In the present study, the rat models of DFU were established, and collagen deposition, autophagy activation and cell apoptosis in tendon tissues were assessed using Hematoxylin–Eosin (HE) staining, immunohistochemistry (IHC), and TdT-mediated dUTP Nick-End Labeling (TUNEL) assay, respectively. Tendon fibroblasts were isolated from Achilles tendon of the both limbs, and the effect of HG on autophagy activation in tendon fibroblasts was assessed using Western blot analysis, Cell Counting Kit-8 (CCK-8) assay, and flow cytometry. We found that cell apoptosis was increased significantly and autophagy activation was decreased in foot tendon tissues of DFU rats compared with normal tissues. The role of HG in regulating tendon fibroblasts viability was then investigated in vitro, and data showed that HG repressed cell viability and increased cell apoptosis. Furthermore, HG treatment reduced LC3-II expression and increased p62 expression, indicating that HG repressed autophagy activation of tendon fibroblasts. The autophagy activator rapamycin reversed the effect. More importantly, rapamycin alleviated the suppressive role of HG in tendon fibroblasts viability. Taken together, our data demonstrate that HG represses tendon fibroblasts proliferation by inhibiting autophagy activation in tendon injury.

Highlights

  • Diabetes mellitus (DM) affects approximately 350 million people globally and its prevalence is rapidly increasing in recent years [1, 2]

  • Cell apoptosis was increased and autophagy activation was decreased in foot tendons tissues of Diabetic foot ulcer (DFU) rats Cell apoptosis and autophagy activation were first assessed in foot tendons tissues of DFU rats

  • The results from IHC analysis showed that the protein expression of LC3 and Collagen I were decreased in foot tendons tissues of DFU rats compared with controls (Figure 1B)

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Summary

Introduction

Diabetes mellitus (DM) affects approximately 350 million people globally and its prevalence is rapidly increasing in recent years [1, 2]. Tendon fibroblasts (or Tenocytes) exert a crucial physiological role in regulating tendon adaption, response to mechanical loading and tendon repair after tissue injury [6, 9]. The role of tendon fibroblasts in the progression of DFU remains unclear. Current studies have confirmed that autophagy is involved in a variety of physiological and pathological processes, the role of autophagy in wound healing, especially in DFU, and the underlying mechanism was poorly understood. Based on the above findings, here we investigated whether autophagy was activated or repressed in foot tendons tissues of DFU rats. The current results showed that cell apoptosis was increased, concurrently autophagy activation was decreased in tendons of diabetic foot patients compared with control. HG treatment promoted cell apoptosis and repressed autophagy activation in tendon fibroblasts by activating mTOR signaling

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