Abstract
Foot ulcers are one of the most common and severe complication of diabetes mellitus with significant resultant morbidity and mortality. Multiple factors impair wound healing include skin injury, diabetic neuropathy, ischemia, infection, inadequate glycemic control, poor nutritional status, and severe morbidity. It is currently believed that oxidative stress plays a vital role in diabetic wound healing. An imbalance of free radicals and antioxidants in the body results in overproduction of reactive oxygen species which lead to cell, tissue damage, and delayed wound healing. Therefore, decreasing ROS levels through antioxidative systems may reduce oxidative stress-induced damage to improve healing. In this context, we provide an update on the role of oxidative stress and antioxidants in diabetic wound healing through following four perspectives. We then discuss several therapeutic strategies especially dietary bioactive compounds by targeting oxidative stress to improve wounds healing.
Highlights
Diabetes mellitus (DM) and its complications are increasingly prevalent worldwide with a serious burden on patients and health care systems [1] Diabetic foot ulcers have a substantial impact on disability, morbidity, and mortality
This review will further develop the discussion on how oxidative stress may affect diabetic wound healing in terms of skin injury, neuropathy, arterial disease, and infection
Oxidative stress caused by activated biochemical pathways, such as the advanced glycation end product (AGE)/RAGE pathway, the polyol pathway, PKC activation, and the hexosamine pathway, results in production of inflammatory mediators, pericyte degeneration, thickening basement membrane, endothelial hyperplasia, NO reduction, impaired vasodilation, and increasing procoagulant biomarkers, such as IL-6, TNF-α, D-dimer, and PAI-1
Summary
Diabetes mellitus (DM) and its complications are increasingly prevalent worldwide with a serious burden on patients and health care systems [1] Diabetic foot ulcers have a substantial impact on disability, morbidity, and mortality. The mechanism of diabetic wound chronicity has not been well understood. It is currently believed that oxidative stress plays a vital role in the occurrence and development of diabetic wound [2, 3]. Oxidative stress is caused by overproduction of reactive oxygen species and insufficient antioxidant systems. The process of oxidative stress in wound development and healing remains unclear. This review will further develop the discussion on how oxidative stress may affect diabetic wound healing in terms of skin injury, neuropathy, arterial disease, and infection. The plausible role of antioxidants including plant bioactive compounds on promoting wound healing will be addressed in order to explore novel approaches and strategies for promotion of diabetic wound healing
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