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Emerging therapy for diabetic neuropathy: Cell therapy targeting vessels and nerves. Endocr Metab Immune Disord Drug Targets. 2012 Jan 11
Diabetic neuropathy (DN), the most common complication of diabetes, frequently leads to foot ulcers and may progress to limb amputations. Despite continuous increase in incidences, there is no clinical therapy to effectively treat DN. Pathogenetically, DN is characterized by reduced vascularity in peripheral nerves and deficiency in angiogenic and neurotrophic factors. We will briefly review the pathogenic mechanisms of DN and the effects of cell therapies for DN. To reverse the changes of DN, studies have attempted neurotrophic or angiogenic factors for treatment in the form of protein or gene therapy; however, the effects were modest if not ineffective. Recent studies have demonstrated that bone marrow (BM)-derived cells such as mononuclear cells or endothelial progenitor cells (EPCs) can effectively treat various cardiovascular diseases through their paracrine effects. Becuase BM-derived cells can produce multiple angiogenic and neurotrophic cytokines, they were used for treating experimental DN and found to reverse manifestations of DN. Particularly, EPCs were shown to exert favorable therapeutic effects through enhanced neural neovascularization and neuro-protective effects. These findings clearly indicate that DN is a complex disorder with pathogenic involvement of both vascular and neural components. Therefore, cell therapies which target both vascular and neural elements are shown to be advantageous in treating DN.
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