Diabetes impairs arteriogenesis in the peripheral circulation: review of molecular mechanisms

摘要: Patients suffering from both diabetes and PAD (peripheral arterial disease) are at risk of developing critical limb ischaemia ulceration, potentially requiring amputation. In addition, complicates surgical treatment impairs arteriogenesis. Arteriogenesis is defined as the remodelling pre-existing arterioles into conductance vessels to restore perfusion distal occluded artery. Several strategies promote arteriogenesis in peripheral circulation have been devised, but mechanisms through which poorly understood. The present review provides an overview current literature on deteriorating effects key players process. Diabetes affects a number levels. First, it elevates vasomotor tone attenuates sensing shear stress response vasodilatory stimuli, reducing recruitment dilatation collateral arteries. Secondly, downstream signalling monocytes, without decreasing monocyte attraction. EPC (endothelial progenitor cell) function attenuated diabetes. There ample evidence that growth factor impaired diabetic Although these defects could be restored animal experiments, clinical results disappointing. Furthermore, diabetes-induced impairment eNOS NO synthase) strongly outward remodelling, plays role several processes. Finally, structural phase arteriogenesis, matrix turnover, smooth muscle cell proliferation fibroblast migration. concludes with suggestions for new more sophisticated therapeutic approaches population.