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      The MSC-Derived Exosomal lncRNA H19 Promotes Wound Healing in Diabetic Foot Ulcers by Upregulating PTEN via MicroRNA-152-3p

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          Abstract

          Mesenchymal stem cells (MSCs) have been reported to hold promise to accelerate the wound-healing process in diabetic foot ulcer (DFU) due to the multilineage differentiation potential. Hence, this study intended to explore the wound healing role of MSC-derived exosomes containing long noncoding RNA (lncRNA) H19 in DFU. lncRNA H19 was predicated to bind to microRNA-152-3p (miR-152-3p), which targeted phosphatase and tensin homolog (PTEN) deleted on chromosome ten. Fibroblasts in DFU samples exhibited highly expressed miR-152-3p and poorly expressed lncRNA H19 and PTEN, along with an activated phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K)/protein kinase B (Akt1) signaling pathway. The fibroblasts were cocultured with lncRNA H19-transfected MSCs and MSC-derived exosomes to assess the effect of the lncRNA H19/miR-152-3p/PTEN axis on the biological activities and inflammation in fibroblasts. Mouse models of DFU were developed by streptozotocin, which was injected with MSC-derived exosomes overexpressing lncRNA H19. lncRNA H19 in MSCs was transferred through exosomes to fibroblasts, the mechanism of which improved wound healing in DFU, corresponded to promoted fibroblast proliferation and migration, as well as suppressed apoptosis and inflammation. Wound healing in mice with DFU was facilitated following the injection of MSC-derived exosomes overexpressing lncRNA H19. Taken together, MSC-derived exosomal lncRNA H19 prevented the apoptosis and inflammation of fibroblasts by impairing miR-152-3p-mediated PTEN inhibition, leading to the stimulated wound-healing process in DFU.

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          Most cited references24

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          The dysvascular foot: a system for diagnosis and treatment.

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            Literature review on the management of diabetic foot ulcer.

            Diabetic foot ulcer (DFU) is the most costly and devastating complication of diabetes mellitus, which affect 15% of diabetic patients during their lifetime. Based on National Institute for Health and Clinical Excellence strategies, early effective management of DFU can reduce the severity of complications such as preventable amputations and possible mortality, and also can improve overall quality of life. The management of DFU should be optimized by using a multidisciplinary team, due to a holistic approach to wound management is required. Based on studies, blood sugar control, wound debridement, advanced dressings and offloading modalities should always be a part of DFU management. Furthermore, surgery to heal chronic ulcer and prevent recurrence should be considered as an essential component of management in some cases. Also, hyperbaric oxygen therapy, electrical stimulation, negative pressure wound therapy, bio-engineered skin and growth factors could be used as adjunct therapies for rapid healing of DFU. So, it's suggested that with appropriate patient education encourages them to regular foot care in order to prevent DFU and its complications.
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              Diabetic foot disease: From the evaluation of the "foot at risk" to the novel diabetic ulcer treatment modalities.

              The burden of diabetic foot disease (DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy (DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities.
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                Author and article information

                Contributors
                Journal
                Mol Ther Nucleic Acids
                Mol Ther Nucleic Acids
                Molecular Therapy. Nucleic Acids
                American Society of Gene & Cell Therapy
                2162-2531
                14 December 2019
                06 March 2020
                14 December 2019
                : 19
                : 814-826
                Affiliations
                [1 ]Department of Endocrinology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, People’s Republic of China
                [2 ]The 2 nd Department of General, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, People’s Republic of China
                [3 ]School of Life Science and Technology, Harbin Institute of Technology, Harbin 150001, People’s Republic of China
                [4 ]Department of Microbiology, Harbin Medical University, Harbin 150081, People’s Republic of China
                [5 ]Department of Endocrinology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518033, People’s Republic of China
                Author notes
                []Corresponding author: Changlong Bi, Department of Endocrinology, The Eighth Affiliated Hospital, Sun Yat-sen University, No. 3025, Shennan Middle Road, Shenzhen 518033, Guangdong Province, P. R. China. bichanglongdr@ 123456163.com
                [∗∗ ]Corresponding author: Aixia Zhai, Department of Microbiology, Harbin Medical University, No. 157, Baojian Road, Harbin 150081, Heilongjiang Province, P. R. China. aixiazhai@ 123456126.com
                [6]

                These authors contributed equally to this work.

                Article
                S2162-2531(19)30397-X
                10.1016/j.omtn.2019.11.034
                7005423
                31958697
                1e2f21af-adfb-45d7-90d8-f7ffa63241f1
                © 2019.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 11 April 2019
                : 29 November 2019
                Categories
                Article

                Molecular medicine
                diabetic foot ulcer,long noncoding rna h19,microrna-152-3p,pten,mesenchymal stem cells,exosome

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