Perspectives on Stem Cell Therapy in Diabetic Neuropathic Pain

Tadeu Lima Montagnoli,Aimeé Diogenes Santos,Susumu Zapata Sudo,Fernanda Gubert,Juliana Ferreira Vasques,Rosalia Mendez-Otero,Mauro Paes Leme de Sá,Gisele Zapata-Sudo

Neurology International（2024）

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Abstract

Diabetes mellitus-related morbidity and mortality are primarily caused by long-term complications such as retinopathy, nephropathy, cardiomyopathy, and neuropathy. Diabetic neuropathy (DN) involves the progressive degeneration of axons and nerve fibers due to chronic exposure to hyperglycemia. This metabolic disturbance leads to excessive activation of the glycolytic pathway, inducing oxidative stress and mitochondrial dysfunction, ultimately resulting in nerve damage. There is no specific treatment for painful DN, and new approaches should aim not only to relieve pain but also to prevent oxidative stress and reduce inflammation. Given that existing therapies for painful DN are not effective for diabetic patients, mesenchymal stromal cells (MSCs)-based therapy shows promise for providing immunomodulatory and paracrine regulatory functions. MSCs from various sources can improve neuronal dysfunction associated with DN. Transplantation of MSCs has led to a reduction in hyperalgesia and allodynia, along with the recovery of nerve function in diabetic rats. While the pathogenesis of diabetic neuropathic pain is complex, clinical trials have demonstrated the importance of MSCs in modulating the immune response in diabetic patients. MSCs reduce the levels of inflammatory factors and increase anti-inflammatory cytokines, thereby interfering with the progression of DM. Further investigation is necessary to ensure the safety and efficacy of MSCs in preventing or treating neuropathic pain in diabetic patients.

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Key words

diabetes,neuropathic pain,stem cells,neuroinflammation,glial activation

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【要点】：本文探讨了基于间充质干细胞（MSCs）疗法在治疗糖尿病神经痛方面的前景，提出了一种旨在缓解疼痛、预防氧化应激和减轻炎症的新型治疗方法。

【方法】：论文提出了基于MSCs的疗法，通过免疫调节和旁分泌调节功能来治疗糖尿病神经痛。

【实验】：研究者使用了糖尿病大鼠模型进行实验，通过移植MSCs，观察到减轻了痛觉过敏和触觉过敏，并恢复了神经功能。临床实验也展示了MSCs在调节糖尿病患者免疫反应中的重要性，它能降低炎症因子水平并增加抗炎细胞因子，从而干扰糖尿病的进程。然而，关于MSCs在预防或治疗糖尿病患者神经痛方面的安全性和有效性的进一步研究是必要的。