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Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Stem Cells. Nov 26, 2020; 12(11): 1255-1275
Published online Nov 26, 2020. doi: 10.4252/wjsc.v12.i11.1255
Understanding cellular and molecular mechanisms of pathogenesis of diabetic tendinopathy
Pan-Pan Lu, Min-Hao Chen, Guang-Chun Dai, Ying-Juan Li, Liu Shi, Yun-Feng Rui
Pan-Pan Lu, Min-Hao Chen, Guang-Chun Dai, Liu Shi, Yun-Feng Rui, Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
Pan-Pan Lu, Min-Hao Chen, Guang-Chun Dai, Liu Shi, Yun-Feng Rui, Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
Pan-Pan Lu, Min-Hao Chen, Guang-Chun Dai, Liu Shi, Yun-Feng Rui, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
Pan-Pan Lu, Min-Hao Chen, Guang-Chun Dai, Ying-Juan Li, Yun-Feng Rui, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
Ying-Juan Li, Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
Ying-Juan Li, Liu Shi, Yun-Feng Rui, China Orthopedic Regenerative Medicine Group, Hangzhou 310000, Zhejiang Province, China
Author contributions: Lu PP wrote the paper; Chen MH and Dai GC provided assistance with preparing the tables and figures; Li YJ assisted in performing the search and collecting the relevant publications; Shi L provided input during the drafting of the paper; Rui YF revised and proofread the paper.
Supported by National Natural Science Foundation of China, Nos. 81572187 and 81871812; Jiangsu Provincial Medical Talent, The Project of Invigorating Health Care through Science, Technology and Education, No. ZDRCA2016083; and The Six Projects Sponsoring Talent Summits of Jiangsu Province, China, No. LGY2017099.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yun-Feng Rui, MD, PhD, Deputy Director, Professor, Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Dingjiaqiao, Nanjing 210009, Jiangsu Province, China. ruiyunfeng@126.com
Received: June 28, 2020
Peer-review started: June 28, 2020
First decision: August 9, 2020
Revised: August 19, 2020
Accepted: September 10, 2020
Article in press: September 10, 2020
Published online: November 26, 2020
Processing time: 151 Days and 3 Hours
Abstract

There is accumulating evidence of an increased incidence of tendon disorders in people with diabetes mellitus. Diabetic tendinopathy is an important cause of chronic pain, restricted activity, and even tendon rupture in individuals. Tenocytes and tendon stem/progenitor cells (TSPCs) are the dominant cellular components associated with tendon homeostasis, maintenance, remodeling, and repair. Some previous studies have shown alterations in tenocytes and TSPCs in high glucose or diabetic conditions that might cause structural and functional variations in diabetic tendons and even accelerate the development and progression of diabetic tendinopathy. In this review, the biomechanical properties and histopathological changes in diabetic tendons are described. Then, the cellular and molecular alterations in both tenocytes and TSPCs are summarized, and the underlying mechanisms involved are also analyzed. A better understanding of the underlying cellular and molecular pathogenesis of diabetic tendinopathy would provide new insight for the exploration and development of effective therapeutics.

Keywords: Tendinopathy; Diabetes; Mechanism; Tenocyte; Tendon stem/progenitor cells

Core Tip: Tendinopathy is an important cause of chronic pain, restricted activity, and even tendon rupture in individuals with diabetes. Both tenocytes and tendon stem/progenitor cells (TSPCs) play essential roles in tendon maintenance, regeneration, and repair. In this review, we describe the biomechanical properties and histopathological changes in diabetic tendons. Then, we summarize the cellular and molecular alterations and the underlying mechanisms involved in tenocytes and TSPCs that might be associated with the development and progression of diabetic tendinopathy, providing clues for potential effective therapeutics for diabetic tendinopathy.