Fibronectin in hyperglycaemia and its potential use in the treatment of diabetic foot ulcers: A review

Abstract
Metabolism of fibronectin, the protein that plays a key role in the healing of
wounds, is changed in the patients with diabetes mellitus. Fibronectin can interact
with other proteins and proteoglycans and organise them to form the extracellular
matrix, the basis of the granulation tissue in healing wounds. However,
diabetic foot ulcers (DFUs) suffer from inadequate deposition of this protein.
Degradation prevails over fibronectin synthesis in the proteolytic inflammatory
environment in the ulcers. Because of the lack of fibronectin in the wound bed,
the assembly of the extracellular matrix and the deposition of the granulation tissue
cannot be started. A number of methods have been designed that prevents
fibronectin degradation, replace lacking fibronectin or support its formation in
non-healing wounds in animal models of diabetes. The aim of this article is to
review the metabolism of fibronectin in DFUs and to emphasise that it would be
useful to pay more attention to fibronectin matrix assembly in the ulcers when
laboratory methods are translated to clinical practice.