Regeneration and Healing of Bone and Cartilage in Type-1 and Type-2 Diabetes: The Effects of Insulin

Abstract

Increased fragility of long bones and delay in fracture healing in adults as well as skeletal development disorders in children are thought to be associated with endochondral ossification problems. The extracellular matrix (ECM) of cartilage is absorbed during endochondral ossification. During the recovery process from damage, chondrocytes undergo hypertrophy and increase their cell volume; on the other hand, it is also necessary to digest the ECM elements around the cells. Recent research on the proteolytic enzymes in ECM assumed to be responsible for the digestion is connected to proteinases digesting type II collagen and aggrecan. ADAMTS1, 4, and 5 are known as major aggrecanases within the matrix metalloproteinase (MMP) enzymes in human cartilage. These are regarded as main determiners among MMPs of bone growth, healing, and remodeling. In this mini review article, the remodeling and restoration of osseous tissue in type-1 and -2 diabetes mellitus (DM) and the effect of insulin on these processes are discussed briefly in the light of the current literature.