Autophagy: The missing link in diabetic neuropathy?

Autophagy is a dynamic process which plays an important role in cellular homeostasis through recycling of damaged proteins and organelles. Chronic hyperglycemia associated with diabetes is known to impair the cellular autophagic pathways to a varied extent in some of the diabetic complications. But the role of autophagy driven quality control of proteins and the cellular organelles has been understudied in diabetic complications including neuropathy (DN). The present article hypothesizes that enhancing autophagy in neuronal cells may help them to get rid of bioenergetic crisis, necrosis, apoptosis associated with DN. Some forms of autophagic turnover also help to maintain integral, healthy mitochondria, malfunctioning of which produces cellular reactive oxygen species and may prevent accumulation of damaged protein aggregates. Involvement of various energy derived metabolic, cellular death pathways and oxidative stress in the pathogenesis of DN and how autophagy may halts the progression of DN has been discussed with supporting literature.