An Overview on Role of Insulin in Wound Healing

Abstract

Wound healing is a complex, multi-phase physiological process involving hemostasis, inflammation, proliferation, and remodeling. Proper coordination of cellular and molecular mechanisms is essential to restore tissue integrity. Insulin, a key anabolic hormone primarily known for its role in glucose metabolism, has emerged as a significant modulator of wound repair due to its cellular effects on proliferation, differentiation, and inflammation. Insulin stimulates the proliferation of keratinocytes and fibroblasts, which are vital for re-epithelialization and extracellular matrix formation. It enhances endothelial cell migration, supporting angiogenesis, which is crucial for supplying nutrients and oxygen to the healing tissue. Insulin promotes collagen synthesis and supports the formation of granulation tissue. It modulates the expression of matrix metalloproteinases (MMPs), enzymes involved in the remodeling of the extracellular matrix. Insulin has been shown to reduce pro-inflammatory cytokines (e.g., TNF-α, IL-6) and increase anti-inflammatory mediators. This effect helps in controlling excessive inflammation, which is often detrimental to proper wound healing, especially in chronic wounds. Insulin enhances the expression of vascular endothelial growth factor (VEGF) and other angiogenic factors, stimulating the formation of new blood vessels. By facilitating glucose uptake into cells, insulin ensures that energy requirements for wound healing processes are met, especially in high-demand cells like macrophages and fibroblasts. Topical insulin therapy has been investigated in both animal models and clinical trials, showing accelerated healing in acute and chronic wounds. It holds potential particularly in diabetic wound care, where impaired insulin signaling contributes to delayed healing.