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Repaired skin with a history of biofilm infection is known to be compromised in barrier function. Loss of barrier function is also observed in the oxidative stress affected diabetic and aged skin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Recent Advances:<\/jats:title>\n                    <jats:p>\n                      Loss of barrier function makes the skin prone to biofilm infection and cellulitis, which contributes to chronic inflammation and vasculopathy. Hyperglycemia favors biofilm formation as glucose lowering led to reduction in biofilm development. While vasculopathy limits oxygen supply, the O\n                      <jats:sub>2<\/jats:sub>\n                      cost of inflammation is high increasing hypoxia severity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Critical Issues:<\/jats:title>\n                    <jats:p>The host nervous system can be inhabited by bacteria. Because electrical impulses are a part of microbial physiology, polymicrobial colonization of the host's neural circuit is likely to influence transmission of action potential. The identification of perineural apatite in diabetic patients with peripheral neuropathy suggests bacterial involvement. DPN starts in both feet at the same time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Future Directions:<\/jats:title>\n                    <jats:p>\n                      Pair-matched studies of DPN in the foot affected with DFU (\n                      <jats:italic toggle=\"yes\">i.e<\/jats:italic>\n                      ., DFU-DPN) compared with DPN in the without ulcer, and intact skin barrier function, are likely to provide critical insight that would help inform effective care strategies. This review characterizes DFU-DPN from a translational science point of view presenting a new paradigm that recognizes the current literature in the context of factors that are unique to DFU-DPN.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/ars.2022.0093","type":"journal-article","created":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T04:45:33Z","timestamp":1658205933000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Diabetic Peripheral Neuropathy Associated with Foot Ulcer: One of a Kind"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3151-5202","authenticated-orcid":false,"given":"Chandan K.","family":"Sen","sequence":"first","affiliation":[{"name":"Indiana Center for Regenerative Medicine &amp; Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA."},{"name":"Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sashwati","family":"Roy","sequence":"additional","affiliation":[{"name":"Indiana Center for Regenerative Medicine &amp; Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA."},{"name":"Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6661-9293","authenticated-orcid":false,"given":"Savita","family":"Khanna","sequence":"additional","affiliation":[{"name":"Indiana Center for Regenerative Medicine &amp; Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA."},{"name":"Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,1,25]]},"reference":[{"key":"e_1_3_5_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/15368378.2021.1874974"},{"key":"e_1_3_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mvr.2020.103987"},{"key":"e_1_3_5_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/dth.14840"},{"key":"e_1_3_5_5_1","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/2435261"},{"key":"e_1_3_5_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2010.03151.x"},{"key":"e_1_3_5_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13195-015-0131-4"},{"key":"e_1_3_5_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439"},{"key":"e_1_3_5_9_1","doi-asserted-by":"publisher","DOI":"10.7150\/ijms.53728"},{"key":"e_1_3_5_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12035-022-02745-2"},{"key":"e_1_3_5_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.20220"},{"key":"e_1_3_5_12_1","doi-asserted-by":"publisher","DOI":"10.5455\/medarh.2020.74.443-448"},{"key":"e_1_3_5_13_1","doi-asserted-by":"publisher","DOI":"10.5853\/jos.2019.02978"},{"key":"e_1_3_5_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002504"},{"key":"e_1_3_5_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/RLI.0000000000000046"},{"key":"e_1_3_5_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.040672"},{"key":"e_1_3_5_17_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semvascsurg.2022.04.002"},{"key":"e_1_3_5_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajpath.2011.01.015"},{"key":"e_1_3_5_19_1","doi-asserted-by":"publisher","DOI":"10.1242\/jcs.215939"},{"key":"e_1_3_5_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/nm.2750"},{"key":"e_1_3_5_21_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.CON.0000453315.82884.a1"},{"key":"e_1_3_5_22_1","doi-asserted-by":"publisher","DOI":"10.1886\/5\/ed.31.1.57"},{"key":"e_1_3_5_23_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.5.4.386"},{"key":"e_1_3_5_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.818"},{"key":"e_1_3_5_25_1","unstructured":"Brown BD Hood Watson KL. 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