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ASSOCIATIONS BETWEEN INDIVIDUAL RETINAL LAYER THICKNESSES AND DIABETIC PERIPHERAL NEUROPATHY USING RETINAL LAYER SEGMENTATION ANALYSIS. Retina 2019; 38:2190-2196. [PMID: 28902096 DOI: 10.1097/iae.0000000000001835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate clinical correlations between the thicknesses of individual retinal layers in the foveal area of diabetic patients and the presence of diabetic peripheral neuropathy (DPN). METHODS This retrospective, observational, cross-sectional study enrolled a total of 120 eyes from 120 patients. The eyes were divided into 3 groups: normal controls (n = 42 eyes), patients with diabetes mellitus (n = 42 eyes) but no DPN, and patients with diabetes mellitus and DPN (n = 36 eyes). The primary outcome measures were the thickness of all retinal layers in the central 1-mm zone measured using the segmentation analysis of spectral-domain optical coherence tomography. Correlations between the thicknesses of the individual retinal layers and the presence of DPN were also analyzed. Logistic regression analyses were used to determine which change in layer thickness had the most significant association with the presence of DPN. RESULTS The mean thicknesses and the ratios of retinal nerve fiber layers to total retina thicknesses in the DPN group were 10.77 ± 1.79 μm and 4.10 ± 0.55%, which was significantly lower than those in normal controls and the diabetes mellitus with no DPN group (P = 0.014 and P = 0.001, respectively). Logistic regression analyses also showed that the decrease in thicknesses of the retinal nerve fiber layers and the inner nuclear layer are significant factors for predicting a higher risk for DPN development (odds ratio = 7.407 and 1.757; P < 0.001 and P = 0.001, respectively). CONCLUSION A decrease in the retinal nerve fiber layer and the inner nuclear layer thickness was significantly associated with the presence of DPN.
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Tiong YL, Ng KY, Koh RY, Ponnudurai G, Chye SM. Melatonin Prevents Oxidative Stress-Induced Mitochondrial Dysfunction and Apoptosis in High Glucose-Treated Schwann Cells via Upregulation of Bcl2, NF-κB, mTOR, Wnt Signalling Pathways. Antioxidants (Basel) 2019; 8:antiox8070198. [PMID: 31247931 PMCID: PMC6680940 DOI: 10.3390/antiox8070198] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/07/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022] Open
Abstract
Neuropathy is a complication that affects more than 50% of long-standing diabetic patients. One of the causes of diabetes neuropathy (DN) is the apoptosis of Schwann cells due to prolonged exposure to high glucose and build-up of oxidative stress. Melatonin is a hormone that has a known antioxidant property. In this study, we investigated the protective effect of melatonin on high glucose-induced Schwann cells' apoptosis. Our results revealed that high glucose promoted apoptosis via mitochondrial-related oxidative stress and downregulated Bcl-2 family proteins in Schwann cells. In this signalling pathway, Bcl-2, Bcl-XL and Mcl-1 proteins were down-regulated while p-BAD and Puma proteins were up-regulated by high glucose treatment. Besides, we also proved that high glucose promoted apoptosis in Schwann cells through decreasing the p-NF-κB in the NF-κB signalling pathway. Key regulators of mTOR signalling pathway such as p-mTOR, Rictor and Raptor were also down-regulated after high glucose treatment. Additionally, high glucose treatment also decreased the Wnt signalling pathway downstream proteins (Wnt 5a/b, p-Lrp6 and Axin). Our results showed that melatonin treatment significantly inhibited high glucose-induced ROS generation, restored mitochondrial membrane potential and inhibited high glucose-induced apoptosis in Schwann cells. Furthermore, melatonin reversed the alterations of protein expression caused by high glucose treatment. Our results concluded that melatonin alleviates high glucose-induced apoptosis in Schwann cells through mitigating mitochondrial-related oxidative stress and the alterations of Bcl-2, NF-κB, mTOR and Wnt signalling pathways.
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Affiliation(s)
- Yee Lian Tiong
- School of Postgraduate Studies, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Khuen Yen Ng
- School of Pharmacy, Monash University Malaysia, Selangor 47500, Malaysia
| | - Rhun Yian Koh
- School of Health Science, International Medical University, Kuala Lumpur 57000, Malaysia
| | | | - Soi Moi Chye
- School of Health Science, International Medical University, Kuala Lumpur 57000, Malaysia.
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53
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Ragno VM, Zello GA, Klein CD, Montgomery JB. From Table to Stable: A Comparative Review of Selected Aspects of Human and Equine Metabolic Syndrome. J Equine Vet Sci 2019; 79:131-138. [PMID: 31405493 DOI: 10.1016/j.jevs.2019.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 12/18/2022]
Abstract
Obesity data in people and companion animals are depicting a future of increasing morbidity, cost for society, and significant health and welfare concerns. Between 25 and 50% of cats, dogs, and horses in developed countries are overweight or obese, which mirrors the situation in humans. Equine metabolic syndrome (EMS) was named after human metabolic syndrome (MetS), which has about 30 years of lead in research efforts. Even though the complications of the two syndromes seem to grossly differ (cardiac vs. laminitis risk), a number of similar disease mechanisms are worthy of investigation. Since the first EMS consensus statement by the American College of Veterinary Internal Medicine in 2010, numerous studies have confirmed the link between insulin dysregulation and laminitis, even though the mechanisms are not fully understood. After the discovery of the role of adipokines in MetS, evidence about inflammatory mechanisms related to adiposity in rodent models, companion animals, horses, and humans is constantly increasing. Oxidative and dicarbonyl stress have been correlated with insulin dysregulation, obesity, and recently with laminitis. Vascular actions of insulin through nitric oxide, endothelin-1, and other mechanisms are being studied in horses and can provide a better understanding of laminitis pathophysiology. More research is needed on neuropathic mechanisms in insulin-dysregulated horses, which could be important in the pathogenesis of laminitis and laminitic pain. Human literature can provide viable material for novel studies in areas that have received limited attention, in addition to being valuable information for clients about the consequences of unhealthy management of their horses.
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Affiliation(s)
- Valentina M Ragno
- Department of Large Animal Clinical Sciences, WCVM, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada.
| | - Gordon A Zello
- Section of Nutrition, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon SK S7N 5E5, Canada
| | - Colby D Klein
- Department of Large Animal Clinical Sciences, WCVM, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
| | - Julia B Montgomery
- Department of Large Animal Clinical Sciences, WCVM, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
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Abstract
PURPOSE OF REVIEW Based on a systematic literature search, we performed a comprehensive review of risk factors for falls and fractures in patients with diabetes. RECENT FINDINGS Patients with diabetes have an increased risk of fractures partly explained by increased bone fragility. Several risk factors as altered body composition including sarcopenia and obesity, impaired postural control, gait deficits, neuropathy, cardiovascular disease, and other co-morbidities are considered to increase the risk of falling. Diabetes and bone fragility is well studied, but new thresholds for fracture assessment should be considered. In general, the risk factors for falls in patients with diabetes are well documented in several studies. However, the fall mechanisms among diabetic patients have only been assessed in few studies. Thus, a gab of knowledge exits and may influence the current understanding and treatment, in order to reduce the risk of falling and thereby prevent fractures.
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Affiliation(s)
| | - Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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55
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Ding X, Fang C, Li X, Cao YJ, Zhang QL, Huang Y, Pan J, Zhang X. Type 1 diabetes-associated cognitive impairment and diabetic peripheral neuropathy in Chinese adults: results from a prospective cross-sectional study. BMC Endocr Disord 2019; 19:34. [PMID: 30917808 PMCID: PMC6437981 DOI: 10.1186/s12902-019-0359-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 03/18/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To compare neurocognitive functioning of Type 1 diabetic mellitus (T1DM) and healthy adults, and explore risk factors of cognitive dysfunction of T1DM patients, especially the association between cognitive impairment and diabetic peripheral neuropathy (DPN). METHODS Seventy T1DM (age: 32.17 ± 9.57 yr., duration: 8.99 ± 7.02 yr) patients and 48 healthy volunteers were included. All subjects received evaluation of MMSE and MoCA scales. Cognitive function of T1DM patients was evaluated in different cognitive domains. Risk factors affecting cognitive function were further explored. RESULTS Three patients with educational level ≤ 6-year were excluded from final analysis. Scores of both MMSE (28.4 ± 1.7 vs. 29.1 ± 1.0, P = 0.005) and MoCA scales (25.9 ± 2.7 vs.27.1 ± 2.4, P = 0.017) in T1DM group were lower than that in control group. For MMSE scale, scores of orientation (9.60 ± 0.79 vs.9.87 ± 0.39, P < 0.001) and language function (8.56 ± 0.65 vs.8.83 ± 0.38, P < 0.001) in T1DM groups were lower than that in control group. For MoCA scale, scores of attention and concentration (2.30 ± 0.74 vs.2.57 ± 0.58, P < 0.001), visuospatial/executive function (4.32 ± 0.91 vs.4.64 ± 0.63, P < 0.001), memory (2.96 ± 1.50 vs.3.66 ± 1.28, P < 0.001), language function (5.71 ± 0.69 vs.5.87 ± 0.39, P = 0.007), and abstraction (1.55 ± 0.68 vs.1.82 ± 0.42, P < 0.001) were lower in T1DM group than that in control group. Logistic regression showed age, fasting C peptide, educational level and nerve conduction velocity (NCV) were associated with cognitive dysfunction diagnosed by MoCA scores for the patients with type 1 diabetes. CONCLUSIONS T1DM adults had mild to moderate cognitive impairment, mainly presenting as dysfunctions of attention and concentration, visuospatial/executive, language, and abstraction. In addition to age, fasting C peptide level, and educational level, DPN, as a diabetic complication, was identified to be associated with cognitive impairments.
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Affiliation(s)
- Xin Ding
- Division of Neonatology, Children’s Hospital of Soochow University, Suzhou, 215025 China
| | - Chen Fang
- Department of Endocrinology, the Second Affiliated Hospital of Soochow University, Suzhou, 215004 China
| | - Xiang Li
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004 China
| | - Yong-Jun Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004 China
| | - Qi-Lin Zhang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004 China
| | - Yun Huang
- Department of Endocrinology, the Second Affiliated Hospital of Soochow University, Suzhou, 215004 China
| | - Jian Pan
- Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, 215025 China
| | - Xia Zhang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004 China
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Raghav A, Singh P, Ahmad J. New insights into bioelectronic medicines: A new approach to tackle diabetic peripheral neuropathy pain in clinics. Diabetes Metab Syndr 2019; 13:1011-1014. [PMID: 31336436 DOI: 10.1016/j.dsx.2019.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/17/2019] [Indexed: 11/20/2022]
Abstract
Bioelectronic medicines are a newer way to treat and diagnose the diseases associated with biological systems. All vital organs of the body are innervated, commanding brain to regulate the homeostasis functions. Bioelectronic medicines rely on implications of electrical stimulations or signals associated with the nervous system for real-time treatment. Diabetic peripheral neuropathy (DPN) is a most prevalent micro-vascular complication associated with diabetes mellitus. Complex plexus of nerves were affected in this complication with impaired function. Bioelectronic medicines are future hope for effective treatment of DPN.
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Affiliation(s)
- Alok Raghav
- Rajiv Gandhi Centre for Diabetes and Endocrinology, J.N Medical College, Faculty of Medicine, Aligarh Muslim University, Aligarh, 202002, India.
| | - Prerna Singh
- Department of Biochemistry, Banaras Hindu University, Varanasi, 221005, India
| | - Jamal Ahmad
- Rajiv Gandhi Centre for Diabetes and Endocrinology, J.N Medical College, Faculty of Medicine, Aligarh Muslim University, Aligarh, 202002, India
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57
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Hughes FM, Hirshman NA, Inouye BM, Jin H, Stanton EW, Yun CE, Davis LG, Routh JC, Purves JT. NLRP3 Promotes Diabetic Bladder Dysfunction and Changes in Symptom-Specific Bladder Innervation. Diabetes 2019; 68:430-440. [PMID: 30425063 PMCID: PMC6341307 DOI: 10.2337/db18-0845] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/06/2018] [Indexed: 12/12/2022]
Abstract
The NLRP3 inflammasome senses diabetic metabolites and initiates inflammation implicated in diabetic complications and neurodegeneration. No studies have investigated NLRP3 in diabetic bladder dysfunction (DBD), despite a high clinical prevalence. In vitro, we found that numerous diabetic metabolites activate NLRP3 in primary urothelial cells. In vivo, we demonstrate NLRP3 is activated in urothelia from a genetic type 1 diabetic mouse (Akita) by week 15. We then bred an NLRP3-/- genotype into these mice and found this blocked bladder inflammation and cystometric markers of DBD. Analysis of bladder innervation established an NLRP3-dependent decrease in overall nerve density and Aδ-fibers in the bladder wall along with an increase in C-fiber populations in the urothelia, which potentially explains the decreased sense of bladder fullness reported by patients and overactivity detected early in DBD. Together, the results demonstrate the role of NLRP3 in the genesis of DBD and suggest specific NLRP3-mediated neuronal changes can produce specific DBD symptoms.
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Affiliation(s)
- Francis M Hughes
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC
- Department of Bioengineering, Clemson University, Clemson, SC
| | - Nathan A Hirshman
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC
| | - Brian M Inouye
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC
| | - Huixia Jin
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC
| | - Eloise W Stanton
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC
| | - Chloe E Yun
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC
| | - Leah G Davis
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC
- Duke Cancer Center Biostatistics, Duke University Medical Center, Durham, NC
| | - Jonathan C Routh
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - J Todd Purves
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC
- Department of Bioengineering, Clemson University, Clemson, SC
- Department of Pediatrics, Duke University Medical Center, Durham, NC
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58
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Wittig L, Carlson KV, Andrews JM, Crump RT, Baverstock RJ. Diabetic Bladder Dysfunction:A Review. Urology 2019; 123:1-6. [DOI: 10.1016/j.urology.2018.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 12/11/2022]
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59
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Cai TT, Ye XL, Yong HJ, Song B, Zheng XL, Cui BT, Zhang FM, Lu YB, Miao H, Ding DF. Fecal microbiota transplantation relieve painful diabetic neuropathy: A case report. Medicine (Baltimore) 2018; 97:e13543. [PMID: 30558014 PMCID: PMC6320208 DOI: 10.1097/md.0000000000013543] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Fecal microbiota transplantation (FMT) has been used in a wide variety of diseases. In this article, we reported a 46-year-old female with diabetic neuropathy (DN) achieved remission by the treatment of FMT. PATIENT CONCERNS The patient with an 8-year history of diabetes and hypertension was admitted to hospital due to sensitive pain of her right thigh and poor blood glucose control. The traditional hypoglycemic and analgesic treatment were useless to her symptoms. DIAGNOSIS Diabetic-induced neuropathy was considered. INTERVENTIONS This patient received twice FMTs for 3 months. OUTCOMES After twice FMTs, the clinical response of patient was pleasant. The glycemic control was improved, with a remarkable relief of the symptoms of painful DN in particular. No obvious adverse effects were observed during the FMTs and follow-up observation-testing. LESSONS We proposed that FMT could be a promising treatment in patients with diabetes or diabetes-related complications like DN. FMT also appeared to be definitely safer and more tolerable than the pharmacologic treatment in patients with DN.
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Affiliation(s)
- Ting-ting Cai
- Department of Endocrinology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing
- Nanjing Medical University, Nanjing, Jiangsu
| | - Xiao-long Ye
- Department of Endocrinology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing
| | - Hui-juan Yong
- Department of Endocrinology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing
| | - Bin Song
- Department of Endocrinology, Clinical Medical College of Yangzhou University
| | - Xiao-ling Zheng
- Department of Endocrinology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing
- Nanjing Medical University, Nanjing, Jiangsu
| | - Bo-ta Cui
- Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, China
| | - Fa-ming Zhang
- Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, China
| | - Yi-bing Lu
- Department of Endocrinology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing
| | - Heng Miao
- Department of Endocrinology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing
| | - Da-fa Ding
- Department of Endocrinology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing
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Gioacchini FM, Albera R, Re M, Scarpa A, Cassandro C, Cassandro E. Hyperglycemia and diabetes mellitus are related to vestibular organs dysfunction: truth or suggestion? A literature review. Acta Diabetol 2018; 55:1201-1207. [PMID: 29936650 DOI: 10.1007/s00592-018-1183-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/11/2018] [Indexed: 12/12/2022]
Abstract
Diabetes mellitus is an independent risk factor for falling, particularly in the elderly. Due to chronic hyperglycemia and hyperinsulinemia patients with diabetes mellitus may have neurological deficits as peripheral neuropathy that is a debilitating micro-vascular complication affecting the proximal and distal peripheral sensory and motor nerves. Sensory neuropathy is prominent and represents the chief contributor to postural instability in diabetic subjects. Diabetic retinopathy is another complication consequent to a breakdown of the inner blood-retinal barrier with accumulation of extracellular fluids in the macula and growth of new vessels causing retinal detachment. Together peripheral neuropathy and retinopathy contribute to increase the risk of falls in diabetic patients, but a certain vestibular organs impairment should not be underestimated. Nevertheless, the exact mechanism and localization of peripheral vestibular damage consequent to chronic hyperglycemia and hyperinsulinemia are currently not still understood. Moreover it is not defined the possible role of these two blood conditions in worsening the prognosis of typical vestibular pathologies like "benign paroxysmal positional vertigo" and "Meniere disease". The aim of this review was to retrieve all studies investigating about the balance system alterations in patients suffering of diabetes. A search thorough Ovid MEDLINE was performed to enroll all eligible articles. Fourteen studies comprising a total of 1364 patients were included and analyzed in detail. On the basis of data reported in our review it appears plausible to hypothesize a direct connection among chronic hyperglycemic/hyperinsulinemic damage and peripheral vestibular organ dysfunction.
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Affiliation(s)
- Federico Maria Gioacchini
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
- Otolaryngology Department, Marche Polytechnic University, Ospedali Riuniti of Ancona, Via Conca 71, 60020, Torrette, AN, Italy.
| | - Roberto Albera
- Surgical Sciences Department, University of Turin, Turin, Italy
| | - Massimo Re
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | - Ettore Cassandro
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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Park JH, Kim DS. Response: The Necessity of the Simple Tests for Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus Patients without Neuropathic Symptoms in Clinical Practice ( Diabetes Metab J 2018;42:442-6). Diabetes Metab J 2018; 42:546-547. [PMID: 30565444 PMCID: PMC6300441 DOI: 10.4093/dmj.2018.0248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jung Hwan Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Sun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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62
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Catalano-Iniesta L, Iglesias-Osma MC, Sánchez-Robledo V, Carretero-Hernández M, Blanco EJ, Carretero J, García-Barrado MJ. Variations in adrenal gland medulla and dopamine effects induced by the lack of Irs2. J Physiol Biochem 2018; 74:667-677. [PMID: 30367392 DOI: 10.1007/s13105-018-0655-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 10/18/2018] [Indexed: 01/26/2023]
Abstract
The adrenomedullary chromaffin cells' hormonal pathway has been related to the pathophysiology of diabetes mellitus. In mice, the deletion of insulin receptor substrate type 2 (Irs2) causes peripheral insulin resistance and reduction in β-cell mass, leading to overt diabetes, with gender differences on adrenergic signaling. To further unravel the relevance of Irs2 on glycemic control, we analyzed in adult Irs2 deficient (Irs2-/-) mice, of both sexes but still normoglycemic, dopamine effects on insulin secretion and glycerol release, as well as their adrenal medulla by an immunohistochemical and morphologic approach. In isolated islets, 10 μM dopamine significantly inhibited insulin release in wild-type (WT) and female Irs2-/- mice; however, male Irs2-/- islets were insensitive to that catecholamine. Similarly, on isolated adipocytes, gender differences were observed between WT and Irs2-/- mice in basal and evoked glycerol release with crescent concentrations of dopamine. By immunohistochemistry, reactivity to tyrosine hydroxylase (TH) in female mice was significantly higher in the adrenal medulla of Irs2-/- compared to WT; although no differences for TH-immunopositivity were observed between the male groups of mice. However, compared to their corresponding WT animals, adrenomedullary chromaffin cells of Irs2-/- mice showed a significant decrease in the cellular and nuclear areas, and even in their percentage of apoptosis. Therefore, our observations suggest that, together with gender differences on dopamine responses in Irs2-/- mice, disturbances in adrenomedullary chromaffin cells could be related to deficiency of Irs2. Accordingly, Irs2 could be necessary for adequate glucose homeostasis and maintenance of the population of the adrenomedullary chromaffin cells.
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Affiliation(s)
- Leonardo Catalano-Iniesta
- Department of Physiology and Pharmacology, INCyL and IBSAL, Faculty of Medicine, University of Salamanca, Avda. Alfonso X el Sabio, s/n, E-37007, Salamanca, Spain.,Laboratory of Neuroendocrinology, Institute of Neurosciences of Castilla y León (INCyL), University of Salamanca, Salamanca, Spain.,Laboratory of Neuroendocrinology and Obesity, Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - María Carmen Iglesias-Osma
- Department of Physiology and Pharmacology, INCyL and IBSAL, Faculty of Medicine, University of Salamanca, Avda. Alfonso X el Sabio, s/n, E-37007, Salamanca, Spain.,Laboratory of Neuroendocrinology, Institute of Neurosciences of Castilla y León (INCyL), University of Salamanca, Salamanca, Spain.,Laboratory of Neuroendocrinology and Obesity, Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Virginia Sánchez-Robledo
- Department of Physiology and Pharmacology, INCyL and IBSAL, Faculty of Medicine, University of Salamanca, Avda. Alfonso X el Sabio, s/n, E-37007, Salamanca, Spain.,Laboratory of Neuroendocrinology, Institute of Neurosciences of Castilla y León (INCyL), University of Salamanca, Salamanca, Spain.,Laboratory of Neuroendocrinology and Obesity, Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Marta Carretero-Hernández
- Laboratory of Neuroendocrinology, Institute of Neurosciences of Castilla y León (INCyL), University of Salamanca, Salamanca, Spain.,Laboratory of Neuroendocrinology and Obesity, Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.,Department of Human Anatomy and Histology, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Enrique J Blanco
- Laboratory of Neuroendocrinology, Institute of Neurosciences of Castilla y León (INCyL), University of Salamanca, Salamanca, Spain.,Laboratory of Neuroendocrinology and Obesity, Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.,Department of Human Anatomy and Histology, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - José Carretero
- Laboratory of Neuroendocrinology, Institute of Neurosciences of Castilla y León (INCyL), University of Salamanca, Salamanca, Spain.,Laboratory of Neuroendocrinology and Obesity, Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.,Department of Human Anatomy and Histology, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - María José García-Barrado
- Department of Physiology and Pharmacology, INCyL and IBSAL, Faculty of Medicine, University of Salamanca, Avda. Alfonso X el Sabio, s/n, E-37007, Salamanca, Spain. .,Laboratory of Neuroendocrinology, Institute of Neurosciences of Castilla y León (INCyL), University of Salamanca, Salamanca, Spain. .,Laboratory of Neuroendocrinology and Obesity, Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.
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63
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Wittig L, Andrews JM, Crump RT, Carlson KV, Baverstock RJ. Investigating the effect of early bladder management in patients with chronic kidney disease and diabetes: Lessons learned from a failed pilot study. Can Urol Assoc J 2018; 12:301-302. [PMID: 30333077 DOI: 10.5489/cuaj.5304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Luc Wittig
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - J Matthew Andrews
- Division of Urology, Department of Surgery, Memorial University, St. John's, NL, Canada
| | - R Trafford Crump
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Kevin V Carlson
- Vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary AB, Canada
| | - Richard J Baverstock
- Vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary AB, Canada
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Yuan T, Li J, Fu Y, Xu T, Li J, Wang X, Zhou Y, Dong Y, Zhao W. A cardiac risk score based on sudomotor function to evaluate cardiovascular autonomic neuropathy in asymptomatic Chinese patients with diabetes mellitus. PLoS One 2018; 13:e0204804. [PMID: 30281621 PMCID: PMC6169902 DOI: 10.1371/journal.pone.0204804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/14/2018] [Indexed: 01/17/2023] Open
Abstract
Backgrounds Cardiac autonomic neuropathy is a common but always overlooked. More convenient diagnostic methods are needed. Hypothesis Cardiac autonomic neuropathy risk score evaluated by SUDOSCAN has a fine diagnostic efficacy detecting cardiac autonomic neuropathy. Methods This is a cross-sectional study among patients with diabetes mellitus. Subjects undertook SUDOSCAN tests and cardiac autonomic reflex tests, including heart rate variability due to Valsalva maneuver, heart rate response due to deep breathing and heart rate response due to standing up. Presenting 2 abnormal results was defined as cardiac autonomic neuropathy. Results Subjects with cardiac autonomic neuropathy has significantly higher cardiac autonomic neuropathy risk score (32.88±1.60 vs 27.64±1.24,P = 0.010). Cardiac autonomic neuropathy risk score was correlated significantly with the heart rate response due to deep breathing(P = 0.004). Multiple regression analysis including significant variables showed an independent association of cardiac autonomic neuropathy risk score and heart rate response due to deep breathing (P = 0.031) and age (P = 0.000). In receiver operating characteristic curve analysis evaluating the relationship between cardiac autonomic neuropathy risk score and cardiac autonomic neuropathy, The cut-off value was 20.5, with the sensitivity of 90.48%, the specificity of 29.5%, and the positive predictive value of 46.9%. In two-step diagnostic methods, Setting 20.5 as the cut-off value of cardiac autonomic neuropathy risk score and abnormal heart rate response due to standing up as the second diagnostic step’s positive result, and setting 16.5 as the cut-off value of cardiac autonomic neuropathy risk score and abnormal heart rate response due to deep breathing as the second diagnostic step’s positive result, both achieved good diagnostic efficacy. Conclusion Cardiac autonomic neuropathy risk score evaluated by SUDOSCAN is a good screening test for cardiac autonomic neuropathy. The two-step diagnostic methods could be considered as surrogate diagnostic methods.
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Affiliation(s)
- Tao Yuan
- Department of Endocrinology, Key Laboratory of Endocrinology of the National Health and Family Planning Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Jiapei Li
- Department of Endocrinology, Key Laboratory of Endocrinology of the National Health and Family Planning Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Yong Fu
- Department of Endocrinology, Key Laboratory of Endocrinology of the National Health and Family Planning Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Juan Li
- Department of Endocrinology, Key Laboratory of Endocrinology of the National Health and Family Planning Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xiangqing Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of the National Health and Family Planning Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Zhou
- Department of Endocrinology, Key Laboratory of Endocrinology of the National Health and Family Planning Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Yingyue Dong
- Department of Endocrinology, Key Laboratory of Endocrinology of the National Health and Family Planning Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Weigang Zhao
- Department of Endocrinology, Key Laboratory of Endocrinology of the National Health and Family Planning Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
- * E-mail:
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Luo P, Liu D, Li C, He WX, Zhang CL, Chang MJ. Enteric glial cell activation protects enteric neurons from damage due to diabetes in part via the promotion of neurotrophic factor release. Neurogastroenterol Motil 2018; 30:e13368. [PMID: 29740907 DOI: 10.1111/nmo.13368] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 04/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diabetes can result in pathological changes to enteric nervous system. Our aim was to test the dynamic changes of enteric neurons and identify the role of enteric glial cells (EGCs) in regulating enteric neuron expression in diabetic rats. METHODS A single injection of streptozotocin (STZ) was used to establish diabetic rats. Animals were randomly distributed into diabetic 1-, 4-, 8-, and 16-week groups, as well as age-matched control groups. The PGP9.5- and glial fibrillary acidic protein (GFAP)-immunopositive cells were quantified by immunohistochemistry. The protein levels of PGP9.5, ChAT, nNOS, S-100β, and c-fos were determined by western blotting. The levels of nerve growth factor (NGF), neurotrophin 3 (NT-3), and glial cell-derived neurotrophic factor (GDNF) were tested by ELISA. KEY RESULTS An increase in blood glucose and a decrease in body weight were observed following STZ administration. PGP9.5 expression did not change in the diabetic ileum. However, ChAT increased after 16 weeks, and nNOS decreased after 8 and 16 weeks in the ilea of diabetic rats. The absence of degeneration of enteric neurons during the acute stage of the disease could be the consequence of the up-regulation of GFAP, S-100β, and c-fos. Moreover, the content of NGF, NT-3, and GDNF in the ileum increased by varying degrees after 1 and/or 4 weeks of diabetes. Using 2 co-culture models of EGCs and SH-SY5Y cells in a high glucose condition, the supportive role of EGCs was further confirmed. CONCLUSIONS & INFERENCES Enteric glial cell activation can protect enteric neurons from damage due to diabetes in the acute stage of the disease, in part via the promotion of neurotrophin release.
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Affiliation(s)
- P Luo
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - D Liu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - C Li
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - W-X He
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - C-L Zhang
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - M-J Chang
- Center for Translational Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Park JH, Kim DS. The Necessity of the Simple Tests for Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus Patients without Neuropathic Symptoms in Clinical Practice. Diabetes Metab J 2018; 42:442-446. [PMID: 30362305 PMCID: PMC6202562 DOI: 10.4093/dmj.2017.0090] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 08/22/2018] [Indexed: 11/29/2022] Open
Abstract
Early recognition and appropriate management of diabetic peripheral polyneuropathy (DPNP) is important. We evaluated the necessity of simple, non-invasive tests for DPNP detection in clinical practice. We enrolled 136 randomly-chosen patients with type 2 diabetes mellitus and examined them with the 10-g Semmes-Weinstein monofilament examination, the 128-Hz tuning-fork, ankle-reflex, and pinprick tests; the Total Symptom Score and the 15-item self-administered questionnaire of the Michigan Neuropathy Screening Instrument. Among 136 patients, 48 had subjective neuropathic symptoms and 88 did not. The abnormal-response rates varied depending on the methods used according to the presence of subjective neuropathic symptoms (18.8% vs. 5.7%, P<0.05; 58.3% vs. 28.4%, P<0.005; 81.3% vs. 54.5%, P<0.005; 12.5% vs. 5.7%, P=0.195; 41.7% vs. 2.3%, P<0.001; and 77.1% vs. 9.1%, P<0.001; respectively). The largest abnormal response was derived by combining all methods. Moreover, these tests should be implemented more extensively in diabetic patients without neuropathic symptoms to detect DPNP early.
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Affiliation(s)
- Jung Hwan Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Sun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Avalos DJ, Sarosiek I, Loganathan P, McCallum RW. Diabetic gastroparesis: current challenges and future prospects. Clin Exp Gastroenterol 2018; 11:347-363. [PMID: 30310300 PMCID: PMC6165730 DOI: 10.2147/ceg.s131650] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Diabetic gastroparesis (DMGP) is a condition of delayed gastric emptying after gastric outlet obstruction has been excluded. Symptoms of nausea, vomiting, early satiety, bloating, and abdominal pain are associated with DMGP. Uncontrolled symptoms can lead to overall poor quality of life and financial burdens on the healthcare system. A combination of antiemetics and prokinetics is used in symptom control; metoclopramide is the main prokinetic available for clinical use and is the only U.S. Food and Drug Administration-approved agent in the United States. However, a black box warning in 2009 reporting its association with tardive dyskinesia and recommending caution in chronically using this agent beyond 3 months has decreased its role in clinical practice. There is an unmet need for new prokinetics with good efficacy and safety profiles. Currently, there are several new drugs with different mechanisms of action in the pipeline that are under investigation and show promising preliminary results. Surgically combining gastric electrical stimulation with pyloroplasty is considered "gold" standard. Advances in therapeutic endoscopic intervention with gastric per-oral endoscopic pyloromyotomy have also been shown to improve gastric emptying and gastroparesis (GP) symptoms. In this review, we will comment on the challenges encountered when managing patients with DMGP and provide an update on advances in drug development and endoscopic and surgical interventions.
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Affiliation(s)
- Danny J Avalos
- Division of Gastroenterology, Center for Neurogastroenterology and GI Motility, Texas Tech University Health Sciences Center, El Paso, TX, USA,
| | - Irene Sarosiek
- Division of Gastroenterology, Center for Neurogastroenterology and GI Motility, Texas Tech University Health Sciences Center, El Paso, TX, USA,
| | - Priyadarshini Loganathan
- Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Richard W McCallum
- Division of Gastroenterology, Center for Neurogastroenterology and GI Motility, Texas Tech University Health Sciences Center, El Paso, TX, USA,
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Pan H, Ding Y, Yan N, Nie Y, Li M, Tong L. Trehalose prevents sciatic nerve damage to and apoptosis of Schwann cells of streptozotocin-induced diabetic C57BL/6J mice. Biomed Pharmacother 2018; 105:907-914. [DOI: 10.1016/j.biopha.2018.06.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/08/2018] [Accepted: 06/13/2018] [Indexed: 02/06/2023] Open
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Merante D, Rosenstock J, Sharma U, Feins K, Hsu C, Vinik A. Efficacy of Mirogabalin (DS-5565) on Patient-Reported Pain and Sleep Interference in Patients with Diabetic Neuropathic Pain: Secondary Outcomes of a Phase II Proof-of-Concept Study. PAIN MEDICINE 2018; 18:2198-2207. [PMID: 28371941 DOI: 10.1093/pm/pnw342] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective To evaluate the effects of mirogabalin on patient-reported pain and sleep interference in diabetic peripheral neuropathic pain (DPNP). Subjects Adults (≥18 years) with type 1 or 2 diabetes, glycosylated hemoglobin of 10% or less at screening, and DPNP for six months or more were eligible for participation. Methods Subjects (N = 452) were randomly assigned (2:1:1:1:1:1:1) to receive placebo, dose-ranging mirogabalin (5, 10, 15, 20, 30 mg/day), or pregabalin (300 mg/day) for five weeks. Secondary efficacy end points studied here included patient global impression of change (PGIC), modified brief pain inventory (BPI), and average daily sleep interference score (ADSIS). Correlation plots were generated to examine the relationship between ADSIS and average daily pain score (ADPS). Results At week 5, significant reductions in ADSIS were observed in the mirogabalin 15, 20, and 30 mg/day groups, compared with placebo (P < 0.05). Baseline ADSIS and ADPS were strongly correlated (R2 = 0.4407), as were mean changes from baseline in ADSIS and ADPS at week 5 (R2 = 0.6694). The mirogabalin 30 mg/day group showed significant improvement compared with placebo in four of six BPI subscales at end point; the mirogabalin 15 mg/day group showed significant improvement in three of six BPI subscales (P < 0.05). At end of treatment, the percentage of subject with PGIC status of "much improved or better" was greater in all mirogabalin dose groups than in the placebo group (P < 0.05). A low incidence of treatment-related adverse events was reported for mirogabalin. Conclusions Results support the effectiveness of mirogabalin in improving patient-reported pain and sleep interference in DPNP.
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Affiliation(s)
- Domenico Merante
- Daiichi Sankyo Development Ltd, Gerrards Cross, Buckinghamshire, UK
| | - Julio Rosenstock
- Dallas Diabetes and Endocrine Center at Medical City, Dallas, Texas
| | | | - Karen Feins
- Daiichi Sankyo Pharma Development, Edison, New Jersey
| | - Ching Hsu
- Daiichi Sankyo Pharma Development, Edison, New Jersey
| | - Aaron Vinik
- The Strelitz Diabetes Center, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Garcia-Perez E, Schönberger T, Sumalla M, Stierstorfer B, Solà R, Doods H, Serra J, Gorodetskaya N. Behavioural, morphological and electrophysiological assessment of the effects of type 2 diabetes mellitus on large and small nerve fibres in Zucker diabetic fatty, Zucker lean and Wistar rats. Eur J Pain 2018; 22:1457-1472. [DOI: 10.1002/ejp.1235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 01/09/2023]
Affiliation(s)
| | - T. Schönberger
- Boehringer Ingelheim Pharma GmbH & Co. KG; Biberach an der Riss Germany
| | - M. Sumalla
- Neuroscience Technologies; Barcelona Spain
| | - B. Stierstorfer
- Boehringer Ingelheim Pharma GmbH & Co. KG; Biberach an der Riss Germany
| | - R. Solà
- Neuroscience Technologies; Barcelona Spain
| | - H. Doods
- Boehringer Ingelheim Pharma GmbH & Co. KG; Biberach an der Riss Germany
| | - J. Serra
- Neuroscience Technologies; Barcelona Spain
| | - N. Gorodetskaya
- Boehringer Ingelheim Pharma GmbH & Co. KG; Biberach an der Riss Germany
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Assessment of vestibular-evoked myogenic potentials and video head impulse test in type 2 diabetes mellitus patients with or without polyneuropathy. Eur Arch Otorhinolaryngol 2018; 275:719-724. [DOI: 10.1007/s00405-018-4873-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/08/2018] [Indexed: 02/07/2023]
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Kateel R, Augustine AJ, Prabhu S, Ullal S, Pai M, Adhikari P. Clinical and microbiological profile of diabetic foot ulcer patients in a tertiary care hospital. Diabetes Metab Syndr 2018; 12:27-30. [PMID: 28867530 DOI: 10.1016/j.dsx.2017.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 08/20/2017] [Indexed: 11/24/2022]
Abstract
AIM To evaluate the clinical and microbiological profile of diabetic foot ulcer patients admitted to a tertiary care hospital. METHODOLOGY This study recruited 120 diabetic foot ulcer patients of all grade. Their medical records were evaluated retrospectively. RESULTS We found that median age of patient was 60(52, 67.75) years. 68.3% of patients were males. Median duration of diabetes mellitus was 15(10, 20) years. Mean HbA1C and fasting glucose was 10.3±2.3 and 167.6±52.42 respectively. Neuropathy (35%) and peripheral vascular disease (23.3%) was major micro vascular and macro vascular complication associated. Different locations of ulcers were toe (23.3%), sole (20%), dorsum (18.3%), shin (16.6%), heel (13.3%), and ankle (8.3%). Bacterial infection was seen in 81.66% patients out of which 23.3% had poly microbial infection. CONCLUSION Diabetic foot ulcer patient had poor blood glucose control with elevated HbA1C and fasting blood glucose level. Neuropathy and peripheral vascular disease, hypertension were major complications. Staphylococcus aureus, Pseudomonas aeruginosa were common infecting bacteria.
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Affiliation(s)
- Ramya Kateel
- Department of Medicine, Manipal University, Mangalore, India
| | | | | | - Sheetal Ullal
- Department of Pharmacology, Manipal University, Mangalore, India
| | - Manohar Pai
- Department of Surgery, Manipal University, Mangalore, India
| | - Prabha Adhikari
- Department of Medicine, Yenepoya University, Deralakatte, Mangalore, India.
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Abstract
Neuropathic pain is associated with sleep disturbances, and in turn poor sleep quality leads to increased pain sensitivity, so it is essential to assess sleep alongside neuropathic pain. Responses to drugs are inconsistent and identifying the best treatment option that will reduce pain and improve sleep quality remains challenging for clinicians. Anticonvulsants such as pregabalin and gabapentin improve neuropathic pain and have a positive effect on comorbid sleep disturbances. Opioids and antidepressants are effective in reducing pain but can exacerbate sleep disturbances. FUNDING Pfizer, Italy.
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Ioannou A, Varotsis C. Modifications of hemoglobin and myoglobin by Maillard reaction products (MRPs). PLoS One 2017; 12:e0188095. [PMID: 29136023 PMCID: PMC5685578 DOI: 10.1371/journal.pone.0188095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/31/2017] [Indexed: 12/13/2022] Open
Abstract
High performance liquid chromatography (HPLC) coupled with a Fraction Collector was employed to isolate Maillard reaction products (MRPs) formed in model systems comprising of asparagine and monosaccharides in the 60-180°C range. The primary MRP which is detected at 60°C is important for Acrylamide content and color/aroma development in foods and also in the field of food biotechnology for controlling the extent of the Maillard reaction with temperature. The discrete fractions of the reaction products were reacted with Hemoglobin (Hb) and Myoglobin (Mb) at physiological conditions and the reaction adducts were monitored by UV-vis and Attenuated Total Reflection-Fourier transform infrared (FTIR) spectrophotometry. The UV-vis kinetic profiles revealed the formation of a Soret transition characteristic of a low-spin six-coordinated species and the ATR-FTIR spectrum of the Hb-MRP and Mb-MRP fractions showed modifications in the protein Amide I and II vibrations. The UV-vis and the FTIR spectra of the Hb-MRPs indicate that the six-coordinated species is a hemichrome in which the distal E7 Histidine is coordinated to the heme Fe and blocks irreversibly the ligand binding site. Although the Mb-MRPs complex is a six-coordinated species, the 1608 cm-1 FTIR band characteristic of a hemichrome was not observed.
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Affiliation(s)
- Aristos Ioannou
- Department of Environmental Science and Technology, Cyprus University of Technology, Limassol, Cyprus
| | - Constantinos Varotsis
- Department of Environmental Science and Technology, Cyprus University of Technology, Limassol, Cyprus
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Sifuentes-Franco S, Pacheco-Moisés FP, Rodríguez-Carrizalez AD, Miranda-Díaz AG. The Role of Oxidative Stress, Mitochondrial Function, and Autophagy in Diabetic Polyneuropathy. J Diabetes Res 2017; 2017:1673081. [PMID: 29204450 PMCID: PMC5674726 DOI: 10.1155/2017/1673081] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/25/2017] [Accepted: 09/12/2017] [Indexed: 02/07/2023] Open
Abstract
Diabetic polyneuropathy (DPN) is the most frequent and prevalent chronic complication of diabetes mellitus (DM). The state of persistent hyperglycemia leads to an increase in the production of cytosolic and mitochondrial reactive oxygen species (ROS) and favors deregulation of the antioxidant defenses that are capable of activating diverse metabolic pathways which trigger the presence of nitro-oxidative stress (NOS) and endoplasmic reticulum stress. Hyperglycemia provokes the appearance of micro- and macrovascular complications and favors oxidative damage to the macromolecules (lipids, carbohydrates, and proteins) with an increase in products that damage the DNA. Hyperglycemia produces mitochondrial dysfunction with deregulation between mitochondrial fission/fusion and regulatory factors. Mitochondrial fission appears early in diabetic neuropathy with the ability to facilitate mitochondrial fragmentation. Autophagy is a catabolic process induced by oxidative stress that involves the formation of vesicles by the lysosomes. Autophagy protects cells from diverse stress factors and routine deterioration. Clarification of the mechanisms involved in the appearance of complications in DM will facilitate the selection of specific therapeutic options based on the mechanisms involved in the metabolic pathways affected. Nowadays, the antioxidant agents consumed exogenously form an adjuvant therapeutic alternative in chronic degenerative metabolic diseases, such as DM.
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Affiliation(s)
- Sonia Sifuentes-Franco
- Institute of Experimental and Clinical Therapeutics, Department of Physiology, University Health Sciences Centre, University of Guadalajara, Guadalajara, JAL, Mexico
| | - Fermín Paul Pacheco-Moisés
- Department of Chemistry, University Centre for Exact and Engineering Sciences, University of Guadalajara, Guadalajara, JAL, Mexico
| | - Adolfo Daniel Rodríguez-Carrizalez
- Institute of Experimental and Clinical Therapeutics, Department of Physiology, University Health Sciences Centre, University of Guadalajara, Guadalajara, JAL, Mexico
| | - Alejandra Guillermina Miranda-Díaz
- Institute of Experimental and Clinical Therapeutics, Department of Physiology, University Health Sciences Centre, University of Guadalajara, Guadalajara, JAL, Mexico
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Wang J, Sun Z, Wang Y, Wang H, Guo Y. The role and mechanism of glutamic NMDA receptor in the mechanical hyperalgesia in diabetic rats. Neurol Res 2017; 39:1006-1013. [PMID: 28814157 DOI: 10.1080/01616412.2017.1364515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Some studies have shown that painful neuropathy is a common and costly complication of both type 1 and type 2 diabetes mellitus, and glutamate is involved in the process although the mechanisms are not clear. The purpose of the present study was to investigate the effect of N-methyl-D-aspartate (NMDA) receptor on mechanical hyperalgesia in diabetic rats and the possible mechanism. METHODS Diabetic rat model was established by intraperitoneal injection of streptozotocin (STZ, 1%, 70 mg/kg) once, and evaluated by the change in the fasting blood glucose. The mechanical hyperalgesia was estimated by mechanical withdrawal threshold (MWT) using a set of calibrated Von Frey's filaments. In addition, the expressions of phosphorylated NMDA NR1 and phosphorylated cAMP response element binding protein (pCREB) in L4/L5 dorsal horns of spinal cord were observed. RESULTS Behavioral results showed that MK-801, an antagonist of NMDA receptor, could reduce the proportion of mechanical hyperalgesia in diabetic rats from 76.67 to 20.00%. Meanwhile, the mean MWTs in STZ group or saline-treated STZ group decreased significantly at 3-8 week, while, the MWTs in MK-801 treated STZ group were significant higher than those in STZ or saline-treated STZ group. In addition, the expressions of NMDA NR1 and pCREB in L4/5 dorsal horns of spinal cord were significant higher in diabetic rats, and MK-801 down-regulated their expressions partly. CONCLUSION All these results suggested that NMDA receptor and pCREB in the spinal cord were involved in the regulation of mechanical hyperalgesia in diabetic rats.
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Affiliation(s)
- Jin Wang
- a Department of Clinical Medicine , Xi'an Jiaotong University Health Science Center , Xi'an , China
| | - Zhaohui Sun
- a Department of Clinical Medicine , Xi'an Jiaotong University Health Science Center , Xi'an , China
| | - Yuzhao Wang
- a Department of Clinical Medicine , Xi'an Jiaotong University Health Science Center , Xi'an , China
| | - Huisheng Wang
- b Department of Physiology and Pathophysiology , Xi'an Jiaotong University Health Science Center , Xi'an , China
| | - Yuan Guo
- b Department of Physiology and Pathophysiology , Xi'an Jiaotong University Health Science Center , Xi'an , China
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Bansal R, Singh R. Exploring the potential of natural and synthetic neuroprotective steroids against neurodegenerative disorders: A literature review. Med Res Rev 2017; 38:1126-1158. [PMID: 28697282 DOI: 10.1002/med.21458] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/01/2017] [Accepted: 06/20/2017] [Indexed: 12/18/2022]
Abstract
Neurodegeneration is a complex process, which leads to progressive brain damage due to loss of neurons. Despite exhaustive research, the cause of neuronal loss in various degenerative disorders is not entirely understood. Neuroprotective steroids constitute an important line of attack, which could play a major role against the common mechanisms associated with various neurodegenerative disorders like Alzheimer's disease, Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis. Natural endogenous steroids induce the neuroprotection by protecting the nerve cells from neuronal injury through multiple mechanisms, therefore the structural modifications of the endogenous steroids could be helpful in the generation of new therapeutically useful neuroprotective agents. The review article will keep the readers apprised of the detailed description of natural as well as synthetic neuroprotective steroids from the medicinal chemistry point of view, which would be helpful in drug discovery efforts aimed toward neurodegenerative diseases.
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Affiliation(s)
- Ranju Bansal
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Ranjit Singh
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
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Gupta B, Singh SK. Association of aldose reductase gene polymorphism (C-106T) in susceptibility of diabetic peripheral neuropathy among north Indian population. J Diabetes Complications 2017; 31:1085-1089. [PMID: 28495421 DOI: 10.1016/j.jdiacomp.2017.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/21/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
AIM/HYPOTHESIS Polymorphism in aldose reductase (ALR) gene at nucleotide C(-106)T (rs759853) in the promoter region is associated with susceptibility to development of diabetic peripheral neuropathy. The aim of this study was to detect the association of the C (-106)T polymorphism of ALR gene and its frequency among patients with type 2 diabetes mellitus with and without peripheral neuropathy. METHODS The study subjects were divided into three groups. Group I included 356 patients with diabetes having peripheral neuropathy. Group II included 294 patients with diabetes without peripheral neuropathy and group III included 181 healthy subjects. Genotyping of ALR C(-106)T SNPs was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and direct sequencing methods. The genetic risk among the groups was compared and tested by calculating odds ratio with 95% class interval. RESULTS ALR 106TT genotype was significantly higher in group I compared to group II with an odds ratio of 2.12 (95% CI: 1.22-3.67; p<0.01). Recessive model (CC+CT vs. TT), as well as T allele distribution also showed significant association to develop neuropathy with relative risk of 1.97 (95% CI: 1.16-3.35; p<0.01) and 1.36 (95% CI: 1.07-1.72; p=0.01) respectively. CONCLUSION/INTERPRETATION In conclusion, the ALR C-106T polymorphism was associated with higher risk of peripheral neuropathy in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Balram Gupta
- Department of Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005
| | - S K Singh
- Department of Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005.
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Li R, Ma J, Wu Y, Nangle M, Zou S, Li Y, Yin J, Zhao Y, Xu H, Zhang H, Li X, Ye QS, Wang J, Xiao J. Dual Delivery of NGF and bFGF Coacervater Ameliorates Diabetic Peripheral Neuropathy via Inhibiting Schwann Cells Apoptosis. Int J Biol Sci 2017; 13:640-651. [PMID: 28539836 PMCID: PMC5441180 DOI: 10.7150/ijbs.18636] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 03/09/2017] [Indexed: 01/09/2023] Open
Abstract
Diabetic neuropathy is a kind of insidious complications that impairs neural and vascular function and ultimately leads to somatic and visceral denervation. Basic fibroblast growth factor (bFGF) and nerve growth factor (NGF) are important neurotrophic factors for stimulating angiogenesis and improving peripheral nerve function. Administrating a single factor has good therapeutic effect on diabetic peripheral neuropathy (DPN). However, the short half-life and rapid diffusion of growth factors under physiological conditions limits its clinical applications. Here, we used a biodegradable coacervate, composed of heparin and polycation, to dominate the combined release of bFGF and NGF in a steady fashion. We found this combined growth factors (GFs) coacervate, administered as a single injection, improved motor and sensory functions, restored morphometric structure and decreased apoptosis of Schwann cells in a rat model of prolonged DPN. Similarly the GFs coacervate, as compared with free bFGF and NGF combination, markedly reduced the apoptosis level of a rat Schwann cell line, RSC 96 cells in vitro. We also demonstrated that neuroprotective effects of the GFs coacervate in both rat DPN model and hyperglycemia-induced RSC 96 cell model is likely due to suppression of endocytoplasmic reticulum stress (ERS).
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Affiliation(s)
- Rui Li
- WZMU-JCU Joint Research Group for Stem Cell and Tissue Engineering, Institute of Stem Cell and Tissue Engineering, School of Pharmacy, Wenzhou Medical University, Wenzhou 325035, China
| | - Jianfeng Ma
- WZMU-JCU Joint Research Group for Stem Cell and Tissue Engineering, Institute of Stem Cell and Tissue Engineering, School of Pharmacy, Wenzhou Medical University, Wenzhou 325035, China.,UQ-WMU Joint Research Group for Regenerative Medicine, Oral Health Centre, University of Queensland, Brisbane 4006, Australia
| | - Yanqing Wu
- The Institute of Life Sciences, Wenzhou University, Wenzhou 325035, China
| | - Matthew Nangle
- UQ-WMU Joint Research Group for Regenerative Medicine, Oral Health Centre, University of Queensland, Brisbane 4006, Australia
| | - Shuang Zou
- WZMU-JCU Joint Research Group for Stem Cell and Tissue Engineering, Institute of Stem Cell and Tissue Engineering, School of Pharmacy, Wenzhou Medical University, Wenzhou 325035, China
| | - Yiyang Li
- WZMU-JCU Joint Research Group for Stem Cell and Tissue Engineering, Institute of Stem Cell and Tissue Engineering, School of Pharmacy, Wenzhou Medical University, Wenzhou 325035, China
| | - Jiayu Yin
- WZMU-JCU Joint Research Group for Stem Cell and Tissue Engineering, Institute of Stem Cell and Tissue Engineering, School of Pharmacy, Wenzhou Medical University, Wenzhou 325035, China
| | - Yingzheng Zhao
- WZMU-JCU Joint Research Group for Stem Cell and Tissue Engineering, Institute of Stem Cell and Tissue Engineering, School of Pharmacy, Wenzhou Medical University, Wenzhou 325035, China
| | - Helin Xu
- WZMU-JCU Joint Research Group for Stem Cell and Tissue Engineering, Institute of Stem Cell and Tissue Engineering, School of Pharmacy, Wenzhou Medical University, Wenzhou 325035, China
| | - Hongyu Zhang
- WZMU-JCU Joint Research Group for Stem Cell and Tissue Engineering, Institute of Stem Cell and Tissue Engineering, School of Pharmacy, Wenzhou Medical University, Wenzhou 325035, China
| | - Xiaokun Li
- The Institute of Life Sciences, Wenzhou University, Wenzhou 325035, China
| | - Qing Song Ye
- WZMU-JCU Joint Research Group for Stem Cell and Tissue Engineering, Institute of Stem Cell and Tissue Engineering, School of Pharmacy, Wenzhou Medical University, Wenzhou 325035, China.,UQ-WMU Joint Research Group for Regenerative Medicine, Oral Health Centre, University of Queensland, Brisbane 4006, Australia
| | - Jian Wang
- Department of Peripheral Neurosurgery, the First Affiliated Hospital Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Jian Xiao
- WZMU-JCU Joint Research Group for Stem Cell and Tissue Engineering, Institute of Stem Cell and Tissue Engineering, School of Pharmacy, Wenzhou Medical University, Wenzhou 325035, China
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Actualización en el diagnóstico, tratamiento y prevención de la neuropatía diabética periférica. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2016.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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81
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Kandimalla R, Dash S, Kalita S, Choudhury B, Malampati S, Devi R, Ramanathan M, Talukdar NC, Kotoky J. Bioactive Fraction of Annona reticulata Bark (or) Ziziphus jujuba Root Bark along with Insulin Attenuates Painful Diabetic Neuropathy through Inhibiting NF-κB Inflammatory Cascade. Front Cell Neurosci 2017; 11:73. [PMID: 28381989 PMCID: PMC5361110 DOI: 10.3389/fncel.2017.00073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/28/2017] [Indexed: 02/01/2023] Open
Abstract
The present study explains the neuroprotective ability of bioactive fractions of Annona reticulata bark (ARB) and Ziziphus jujuba root bark (ZJ) along with insulin against diabetic neuropathy. By using different solvents of increasing polarity ARB and ZJ were undergone for bioactive guided fractionation. The neuroprotective ability of the all the plant fractions were tested against H2O2 induced toxicity in SHSY5Y neuroblastoma cell lines and DRG neuronal cells. Among all the fractions tested, the methanol extract of ARB and ZJ (ARBME and ZJME) and its water fractions (ARBWF and ZJWF) exhibited significant neuroprotection against H2O2 induced toxicity in SHSY5Y cells and DRG neuronal cells. Further both the active fractions were tested against streptozotocin (55 mg/kg i.p.) induced diabetic neuropathy in male Wistar rats. Body weight changes, blood glucose levels and pain threshold through hot plate, tail immersion, cold plate and Randall-Sillitto methods were measured throughout the study at weekly interval. After completion of the drug treatment period, all the animals were sacrificed to measure the sciatic nerve lipid peroxidation, antioxidative enzyme levels (SOD, catalase, and GSH) and cytokine levels (IL-1β, IL-6, IL-10, TNF-α, iNOS, and NFκB) through ELISA and western blotting analysis. Results of this study explain that ARBME, ZJME, ARBWF, and ZJWF along with insulin potentially attenuate the thermal, mechanical hyperalgesia and cold allodynia in diabetic neuropathic rats, where insulin treatment alone failed to diminish the same. Reduction of sciatic nerve oxidative stress, NF-κB and iNOS mediated inflammatory cascade and normalization of abnormal cytokine release confirms the possible mechanism of action. The present study confirms the neuroprotective ability of ARB and ZJ against painful diabetic neuropathy through inhibiting oxidative stress and NF-κB inflammatory cascade.
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Affiliation(s)
- Raghuram Kandimalla
- Drug Discovery Laboratory, Institute of Advanced Study in Science and Technology Guwahati, India
| | - Suvakanta Dash
- Girijananda Chowdhury Institute of Pharmaceutical Science Guwahati, India
| | - Sanjeeb Kalita
- Drug Discovery Laboratory, Institute of Advanced Study in Science and Technology Guwahati, India
| | - Bhaswati Choudhury
- Drug Discovery Laboratory, Institute of Advanced Study in Science and Technology Guwahati, India
| | - Sandeep Malampati
- School of Chinese Medicine, Hong Kong Baptist University Kowloon Tong, Hong Kong
| | - Rajlakshmi Devi
- Drug Discovery Laboratory, Institute of Advanced Study in Science and Technology Guwahati, India
| | | | - Narayan C Talukdar
- Drug Discovery Laboratory, Institute of Advanced Study in Science and Technology Guwahati, India
| | - Jibon Kotoky
- Drug Discovery Laboratory, Institute of Advanced Study in Science and TechnologyGuwahati, India; National Institute of Pharmaceutical Education and ResearchGuwahati, India
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Marche P, Dubois S, Abraham P, Parot-Schinkel E, Gascoin L, Humeau-Heurtier A, Ducluzeau PH, Mahe G. Neurovascular microcirculatory vasodilation mediated by C-fibers and Transient receptor potential vanilloid-type-1 channels (TRPV 1) is impaired in type 1 diabetes. Sci Rep 2017; 7:44322. [PMID: 28287157 PMCID: PMC5347083 DOI: 10.1038/srep44322] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/06/2017] [Indexed: 01/20/2023] Open
Abstract
Microvascular dysfunction may have an early onset in type 1 diabetes (T1D) and can precede major complications. Our objectives were to assess the endothelial-dependent (acetylcholine, ACh; and post-occlusive hyperemia, PORH), non-endothelial-dependent (sodium nitroprusside, SNP) and neurovascular-dependent (local heating, LH and current induced vasodilation, CIV) microcirculatory vasodilation in T1D patients compared with matched control subjects using a laser speckle contrast imager. Seventeen T1D patients - matched with 17 subjects according to age, gender, Body-Mass-Index, and smoking status - underwent macro- and microvascular investigations. The LH early peak assessed the transient receptor potential vanilloid type 1 channels (TRPV1) mediated vasodilation, whereas the plateau assessed the Nitirc-Oxyde (NO) and endothelium-derived hyperpolarizing factor (EDHF) pathways. PORH explored sensory nerves and (EDHF), while CIV assessed sensory nerves (C-fibers) and prostaglandin-mediated vasodilation. Using neurological investigations, we observed that C-fiber and A-delta fiber functions in T1D patients were similar to control subjects. PORH, CIV, LH peak and plateau vasodilations were significantly decreased in T1D patients compared to controls, whereas there was no difference between the two groups for ACh and SNP vasodilations. Neurovascular microcirculatory vasodilations (C-fibers and TRPV 1-mediated vasodilations) are impaired in TD1 patients whereas no abnormalities were found using clinical neurological investigations. Clinicaltrials: No. NCT02538120.
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Affiliation(s)
- P Marche
- Endocrinology Department, University Hospital of Angers, Angers, France
| | - S Dubois
- Endocrinology Department, University Hospital of Angers, Angers, France
| | - P Abraham
- Laboratory of Vascular Investigations, University Hospital of Angers, UMR CNRS6214/INSERM1083, LUNAM Université, Angers, France
| | - E Parot-Schinkel
- Methodology and Biostatistics Unit, University Hospital of Angers, Angers, France
| | - L Gascoin
- Laboratory of Vascular Investigations, University Hospital of Angers, UMR CNRS6214/INSERM1083, LUNAM Université, Angers, France
| | - A Humeau-Heurtier
- University of Angers, LARIS - Laboratoire Angevin de Recherche en Ingénierie des Systèmes, Angers, France
| | - P H Ducluzeau
- Endocrinology Department, University Hospital of Tours, Tours, France
| | - G Mahe
- INSERM Clinical Investigation Center (CIC 14 14), Rennes, France, Université de Rennes 1 and LUNAM University, Inserm 1083/CNRS 6214, Faculty of Medicine, Angers, France
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Toopchizadeh V, Shiva S, Khiabani NY, Ghergherechi R. Electrophysiologic pattern and prevalence of subclinical peripheral neuropathy in children and adolescents with type I diabetes mellitus in Iran. Saudi Med J 2017; 37:299-303. [PMID: 26905353 PMCID: PMC4800895 DOI: 10.15537/smj.2016.3.13625] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To evaluate electrophysiologic pattern of subclinical diabetic peripheral neuropathy (DPN) in children and adolescents with type 1 diabetes mellitus (T1DM) based on nerve conduction study. METHODS In this cross sectional study, 40 children and adolescents (62.5% female with mean age of 12.73 ± 0.43 years) with T1DM for at least 5 years attending the Pediatrics Clinics. Tabriz University of Medical Sciences, Tabriz, Iran, between 2014 and 2015 were recruited. Demographic and laboratory findings were recorded and all patients underwent clinical neurological examination and electrophysiologic studies. RESULTS According to electrophysiologic studies, DPN was found in 57.5% of patients including early stage of neuropathy (15%), mild sensory axonal neuropathy (25%), mild sensory motor axonal neuropathy (10%), and moderate sensory motor axonal neuropathy (7.5%). Age, duration of diabetes, fasting blood sugar, and glycosylated hemoglobin levels had no significant difference between patients with and without DPN. Reduced deep tendon reflexes were observed in the upper limb (30%) and lower limb (47.5%) of patients, which were both significantly higher in DPN patients (upper limb [p=0.03] and lower limb [p=0.04]). The most frequent electrophysiologic findings were unobtainable H-reflex, low amplitude sural, and median sensory responses. CONCLUSION Subclinical DPN is a common complication found in children and adolescents with TIDM and peripheral sensory axonal neuropathy is the most frequent type. Nerve conduction study is recommended for early detection of DPN and prevention of its progress.
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Affiliation(s)
- Vahideh Toopchizadeh
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. E-mail.
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84
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Wongdee K, Krishnamra N, Charoenphandhu N. Derangement of calcium metabolism in diabetes mellitus: negative outcome from the synergy between impaired bone turnover and intestinal calcium absorption. J Physiol Sci 2017; 67:71-81. [PMID: 27671701 PMCID: PMC10717635 DOI: 10.1007/s12576-016-0487-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 09/06/2016] [Indexed: 12/31/2022]
Abstract
Both types 1 and 2 diabetes mellitus (T1DM and T2DM) are associated with profound deterioration of calcium and bone metabolism, partly from impaired intestinal calcium absorption, leading to a reduction in calcium uptake into the body. T1DM is associated with low bone mineral density (BMD) and osteoporosis, whereas the skeletal changes in T2DM are variable, ranging from normal to increased and to decreased BMD. However, both types of DM eventually compromise bone quality through production of advanced glycation end products and misalignment of collagen fibrils (so-called matrix failure), thereby culminating in a reduction of bone strength. The underlying cellular mechanisms (cellular failure) are related to suppression of osteoblast-induced bone formation and bone calcium accretion, as well as to enhancement of osteoclast-induced bone resorption. Several other T2DM-related pathophysiological changes, e.g., osteoblast insulin resistance, impaired productions of osteogenic growth factors (particularly insulin-like growth factor 1 and bone morphogenetic proteins), overproduction of pro-inflammatory cytokines, hyperglycemia, and dyslipidemia, also aggravate diabetic osteopathy. In the kidney, DM and the resultant hyperglycemia lead to calciuresis and hypercalciuria in both humans and rodents. Furthermore, DM causes deranged functions of endocrine factors related to mineral metabolism, e.g., parathyroid hormone, 1,25-dihydroxyvitamin D3, and fibroblast growth factor-23. Despite the wealth of information regarding impaired bone remodeling in DM, the long-lasting effects of DM on calcium metabolism in young growing individuals, pregnant women, and neonates born to women with gestational DM have received scant attention, and their underlying mechanisms are almost unknown and worth exploring.
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Affiliation(s)
- Kannikar Wongdee
- Center of Calcium and Bone Research (COCAB), Faculty of Science, Mahidol University, Bangkok, Thailand
- Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
| | - Nateetip Krishnamra
- Center of Calcium and Bone Research (COCAB), Faculty of Science, Mahidol University, Bangkok, Thailand
- Department of Physiology, Faculty of Science, Mahidol University, Rama VI Road, Bangkok, 10400, Thailand
| | - Narattaphol Charoenphandhu
- Center of Calcium and Bone Research (COCAB), Faculty of Science, Mahidol University, Bangkok, Thailand.
- Department of Physiology, Faculty of Science, Mahidol University, Rama VI Road, Bangkok, 10400, Thailand.
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Cox AA, Sagot Y, Hedou G, Grek C, Wilkes T, Vinik AI, Ghatnekar G. Low-Dose Pulsatile Interleukin-6 As a Treatment Option for Diabetic Peripheral Neuropathy. Front Endocrinol (Lausanne) 2017; 8:89. [PMID: 28512447 PMCID: PMC5411416 DOI: 10.3389/fendo.2017.00089] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/06/2017] [Indexed: 01/27/2023] Open
Abstract
Diabetic peripheral neuropathy (DPN) remains one of the most common and serious complications of diabetes. Currently, pharmacological agents are limited to treating the pain associated with DPN, and do not address the underlying pathological mechanisms driving nerve damage, thus leaving a significant unmet medical need. Interestingly, research conducted using exercise as a treatment for DPN has revealed interleukin-6 (IL-6) signaling to be associated with many positive benefits such as enhanced blood flow and lipid metabolism, decreased chronic inflammation, and peripheral nerve fiber regeneration. IL-6, once known solely as a pro-inflammatory cytokine, is now understood to signal as a multifunctional cytokine, capable of eliciting both pro- and anti-inflammatory responses in a context-dependent fashion. IL-6 released from muscle in response to exercise signals as a myokine and as such has a unique kinetic profile, whereby levels are transiently elevated up to 100-fold and return to baseline levels within 4 h. Importantly, this kinetic profile is in stark contrast to long-term IL-6 elevation that is associated with pro-inflammatory states. Given exercise induces IL-6 myokine signaling, and exercise has been shown to elicit numerous beneficial effects for the treatment of DPN, a causal link has been suggested. Here, we discuss both the clinical and preclinical literature related to the application of IL-6 as a treatment strategy for DPN. In addition, we discuss how IL-6 may directly modulate Schwann and nerve cells to explore a mechanistic understanding of how this treatment elicits a neuroprotective and/or regenerative response. Collectively, studies suggest that IL-6, when administered in a low-dose pulsatile strategy to mimic the body's natural response to exercise, may prove to be an effective treatment for the protection and/or restoration of peripheral nerve function in DPN. This review highlights the studies supporting this assertion and provides rationale for continued investigation of IL-6 for the treatment of DPN.
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Affiliation(s)
| | - Yves Sagot
- Relief Therapeutics SA, Zurich, Switzerland
| | - Gael Hedou
- Relief Therapeutics SA, Zurich, Switzerland
| | | | | | | | - Gautam Ghatnekar
- FirstString Research, Mt. Pleasant, SC, USA
- *Correspondence: Gautam Ghatnekar,
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Chen H, Zhu W, Lu J, Fan J, Sun L, Feng X, Liu H, Zhang Z, Wang Y. The Effects of Auricular Electro-Acupuncture on Ameliorating the Dysfunction of Interstitial Cells of Cajal Networks and nNOSmRNA Expression in Antrum of STZ-Induced Diabetic Rats. PLoS One 2016; 11:e0166638. [PMID: 27930657 PMCID: PMC5145159 DOI: 10.1371/journal.pone.0166638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 11/01/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUD Interstitial cells of Cajal (ICCs) and nNOS play a crucial role in diabetic gastrointestinal dysmotility(DGD). Our previous study found that electro-acupuncture(EA) on ear point 'stomach' could repair the gastric dysrhythmias in rats induced by rectal distention(RD) after meal. However, little were known about the possible effect of auricular electro-acupuncture (AEA) on diabetic rats. Thus, we designed this study to investigate the effect of AEA on streptozotocin(STZ)-induced diabetic rats. METHOD Forty male Sprague_Dawley (SD) rats were injected with STZ, at the end of 8th week after injection, animals were randomly divided into four groups and received 2 weeks-treatment(10 times) respectively: control group(CON,n = 10, no stimulation), sham auricular electro-acupuncture group(SEA,n = 10, low frequency EA on earlobes), auricular eletro-acupuncture group(AEA,n = 10, low frequency EA on ear point 'stomach'), and ST-36 group(ST-36,n = 10, low frequency EA on ST-36). Gastrointestinal (GI) motility was measured by GI transit rate. ICCs(c-kit+ expression) in antrum were analyzed by Immunohistochemistry and western blotting. NO level in blood serum were detected by Griess Reagent, and nNOSmRNA expression in antrum were determined by Real-time PCR. RESULTS GI transit rate and ICCs(c-kit+ expression) in antrum of AEA group have the tendency to increase compared with CON group, but had no statistics difference (P>0.05). nNOSmRNA expression in antrum of AEA group was dramatically increased compared with CON group (P = 0.037). CONCLUSIONS Low frequency EA on ear 'stomach' point could significantly up-regulate nNOS mRNA expression and ameliorate the ICCs networks partly in gastric antrum of STZ -induced diabetic rats, which may has benefits on regulating the GI motility.
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Affiliation(s)
- Huan Chen
- Department of Acupuncture, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Weijian Zhu
- Department of Acupuncture, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jing Lu
- Department of Acupuncture, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jinqing Fan
- Department of Acupuncture, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Luning Sun
- Department of Pharmacy, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoke Feng
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hao Liu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhaohui Zhang
- Department of Acupuncture, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yongqing Wang
- Department of Pharmacy, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Crews RT, Schneider KL, Yalla SV, Reeves ND, Vileikyte L. Physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers: a critical review. Diabetes Metab Res Rev 2016; 32:791-804. [PMID: 27155091 PMCID: PMC5466070 DOI: 10.1002/dmrr.2817] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/24/2016] [Accepted: 04/21/2016] [Indexed: 02/06/2023]
Abstract
Obesity and a sedentary lifestyle are common challenges among individuals at risk of diabetic foot ulcers. While substantial research exists on physical activity interventions in adults with diabetes, those at greatest risk for foot ulceration were often excluded or not well represented. Both at-risk patients and their clinicians may be hesitant to increase physical activity because of their perception of diabetic foot ulcer risks. Physical activity is not contraindicated for those at risk of diabetic foot ulcer, yet patients at risk present with unique barriers to initiating increases in physical activity. This review focuses upon the physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers. Offloading, diabetic peripheral neuropathy, depression, pain, self-efficacy and social support, diabetic foot ulcer risk-specific beliefs and emotions, and research to date on exercise interventions in this population are all discussed. Additionally, recommendations for implementing and researching physical activity interventions for individuals at risk for diabetic foot ulcer are provided. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ryan T Crews
- Center for Lower Extremity Ambulatory Research (CLEAR) at Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
| | - Kristin L Schneider
- Department of Psychology, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Sai V Yalla
- Center for Lower Extremity Ambulatory Research (CLEAR) at Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Neil D Reeves
- School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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Retinal Neurodegeneration Associated With Peripheral Nerve Conduction and Autonomic Nerve Function in Diabetic Patients. Am J Ophthalmol 2016; 170:15-24. [PMID: 27381712 DOI: 10.1016/j.ajo.2016.06.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/08/2016] [Accepted: 06/25/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE In this study, we evaluated the correlation of retinal thickness with peripheral nerve conduction and autonomic nerve function in diabetic patients. DESIGN Cross-sectional study. METHODS Medical records of 160 patients (mean age, 63.61 ± 12.52 years) with diabetes without diabetic retinopathy or mild nonproliferative diabetic retinopathy (NPDR) were reviewed. The mean retinal thickness of the parafoveal area and ganglion cell/inner plexiform layer (GC-IPL) thickness in 6 macular regions were measured using optical coherence tomography. Peripheral nerve conduction studies were conducted on peroneal and posterior tibial motor nerves and the sural sensory nerve. Five cardiovascular autonomic function tests were performed. We classified patients into groups by severity of peripheral neuropathy and autonomic dysfunction and analyzed the correlations with mean retinal thickness. RESULTS The mean retinal thickness of the parafovea was 315.05 ± 12.70 μm and mean macular GC-IPL thickness was 79.89 ± 4.70 μm. Macular GC-IPL thickness showed significant correlation with peripheral nerve conduction (no peripheral neuropathy vs definite peripheral neuropathy: 82.0 ± 4.8 μm vs 75.2 ± 3.8 μm, P < .001). GC-IPL thickness decreased with severity of autonomic nerve dysfunction (no/mild dysfunction vs severe dysfunction: 81.2 ± 6.6 μm vs 77.6 ± 5.9 μm, P = .005). There was no significant correlation between the retinal thickness of the parafovea and electrodiagnostic tests. CONCLUSION The decrease of GC-IPL thickness was positively correlated with both peripheral nerve conduction and autonomic nerve function in diabetic patients who presented with no diabetic retinopathy or mild NPDR.
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Wang XQ, Yang JH, Duan YZ, Ju J. Factors associated with diabetic gastrointestinal dysfunction. Shijie Huaren Xiaohua Zazhi 2016; 24:3209-3214. [DOI: 10.11569/wcjd.v24.i20.3209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the data of diabetic patients with diabetic gastrointestinal dysfunction and those without to identify factors associated with gastrointestinal dysfunction in patients with diabetes mellitus.
METHODS: One hundred and eighty diabetes mellitus patients treated from 2006 to 2015 at the Second Affiliated Hospital of Kunming Medical University were included, including 80 with diabetic gastrointestinal dysfunction as a case group, and 100 without diabetic gastrointestinal dysfunction as a control group. The two groups were compared with regard to gender, age, medical history, islet function (C-peptide release test), glycosylated hemoglobin, fasting blood-glucose, 2 h postprandial blood glucose, diabetic complications (diabetic nephropathy, diabetic eye disease, coronary heart disease, diabetic ketosis and cerebral artery elasticity, peripheral vascular atherosclerosis, and diabetic peripheral neuropathy) and other related paramters.
RESULTS: There was no significant difference in sex distribution between the two groups (P = 0.083). C-peptide levels at 0, 1, and 2 h were significantly lower in the case group than in the control group (1.79 ng/mL ± 1.54 ng/mL vs 1.98 ng/mL ± 1.20 ng/mL, P = 0.367; 2.86 ng/mL ± 2.33 ng/mL vs 3.97 ng/mL ± 2.77 ng/mL, P = 0.05; 3.33 ng/mL ± 2.58 ng/mL vs 8.44 ng/mL ± 3.62 ng/mL, P < 0.001). Fasting blood glucose was lower in the case group than in the control group (8.53 mmol/L ± 3.61 mmol/L vs 9.10 mmol/L ± 3.70 mmol/L, P = 0.30). The proportions of patients with peripheral atherosclerosis and those with coronary heart disease in the case group were significantly higher than those in the control group (25% vs 7%, P = 0.01; 26.25% vs 24%, P = 0.73). The proportions of diabetic nephropathy, diabetes, eye diseases, diabetic ketosis, and peripheral neuropathy were also significantly higher in the case group than in the control group (37.5% vs 16%, P = 0.02; 45% vs 15%, P < 0.001; 22.5% vs 20%, P = 0.72; 51.25% vs 21%, P < 0.001).
CONCLUSION: The occurrence of diabetic gastrointestinal dysfunction is associated with islet function, history, coronary heart disease, diabetic nephropathy, diabetic eye disease, and peripheral neuropathy. Patients with poor islet function, long history of disease, complications like coronary heart disease, diabetic nephropathy, diabetic eye disease, and peripheral neuropathy are more likely to develop diabetic gastrointestinal disorders. However, diabetic gastrointestinal dysfunction has no significant correlation with age, glycosylated hemoglobin, fasting blood glucose, 2 h postprandial blood glucose, diabetes ketosis, or peripheral vascular atherosclerosis.
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91
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Wang XQ, Hu MM, Wang W, Gao F, Zhang LM, Yan FY, Ju J. Pathogenesis of diabetic gastrointestinal dysfunction. Shijie Huaren Xiaohua Zazhi 2016; 24:2682-2687. [DOI: 10.11569/wcjd.v24.i17.2682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Diabetic gastrointestinal dysfunction is a common complication in patients with diabetes mellitus. Most of the symptoms are related to impaired gastrointestinal function. The pathogenesis and etiology of diabetic gastroenteropathy are complex, involving the parasympathetic and sympathetic nervous systems, enteric neurons, smooth muscle cells, the network of interstitial cells of Cajal, cholinergic receptors and neuronal nitric oxide synthase. This article reviews the pathogenesis of diabetic gastrointestinal dysfunction.
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92
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Lee WJ, Jang S, Lee SH, Lee HS. Correlation Between the Severity of Diabetic Peripheral Polyneuropathy and Glycosylated Hemoglobin Levels: A Quantitative Study. Ann Rehabil Med 2016; 40:263-70. [PMID: 27152276 PMCID: PMC4855120 DOI: 10.5535/arm.2016.40.2.263] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/20/2015] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate risk factors for diabetic peripheral polyneuropathy and their correlation with the quantified severity of nerve dysfunction in patients with diabetes mellitus (DM). Methods A total of 187 diabetic patients with clinically suspected polyneuropathy (PN) were subclassified into 2 groups according to electrodiagnostic testing: a DM-PN group of 153 diabetic patients without electrophysiological abnormality and a DM+PN group of 34 diabetic patients with polyneuropathy. For all patients, age, sex, height, weight, duration of DM, and plasma glycosylated hemoglobin (HbA1c) level were comparatively investigated. A composite score was introduced to quantitatively analyze the results of the nerve conduction studies. Logistic regression analysis and multiple regression analysis were used to evaluate correlations between significant risk factors and severity of diabetic polyneuropathy. Results The DM+PN group showed a significantly higher HbA1c level and composite score, as compared with the DM-PN group. Increased HbA1c level and old age were significant predictive factors for polyneuropathy in diabetic patients (odds ratio=5.233 and 4.745, respectively). In the multiple linear regression model, HbA1c and age showed a significant positive association with composite score, in order (β=1.560 and 0.253, respectively). Conclusion Increased HbA1c level indicative of a state of chronic hyperglycemia was a risk factor for polyneuropathy in diabetic patients and a quantitative measure of its severity.
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Affiliation(s)
- Won-Jae Lee
- Department of Physical Medicine & Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Sol Jang
- Department of Physical Medicine & Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Seung-Hwa Lee
- Department of Physical Medicine & Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Hyun-Seok Lee
- Department of Physical Medicine & Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
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93
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Hypoxia-induced sensitisation of TRPA1 in painful dysesthesia evoked by transient hindlimb ischemia/reperfusion in mice. Sci Rep 2016; 6:23261. [PMID: 26983498 PMCID: PMC4794653 DOI: 10.1038/srep23261] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 03/02/2016] [Indexed: 11/13/2022] Open
Abstract
Dysesthesia is an unpleasant abnormal sensation, which is often accompanied by peripheral neuropathy or vascular impairment. Here, we examined the roles of transient receptor potential ankyrin 1 (TRPA1) in dysesthesia-like behaviours elicited by transient hindlimb ischemia (15–60 min) by tightly compressing the hindlimb, and reperfusion by releasing the ligature. The paw-withdrawal responses to tactile stimulation were reduced during ischemia and lasted for a while after reperfusion. Hindlimb ischemia/reperfusion elicited spontaneous licking of the ischemic hindpaw that peaked within 10 min. The licking was inhibited by reactive oxygen species (ROS) scavengers, a TRPA1 antagonist, or TRPA1 deficiency, but not by TRPV1 deficiency. In human TRPA1-expressing cells as well as cultured mouse dorsal root ganglion neurons, the H2O2-evoked TRPA1 response was significantly increased by pretreatment with hypoxia (80 mmHg) for 30 min. This hypoxia-induced TRPA1 sensitisation to H2O2 was inhibited by overexpressing a catalytically-inactive mutant of prolyl hydroxylase (PHD) 2 or in a TRPA1 proline mutant resistant to PHDs. Consistent with these results, a PHD inhibitor increased H2O2-evoked nocifensive behaviours through TRPA1 activation. Our results suggest that transient hindlimb ischemia/reperfusion-evoked spontaneous licking, i.e. painful dysesthesia, is caused by ROS-evoked activation of TRPA1 sensitised by hypoxia through inhibiting PHD-mediated hydroxylation of a proline residue in TRPA1.
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94
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Pitarokoili K, Kerasnoudis A, Behrendt V, Labedi A, Ayzenberg I, Gold R, Yoon MS. Facing the diagnostic challenge: Nerve ultrasound in diabetic patients with neuropathic symptoms. Muscle Nerve 2016; 54:18-24. [DOI: 10.1002/mus.24981] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 11/10/2015] [Accepted: 11/16/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Kalliopi Pitarokoili
- Department of Neurology; Ruhr University, St. Josef-Hospital; Gudrunstr. 56 44791 Bochum Germany
| | - Antonios Kerasnoudis
- Department of Neurology; Ruhr University, St. Josef-Hospital; Gudrunstr. 56 44791 Bochum Germany
| | - Volker Behrendt
- Department of Neurology; Ruhr University, St. Josef-Hospital; Gudrunstr. 56 44791 Bochum Germany
| | - Adnan Labedi
- Department of Neurology; Ruhr University, St. Josef-Hospital; Gudrunstr. 56 44791 Bochum Germany
| | - Ilya Ayzenberg
- Department of Neurology; Ruhr University, St. Josef-Hospital; Gudrunstr. 56 44791 Bochum Germany
| | - Ralf Gold
- Department of Neurology; Ruhr University, St. Josef-Hospital; Gudrunstr. 56 44791 Bochum Germany
| | - Min-Suk Yoon
- Department of Neurology; Ruhr University, St. Josef-Hospital; Gudrunstr. 56 44791 Bochum Germany
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95
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Yang M, Qian C, Liu Y. Suboptimal Treatment of Diabetic Peripheral Neuropathic Pain in the United States. PAIN MEDICINE 2015; 16:2075-83. [DOI: 10.1111/pme.12845] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 05/15/2015] [Accepted: 05/29/2015] [Indexed: 01/16/2023]
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Abstract
Diabetic neuropathy is the most common microvascular complication of diabetes mellitus with high morbidity and mortality, and low quality of life. It has a broad spectrum of clinical forms, although distal symmetrical polyneuropathy is the most prevalent. Several oral complications including burning mouth syndrome, dry mouth, and impairment of the senses taste and smell are less-known manifestations of diabetic neuropathy and often overlooked. Periodontitis, tooth loss, and temporomandibular joint dysfunction may be also present in these patients and are equally debilitating. Periodontitis was declared the sixth complication of diabetes in 1993 and may contribute to poor glucose control. Hence, periodontitis and diabetes mutually and adversely affect each other. This review summarizes the available body of scientific literature that discusses oral manifestations in patients with diabetic neuropathy and identifies important areas where more research is needed.
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Affiliation(s)
- Wenche S Borgnakke
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Avenue Rm# G049, Ann Arbor, MI, 48109-1078, USA.
| | - Patricia F Anderson
- Emerging Technologies Informationist, Taubman Health Sciences Library, University of Michigan, 1135 E Catherine St, Ann Arbor, MI, 48109-5726, USA.
| | - Carol Shannon
- Informationist, Academic & Clinical Engagement, Taubman Health Sciences Library, University of Michigan, 1135 E Catherine St, Ann Arbor, MI, 48109-5726, USA.
| | - Anca Jivanescu
- Department of Prosthodontics, Faculty of Dentistry, University of Medicine and Pharmacy "Victor Babes" Timisoara, P-ta Eftimie Murgu Nr. 2, Timisoara, Romania.
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97
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Finamore F, Priego-Capote F, Nolli S, Fontana P, Sanchez JC. Aspirin-mediated acetylation of haemoglobin increases in presence of high glucose concentration and decreases protein glycation. EUPA OPEN PROTEOMICS 2015. [DOI: 10.1016/j.euprot.2015.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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98
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Kahleova H, Pelikanova T. Vegetarian Diets in the Prevention and Treatment of Type 2 Diabetes. J Am Coll Nutr 2015; 34:448-58. [DOI: 10.1080/07315724.2014.976890] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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99
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Schreiber AK, Nones CFM, Reis RC, Chichorro JG, Cunha JM. Diabetic neuropathic pain: Physiopathology and treatment. World J Diabetes 2015; 6:432-444. [PMID: 25897354 PMCID: PMC4398900 DOI: 10.4239/wjd.v6.i3.432] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/26/2014] [Accepted: 02/09/2015] [Indexed: 02/05/2023] Open
Abstract
Diabetic neuropathy is a common complication of both type 1 and type 2 diabetes, which affects over 90% of the diabetic patients. Although pain is one of the main symptoms of diabetic neuropathy, its pathophysiological mechanisms are not yet fully known. It is widely accepted that the toxic effects of hyperglycemia play an important role in the development of this complication, but several other hypotheses have been postulated. The management of diabetic neuropathic pain consists basically in excluding other causes of painful peripheral neuropathy, improving glycemic control as a prophylactic therapy and using medications to alleviate pain. First line drugs for pain relief include anticonvulsants, such as pregabalin and gabapentin and antidepressants, especially those that act to inhibit the reuptake of serotonin and noradrenaline. In addition, there is experimental and clinical evidence that opioids can be helpful in pain control, mainly if associated with first line drugs. Other agents, including for topical application, such as capsaicin cream and lidocaine patches, have also been proposed to be useful as adjuvants in the control of diabetic neuropathic pain, but the clinical evidence is insufficient to support their use. In conclusion, a better understanding of the mechanisms underlying diabetic neuropathic pain will contribute to the search of new therapies, but also to the improvement of the guidelines to optimize pain control with the drugs currently available.
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Combined therapy of diabetic peripheral neuropathy with breviscapine and mecobalamin: a systematic review and a meta-analysis of Chinese studies. BIOMED RESEARCH INTERNATIONAL 2015; 2015:680756. [PMID: 25866802 PMCID: PMC4383387 DOI: 10.1155/2015/680756] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 01/27/2023]
Abstract
Objective. A meta-analysis on combined therapy of diabetic peripheral neuropathy (DPN) with breviscapine and mecobalamin was performed to evaluate the efficacy of this therapy. Methods. Six English databases (Medline, Cochrane Library, PubMed, EMBASE, Web of Science, and CINAHL) and four Chinese databases (China National Knowledge Infrastructure, VIP Journals Database, CBM, and Wanfang database) were searched for studies on the clinical trials in which DPN was treated with breviscapine and mecobalamin, and RevMan 5.1 package was employed for analyzing pooled trials and publication bias. Results. A total of 17 articles including 1398 DPN patients were identified. Homogeneity was observed among different studies (P = 0.74). The efficacy of combined therapy with breviscapine and mecobalamin was significantly better than that in control group [P < 0.0001 (OR = 5.01, 95% CI: 3.70–6.78)]. Conclusion. Available findings suggest that the therapeutic efficacy of breviscapine combining mecobalamin is superior to mecobalamin alone, and this strategy is required to be popularized in clinical practice.
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