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Asiri MMH, Engelsman S, Eijkelkamp N, Höppener JWM. Amyloid Proteins and Peripheral Neuropathy. Cells 2020; 9:E1553. [PMID: 32604774 PMCID: PMC7349787 DOI: 10.3390/cells9061553] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022] Open
Abstract
Painful peripheral neuropathy affects millions of people worldwide. Peripheral neuropathy develops in patients with various diseases, including rare familial or acquired amyloid polyneuropathies, as well as some common diseases, including type 2 diabetes mellitus and several chronic inflammatory diseases. Intriguingly, these diseases share a histopathological feature-deposits of amyloid-forming proteins in tissues. Amyloid-forming proteins may cause tissue dysregulation and damage, including damage to nerves, and may be a common cause of neuropathy in these, and potentially other, diseases. Here, we will discuss how amyloid proteins contribute to peripheral neuropathy by reviewing the current understanding of pathogenic mechanisms in known inherited and acquired (usually rare) amyloid neuropathies. In addition, we will discuss the potential role of amyloid proteins in peripheral neuropathy in some common diseases, which are not (yet) considered as amyloid neuropathies. We conclude that there are many similarities in the molecular and cell biological defects caused by aggregation of the various amyloid proteins in these different diseases and propose a common pathogenic pathway for "peripheral amyloid neuropathies".
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Affiliation(s)
- Mohammed M. H. Asiri
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (M.M.H.A.); (S.E.); (J.W.M.H.)
- The National Centre for Genomic Technology, Life Science and Environment Research Institute, King Abdulaziz City for Science and Technology, P.O. Box 6086, 11461 Riyadh, Saudi Arabia
| | - Sjoukje Engelsman
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (M.M.H.A.); (S.E.); (J.W.M.H.)
| | - Niels Eijkelkamp
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (M.M.H.A.); (S.E.); (J.W.M.H.)
| | - Jo W. M. Höppener
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (M.M.H.A.); (S.E.); (J.W.M.H.)
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands
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Abstract
Neuropathic pain caused by a lesion or disease of the somatosensory nervous system is a common chronic pain condition with major impact on quality of life. Examples include trigeminal neuralgia, painful polyneuropathy, postherpetic neuralgia, and central poststroke pain. Most patients complain of an ongoing or intermittent spontaneous pain of, for example, burning, pricking, squeezing quality, which may be accompanied by evoked pain, particular to light touch and cold. Ectopic activity in, for example, nerve-end neuroma, compressed nerves or nerve roots, dorsal root ganglia, and the thalamus may in different conditions underlie the spontaneous pain. Evoked pain may spread to neighboring areas, and the underlying pathophysiology involves peripheral and central sensitization. Maladaptive structural changes and a number of cell-cell interactions and molecular signaling underlie the sensitization of nociceptive pathways. These include alteration in ion channels, activation of immune cells, glial-derived mediators, and epigenetic regulation. The major classes of therapeutics include drugs acting on α2δ subunits of calcium channels, sodium channels, and descending modulatory inhibitory pathways.
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Affiliation(s)
- Nanna Brix Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; and Department of Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Rohini Kuner
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; and Department of Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Troels Staehelin Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; and Department of Pharmacology, Heidelberg University, Heidelberg, Germany
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Stubbs EB. Targeting the blood-nerve barrier for the management of immune-mediated peripheral neuropathies. Exp Neurol 2020; 331:113385. [PMID: 32562668 DOI: 10.1016/j.expneurol.2020.113385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/03/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023]
Abstract
Healthy peripheral nerves encounter, with increased frequency, numerous chemical, biological, and biomechanical forces. Over time and with increasing age, these forces collectively contribute to the pathophysiology of a spectrum of traumatic, metabolic, and/or immune-mediated peripheral nerve disorders. The blood-nerve barrier (BNB) serves as a critical first-line defense against chemical and biologic insults while biomechanical forces are continuously buffered by a dense array of longitudinally orientated epineural collagen fibers exhibiting high-tensile strength. As emphasized throughout this Experimental Neurology Special Issue, the BNB is best characterized as a functionally dynamic multicellular vascular unit comprised of not only highly specialized endoneurial endothelial cells, but also associated perineurial cells, pericytes, Schwann cells, basement membrane, and invested axons. The composition of the BNB, while anatomically distinct, is not functionally dissimilar to that of the well characterized neurovascular unit of the central nervous system. While the BNB lacks a glial limitans and an astrocytic endfoot layer, the primary function of both vascular units is to establish, maintain, and protect an optimal endoneurial (PNS) or interstitial (CNS) fluid microenvironment that is vital for proper neuronal function. Altered endoneurial homeostasis as a secondary consequence of BNB dysregulation is considered an early pathological event in the course of a variety of traumatic, immune-mediated, or metabolically acquired peripheral neuropathies. In this review, emerging experimental advancements targeting the endoneurial microvasculature for the therapeutic management of immune-mediated inflammatory peripheral neuropathies, including the AIDP variant of Guillain-Barré syndrome, are discussed.
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Affiliation(s)
- Evan B Stubbs
- Research Service (151), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA; Department of Ophthalmology, Loyola University Health Science Division, Maywood, IL 60153, USA.
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Ugrenović S, Jovanović I, Kundalić B, Stojanović V, Pavlović M, Antović A, Milić M, Kokoris JČ. Morphometric analysis of the epineurial and endoneurial blood vessels of the human sciatic nerve in relation to aging. Tissue Cell 2020; 66:101389. [PMID: 32933712 DOI: 10.1016/j.tice.2020.101389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/29/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
The aim of this research is to perform an analysis of the epineurial and endoneurial blood vessels in relation to aging. The research is conducted on samples of the human sciatic nerve of 12 case (age from 27 to 89). The histological sections are stained by streptavidin-biotin method of detecting the presence of Type IV collagen. After morphometric analysis the following stereological parameters have been calculated: the number of blood vessels per unit of area, the volume density of the blood vessels and the surface density of the blood vessels of the epineurium and endoneurium. An additional diameter measurement is performed for the endoneural blood vessels. In order to perform a more detailed analysis, the cases were classified into three age groups, the first (27-48 years), the second (49-70 years) and, the third (over 70 years). The bivariate correlation analysis showed that the number of blood vessels of the endoneurium, their volume and surface densities in relation to age produced a statistically significant positive correlation. One Way ANOVA test demonstrated a statistically significant increase in the number of endoneurial blood vessels in the age group III when compared the age group I and, in addition, it showed a significant decrease in the diameter of the age group II when compared to the age group I. Paired t - test shows a statistically significant higher number of endoneurial blood vessels in relation to the epineurial, namely, in the age group III. The volume and surface density of the epineurial blood vessels is significantly higher than the endoneurial in both the I and II age group. Age brings about significant changes of the endoneurial vascular network of the sciatic nerve due to the increase in density of the endoneurial blood vessels, their volume and surface densities. Consequently, in the cases older than 70 years, the number of endoneurial blood vessels significantly exceeds the number of epineurial blood vessels.
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Affiliation(s)
| | - Ivan Jovanović
- Department of Anatomy, Faculty of Medicine, University of Niš, Serbia
| | - Braca Kundalić
- Department of Anatomy, Faculty of Medicine, University of Niš, Serbia
| | - Vesna Stojanović
- Department of Anatomy, Faculty of Medicine, University of Niš, Serbia
| | - Miljana Pavlović
- Department of Anatomy, Faculty of Medicine, University of Niš, Serbia
| | - Aleksandra Antović
- Department of Forensic Medicine, Faculty of Medicine, University of Niš, Serbia
| | - Miroslav Milić
- Department of Forensic Medicine, Faculty of Medicine, University of Niš, Serbia
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Pai YW, Tang CL, Lin CH, Lin SY, Lee IT, Chang MH. Glycaemic control for painful diabetic peripheral neuropathy is more than fasting plasma glucose and glycated haemoglobin. DIABETES & METABOLISM 2020; 47:101158. [PMID: 32413414 DOI: 10.1016/j.diabet.2020.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/01/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The relationship between postprandial hyperglycaemia and diabetic peripheral neuropathy (DPN), whether painful or painless, has yet to be determined. Thus, the aim of this study was to investigate the relationship in patients with type 2 diabetes (T2D). METHODS This cross-sectional study was conducted in adults with T2D between January and October 2013. Blood samples were collected after overnight fasting every 3 months prior to enrolment. For this study, increased postprandial glycaemic exposure was defined as high glycated haemoglobin (HbA1c) and near-normal mean fasting plasma glucose (FPG) levels. Both painless and painful DPN were evaluated using two validated tools, the Michigan Neuropathy Screening Instrument (MNSI) and Douleur Neuropathique 4 (DN4) questionnaire. RESULTS This study included 1040 participants with mean FPG levels<140mg/dL, 535 of which were<126mg/dL. Of these patients, 200/1040 (19.2%) and 105/535 (19.6%) had DPN. Multivariate analysis demonstrated that higher HbA1c levels (≥7%) did not increase risk of painless DPN, but did significantly increase risk of painful DPN in T2D patients with FPG<140mg/dL and<126mg/dL, with corresponding odds ratios of 2.49 and 3.77 (95% confidence intervals: 1.09-5.71 and 1.20-11.79), respectively, after adjusting for demographic factors, diabetes-related variables and comorbidities. CONCLUSION This study is the first to reveal that increased postprandial glycaemic exposure, as assessed by high HbA1c and near-normal FPG levels, is associated with an increased risk of painful DPN in adults with T2D.
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Affiliation(s)
- Y-W Pai
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - C-L Tang
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - C-H Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - S-Y Lin
- Centre for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - I-T Lee
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - M-H Chang
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Kuthati Y, Navakanth Rao V, Busa P, Tummala S, Davuluri Venkata Naga G, Wong CS. Scope and Applications of Nanomedicines for the Management of Neuropathic Pain. Mol Pharm 2020; 17:1015-1027. [PMID: 32142287 DOI: 10.1021/acs.molpharmaceut.9b01027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Neuropathic pain, resulting from the dysfunction of the peripheral and central nervous system, occurs in a variety of pathological conditions including trauma, diabetes, cancer, HIV, surgery, multiple sclerosis, ischemic attack, alcoholism, spinal cord damage, and many others. Despite the availability of various treatment strategies, the percentage of patients achieving adequate pain relief remains low. The clinical failure of most effective drugs is often not due to a lack of drug efficacy but due to the dose-limiting central nervous system (CNS) toxicity of the drugs that preclude dose escalation. There is a need for cross-disciplinary collaborations to meet these challenges. In this regard, the integration of nanotechnology with neuroscience is one of the most important fields. In recent years, promising preclinical research has been reported in this field. This review highlights the current challenges associated with conventional neuropathic pain treatments, the scope for nanomaterials in delivering drugs across the blood-brain barrier, and the state and prospects of nanomaterials for the management of neuropathic pain.
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Affiliation(s)
- Yaswanth Kuthati
- Department of Anesthesiology, Cathy General Hospital, Taipei 280, Taiwan
| | - Vaikar Navakanth Rao
- Institute of Pharmacology and Toxicology, Tzu Chi University, Hualien 970, Taiwan
| | - Prabhakar Busa
- Department of Life Sciences, National Dong Hwa University, Hualien 97401, Taiwan
| | - Srikrishna Tummala
- Department of Chemistry, National Dong Hwa University, Hualien 97401, Taiwan
| | | | - Chih Shung Wong
- Department of Anesthesiology, Cathy General Hospital, Taipei 280, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 280, Taiwan
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Biology of the human blood-nerve barrier in health and disease. Exp Neurol 2020; 328:113272. [PMID: 32142802 DOI: 10.1016/j.expneurol.2020.113272] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 12/13/2022]
Abstract
A highly regulated endoneurial microenvironment is required for normal axonal function in peripheral nerves and nerve roots, which structurally consist of an outer collagenous epineurium, inner perineurium consisting of multiple concentric layers of specialized epithelioid myofibroblasts that surround the innermost endoneurium, which consists of myelinated and unmyelinated axons embedded in a looser mesh of collagen fibers. Endoneurial homeostasis is achieved by tight junction-forming endoneurial microvessels that control ion, solute, water, nutrient, macromolecule and leukocyte influx and efflux between the bloodstream and endoneurium, and the innermost layers of the perineurium that control interstitial fluid component flux between the freely permeable epineurium and endoneurium. Strictly speaking, endoneurial microvascular endothelium should be considered the blood-nerve barrier (BNB) due to direct communication with circulating blood. The mammalian BNB is considered the second most restrictive vascular system after the blood-brain barrier (BBB) based on classic in situ permeability studies. Structural alterations in endoneurial microvessels or interactions with hematogenous leukocytes have been described in several human peripheral neuropathies; however major advances in BNB biology in health and disease have been limited over the past 50 years. Guided by transcriptome and proteome studies of normal and pathologic human peripheral nerves, purified primary and immortalized human endoneurial endothelial cells that form the BNB and leukocytes from patients with well-characterized peripheral neuropathies, validated by in situ or ex vivo protein expression studies, data are emerging on the molecular and functional characteristics of the human BNB in health and in specific peripheral neuropathies, as well as chronic neuropathic pain. These early advancements have the potential to not only increase our understanding of how the BNB works and adapts or fails to adapt to varying insult, but provide insights relevant to pathogenic leukocyte trafficking, with translational potential and specific therapeutic application for chronic peripheral neuropathies and neuropathic pain.
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Chandler E, Brown M, Wintergerst K, Doll E. Treatment-Induced Neuropathy of Diabetes (TIND) in Pediatrics: A Case Report and Review of the Literature. J Clin Endocrinol Metab 2020; 105:5587829. [PMID: 31613321 DOI: 10.1210/clinem/dgz067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/03/2019] [Indexed: 02/13/2023]
Abstract
CONTEXT Treatment-induced neuropathy of diabetes (TIND) is a rarely reported but important consideration in patients presenting with an acute onset of neuropathic symptoms following rapid correction of hyperglycemia in diabetes. Although it has been reported in children, the preponderance of literature focuses on adults with TIND. CASE DESCRIPTION We report an 18-year-old male with this condition and his clinical course. We then discuss the proposed pathophysiology of TIND and review the literature. We also provide a standard workup for the diagnosis of TIND. CONCLUSION In both pediatric and adult populations, TIND should be considered in diabetic patients who develop neuropathy acutely following rapid correction of hyperglycemia. Because the pathophysiology of TIND remains poorly understood, there is insufficient information regarding how to target susceptible individuals and prevent the development of TIND.
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Affiliation(s)
- Erika Chandler
- Department of Neurology, Division of Child Neurology, University of Louisville, Louisville, Kentucky
| | - Martin Brown
- Department of Neurology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Kupper Wintergerst
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Elizabeth Doll
- Department of Neurology, Division of Child Neurology, University of Louisville, Louisville, Kentucky
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Preguiça I, Alves A, Nunes S, Gomes P, Fernandes R, Viana SD, Reis F. Diet-Induced Rodent Models of Diabetic Peripheral Neuropathy, Retinopathy and Nephropathy. Nutrients 2020; 12:nu12010250. [PMID: 31963709 PMCID: PMC7019796 DOI: 10.3390/nu12010250] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 12/12/2022] Open
Abstract
Unhealthy dietary habits are major modifiable risk factors for the development of type 2 diabetes mellitus, a metabolic disease with increasing prevalence and serious consequences. Microvascular complications of diabetes, namely diabetic peripheral neuropathy (DPN), retinopathy (DR), and nephropathy (DN), are associated with high morbidity rates and a heavy social and economic burden. Currently, available therapeutic options to counter the evolution of diabetic microvascular complications are clearly insufficient, which strongly recommends further research. Animal models are essential tools to dissect the molecular mechanisms underlying disease progression, to unravel new therapeutic targets, as well as to evaluate the efficacy of new drugs and/or novel therapeutic approaches. However, choosing the best animal model is challenging due to the large number of factors that need to be considered. This is particularly relevant for models induced by dietary modifications, which vary markedly in terms of macronutrient composition. In this article, we revisit the rodent models of diet-induced DPN, DR, and DN, critically comparing the main features of these microvascular complications in humans and the criteria for their diagnosis with the parameters that have been used in preclinical research using rodent models, considering the possible need for factors which can accelerate or aggravate these conditions.
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Affiliation(s)
- Inês Preguiça
- Institute of Pharmacology & Experimental Therapeutics, & Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (I.P.); (A.A.); (S.N.); (P.G.); (R.F.); (S.D.V.)
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal
| | - André Alves
- Institute of Pharmacology & Experimental Therapeutics, & Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (I.P.); (A.A.); (S.N.); (P.G.); (R.F.); (S.D.V.)
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal
| | - Sara Nunes
- Institute of Pharmacology & Experimental Therapeutics, & Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (I.P.); (A.A.); (S.N.); (P.G.); (R.F.); (S.D.V.)
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal
| | - Pedro Gomes
- Institute of Pharmacology & Experimental Therapeutics, & Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (I.P.); (A.A.); (S.N.); (P.G.); (R.F.); (S.D.V.)
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal
- Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), University of Porto, 4200-450 Porto, Portugal
| | - Rosa Fernandes
- Institute of Pharmacology & Experimental Therapeutics, & Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (I.P.); (A.A.); (S.N.); (P.G.); (R.F.); (S.D.V.)
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal
| | - Sofia D. Viana
- Institute of Pharmacology & Experimental Therapeutics, & Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (I.P.); (A.A.); (S.N.); (P.G.); (R.F.); (S.D.V.)
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal
- Polytechnic Institute of Coimbra, ESTESC-Coimbra Health School, Pharmacy, 3046-854 Coimbra, Portugal
| | - Flávio Reis
- Institute of Pharmacology & Experimental Therapeutics, & Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (I.P.); (A.A.); (S.N.); (P.G.); (R.F.); (S.D.V.)
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal
- Correspondence: ; Tel.: +351-239-480-053
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Vetrano IG, Acerbi F, Falco J, Devigili G, Rinaldo S, Messina G, Prada F, D'Ammando A, Nazzi V. Fluorescein-guided removal of peripheral nerve sheath tumors: a preliminary analysis of 20 cases. J Neurosurg 2019; 134:260-269. [PMID: 31812148 DOI: 10.3171/2019.9.jns19970] [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: 04/05/2019] [Accepted: 09/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Benign peripheral nerve sheath tumors (PNSTs) include mainly schwannomas-the most common tumors arising from peripheral nerves-and neurofibromas. Due to their origin, distinguishing between functional intact nerve and the fibers from whence the PNST arose may not always be easy to perform. The introduction of intraoperative tools to better visualize these tumors could be helpful in achieving a gross-total resection. In this study, the authors present a series of patients harboring PNST in which the surgery was performed under fluorescein guidance. METHODS Between September 2018 and February 2019, 20 consecutive patients with a total of 25 suspected PNSTs underwent fluorescein-guided surgery performed under microscopic view with a dedicated filter integrated into the surgical microscope (YELLOW 560) and with intraoperative monitoring. All patients presented with a different degree of contrast enhancement at preoperative MRI. Fluorescein was intravenously injected after intubation at a dose of 1 mg/kg. Preoperative clinical and radiological data, intraoperative fluorescein characteristics, and postoperative neurological and radiological outcomes were collected and analyzed. RESULTS Six patients were affected by neurofibromatosis or schwannomatosis. There were 14 schwannomas, 8 neurofibromas, 1 myxoma, 1 reactive follicular hyperplasia, and 1 giant cell tumor of tendon sheath. No patient experienced worsening of neurological status after surgery. No side effects related to fluorescein injection were found in this series. Fluorescein allowed an optimal intraoperative distinction between tumor and surrounding nerves in 13 of 14 schwannomas and in all neurofibromas. In 6 neurofibromas and in 1 schwannoma, the final YELLOW 560 visualization showed the presence of small tumor remnants that were not visible under white-light illumination and that could be removed, obtaining a gross-total resection. CONCLUSIONS Fluorescein was demonstrated to be a feasible, safe, and helpful intraoperative adjunct to better identify and distinguish PNSTs from intact functional nerves, with a possible impact on tumor resection, particularly in diffuse neurofibromas.
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Affiliation(s)
- Ignazio G Vetrano
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta
| | - Francesco Acerbi
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta
| | - Jacopo Falco
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta
| | - Grazia Devigili
- 2Neurological Unit 1, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and
| | - Sara Rinaldo
- 2Neurological Unit 1, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and
| | - Giuseppe Messina
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta
| | - Francesco Prada
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta
- 3Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Antonio D'Ammando
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta
| | - Vittoria Nazzi
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta
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Ravichandran S, Srivastav S, Kamble PH, Chambial S, Shukla R, Sharma P, Sharma RK. VEGF-A and cardiac autonomic function in newly diagnosed type 2 diabetes mellitus: A cross-sectional study at a tertiary care center. J Family Med Prim Care 2019; 8:3185-3190. [PMID: 31742140 PMCID: PMC6857358 DOI: 10.4103/jfmpc.jfmpc_537_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/22/2019] [Accepted: 09/19/2019] [Indexed: 11/26/2022] Open
Abstract
Introduction: Cardiac autonomic neuropathy (CAN) is a key complication of type 2 diabetes mellitus (Ty2DM). Vascular endothelial-derived growth factor (VEGF-A) plays a key role in diabetic macrovascular and microvascular complications. It is shown to be elevated in diabetic neuropathy and has the potential to serve as a biomarker in Ty2DM. We evaluated VEGF-A levels and cardiac autonomic function in newly diagnosed Ty2DM patients. Materials and Methods: Forty-four newly diagnosed patients (with symptoms within 1 year from the date of recruitment) were included in the study. Cardiac autonomic function was assessed using heart rate variability (HRV) and Ewing's battery tests. Ewing's scores were computed and tabulated. VEGF-A levels were estimated using enzyme-linked immunosorbent assay (ELISA). Results: The patients demonstrated normal responses to the reactivity tests. Ewing's scores were 0 (0-0) and 0 (0-0) for sympathetic and parasympathetic parameters, respectively. The autonomic tone was impaired as assessed by HRV parameters. VEGF-A levels were elevated (308.3 ± 167.2 pg/mL) when compared with the previous literature. Discussion: Impaired tone with normal reactivity was suggestive of early stage of autonomic neuropathy. Elevated VEGF-A levels may be attributed to a protective action of the factor seen in early stages of neuropathy in Ty2DM. Serial VEGF-A estimation in large cohorts of newly diagnosed diabetics may validate it as a biomarker in CAN seen in Ty2DM.
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Affiliation(s)
- Suresh Ravichandran
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shival Srivastav
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Shailja Chambial
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ravindra Shukla
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rajesh Kumar Sharma
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Xiong Q, Liu J, Xu Y. Effects of Uric Acid on Diabetes Mellitus and Its Chronic Complications. Int J Endocrinol 2019; 2019:9691345. [PMID: 31737070 PMCID: PMC6815590 DOI: 10.1155/2019/9691345] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/26/2019] [Accepted: 09/06/2019] [Indexed: 02/07/2023] Open
Abstract
With the deepening of the researches on uric acid, especially in the study of metabolic diseases, uric acid has been found to be closely related to obesity, metabolic syndrome, nonalcoholic fatty liver disease, diabetes, and other metabolic diseases. Uric acid causes a series of pathophysiological changes through inflammation, oxidative stress, vascular endothelial injury, and so on and thus subsequently promotes the occurrence and development of diseases. This review confirmed the positive correlation between uric acid and diabetes mellitus and its chronic complications through the pathogenesis and clinical studies aspects.
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Affiliation(s)
- Qing Xiong
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
- Department of Endocrinology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, Hainan 570208, China
| | - Jie Liu
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Yancheng Xu
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
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63
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Deng Z, Wang M, Fan YH, Huang R, Rao Y, Mai X, Liu M. A systematic review of randomized controlled trials of the Wenyang Huoxue method in treating diabetic peripheral neuropathy. Medicine (Baltimore) 2019; 98:e17618. [PMID: 31626140 PMCID: PMC6824654 DOI: 10.1097/md.0000000000017618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 09/05/2019] [Accepted: 09/19/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of the Wenyang Huoxue method for patients with diabetic peripheral neuropathy. METHODS A systematic literature search was performed using 7 databases: PUBMED, EMBASE, the Chinese National Knowledge Infrastructure, Wanfang, Chinese BioMedical, and the VIP Chinese Science and Technique Journals. The publication time was from the start of each database up to November 2018. Review Manager 5.3 software was used for assessing potential bias, data synthesis, and the subgroup analysis. Begg and Egger tests were used to assess funnel plot symmetries using Stata 14.0 software. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. RESULTS A total of 22 trials involving 1835 participants were eligible. There were significant differences in a total effective rate between the Wenyang Huoxue method combined with Western medicine and Western medicine alone (RR = 1.33, 95% CI 1.26-1.41; P < .00001). As for the sensory conduction velocity (SCV) of the peroneal nerve, the Wenyang Huoxue method combined with Western medicine compared with Western medicine alone had a significant increase (weighted mean difference [WMD] = 5.00, 95% CI 3.42-6.57; P < .00001). Also, the Wenyang Huoxue method combined with Western medicine had significant increases in motor conduction velocity (MCV) of the peroneal nerve (WMD = 4.48, 95% CI 3.78-5.19; P < .00001), tibial nerve SCV (WMD = 3.47, 95% CI 2.66-4.28; P < .00001), tibial nerve MCV (4.87, 95% CI 3.21-6.53; P < .00001), median nerve SCV (WMD = 3.78, 95% CI 3.07-4.50; P < .00001), and median nerve MCV (WMD = 4.50, 95% CI 3.40-5.59; P < .00001). However, the effect of the Wenyang Huoxue method on fasting blood glucose, 2-h postprandial blood glucose, and glycosylated hemoglobin was not statistically significant. Egger's test results showed that there was no publication bias (P = .0008), but the trim and filling method showed steady results. An influence analysis showed that no single study affected the overall result. The GRADE quality of the evidence was low to moderate across the different outcomes. CONCLUSION Despite of the apparently positive findings, the quality of GRADE is not high, suggesting that the Wenyang Huoxue method can improve nerve conduction velocity to a certain extent, but more rigorous literature is needed to support this evidence.
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Affiliation(s)
| | | | | | | | - Yawen Rao
- Guangzhou University of Chinese Medicine
| | - Xurong Mai
- Guangzhou University of Chinese Medicine
| | - Min Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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64
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Milora KA, Rall GF. Interferon Control of Neurotropic Viral Infections. Trends Immunol 2019; 40:842-856. [PMID: 31439415 DOI: 10.1016/j.it.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 12/29/2022]
Abstract
Interferons (IFNs) comprise a pleiotropic family of signaling molecules that are often the first line of defense against viral infection. Inflammatory responses induced by IFN are generally well tolerated during peripheral infections; yet, the same degree of inflammation during infection of the central nervous system (CNS) could be catastrophic. Thus, IFN responses must be modified within the CNS to ensure host survival. In this review, we discuss emerging principles highlighting unique aspects of antiviral effects of IFN protection following neurotropic viral infection, chiefly using new techniques in rodent models. Evaluation of these unique responses provides insights into how the immune system eradicates or controls pathogens, while avoiding host damage. Defining these principles may have direct impact on the development of novel clinical approaches.
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Affiliation(s)
- Katelynn A Milora
- Program in Blood Cell Development and Function, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Glenn F Rall
- Program in Blood Cell Development and Function, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
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65
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Chatterjee P, Srivastava AK, Kumar DA, Chakrawarty A, Khan MA, Ambashtha AK, Kumar V, De Taboada L, Dey AB. Effect of deep tissue laser therapy treatment on peripheral neuropathic pain in older adults with type 2 diabetes: a pilot randomized clinical trial. BMC Geriatr 2019; 19:218. [PMID: 31405365 PMCID: PMC6689877 DOI: 10.1186/s12877-019-1237-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 07/30/2019] [Indexed: 12/24/2022] Open
Abstract
Background This study assessed the safety and efficacy of deep tissue laser therapy on the management of pain, functionality, systemic inflammation, and overall quality of life of older adults with painful diabetic peripheral neuropathy. Methods The effects of deep tissue laser therapy (DTLT) were assessed in a randomized, double-masked, sham-controlled, interventional trial. Forty participants were randomized (1:1) to receive either DTLT or sham laser therapy (SLT). In addition to the standard-of-care treatment, participants received either DTLT or SLT twice weekly for 4 weeks and then once weekly for 8 weeks (a 12-week intervention period). The two treatments were identical, except that laser emission was disabled during SLT. Assessments for pain, functionality, serum levels of inflammatory biomarkers, and quality of life (QOL) were performed at baseline and after the 12-week intervention period. The results from the two treatments were compared using ANOVA in a pre-test-post-test design. Results All participants randomized to the DTLT group and 85% (17 of 20) of participants randomized to the SLT group completed the trial. No significant differences in baseline characteristics between the groups were observed. After the 12-week intervention period, pain levels significantly decreased in both groups and were significantly lower in the DTLT group than in the SLT group. The Timed Up and Go test times (assessing functionality) were significantly improved in both groups and were 16% shorter in the DTLT group than in the SLT group. Serum levels of IL-6 decreased significantly in both groups. Additionally, serum levels of MCP-1 decreased significantly in the DTLT group but not in the SLT group. Patients’ quality of life improved significantly in the DTLT group but not in the SLT group. Conclusions Deep tissue laser therapy significantly reduced pain and improved the quality of life of older patients with painful diabetic peripheral neuropathy. Trial registration Clinical Trial Registry-India CTRI/2017/06/008739. [Registered on: 02/06/2017]. The trial was registered retrospectively.
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Affiliation(s)
- Prasun Chatterjee
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Achal K Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepa A Kumar
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avinash Chakrawarty
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof A Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vijay Kumar
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Aparajit B Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
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Nam JW, Lee MJ, Kim HJ. Diagnostic Efficacy of 18F-FDG PET/MRI in Peripheral Nerve Injury Models. Neurochem Res 2019; 44:2092-2102. [PMID: 31377996 DOI: 10.1007/s11064-019-02846-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/14/2019] [Accepted: 07/24/2019] [Indexed: 12/28/2022]
Abstract
The aim of this study was to evaluate the diagnostic efficacy of 18F-FDG PET/MRI in two different peripheral neuropathic pain models using the injured rat sciatic nerves. Twelve rats, with operation on left sciatic nerves, were evenly divided into three groups: sham surgery (control group), crushing injury and chronic constriction injury (CCI) (experimental groups). The nerve damage was assessed at 3 weeks postoperatively using following methods: paw withdrawal threshold values (RevWT), maximum standardized uptake values on PET/MRI images (SUVR), and counting the number of myelinated axons in proximal and distal sites of nerve injury (MAxR). The results were quantified and statistically analyzed. Compared to the control group, the crushing injury demonstrated significant differences in RevWT (p < 0.0001) and SUVR (p = 0.027) and the CCI group demonstrated significant differences in RevWT (p < 0.0001), SUVR (p = 0.001) and MAxR (p = 0.048). There were no significant differences between the two experimental groups for all assessments. Correlation analysis demonstrated that RevWT and SUVR assessments were highly correlated (r = -- 0.710, p = 0.010), and SUVR and MAxR were highly correlated (r = 0.611, p = 0.035). However, there was no significant correlation between RevWT and MAxR. The PET scan may be a valuable imaging modality to enable noninvasive, objective diagnosis of neuropathic pain caused by peripheral nerve injury. Also, MRI fused with PET may help clarify the anatomic location of soft tissue structures, including the peripheral nerves.
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Affiliation(s)
- Jung Woo Nam
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Department of Oral and Maxillofacial Surgery, Wonkwang University Sanbon Hospital, 321, Sanbon-ro, Gunpo-si, Gyeonggi-do, 15865, Republic of Korea
| | - Mi Jee Lee
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyung Jun Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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