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Kristensen FPB, Christensen DH, Callaghan BC, Nielsen JS, Højlund K, Andersen H, Dekkers OM, Groenwold RHH, Sørensen HT, Thomsen RW. Lipid Levels and Risk of Diabetic Polyneuropathy in 2 Danish Type 2 Diabetes Cohorts. Neurology 2024; 103:e209538. [PMID: 38833657 DOI: 10.1212/wnl.0000000000209538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Reduction of blood lipids may aid in preventing diabetic polyneuropathy (DPN), but evidence remains conflicting. We investigated the association between lipid parameters and DPN risk in individuals with type 2 diabetes mellitus (T2DM). METHODS We conducted a population-based cohort study of individuals with newly diagnosed T2DM and a cross-sectional study using a clinically recruited T2DM cohort. Triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and non-HDL cholesterol were measured in routine diabetes care. Each lipid parameter was categorized according to the latest cutoffs in clinical guidelines on dyslipidemia. DPN was assessed with validated hospital diagnosis codes in the population-based cohort and with the Michigan Neuropathy Screening Instrument questionnaire in the clinical cohort. We calculated hazard ratios (HRs) using Cox regression and prevalence ratios (PRs) using Poisson regression. RESULTS We included 61,853 individuals in the population-based cohort (median age 63 [quartiles 54-72] years) and 4,823 in the clinical cohort (median age 65 [quartiles 57-72] years). The incidence rate of hospital-diagnosed DPN in the population-based cohort was 3.6 per 1000 person-years during a median follow-up of 7.3 years. Achieving guideline targets for HDL, LDL, and non-HDL cholesterol showed no association with DPN risk. By contrast, adjusted HRs (95% CI) for DPN were 1.02 (0.89-1.18) for triglyceride levels between 150 and 204 mg/dL (1.7-2.3 mmol/L) and 1.28 (1.13-1.45) for levels >204 mg/dL (2.3 mmol/L). In the clinical cohort with a DPN prevalence of 18%, DPN associated strongly with triglycerides >204 mg/dL (2.3 mmol/L) with an adjusted PR (95% CI) of 1.40 (1.21-1.62). The prevalence of DPN was modestly elevated for individuals with HDL cholesterol <39 mg/dL (1.0/1.3 mmol/L) in men and <50 mg/dL (1.3 mmol/L) in women (PR 1.13 [0.99-1.28]) and for individuals with non-HDL cholesterol >131 mg/dL (3.4 mmol/L) (PR 1.27 [1.05-1.52]). In both cohorts, spline models showed an increasing risk of DPN starting from triglyceride levels >124 mg/dL (1.4 mmol/L). All results were similar among statin users. DISCUSSION High triglyceride levels are a strong DPN risk factor. Future intervention studies shall determine whether triglyceride reduction is more important for DPN prevention than reduction of other lipids.
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Affiliation(s)
- Frederik P B Kristensen
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Diana H Christensen
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Brian C Callaghan
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Jens S Nielsen
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Kurt Højlund
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Henning Andersen
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Olaf M Dekkers
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Rolf H H Groenwold
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Henrik T Sørensen
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Reimar W Thomsen
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
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Zulehner G, Schörgenhofer C, Rommer P, Merrelaar M, Behrens S, Ponleitner M, Herkner H, Staudinger T, Zauner C, Roth D, Altmann P, Kienbacher CL. Serum neurofilament light chain as an early diagnostic biomarker for critical illness polyneuropathy. Minerva Anestesiol 2023; 89:1099-1104. [PMID: 37851416 DOI: 10.23736/s0375-9393.23.17490-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Critical illness polyneuropathy (CIP) commonly occurs in critical care unit (CCU) patients, but timely diagnosis can be challenging. Therefore, new biomarkers, such as serum neurofilament light chain (sNfL), could help to improve early identification of patients with this condition. METHODS CIP was diagnosed or excluded with neurological assessment and nerve conduction measurement in a prospective study of CCU patients. sNfL and secondary predictors for neuropathy (neuron-specific enolase (NSE), S100, folic acid, and vitamin B12) were measured at admission. Cases and controls were compared regarding the predictors. RESULTS Nineteen patients met the inclusion criteria. CIP was considered definitely or most likely present in seven (37%, cases) and definitely or most likely absent in 12 individuals (63%, controls). At admission, sNfL levels were significantly higher in the cases than in the controls: 405 (IQR 77 to 835) vs. 27 (IQR 12 to 90) pg/mL; difference of medians 375, 95% confidence interval [14, 736], pg/mL; P=0.04. We found no significant differences regarding the secondary predictors at baseline. Cases had longer durations of CCU stay (median 19 (IQR 11 to 44) vs. 8 (IQR five to ten) and increased mortality (57% vs. 33% deceased) compared to controls. CONCLUSIONS Levels of serum neurofilament light chain are higher in patients who develop CIP soon after CCU admission and might be helpful in identifying those individuals early.
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Affiliation(s)
- Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Paulus Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Marieke Merrelaar
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Sybille Behrens
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Ponleitner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Staudinger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Christian Zauner
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Patrick Altmann
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Chang KH, Chen CM, Lin CN, Tsai SS, Lyu RK, Chu CC, Ro LS, Liao MF, Chang HS, Weng YC, Hwang JS, Kuo HC. Identification of blood metabolic biomarkers associated with diabetic distal symmetric sensorimotor polyneuropathy in patients with type 2 diabetes mellitus. J Peripher Nerv Syst 2023; 28:651-663. [PMID: 37831393 DOI: 10.1111/jns.12600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Distal symmetric sensorimotor polyneuropathy (DSPN) is a common neurologic complication of type 2 diabetes mellitus (T2DM), but the underlying mechanisms and changes in serum metabolites remain largely undefined. This study aimed to characterize the plasma metabolite profiles of participants with T2DM using targeted metabolomics analysis and identify potential biomarkers for DSPN. METHODS A combined liquid chromatography MS/MS and direct flow injection were used to quantify plasma metabolite obtained from 63 participants with T2DM, 81 with DSPN, and 33 nondiabetic control participants. A total of 130 metabolites, including amino acids, biogenic amines, sphingomyelins (SM), phosphatidylcholines, carnitines, and hexose, were analyzed. RESULTS A total of 16 plasma metabolites and 3 cholesterol-related laboratory parameters were found to have variable importance in the projection score >1.0 and false discovery rate <5.0% between control, T2DM, and DSPN. Among these variables, five serum metabolites, including phenylalanine (AUC = 0.653), alanine (AUC = 0.630), lysine (AUC = 0.622) tryptophan (AUC = 0.620), and SM C16:0 (AUC = 0.630), are potential biomarkers (all p < .05) in distinguishing T2DM with DSPN from those without (AUC = 0.720). CONCLUSIONS In this cross-sectional study, derangement of several metabolites in the plasma was observed in T2DM with and without DSPN, and these metabolites may be potential biomarkers for predicting DSPN. Longitudinal studies are warranted.
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Affiliation(s)
- Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chiung-Mei Chen
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chia-Ni Lin
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Sung-Sheng Tsai
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Rong-Kuo Lyu
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chun-Che Chu
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Long-Sun Ro
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Ming-Feng Liao
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Hong-Shiu Chang
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yi-Ching Weng
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Jawl-Shan Hwang
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Hung-Chou Kuo
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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Zulehner G, Seidel S, Polanz A, Schörgenhofer C, Rommer P, Merrelaar M, Roth D, Herkner H, Behrens S, Kienbacher CL. Lower serum cholesterol levels as a risk factor for critical illness polyneuropathy: a matched case-control study. Sci Rep 2023; 13:20405. [PMID: 37990042 PMCID: PMC10663605 DOI: 10.1038/s41598-023-47232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023] Open
Abstract
Critical illness polyneuropathy (CIP) is a frequent and underdiagnosed phenomenon among intensive care unit patients. The lipophilic nature of neuronal synapses may result in the association of low serum cholesterol levels with a higher rate of CIP development. We aimed to investigate this issue in critically ill patients. All cases diagnosed with CIP in our tertiary care hospital between 2013 and 2017 were 1:1 matched with controls without the condition by age, sex, and ICD diagnoses. The main risk factors examined were the differences in change between initial and minimum serum total cholesterol levels, and minimum serum total cholesterol levels between matched pairs. Other predictors were serum markers of acute inflammation. We included 67 cases and 67 controls (134 critically ill patients, 49% female, 46% medical). Serum total cholesterol levels decreased more profoundly in cases than controls (median: -74 (IQR -115 to -24) vs. -39 (IQR -82 to -4), median difference: -28, 95% CI [-51, -5]), mg/dl). Minimum serum total cholesterol levels were lower in the cases (median difference: -24, 95% CI [-39, -9], mg/dl). We found significant median differences across matched pairs in maximum serum C-reactive protein (8.9, 95% CI [4.6, 13.2], mg/dl), minimum albumin (-4.2, 95% CI [-6.7, -1.7], g/l), decrease in albumin (-3.9, 95% CI [-7.6, -0.2], g/l), and lowest cholinesterase levels (-0.72, 95% CI [-1.05, -0.39], U/l). Subsequently, more pronounced decreases in serum total cholesterol levels and lower minimum total cholesterol levels during critical care unit hospitalizations may be a risk factor for CIP.
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Affiliation(s)
- Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Seidel
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alexander Polanz
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Schörgenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Paulus Rommer
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Marieke Merrelaar
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Sybille Behrens
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Calvin Lukas Kienbacher
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Okamoto K, Nozawa H, Emoto S, Murono K, Sasaki K, Ishihara S. Does statin suppress oxaliplatin-induced peripheral neuropathy in patients with colorectal cancer? A single-center observational study. Support Care Cancer 2023; 31:660. [PMID: 37897532 PMCID: PMC10613143 DOI: 10.1007/s00520-023-08134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Oxaliplatin-induced peripheral neuropathy (OIPN) is a common and dose-limiting toxicity that markedly limits the use of oxaliplatin and affects quality of life. Statins have been shown to exert neuroprotective effects in preclinical settings. The aim of the present study was to clarify whether statins prevented OIPN in patients with colorectal cancer (CRC) receiving adjuvant CAPOX therapy. METHODS We examined 224 patients who received adjuvant CAPOX therapy for CRC between July 2010 and December 2021 at our hospital. Patients were divided into "Statin" and "Non-statin" groups based on statin use. Details on and the adverse events of adjuvant CAPOX therapy were examined in association with statin use. RESULTS Thirty-one patients (14%) were treated with statins. There were no intergroup differences in the relative dose intensity or number of CAPOX cycles between the Statin and Non-statin groups. In total, 94% of patients in the Statin group and 95% of those in the Non-statin group developed OIPN (p=0.67). The severity of OIPN was similar between the two groups (p=0.89). The frequency of treatment delays in CAPOX did not significantly differ between the Statin and Non-statin groups (16% vs. 11%, p=0.45). CONCLUSIONS The efficacy of statins to attenuate OIPN during adjuvant CAPOX therapy was not apparent in the current study. Further studies are needed to confirm the present results.
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Affiliation(s)
- Kazuaki Okamoto
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Eid SA, Rumora AE, Beirowski B, Bennett DL, Hur J, Savelieff MG, Feldman EL. New perspectives in diabetic neuropathy. Neuron 2023; 111:2623-2641. [PMID: 37263266 PMCID: PMC10525009 DOI: 10.1016/j.neuron.2023.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/20/2023] [Accepted: 05/03/2023] [Indexed: 06/03/2023]
Abstract
Diabetes prevalence continues to climb with the aging population. Type 2 diabetes (T2D), which constitutes most cases, is metabolically acquired. Diabetic peripheral neuropathy (DPN), the most common microvascular complication, is length-dependent damage to peripheral nerves. DPN pathogenesis is complex, but, at its core, it can be viewed as a state of impaired metabolism and bioenergetics failure operating against the backdrop of long peripheral nerve axons supported by glia. This unique peripheral nerve anatomy and the injury consequent to T2D underpins the distal-to-proximal symptomatology of DPN. Earlier work focused on the impact of hyperglycemia on nerve damage and bioenergetics failure, but recent evidence additionally implicates contributions from obesity and dyslipidemia. This review will cover peripheral nerve anatomy, bioenergetics, and glia-axon interactions, building the framework for understanding how hyperglycemia and dyslipidemia induce bioenergetics failure in DPN. DPN and painful DPN still lack disease-modifying therapies, and research on novel mechanism-based approaches is also covered.
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Affiliation(s)
- Stephanie A Eid
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA; NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI 48109, USA
| | - Amy E Rumora
- Department of Neurology, Columbia University, New York, NY 10032, USA
| | - Bogdan Beirowski
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - David L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford OX3 9DU, UK
| | - Junguk Hur
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, ND 58202, USA
| | - Masha G Savelieff
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, ND 58202, USA
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA; NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI 48109, USA.
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Lian X, Qi J, Yuan M, Li X, Wang M, Li G, Yang T, Zhong J. Study on risk factors of diabetic peripheral neuropathy and establishment of a prediction model by machine learning. BMC Med Inform Decis Mak 2023; 23:146. [PMID: 37533059 PMCID: PMC10394817 DOI: 10.1186/s12911-023-02232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is a common complication of diabetes. Predicting the risk of developing DPN is important for clinical decision-making and designing clinical trials. METHODS We retrospectively reviewed the data of 1278 patients with diabetes treated in two central hospitals from 2020 to 2022. The data included medical history, physical examination, and biochemical index test results. After feature selection and data balancing, the cohort was divided into training and internal validation datasets at a 7:3 ratio. Training was made in logistic regression, k-nearest neighbor, decision tree, naive bayes, random forest, and extreme gradient boosting (XGBoost) based on machine learning. The k-fold cross-validation was used for model assessment, and the accuracy, precision, recall, F1-score, and the area under the receiver operating characteristic curve (AUC) were adopted to validate the models' discrimination and clinical practicality. The SHapley Additive exPlanation (SHAP) was used to interpret the best-performing model. RESULTS The XGBoost model outperformed other models, which had an accuracy of 0·746, precision of 0·765, recall of 0·711, F1-score of 0·736, and AUC of 0·813. The SHAP results indicated that age, disease duration, glycated hemoglobin, insulin resistance index, 24-h urine protein quantification, and urine protein concentration were risk factors for DPN, while the ratio between 2-h postprandial C-peptide and fasting C-peptide(C2/C0), total cholesterol, activated partial thromboplastin time, and creatinine were protective factors. CONCLUSIONS The machine learning approach helped established a DPN risk prediction model with good performance. The model identified the factors most closely related to DPN.
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Affiliation(s)
- Xiaoyang Lian
- Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Juanzhi Qi
- School of Artificial Intelligence and Information Technology, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
| | - Mengqian Yuan
- Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Xiaojie Li
- Jiangsu Health Vocational College, Nanjing, 210036, Jiangsu, China
| | - Ming Wang
- Geriatric Hospital of Nanjing Medical University, Jiangsu Province Official Hospital, Nanjing, Jiangsu, 210036, China
| | - Gang Li
- School of Artificial Intelligence and Information Technology, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
| | - Tao Yang
- School of Artificial Intelligence and Information Technology, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China.
| | - Jingchen Zhong
- Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China.
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Rakusa M, Marolt I, Stevic Z, Rebrina SV, Milenkovic T, Stepien A. Efficacy of Pregabalin and Duloxetine in Patients with Painful Diabetic Peripheral Neuropathy (PDPN): A Multi-Centre Phase IV Clinical Trial-BLOSSOM. Pharmaceuticals (Basel) 2023; 16:1017. [PMID: 37513930 PMCID: PMC10386018 DOI: 10.3390/ph16071017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Our trial (ClinicalTrials.gov Identifier: NCT04246619) evaluates the efficacy of two generic medications, pregabalin and duloxetine, for treating pain in PDPN patients. METHODS The patients were randomised either into the pregabalin (99) or the duloxetine (102) arm. Pain was evaluated using the DN-4 questionnaire, and visual analogue scales (VASs, 0-100 mm) were used to measure the average pain intensity (API), worst pain intensity (WPI) in the last 24 h and current pain intensity (CPI). RESULTS The proportion of patients with a clinically significant improvement in the API at Week 12 was 88.3% [CI 81.7%, 94.8%] in the pregabalin arm and 86.9% [CI 76.7%, 97.1%] in the duloxetine arm. After 12 weeks, the CPI, API, and WPI decreased by -35.3 [-40.5, -30.0], -37.0 [-41.4, -32.6], and -41.6 [-46.6, -36.5] in the pregabalin arm, and by -35.0 [-39.2, -30.7], -36.9 [-41.5, -32.3], and -40.0 [-44.8, -35.2] in the duloxetine arm (all in mm, all p < 0.001). CONCLUSION Our results demonstrate that pregabalin and duloxetine are effective medications for treating pain in PDPN in more than 86% of all randomised patients.
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Affiliation(s)
- Martin Rakusa
- Division of Neurology, University Medical Centre Maribor, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Iris Marolt
- Outpatient Diabetes Clinic, Community Health Centre Koper, 6000 Koper, Slovenia
| | - Zorica Stevic
- Neuropathy Center, Neurology Clinic, Clinical Center of Serbia, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | | | - Tatjana Milenkovic
- University Clinic of Endocrinology, Diabetes and Metabolic Disorders, 1000 Skopje, North Macedonia
- Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 1000 Skopje, North Macedonia
| | - Adam Stepien
- Department of Neurology, Military Institute of Medicine-National Institute of Science, 04-052 Warsaw, Poland
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Zhang H, Chen Y, Zhu W, Niu T, Song B, Wang H, Wang W, Zhang H. The mediating role of HbA1c in the association between elevated low-density lipoprotein cholesterol levels and diabetic peripheral neuropathy in patients with type 2 diabetes mellitus. Lipids Health Dis 2023; 22:102. [PMID: 37443036 DOI: 10.1186/s12944-023-01865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Increased levels of low-density lipoprotein cholesterol (LDL-C) have been identified as one potential risk factor for diabetic peripheral neuropathy (DPN) in patients. The current study seeks to clarify the link between LDL-C, hyperglycemia, and DPN in patients with type 2 diabetes mellitus (T2DM). METHODS Here, a total of 120 T2DM individuals were recruited. These volunteers with T2DM were divided into 2 groups, based on the presence or absence of peripheral neuropathy. Additionally, their baseline characteristics were compared. Association among LDL-C and glycosylated hemoglobin (HbA1c) levels and DPN, particularly with respect to specific nerve conduction velocity were analyzed. To identify factors influencing DPN, regression was performed. Furthermore, mediation analysis was employed to evaluate the indirect, direct and total effects of LDL-C on specific nerve conduction velocity, with HbA1c serving as a mediator. RESULTS Compared to 55 patients without DPN, 65 patients with DPN demonstrated elevated levels of LDL-C and HbA1c. Both LDL-C and HbA1c have been found to be associated with reduced the motor fiber conduction velocities of Ulnar (or the Common peroneal) nerve in diabetic patients. HbA1c is one of the known risk factors for DPN in individuals with T2DM. Further mediation analysis revealed that the effect of LDL-C on the Ulnar (or the Common peroneal) nerve motor fiber conduction velocities are fully mediated by HbA1c in patients with T2DM. CONCLUSIONS The impact of elevated LDL-C levels upon the Ulnar (or the Common peroneal) nerve motor fiber conduction velocities in patients with T2DM was found to be entirely mediated by increased HbA1c levels.
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Affiliation(s)
- Hui Zhang
- Henan Key Laboratory of Rare Diseases, Endocrinology and Metabolism Center, The First Affiliated Hospital and College of Clinical Medicine of Henan of Science and Technology, Luoyang, China
| | - Yang Chen
- Department of Endocrinology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wenwen Zhu
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Tong Niu
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Bing Song
- Department of Endocrinology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Hongxiao Wang
- Department of Endocrinology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Wei Wang
- Department of Endocrinology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China.
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
| | - Haoqiang Zhang
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
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Chang KC, Pai YW, Lin CH, Lee IT, Chang MH. The association between hyperlipidemia, lipid-lowering drugs and diabetic peripheral neuropathy in patients with type 2 diabetes mellitus. PLoS One 2023; 18:e0287373. [PMID: 37319238 PMCID: PMC10270586 DOI: 10.1371/journal.pone.0287373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 06/04/2023] [Indexed: 06/17/2023] Open
Abstract
AIMS Previous studies showed conflicting relationship between hyperlipidemia, lipid-lowering therapy and diabetic peripheral neuropathy (DPN). As most of these works emerges from the Western and Australian countries, our study aims to investigate whether hyperlipidemia or lipid-lowering therapy (LLT) is associated with DPN in Taiwanese patients with type 2 diabetes (T2D). METHODS A cross-sectional, hospital-based observation study in adults with T2D was conducted from January to October 2013. DPN was screened using the Michigan Neuropathy Screening Instrument. Data were obtained at the time of enrollment, including medication usage, anthropometric measurements and laboratory examinations. RESULTS 2,448 participants were enrolled, 524 (21.4%) of whom had DPN. Patients with DPN had significantly lower plasma total cholesterol (185.6 ± 38.6 vs 193.4 ± 42.3 mg/dL) and low-density lipoprotein cholesterol levels (114.6 ± 32.7 vs 119 ± 30.8 mg/dL). Multivariate analysis demonstrated that neither hyperlipidemia (adjusted OR (aOR), 0.81; 95% confidence interval (CI), 0.49-1.34) nor LLT (aOR, 1.10; 95% CI, 0.58-2.09) was associated with DPN. Subgroup analysis revealed that neither total cholesterol (aOR, 0.72; 95% CI, 0.2-2.62), low-density lipoprotein cholesterol levels (aOR, 0.75; 95% CI, 0.2-2.79), statin (aOR, 1.09; 95% CI, 0.59-2.03) nor fibrate (aOR, 1.73; 95% CI, 0.33-1.61) was associated with DPN. CONCLUSION Our results suggest that neither hyperlipidemia nor lipid-lowering medication was associated with DPN in adults with T2D. DPN is a multifactorial disease, and our findings indicate that lipid metabolism may play a minor role in its pathogenesis.
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Affiliation(s)
- Kuo-Cheng Chang
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yen-Wei Pai
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ming-Hong Chang
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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11
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Li C, Wang W, Ji Q, Ran X, Kuang H, Yu X, Fang H, Yang J, Liu J, Xue Y, Feng B, Lei M, Zhu D. Prevalence of painful diabetic peripheral neuropathy in type 2 diabetes mellitus and diabetic peripheral neuropathy: A nationwide cross-sectional study in mainland China. Diabetes Res Clin Pract 2023; 198:110602. [PMID: 36871876 DOI: 10.1016/j.diabres.2023.110602] [Citation(s) in RCA: 2] [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: 12/14/2022] [Revised: 01/31/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
AIM The study aimed to assess the prevalence and risk factors of painful diabetic peripheral neuropathy (PDPN) in patients with type 2 diabetes mellitus (T2DM) and diabetic peripheral neuropathy (DPN) in mainland China. METHODS This nationwide cross-sectional study enrolled T2DM patients with DPN from 25 provinces in China between July 2017 and December 2017. The prevalence, characteristics, and risk factors of PDPN were analyzed. RESULTS Among 25,710 patients with T2DM and DPN, 14,699 (57.2%) had PDPN. The median age was 63 years old. Age over 40 years old, education level, hypertension, myocardial infarction, duration of diabetes of over five years, diabetic retinopathy and nephropathy, moderate total cholesterol, moderate and higher low-density lipoprotein (LDL) increased uric acid (UA) and decreased estimated glomerular filtration rate (eGFR) were independently associated with PDPN (all P < 0.05). Compared with low levels of C-peptide, moderate levels were independently associated with a higher risk of PDPN, while high levels were associated with a lower risk (all P < 0.001). CONCLUSIONS In mainland China, more than half of the patients with DPN have neuropathic pain. Patients with older age, lower education level, longer duration of diabetes, lower LDL, increased UA, decreased eGFR, and comorbidities had an increased risk of PDPN.
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Affiliation(s)
- Chenxi Li
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Weimin Wang
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Qiuhe Ji
- Xijing Hospital of PLA Air Force Medical University, Xi'an, Shanxi Province, China
| | - Xingwu Ran
- Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Hongyu Kuang
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xuefeng Yu
- Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Hui Fang
- Tangshan Gongren Hospital, TangShan, Hebei Province, China
| | - Jing Yang
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Jing Liu
- Gansu Provincial Hospital, Lanzhou, Gansu Province, China
| | - Yaoming Xue
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Bo Feng
- Department of Endocrinology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Minxiang Lei
- Department of Endocrinology, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Dalong Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.
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Lari F, Alabduljaleel T, Mojiminiyi O, Shehab D, Al-Temaimi RA. Exploring the relationship between vitamin D and leptin hormones in type 2 diabetes mellitus patients from Kuwait. Horm Mol Biol Clin Investig 2022; 43:273-280. [PMID: 35417932 DOI: 10.1515/hmbci-2021-0091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/13/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) and obesity are prevalent in Kuwait. Vitamin D (VD) deficiency and leptin resistance are risk factors for both disorders. A correlation between the two risk factors has been suggested albeit inconsistently reported. Our objective was to determine the effect and association of VD and leptin levels and their related common variants with T2DM. METHODS This case-control study included 203 Kuwaiti T2DM patients and 162 healthy Kuwaiti controls. Leptin and VD levels were measured using enzyme linked immunosorbent assays. Genotyping of LEP rs7799039, LEPR rs1137101, VDR rs2228570 and rs731236 was performed using Taqman genotyping assays. RESULTS Leptin levels were higher in T2DM patients than controls, but vitamin D levels did not differ. No correlation was found between the levels of the two hormones. VDR rs731236G associated with T2DM risk (Odds ratio 1.66, p=0.0008). VDR haplotype analysis revealed GG/AA, GA/AA or GG/AG to associate with T2DM risk (p=0.01) and increased risk of diabetic neuropathy (p=0.002). VDR rs2228570GG associated with leptin levels in T2DM (p=0.01). Effect of LEP rs7799039 on leptin (p=0.01) and VD levels (p=0.02) was only evident in healthy controls. CONCLUSIONS VDR rs731236G is associated with T2DM risk in Kuwait, and a VDR haplotype of a less active, low expressing VDR is associated with T2DM and diabetic neuropathy risk. Common variants in leptin and VD related genes appear to mediate the suggested positive correlation of both hormones however their influence is disrupted in T2DM.
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Affiliation(s)
- Fatmah Lari
- Graduate medical program, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Taiba Alabduljaleel
- Graduate medical program, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Olusegun Mojiminiyi
- Department of Clinical Pathology, Clinical chemistry unit, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Dia Shehab
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Rabeah Abbas Al-Temaimi
- Department of Clinical Pathology, Human Genetics Unit, Faculty of Medicine, Kuwait University, Safat, Kuwait
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13
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Wang CS, Pai YW, Lin CH, Lee IT, Chang MH. Renal impairment is one of appropriate predictors of future diabetic peripheral neuropathy: a hospital-based 6-year follow-up study. Sci Rep 2022; 12:5240. [PMID: 35347201 PMCID: PMC8960825 DOI: 10.1038/s41598-022-09333-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Abstract
The relationship between renal impairment and diabetic peripheral neuropathy (DPN) remains inconclusive. We aim to investigate the risk factors for the occurrence of DPN in Taiwanese adults with type 2 diabetes mellitus (T2DM) and focus on renal impairment. A hospital-based study was conducted from 2013 to 2019 and 552 Taiwanese people who had T2DM without DPN at baseline were enrolled. DPN was diagnosed using the Michigan Neuropathy Screening Instrument. Potential risk factors were recorded, including patient’s sociodemographic factors, current medication usage and biochemical markers. As of 2019, 73 developed DPN and 479 had no DPN. The cumulative incidence during the 6-year period was 13.22%. Multivariable logistic regression analysis revealed that lower estimated glomerular filtration rate (eGFR) (odds ratio [OR] 0.98, p = 0.005), advanced age (OR 1.06, p = 0.001), increased body weight (OR 1.04, p = 0.018), duration of DM (OR 1.05, p = 0.036) and male gender (OR 3.69, p = 0.011) were significantly associated with future DPN. In addition, patients with T2DM under the age of 65 with higher serum creatinine concentration (OR 8.91, p = 0.005) and higher baseline HbA1C (OR 1.71, p < 0.001) revealed significantly associated with future DPN. In conclusion, this is the first large scaled hospital-based study with long term follow-up to investigate risk factors for DPN in Taiwanese. Lower eGFR and higher serum creatinine concentration, particularly in people under the age of 65, are predictors of future DPN in Taiwanese people with T2DM. Other predictors included advanced age, increased body weight, duration of DM, male gender for all ages and HbA1c in enrolled patients under the age of 65. Our study not only confirms the association between renal impairment and future DPN but also provides a commonly available assessment to predict the future DPN.
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Affiliation(s)
- Chi-Sheng Wang
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC
| | - Yen-Wei Pai
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC.,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, No 145, XingDa Road, South Dist., Taichung, Taiwan, ROC
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC.,Department of Medicine, School of Medicine, Chung Shan Medical University, No.110, Sec. 1, Jianguo N. Road, Taichung City, 40201, Taiwan, ROC
| | - Ming-Hong Chang
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC. .,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, No 145, XingDa Road, South Dist., Taichung, Taiwan, ROC.
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14
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Zhou T, Lee A, Lo ACY, Kwok JSWJ. Diabetic Corneal Neuropathy: Pathogenic Mechanisms and Therapeutic Strategies. Front Pharmacol 2022; 13:816062. [PMID: 35281903 PMCID: PMC8905431 DOI: 10.3389/fphar.2022.816062] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/27/2022] [Indexed: 12/27/2022] Open
Abstract
Diabetes mellitus (DM) is a major global public health problem that can cause complications such as diabetic retinopathy, diabetic neuropathy, and diabetic nephropathy. Besides the reporting of reduction in corneal nerve density and decrease in corneal sensitivity in diabetic patients, there may be a subsequent result in delayed corneal wound healing and increased corneal infections. Despite being a potential cause of blindness, these corneal nerve changes have not gained enough attention. It has been proposed that corneal nerve changes may be an indicator for diabetic neuropathy, which can provide a window for early diagnosis and treatment. In this review, the authors aimed to give an overview of the relationship between corneal nerves and diabetic neuropathy as well as the underlying pathophysiological mechanisms of corneal nerve fiber changes caused by DM for improved prediction and prevention of diabetic neuropathy. In addition, the authors summarized current and novel therapeutic methods for delayed corneal wound healing, nerve protection and regeneration in the diabetic cornea.
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Affiliation(s)
- Ting Zhou
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Allie Lee
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Amy Cheuk Yin Lo
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jeremy Sze Wai John Kwok
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Alshammari NA, Alodhayani AA, Joy SS, Isnani A, Mujammami M, Alfadda AA, Siddiqui K. Evaluation of Risk Factors for Diabetic Peripheral Neuropathy Among Saudi Type 2 Diabetic Patients with Longer Duration of Diabetes. Diabetes Metab Syndr Obes 2022; 15:3007-3014. [PMID: 36200063 PMCID: PMC9527617 DOI: 10.2147/dmso.s364933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Neuropathy is the most common microvascular complications among diabetic patients. Diabetic peripheral neuropathy (DPN) is the predominant variety which may associate with increased in mortality and morbidity among type 2 diabetes mellitus (T2DM). OBJECTIVE To assess the prevalence of diabetic peripheral neuropathy and its correlation with risk factors among T2DM. METHODS This was a cross-sectional retrospective study, data was collected from a previous cohort study conducted at the University Diabetes Center, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia. The data of T2DM patients were collected from case report form, included demographic data, history of chronic diabetes neuropathy, and laboratory reports. Statistical analysis includes Student`s t test, chi square test, and Pearson correlation and logistic regression were performed. RESULTS A total of 430 patients with T2DM data was collected and analyzed, and of them 54% were females, with the mean age of 55.88 years. The prevalence of diabetic neuropathy among study participants were 40.2%, and 73.3% of them having the subtype polyneuropathy. The mean BMI; p = 0.006, FBS; p < 0.001, HbA1c; p < 0.001, cholesterol p = 0.001, LDL; p < 0.001, and triglyceride; p < 0.001 levels were a significantly higher among participants with diabetic neuropathy than without neuropathy. The male gender (Risk Ratio: 1.294, 95% CI:1.090, 1.536) p = 0.003, fasting blood glucose (Risk Ratio: 1.157, 95% CI:1.051, 1.273) p = 0.003 Cholesterol (Risk Ratio: 1.588, 95% CI:1.174, 2.147) p = 0.003, triglyceride (Risk Ratio: 1.290, 95% CI:1.086, 1.538), p = 0.004, and LDL (Risk Ratio: 1.299, 95% CI:1.073, 1.574), p = 0.007) were found to be significant risk factors for DPN. CONCLUSION DPN is highly prevalent among T2DM patients in Saudi Arabia. Poor glycemic control and hyperlipidemia were associated with significantly higher risk for DPN patients among T2DM.
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Affiliation(s)
- Nawaf A Alshammari
- University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- King Salman Specialist Hospital, Diabetes and Endocrine Center, Hail Health Cluster, Hail, Hail Region, Saudi Arabia
| | - Abdulaziz A Alodhayani
- Department of Family and Community Medicine College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salini S Joy
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Arthur Isnani
- Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Mujammami
- University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, College of Medicine, and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Assim A Alfadda
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, College of Medicine, and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Siddiqui
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Correspondence: Khalid Siddiqui, Strategic Center for Diabetes Research, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Saudi Arabia, Email
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Jende JME, Mooshage C, Kender Z, Schimpfle L, Juerchott A, Nawroth P, Heiland S, Bendszus M, Kopf S, Kurz FT. Troponin T Is Negatively Associated With 3 Tesla Magnetic Resonance Peripheral Nerve Perfusion in Type 2 Diabetes. Front Endocrinol (Lausanne) 2022; 13:839774. [PMID: 35620394 PMCID: PMC9127234 DOI: 10.3389/fendo.2022.839774] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The pathogenesis of diabetic polyneuropathy (DN) is poorly understood and given the increasing prevalence of DN, there is a need for clinical or imaging biomarkers that quantify structural and functional nerve damage. While clinical studies have found evidence of an association between elevated levels of troponin T (hsTNT) and N-terminal pro brain natriuretic peptide (proBNP) with microvascular compromise in type 2 diabetes (T2D), their implication in mirroring DN nerve perfusion changes remains unclear. The objective of this study was, therefore, to investigate whether hsTNT and proBNP assays are associated with MRI nerve perfusion in T2D. METHODS In this prospective cross-sectional single-center case-control study, 56 participants (44 with T2D, 12 healthy control subjects) consented to undergo magnetic resonance neurography (MRN) including dynamic contrast-enhanced (DCE) perfusion imaging of the right leg. Using the extended Tofts model, primary outcome parameters that were quantified are the sciatic nerve's microvascular permeability (Ktrans), the extravascular extracellular volume fraction (ve), and the plasma volume fraction (vp), as well as hsTNT and proBNP values from serological workup. Further secondary outcomes were clinical, serological, and electrophysiological findings. RESULTS In T2D patients, hsTNT was negatively correlated with Ktrans (r=-0.38; p=0.012) and ve (r=-0.30; p=0.048) but not with vp (r=-0.16; p=0.294). HsTNT, Ktrans, and ve were correlated with peroneal nerve conduction velocities (NCVs; r=-0.44; p=0.006, r=0.42; p=0.008, r=0.39; p=0.014), and tibial NCVs (r=-0.38;p=0.022, r=0.33; p=0.048, r=0.37; p=0.025). No such correlations were found for proBNP. CONCLUSIONS This study is the first to find that hsTNT is correlated with a decrease of microvascular permeability and a reduced extravascular extracellular volume fraction of nerves in patients with T2D. The results indicate that hsTNT may serve as a potential marker for the assessment of nerve perfusion in future studies on DN.
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Affiliation(s)
- Johann M. E. Jende
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Mooshage
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Zoltan Kender
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) Heidelberg University Hospital, Heidelberg, Germany
| | - Lukas Schimpfle
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heiland
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research, Associated Partner in the Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - Felix T. Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Research Center, Division of Radiology, Heidelberg, Germany
- *Correspondence: Felix T. Kurz,
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Tran PMH, Kim E, Tran LKH, Khaled BS, Hopkins D, Gardiner M, Bryant J, Bernard R, Morgan J, Bode B, Reed JC, She JX, Purohit S. T1DMicro: A Clinical Risk Calculator for Type 1 Diabetes Related Microvascular Complications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111094. [PMID: 34769614 PMCID: PMC8583376 DOI: 10.3390/ijerph182111094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/04/2021] [Accepted: 10/15/2021] [Indexed: 01/11/2023]
Abstract
Development of complications in type 1 diabetes patients can be reduced by modifying risk factors. We used a cross-sectional cohort of 1646 patients diagnosed with type 1 diabetes (T1D) to develop a clinical risk score for diabetic peripheral neuropathy (DPN), autonomic neuropathy (AN), retinopathy (DR), and nephropathy (DN). Of these patients, 199 (12.1%) had DPN, 63 (3.8%) had AN, 244 (14.9%) had DR, and 88 (5.4%) had DN. We selected five variables to include in each of the four microvascular complications risk models: age, age of T1D diagnosis, duration of T1D, and average systolic blood pressure and HbA1C over the last three clinic visits. These variables were selected for their strong evidence of association with diabetic complications in the literature and because they are modifiable risk factors. We found the optimism-corrected R2 and Harrell’s C statistic were 0.39 and 0.87 for DPN, 0.24 and 0.86 for AN, 0.49 and 0.91 for DR, and 0.22 and 0.83 for DN, respectively. This tool was built to help inform patients of their current risk of microvascular complications and to motivate patients to control their HbA1c and systolic blood pressure in order to reduce their risk of these complications.
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Affiliation(s)
- Paul Minh Huy Tran
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - Eileen Kim
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - Lynn Kim Hoang Tran
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - Bin Satter Khaled
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - Diane Hopkins
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - Melissa Gardiner
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - Jennifer Bryant
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - Risa Bernard
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - John Morgan
- Department of Neurology, Medical College of Georgia, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA;
| | - Bruce Bode
- Atlanta Diabetes Associates, Atlanta, GA 30318, USA;
| | - John Chip Reed
- Southeastern Endocrine and Diabetes, Atlanta, GA 30076, USA;
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
- Department of Obstetrics and Gynecology, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA
| | - Sharad Purohit
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
- Department of Obstetrics and Gynecology, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA
- Department of Undergraduate Health Professionals, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA
- Correspondence:
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18
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Kollmer J, Bendszus M. Magnetic Resonance Neurography: Improved Diagnosis of Peripheral Neuropathies. Neurotherapeutics 2021; 18:2368-2383. [PMID: 34859380 PMCID: PMC8804110 DOI: 10.1007/s13311-021-01166-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 12/15/2022] Open
Abstract
Peripheral neuropathies account for the most frequent disorders seen by neurologists, and causes are manifold. The traditional diagnostic gold-standard consists of clinical neurologic examinations supplemented by nerve conduction studies. Due to well-known limitations of standard diagnostics and atypical clinical presentations, establishing the correct diagnosis can be challenging but is critical for appropriate therapies. Magnetic resonance neurography (MRN) is a relatively novel technique that was developed for the high-resolution imaging of the peripheral nervous system. In focal neuropathies, whether traumatic or due to nerve entrapment, MRN has improved the diagnostic accuracy by directly visualizing underlying nerve lesions and providing information on the exact lesion localization, extension, and spatial distribution, thereby assisting surgical planning. Notably, the differentiation between distally located, complete cross-sectional nerve lesions, and more proximally located lesions involving only certain fascicles within a nerve can hold difficulties that MRN can overcome, when basic technical requirements to achieve sufficient spatial resolution are implemented. Typical MRN-specific pitfalls are essential to understand in order to prevent overdiagnosing neuropathies. Heavily T2-weighted sequences with fat saturation are the most established sequences for MRN. Newer techniques, such as T2-relaxometry, magnetization transfer contrast imaging, and diffusion tensor imaging, allow the quantification of nerve lesions and have become increasingly important, especially when evaluating diffuse, non-focal neuropathies. Innovative studies in hereditary, metabolic or inflammatory polyneuropathies, and motor neuron diseases have contributed to a better understanding of the underlying pathomechanism. New imaging biomarkers might be used for an earlier diagnosis and monitoring of structural nerve injury under causative treatments in the future.
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Affiliation(s)
- Jennifer Kollmer
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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19
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Evans MC, Wade C, Hohenschurz-Schmidt D, Lally P, Ugwudike A, Shah K, Bangerter N, Sharp DJ, Rice ASC. Magnetic Resonance Imaging as a Biomarker in Diabetic and HIV-Associated Peripheral Neuropathy: A Systematic Review-Based Narrative. Front Neurosci 2021; 15:727311. [PMID: 34621152 PMCID: PMC8490874 DOI: 10.3389/fnins.2021.727311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/17/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Peripheral neuropathy can be caused by diabetes mellitus and HIV infection, and often leaves patients with treatment-resistant neuropathic pain. To better treat this condition, we need greater understanding of the pathogenesis, as well as objective biomarkers to predict treatment response. Magnetic resonance imaging (MRI) has a firm place as a biomarker for diseases of the central nervous system (CNS), but until recently has had little role for disease of the peripheral nervous system. Objectives: To review the current state-of-the-art of peripheral nerve MRI in diabetic and HIV symmetrical polyneuropathy. We used systematic literature search methods to identify all studies currently published, using this as a basis for a narrative review to discuss major findings in the literature. We also assessed risk of bias, as well as technical aspects of MRI and statistical analysis. Methods: Protocol was pre-registered on NIHR PROSPERO database. MEDLINE, Web of Science and EMBASE databases were searched from 1946 to 15th August 2020 for all studies investigating either diabetic or HIV neuropathy and MRI, focusing exclusively on studies investigating symmetrical polyneuropathy. The NIH quality assessment tool for observational and cross-sectional cohort studies was used for risk of bias assessment. Results: The search resulted in 18 papers eligible for review, 18 for diabetic neuropathy and 0 for HIV neuropathy. Risk of bias assessment demonstrated that studies generally lacked explicit sample size justifications, and some may be underpowered. Whilst most studies made efforts to balance groups for confounding variables (age, gender, BMI, disease duration), there was lack of consistency between studies. Overall, the literature provides convincing evidence that DPN is associated with larger nerve cross sectional area, T2-weighted hyperintense and hypointense lesions, evidence of nerve oedema on Dixon imaging, decreased fractional anisotropy and increased apparent diffusion coefficient compared with controls. Analysis to date is largely restricted to the sciatic nerve or its branches. Conclusions: There is emerging evidence that various structural MR metrics may be useful as biomarkers in diabetic polyneuropathy, and areas for future direction are discussed. Expanding this technique to other forms of peripheral neuropathy, including HIV neuropathy, would be of value. Systematic Review Registration: (identifier: CRD 42020167322) https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167322.
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Affiliation(s)
- Matthew C. Evans
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Brain Sciences, Care Research and Technology Centre, UK Dementia Research Institute, London, United Kingdom
| | - Charles Wade
- Department of Brain Sciences, Care Research and Technology Centre, UK Dementia Research Institute, London, United Kingdom
| | - David Hohenschurz-Schmidt
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Pete Lally
- Department of Brain Sciences, Care Research and Technology Centre, UK Dementia Research Institute, London, United Kingdom
- Royal School of Mines, Imperial College London, London, United Kingdom
| | - Albert Ugwudike
- Royal School of Mines, Imperial College London, London, United Kingdom
| | - Kamal Shah
- Royal School of Mines, Imperial College London, London, United Kingdom
| | - Neal Bangerter
- Royal School of Mines, Imperial College London, London, United Kingdom
| | - David J. Sharp
- Department of Brain Sciences, Care Research and Technology Centre, UK Dementia Research Institute, London, United Kingdom
| | - Andrew S. C. Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
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20
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Abstract
PURPOSE OF REVIEW Hyperlipidaemia is associated with the development of neuropathy. Indeed, a mechanistic link between altered lipid metabolism and peripheral nerve dysfunction has been demonstrated in a number of experimental and clinical studies. Furthermore, post hoc analyses of clinical trials of cholesterol and triglyceride-lowering pharmacotherapy have shown reduced rates of progression of diabetic neuropathy. Given, there are currently no FDA approved disease-modifying therapies for diabetic neuropathy, modulation of lipids may represent a key therapeutic target for the treatment of diabetic nerve damage. This review summarizes the current evidence base on the role of hyperlipidaemia and lipid lowering therapy on the development and progression of peripheral neuropathy. RECENT FINDINGS A body of literature supports a detrimental effect of dyslipidaemia on nerve fibres resulting in somatic and autonomic neuropathy. The case for an important modulating role of hypertriglyceridemia is stronger than for low-density lipoprotein cholesterol (LDL-C) in relation to peripheral neuropathy. This is reflected in the outcomes of clinical trials with the different therapeutic agents targeting hyperlipidaemia reporting beneficial or neutral effects with statins and fibrates. The potential concern with the association between proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor therapy and cognitive decline raised the possibility that extreme LDL-C lowering may result in neurodegeneration. However, studies in murine models and data from small observational studies indicate an association between increased circulating PCSK9 levels and small nerve fibre damage with a protective effect of PCSK9i therapy against small fibre neuropathy. Additionally, weight loss with bariatric surgery leads to an improvement in peripheral neuropathy and regeneration of small nerve fibres measured with corneal confocal microscopy in people with obesity with or without type 2 diabetes. These improvements correlate inversely with changes in triglyceride levels. SUMMARY Hyperlipidaemia, particularly hypertriglyceridemia, is associated with the development and progression of neuropathy. Lipid modifying agents may represent a potential therapeutic option for peripheral neuropathy. Post hoc analyses indicate that lipid-lowering therapies may halt the progression of neuropathy or even lead to regeneration of nerve fibres. Well designed randomized controlled trials are needed to establish if intensive targeted lipid lowering therapy as a part of holistic metabolic control leads to nerve fibre regeneration and improvement in neuropathy symptoms.
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Affiliation(s)
- Zohaib Iqbal
- Faculty of Biology, Medicine and Health, University of Manchester
- Department of Endocrinology, Diabetes and Metabolism, Peter Mount Building, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Bilal Bashir
- Department of Endocrinology, Diabetes and Metabolism, Peter Mount Building, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Maryam Ferdousi
- Faculty of Biology, Medicine and Health, University of Manchester
- Department of Endocrinology, Diabetes and Metabolism, Peter Mount Building, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Alise Kalteniece
- Faculty of Biology, Medicine and Health, University of Manchester
| | - Uazman Alam
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Rayaz A Malik
- Faculty of Biology, Medicine and Health, University of Manchester
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Handrean Soran
- Faculty of Biology, Medicine and Health, University of Manchester
- Department of Endocrinology, Diabetes and Metabolism, Peter Mount Building, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Weill-Cornell Medicine-Qatar, Doha, Qatar
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21
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Jende JME, Kender Z, Mooshage C, Groener JB, Alvarez-Ramos L, Kollmer J, Juerchott A, Hahn A, Heiland S, Nawroth P, Bendszus M, Kopf S, Kurz FT. Diffusion Tensor Imaging of the Sciatic Nerve as a Surrogate Marker for Nerve Functionality of the Upper and Lower Limb in Patients With Diabetes and Prediabetes. Front Neurosci 2021; 15:642589. [PMID: 33746707 PMCID: PMC7966816 DOI: 10.3389/fnins.2021.642589] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/10/2021] [Indexed: 12/23/2022] Open
Abstract
Background Nerve damage in diabetic neuropathy (DN) is assumed to begin in the distal legs with a subsequent progression to hands and arms at later stages. In contrast, recent studies have found that lower limb nerve lesions in DN predominate at the proximal sciatic nerve and that, in the upper limb, nerve functions can be impaired at early stages of DN. Materials and Methods In this prospective, single-center cross-sectional study, participants underwent diffusion-weighted 3 Tesla magnetic resonance neurography in order to calculate the sciatic nerve’s fractional anisotropy (FA), a surrogate parameter for structural nerve integrity. Results were correlated with clinical and electrophysiological assessments of the lower limb and an examination of hand function derived from the Purdue Pegboard Test. Results Overall, 71 patients with diabetes, 11 patients with prediabetes and 25 age-matched control subjects took part in this study. In patients with diabetes, the sciatic nerve’s FA showed positive correlations with tibial and peroneal nerve conduction velocities (r = 0.62; p < 0.001 and r = 0.56; p < 0.001, respectively), and tibial and peroneal nerve compound motor action potentials (r = 0.62; p < 0.001 and r = 0.63; p < 0.001, respectively). Moreover, the sciatic nerve’s FA was correlated with the Pegboard Test results in patients with diabetes (r = 0.52; p < 0.001), prediabetes (r = 0.76; p < 0.001) and in controls (r = 0.79; p = 0.007). Conclusion This study is the first to show that the sciatic nerve’s FA is a surrogate marker for functional and electrophysiological parameters of both upper and lower limbs in patients with diabetes and prediabetes, suggesting that nerve damage in these patients is not restricted to the level of the symptomatic limbs but rather affects the entire peripheral nervous system.
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Affiliation(s)
- Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Zoltan Kender
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Mooshage
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan B Groener
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany.,Medicover Neuroendocrinology, Munich, Germany.,German Center of Diabetes Research (DZD), Associated Partner in the DZD, München-Neuherberg, Germany
| | - Lucia Alvarez-Ramos
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Jennifer Kollmer
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Artur Hahn
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Experimental Radiology, Department of Neuroradiology, Heidelberg, Germany
| | - Peter Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research (DZD), Associated Partner in the DZD, München-Neuherberg, Germany.,Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research (DZD), Associated Partner in the DZD, München-Neuherberg, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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Nagpal AS, Leet J, Egan K, Garza R. Diabetic Neuropathy: a Critical, Narrative Review of Published Data from 2019. Curr Pain Headache Rep 2021; 25:15. [PMID: 33630186 DOI: 10.1007/s11916-020-00928-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW This manuscript is a systematic, narrative review that compiles and describes all data available from 2019 related to epidemiologic, diagnostic, and therapeutic advances in diabetic neuropathy (DN). RECENT FINDINGS Epidemiology of DN is discussed. Diagnostic modalities include predictive models, electrodiagnostics, imaging, and biomarkers. A majority of studies on the treatment of diabetic peripheral neuropathy (DPN) involve pharmacotherapy, but complementary and alternative medicine, exercise, modalities, psychological, interventional, and surgical options are also explored. DN is a highly prevalent and debilitating consequence of diabetes that can present challenges to the clinician as the assessment is largely subjective with different phenotypic presentations among patients. Treatment of DN is largely symptomatic as the pathogenesis of DN is not fully understood and is likely multifactorial. It is evident from the broad range of treatments that too often provide unsatisfactory relief that there is no consensus about a single most effective treatment for DN, and monotherapy rarely proves to be successful.
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Affiliation(s)
- Ameet S Nagpal
- Department of Anesthesiology, Joe R. & Thereza Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA.
| | - Jennifer Leet
- Department of Rehabilitation Medicine, Joe R. & Theresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Kaitlyn Egan
- Department of Rehabilitation Medicine, Joe R. & Theresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Rudy Garza
- Department of Anesthesiology, Joe R. & Thereza Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
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23
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A systematic review and meta-analysis of the serum lipid profile in prediction of diabetic neuropathy. Sci Rep 2021; 11:499. [PMID: 33436718 PMCID: PMC7804465 DOI: 10.1038/s41598-020-79276-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/04/2020] [Indexed: 12/19/2022] Open
Abstract
Whether the lipid profile in diabetic patients is associated with diabetic neuropathy (DN) development remains ambiguous, as does the predictive value of serum lipid levels in the risk of DN. Here, we performed the first meta-analysis designed to investigate the relationship between DN and the serum levels of triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), and low-density lipoprotein cholesterol (LDL). Candidate studies were comprehensively identified by searching PubMed, Embase, Cochrane Library and Web of Science databases up to May 2020. Observational methodological meta-analysis was conducted to assess the relationships of TG, TC, HDL, and LDL levels with DN. Changes in blood lipids were used to estimate the effect size. The results were pooled using a random-effects or fixed-effects model. Potential sources of heterogeneity were explored by subgroup analysis. Various outcomes were included, and statistical analyses were performed using STATA (Version 12.0). Mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. The Newcastle–Ottawa Scale (NOS) was applied to assess the methodological quality. I2 statistics were calculated to evaluate statistical heterogeneity. Funnel plots were utilized to test for publication bias. A sensitivity analysis was performed by omitting each study one by one. Thirty-nine clinical trials containing 32,668 patients were included in the meta-analysis. The results demonstrated that DN patients showed higher TG and lower HDL levels (MD = 0.34, 95% CI: 0.20–0.48 for TG; MD = -0.05, 95% CI: -0.08–-0.02, I2 = 81.3% for HDL) than controls. Subgroup analysis showed that patients with type 1 diabetes mellitus (T1DM) neuropathy had elevated TG levels in their serum (MD = 0.25, 95% CI: 0.16–0.35,I2 = 64.4% for T1DM). However, only patients with T1DM neuropathy had reduced serum HDL levels, and there was no significant difference in serum HDL levels between patients with T2DM neuropathy and controls (MD = -0.07, 95% CI: -0.10–-0.03, I2 = 12.4% for T1DM; MD = -0.02, 95% CI: -0.07–0.03, I2 = 80.2% for T2DM). TC and LDL levels were not significantly different between DN patients and controls (MD = -0.03, 95% CI: -0.14–0.09, I2 = 82.9% for TC; MD = -0.00, 95% CI: -0.08–0.08, I2 = 78.9% for LDL). In addition, compared with mild or painless DN patients, those with moderate or severe pain DN pain had significantly reduced serum TC and LDL levels (MD = -0.31, 95% CI: -0.49–-0.13, I2 = 0% for TC; MD = -0.19, 95% CI: -0.32–-0.08, I2 = 0% for LDL). TG levels and HDL levels did not vary considerably between patients with mild or painless DN and those with moderate or severe DN pain patients (MD = 0.12, 95% CI: -0.28–0.51, I2 = 83.2% for TG; MD = -0.07, 95% CI:-0.14–0.01, I2 = 58.8% for HDL). Furthermore, people with higher TG and LDL levels had higher risk of DN (OR = 1.36, 95% CI: 1.20–1.54, I2 = 86.1% for TG and OR = 1.10, 95% CI: 1.02–1.19, I2 = 17.8% for LDL). Conversely, high serum HDL levels reduced the risk of DN (OR = 0.85, 95% CI: 0.75–0.96, I2 = 72.6%), while TC levels made no significant difference with the risk of DN (OR = 1.02, 95% CI: 1.00–1.04, I2 = 84.7%). This meta-analysis indicated that serum lipid profile changes are among the biological characteristics of DN. Lipid levels should be explored as routine laboratory markers for predicting the risk of DN, as they will help clinicians choose appropriate therapies, and thus optimize the use of available resources.
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Kristensen FP, Christensen DH, Callaghan BC, Kahlert J, Knudsen ST, Sindrup SH, Feldman EL, Østergaard L, Andersen H, Jensen TS, Sørensen HT, Thomsen RW. Statin Therapy and Risk of Polyneuropathy in Type 2 Diabetes: A Danish Cohort Study. Diabetes Care 2020; 43:2945-2952. [PMID: 32998990 DOI: 10.2337/dc20-1004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/02/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Statins may reduce the risk of diabetic polyneuropathy (DPN) as a result of lipid-lowering and anti-inflammatory effects, but statins have also been associated with neurotoxicity. We examined whether statin therapy affects the risk of DPN. RESEARCH DESIGN AND METHODS We identified all Danish patients with incident type 2 diabetes during 2002-2016. New users initiated statins between 180 days before and 180 days after their first diabetes record, while prevalent users had initiated statins before that period. Patients were followed for incident DPN using validated hospital diagnosis codes, starting 180 days after their first diabetes record. Cox proportional hazard analysis was used to compute adjusted hazard ratios (aHRs) for DPN. RESULTS The study cohort comprised 59,255 (23%) new users, 75,528 (29%) prevalent users, and 124,842 (48%) nonusers; median follow-up time was 6.2 years (interquartile range 3.4-9.6). The incidence rate of DPN events per 1,000 person-years was similar in new users (4.0 [95% CI 3.8-4.2]), prevalent users (3.8 [3.6-3.9]), and nonusers (3.8 [3.7-4.0]). The aHR for DPN was 1.05 (0.98-1.11) in new users and 0.97 (0.91-1.04) in prevalent users compared with statin nonusers. New users had a slightly increased DPN risk during the first year (1.31 [1.12-1.53]), which vanished after >2 years of follow-up. Findings were similar in on-treatment and propensity score-matched analyses and with additional adjustment for pretreatment blood lipid levels. CONCLUSIONS Statin therapy is unlikely to increase or mitigate DPN risk in patients with type 2 diabetes, although a small acute risk of harm cannot be excluded.
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Affiliation(s)
- Frederik P Kristensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark .,The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Diana H Christensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Brian C Callaghan
- The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Søren T Knudsen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Søren H Sindrup
- The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Eva L Feldman
- The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Leif Østergaard
- The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Andersen
- The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Neurology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Troels S Jensen
- The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Neurology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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25
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Jende JME, Kender Z, Rother C, Alvarez-Ramos L, Groener JB, Pham M, Morgenstern J, Oikonomou D, Hahn A, Juerchott A, Kollmer J, Heiland S, Kopf S, Nawroth PP, Bendszus M, Kurz FT. Diabetic Polyneuropathy Is Associated With Pathomorphological Changes in Human Dorsal Root Ganglia: A Study Using 3T MR Neurography. Front Neurosci 2020; 14:570744. [PMID: 33100960 PMCID: PMC7546893 DOI: 10.3389/fnins.2020.570744] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/24/2020] [Indexed: 12/20/2022] Open
Abstract
Diabetic neuropathy (DPN) is one of the most severe and yet most poorly understood complications of diabetes mellitus. In vivo imaging of dorsal root ganglia (DRG), a key structure for the understanding of DPN, has been restricted to animal studies. These have shown a correlation of decreased DRG volume with neuropathic symptom severity. Our objective was to investigate correlations of DRG morphology and signal characteristics at 3 Tesla (3T) magnetic resonance neurography (MRN) with clinical and serological data in diabetic patients with and without DPN. In this cross-sectional study, participants underwent 3T MRN of both L5 DRG using an isotropic 3D T2-weighted, fat-suppressed sequence with subsequent segmentation of DRG volume and analysis of normalized signal properties. Overall, 55 diabetes patients (66 ± 9 years; 32 men; 30 with DPN) took part in this study. DRG volume was smaller in patients with severe DPN when compared to patients with mild or moderate DPN (134.7 ± 21.86 vs 170.1 ± 49.22; p = 0.040). In DPN patients, DRG volume was negatively correlated with the neuropathy disability score (r = −0.43; 95%CI = −0.66 to −0.14; p = 0.02), a measure of neuropathy severity. DRG volume showed negative correlations with triglycerides (r = −0.40; 95%CI = −0.57 to −0.19; p = 0.006), and LDL cholesterol (r = −0.33; 95%CI = −0.51 to −0.11; p = 0.04). There was a strong positive correlation of normalized MR signal intensity (SI) with the neuropathy symptom score in the subgroup of patients with painful DPN (r = 0.80; 95%CI = 0.46 to 0.93; p = 0.005). DRG SI was positively correlated with HbA1c levels (r = 0.30; 95%CI = 0.09 to 0.50; p = 0.03) and the triglyceride/HDL ratio (r = 0.40; 95%CI = 0.19 to 0.57; p = 0.007). In this first in vivo study, we found DRG morphological degeneration and signal increase in correlation with neuropathy severity. This elucidates the potential importance of MR-based DRG assessments in studying structural and functional changes in DPN.
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Affiliation(s)
- Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Zoltan Kender
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Rother
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Lucia Alvarez-Ramos
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
| | - Jan B Groener
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research, München-Neuherberg, Germany.,Medicover Neuroendokrinologie, Munich, Germany
| | - Mirko Pham
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
| | - Jakob Morgenstern
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
| | - Dimitrios Oikonomou
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
| | - Artur Hahn
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jennifer Kollmer
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research, München-Neuherberg, Germany
| | - Peter P Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research, München-Neuherberg, Germany.,Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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26
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Coppini DV. Diabetic neuropathy: are we still barking up the wrong tree and is change finally in sight? Diabetologia 2020; 63:1949-1950. [PMID: 32681387 PMCID: PMC7366434 DOI: 10.1007/s00125-020-05231-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/22/2022]
Affiliation(s)
- David V Coppini
- Mater Dei Hospital, Dun Karm Street, L-Imsida, MSD2090, Malta.
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27
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Christensen DH, Knudsen ST, Gylfadottir SS, Christensen LB, Nielsen JS, Beck-Nielsen H, Sørensen HT, Andersen H, Callaghan BC, Feldman EL, Finnerup NB, Jensen TS, Thomsen RW. Metabolic Factors, Lifestyle Habits, and Possible Polyneuropathy in Early Type 2 Diabetes: A Nationwide Study of 5,249 Patients in the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) Cohort. Diabetes Care 2020; 43:1266-1275. [PMID: 32295810 DOI: 10.2337/dc19-2277] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/17/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the association of metabolic and lifestyle factors with possible diabetic polyneuropathy (DPN) and neuropathic pain in patients with early type 2 diabetes. RESEARCH DESIGN AND METHODS We thoroughly characterized 6,726 patients with recently diagnosed diabetes. After a median of 2.8 years, we sent a detailed questionnaire on neuropathy, including the Michigan Neuropathy Screening Instrument questionnaire (MNSIq), to identify possible DPN (score ≥4) and the Douleur Neuropathique en 4 Questions (DN4) questionnaire for possible associated neuropathic pain (MNSIq ≥4 + pain in both feet + DN4 score ≥3). RESULTS Among 5,249 patients with data on both DPN and pain, 17.9% (n = 938) had possible DPN, including 7.4% (n = 386) with possible neuropathic pain. In regression analyses, central obesity (waist circumference, waist-to-hip ratio, and waist-to-height ratio) was markedly associated with DPN. Other important metabolic factors associated with DPN included hypertriglyceridemia ≥1.7 mmol/L, adjusted prevalence ratio (aPR) 1.36 (95% CI 1.17; 1.59); decreased HDL cholesterol <1.0/1.2 mmol/L (male/female), aPR 1.35 (95% CI 1.12; 1.62); hs-CRP ≥3.0 mg/L, aPR 1.66 (95% CI 1.42; 1.94); C-peptide ≥1,550 pmol/L, aPR 1.72 (95% CI 1.43; 2.07); HbA1c ≥78 mmol/mol, aPR 1.42 (95% CI 1.06; 1.88); and antihypertensive drug use, aPR 1.34 (95% CI 1.16; 1.55). Smoking, aPR 1.50 (95% CI 1.24; 1.81), and lack of physical activity (0 vs. ≥3 days/week), aPR 1.61 (95% CI 1.39; 1.85), were also associated with DPN. Smoking, high alcohol intake, and failure to increase activity after diabetes diagnosis associated with neuropathic pain. CONCLUSIONS Possible DPN was associated with metabolic syndrome factors, insulin resistance, inflammation, and modifiable lifestyle habits in early type 2 diabetes.
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Affiliation(s)
- Diana H Christensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark .,International Diabetic Neuropathy Consortium (IDNC), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren T Knudsen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Sandra S Gylfadottir
- International Diabetic Neuropathy Consortium (IDNC), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Lotte B Christensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens S Nielsen
- Danish Center for Strategic Research in Type 2 Diabetes, Steno Diabetes Center Odense, Odense, Denmark
| | - Henning Beck-Nielsen
- Danish Center for Strategic Research in Type 2 Diabetes, Steno Diabetes Center Odense, Odense, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Andersen
- International Diabetic Neuropathy Consortium (IDNC), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Brian C Callaghan
- International Diabetic Neuropathy Consortium (IDNC), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Eva L Feldman
- International Diabetic Neuropathy Consortium (IDNC), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Nanna B Finnerup
- International Diabetic Neuropathy Consortium (IDNC), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Troels S Jensen
- International Diabetic Neuropathy Consortium (IDNC), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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28
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Pergolizzi JV, Magnusson P, LeQuang JA, Razmi R, Zampogna G, Taylor R. Statins and Neuropathic Pain: A Narrative Review. Pain Ther 2020; 9:97-111. [PMID: 32020545 PMCID: PMC7203325 DOI: 10.1007/s40122-020-00153-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Indexed: 12/11/2022] Open
Abstract
The frequently prescribed drug class of statins have pleiotropic effects and have been implicated in neuropathic pain syndromes. This narrative review examines studies of statin-induced neuropathic pain which to date have been conducted only in animal models. However, the pathophysiology of diabetic neuropathy in humans may shed some light on the etiology of neuropathic pain. Statins have exhibited a paradoxical effect in that statins appear to reduce neuropathic pain in animals but have been associated with neuropathic pain in humans. While there are certain postulated mechanisms offering elucidation as to how statins might be associated with neuropathic pain, there is, as the American Heart Association stated, to date no definitive association between statins and neuropathic pain. Statins are important drugs that reduce cardiovascular risk factors and should be prescribed to appropriate patients with these risk factors but some of this population is also at elevated risk for neuropathic pain from other causes.
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Affiliation(s)
| | - Peter Magnusson
- Cardiology Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden
| | | | - Robin Razmi
- Department of Infectious Disease, Region Gävleborg/Uppsala University, Gävle, Sweden
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29
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Jende JME, Groener JB, Kender Z, Hahn A, Morgenstern J, Heiland S, Nawroth PP, Bendszus M, Kopf S, Kurz FT. Troponin T Parallels Structural Nerve Damage in Type 2 Diabetes: A Cross-sectional Study Using Magnetic Resonance Neurography. Diabetes 2020; 69:713-723. [PMID: 31974140 DOI: 10.2337/db19-1094] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/11/2020] [Indexed: 11/13/2022]
Abstract
Clinical studies have suggested that changes in peripheral nerve microcirculation may contribute to nerve damage in diabetic polyneuropathy (DN). High-sensitivity troponin T (hsTNT) assays have been recently shown to provide predictive values for both cardiac and peripheral microangiopathy in type 2 diabetes (T2D). This study investigated the association of sciatic nerve structural damage in 3 Tesla (3T) magnetic resonance neurography (MRN) with hsTNT and N-terminal pro-brain natriuretic peptide serum levels in patients with T2D. MRN at 3T was performed in 51 patients with T2D (23 without DN, 28 with DN) and 10 control subjects without diabetes. The sciatic nerve's fractional anisotropy (FA), a marker of structural nerve integrity, was correlated with clinical, electrophysiological, and serological data. In patients with T2D, hsTNT showed a negative correlation with the sciatic nerve's FA (r = -0.52, P < 0.001), with a closer correlation in DN patients (r = -0.66, P < 0.001). hsTNT further correlated positively with the neuropathy disability score (r = 0.39, P = 0.005). Negative correlations were found with sural nerve conduction velocities (NCVs) (r = -0.65, P < 0.001) and tibial NCVs (r = -0.44, P = 0.002) and amplitudes (r = -0.53, P < 0.001). This study is the first to show that hsTNT is a potential indicator for structural nerve damage in T2D. Our results indirectly support the hypothesis that microangiopathy contributes to structural nerve damage in T2D.
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Affiliation(s)
- Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan B Groener
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research (DZD), Neuherberg, Germany
| | - Zoltan Kender
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
| | - Artur Hahn
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jakob Morgenstern
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter P Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research (DZD), Neuherberg, Germany
- Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research (DZD), Neuherberg, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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30
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Wang L, Chopp M, Szalad A, Lu X, Zhang Y, Wang X, Cepparulo P, Lu M, Li C, Zhang ZG. Exosomes Derived From Schwann Cells Ameliorate Peripheral Neuropathy in Type 2 Diabetic Mice. Diabetes 2020; 69:749-759. [PMID: 31915154 PMCID: PMC7085247 DOI: 10.2337/db19-0432] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/31/2019] [Indexed: 12/23/2022]
Abstract
Schwann cell-derived exosomes communicate with dorsal root ganglia (DRG) neurons. The current study investigated the therapeutic effect of exosomes derived from healthy Schwann cells (SC-Exos) on diabetic peripheral neuropathy (DPN). We found that intravenous administration of SC-Exos to type 2 diabetic db/db mice with peripheral neuropathy remarkably ameliorated DPN by improving sciatic nerve conduction velocity and increasing thermal and mechanical sensitivity. These functional improvements were associated with the augmentation of epidermal nerve fibers and remyelination of sciatic nerves. Quantitative RT-PCR and Western blot analysis of sciatic nerve tissues showed that SC-Exo treatment reversed diabetes-reduced mature form of miRNA (miR)-21, -27a, and -146a and diabetes-increased semaphorin 6A (SEMA6A); Ras homolog gene family, member A (RhoA); phosphatase and tensin homolog (PTEN); and nuclear factor-κB (NF-κB). In vitro data showed that SC-Exos promoted neurite outgrowth of diabetic DRG neurons and migration of Schwann cells challenged by high glucose. Collectively, these novel data provide evidence that SC-Exos have a therapeutic effect on DPN in mice and suggest that SC-Exo modulation of miRs contributes to this therapy.
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Affiliation(s)
- Lei Wang
- Department of Neurology, Henry Ford Hospital, Detroit, MI
| | - Michael Chopp
- Department of Neurology, Henry Ford Hospital, Detroit, MI
- Department of Physics, Oakland University, Rochester, MI
| | | | - XueRong Lu
- Department of Neurology, Henry Ford Hospital, Detroit, MI
| | - Yi Zhang
- Department of Neurology, Henry Ford Hospital, Detroit, MI
| | - Xinli Wang
- Department of Neurology, Henry Ford Hospital, Detroit, MI
| | | | - Mei Lu
- Department of Biostatistics and Research Epidemiology, Henry Ford Hospital, Detroit, MI
| | - Chao Li
- Department of Neurology, Henry Ford Hospital, Detroit, MI
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31
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Vetter L, Cortassa S, O'Rourke B, Armoundas AA, Bedja D, Jende JME, Bendszus M, Paolocci N, Sollot SJ, Aon MA, Kurz FT. Diabetes Increases the Vulnerability of the Cardiac Mitochondrial Network to Criticality. Front Physiol 2020; 11:175. [PMID: 32210835 PMCID: PMC7077512 DOI: 10.3389/fphys.2020.00175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/14/2020] [Indexed: 02/06/2023] Open
Abstract
Mitochondrial criticality describes a state in which the mitochondrial cardiac network under intense oxidative stress becomes very sensitive to small perturbations, leading from local to cell-wide depolarization and synchronized oscillations that may escalate to the myocardial syncytium generating arrhythmias. Herein, we describe the occurrence of mitochondrial criticality in the chronic setting of a metabolic disorder, type 1 diabetes (T1DM), using a streptozotocin (STZ)-treated guinea pig (GP) animal model. Using wavelet analysis of mitochondrial networks from two-photon microscopy imaging of cardiac myocytes loaded with a fluorescent probe of the mitochondrial membrane potential, we show that cardiomyocytes from T1DM GPs are closer to criticality, making them more vulnerable to cell-wide mitochondrial oscillations as can be judged by the latency period to trigger oscillations after a laser flash perturbation, and their propensity to oscillate. Insulin treatment of T1DM GPs rescued cardiac myocytes to sham control levels of susceptibility, a protective condition that could also be attained with interventions leading to improvement of the cellular redox environment such as preincubation of diabetic cardiac myocytes with the lipid palmitate or a cell-permeable form of glutathione, in the presence of glucose.
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Affiliation(s)
- Larissa Vetter
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States.,Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sonia Cortassa
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Brian O'Rourke
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Antonis A Armoundas
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology Cambridge, MA, United States
| | - Djahida Bedja
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Nazareno Paolocci
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.,Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Steven J Sollot
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Miguel A Aon
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.,Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
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Groener JB, Jende JME, Kurz FT, Kender Z, Treede RD, Schuh-Hofer S, Nawroth PP, Bendszus M, Kopf S. Understanding Diabetic Neuropathy-From Subclinical Nerve Lesions to Severe Nerve Fiber Deficits: A Cross-Sectional Study in Patients With Type 2 Diabetes and Healthy Control Subjects. Diabetes 2020; 69:436-447. [PMID: 31826867 DOI: 10.2337/db19-0197] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 12/05/2019] [Indexed: 11/13/2022]
Abstract
Studies on magnetic resonance neurography (MRN) in diabetic polyneuropathy (DPN) have found proximal sciatic nerve lesions. The aim of this study was to evaluate the functional relevance of sciatic nerve lesions in DPN, with the expectation of correlations with the impairment of large-fiber function. Sixty-one patients with type 2 diabetes (48 with and 13 without DPN) and 12 control subjects were enrolled and underwent MRN, quantitative sensory testing, and electrophysiological examinations. There were differences in mechanical detection (Aβ fibers) and mechanical pain (Aδ fibers) but not in thermal pain and thermal detection clusters (C fibers) among the groups. Lesion load correlated with lower Aα-, Aβ-, and Aδ-fiber but not with C-fiber function in all participants. Patients with lower function showed a higher load of nerve lesions than patients with elevated function or no measurable deficit despite apparent DPN. Longer diabetes duration was associated with higher lesion load in patients with DPN, suggesting that nerve lesions in DPN may accumulate over time and become clinically relevant once a critical amount of nerve fascicles is affected. Moreover, MRN is an objective method for determining lower function mainly in medium and large fibers in DPN.
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Affiliation(s)
- Jan B Groener
- Endocrinology and Clinical Chemistry, Internal Medicine Department I, University Hospital Heidelberg, Heidelberg, Germany
- Deutsches Zentrum für Diabetesforschung (DZD) e.V., München-Neuherberg, Germany
- Medicover Neuroendokrinologie, Munich, Germany
| | - Johann M E Jende
- Neuroradiology, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix T Kurz
- Neuroradiology, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Zoltan Kender
- Endocrinology and Clinical Chemistry, Internal Medicine Department I, University Hospital Heidelberg, Heidelberg, Germany
- Deutsches Zentrum für Diabetesforschung (DZD) e.V., München-Neuherberg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sigrid Schuh-Hofer
- Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter P Nawroth
- Endocrinology and Clinical Chemistry, Internal Medicine Department I, University Hospital Heidelberg, Heidelberg, Germany
- Deutsches Zentrum für Diabetesforschung (DZD) e.V., München-Neuherberg, Germany
- Joint Heidelberg-ICD Translational Diabetes Program, Helmoltz-Zentrum, Munich, Germany
| | - Martin Bendszus
- Neuroradiology, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Kopf
- Endocrinology and Clinical Chemistry, Internal Medicine Department I, University Hospital Heidelberg, Heidelberg, Germany
- Deutsches Zentrum für Diabetesforschung (DZD) e.V., München-Neuherberg, Germany
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Boutari C, Bouzoni E, Joshi A, Stefanakis K, Farr OM, Mantzoros CS. Metabolism updates: new directions, techniques, and exciting research that is broadening the horizons. Metabolism 2020; 102:154009. [PMID: 31715175 DOI: 10.1016/j.metabol.2019.154009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/15/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Chrysoula Boutari
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Eirini Bouzoni
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Aditya Joshi
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Konstantinos Stefanakis
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Olivia M Farr
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Christos S Mantzoros
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA 02130, USA.
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Jende JME, Groener JB, Kender Z, Rother C, Hahn A, Hilgenfeld T, Juerchott A, Preisner F, Heiland S, Kopf S, Nawroth P, Bendszus M, Kurz FT. Structural Nerve Remodeling at 3-T MR Neurography Differs between Painful and Painless Diabetic Polyneuropathy in Type 1 or 2 Diabetes. Radiology 2019; 294:405-414. [PMID: 31891321 DOI: 10.1148/radiol.2019191347] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background The pathophysiologic mechanisms underlying painful symptoms in diabetic polyneuropathy (DPN) are poorly understood. They may be associated with MRI characteristics, which have not yet been investigated. Purpose To investigate correlations between nerve structure, load and spatial distribution of nerve lesions, and pain in patients with DPN. Materials and Methods In this prospective single-center cross-sectional study, participants with type 1 or 2 diabetes volunteered between June 2015 and March 2018. Participants underwent 3-T MR neurography of the sciatic nerve with a T2-weighed fat-suppressed sequence, which was preceded by clinical and electrophysiologic tests. For group comparisons, analysis of variance or the Kruskal-Wallis test was performed depending on Gaussian or non-Gaussian distribution of data. Spearman correlation coefficients were calculated for correlation analysis. Results A total of 131 participants (mean age, 62 years ± 11 [standard deviation]; 82 men) with either type 1 (n = 45) or type 2 (n = 86) diabetes were evaluated with painful (n = 64), painless (n = 37), or no (n = 30) DPN. Participants who had painful diabetic neuropathy had a higher percentage of nerve lesions in the full nerve volume (15.2% ± 1.6) than did participants with nonpainful DPN (10.4% ± 1.7, P = .03) or no DPN (8.3% ± 1.7; P < .001). The amount and extension of T2-weighted hyperintense nerve lesions correlated positively with the neuropathy disability score (r = 0.37; 95% confidence interval [CI]: 0.21, 0.52; r = 0.37; 95% CI: 0.20, 0.52, respectively) and the neuropathy symptom score (r = 0.41; 95% CI: 0.25, 0.55; r = 0.34; 95% CI: 0.17, 0.49, respectively). Negative correlations were found for the tibial nerve conduction velocity (r = -0.23; 95% CI: -0.44, -0.01; r = -0.37; 95% CI: -0.55, -0.15, respectively). The cross-sectional area of the nerve was positively correlated with the neuropathy disability score (r = 0.23; 95% CI: 0.03, 0.36). Negative correlations were found for the tibial nerve conduction velocity (r = -0.24; 95% CI: -0.45, -0.01). Conclusion The amount and extension of T2-weighted hyperintense fascicular nerve lesions were greater in patients with painful diabetic neuropathy than in those with painless diabetic neuropathy. These results suggest that proximal fascicular damage is associated with the evolution of painful sensory symptoms in diabetic polyneuropathy. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Johann M E Jende
- From the Departments of Neuroradiology (J.M.E.J., C.R., A.H., T.H., A.J., F.P., S.H., M.B., F.T.K.) and Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) (J.B.G., Z.K., S.K., P.N.) and the Division of Experimental Radiology, Department of Neuroradiology (S.H.), Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; German Center of Diabetes Research, München-Neuherberg, Germany (J.B.G., S.K., P.N.); and Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Germany (P.N.)
| | - Jan B Groener
- From the Departments of Neuroradiology (J.M.E.J., C.R., A.H., T.H., A.J., F.P., S.H., M.B., F.T.K.) and Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) (J.B.G., Z.K., S.K., P.N.) and the Division of Experimental Radiology, Department of Neuroradiology (S.H.), Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; German Center of Diabetes Research, München-Neuherberg, Germany (J.B.G., S.K., P.N.); and Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Germany (P.N.)
| | - Zoltan Kender
- From the Departments of Neuroradiology (J.M.E.J., C.R., A.H., T.H., A.J., F.P., S.H., M.B., F.T.K.) and Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) (J.B.G., Z.K., S.K., P.N.) and the Division of Experimental Radiology, Department of Neuroradiology (S.H.), Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; German Center of Diabetes Research, München-Neuherberg, Germany (J.B.G., S.K., P.N.); and Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Germany (P.N.)
| | - Christian Rother
- From the Departments of Neuroradiology (J.M.E.J., C.R., A.H., T.H., A.J., F.P., S.H., M.B., F.T.K.) and Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) (J.B.G., Z.K., S.K., P.N.) and the Division of Experimental Radiology, Department of Neuroradiology (S.H.), Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; German Center of Diabetes Research, München-Neuherberg, Germany (J.B.G., S.K., P.N.); and Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Germany (P.N.)
| | - Artur Hahn
- From the Departments of Neuroradiology (J.M.E.J., C.R., A.H., T.H., A.J., F.P., S.H., M.B., F.T.K.) and Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) (J.B.G., Z.K., S.K., P.N.) and the Division of Experimental Radiology, Department of Neuroradiology (S.H.), Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; German Center of Diabetes Research, München-Neuherberg, Germany (J.B.G., S.K., P.N.); and Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Germany (P.N.)
| | - Tim Hilgenfeld
- From the Departments of Neuroradiology (J.M.E.J., C.R., A.H., T.H., A.J., F.P., S.H., M.B., F.T.K.) and Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) (J.B.G., Z.K., S.K., P.N.) and the Division of Experimental Radiology, Department of Neuroradiology (S.H.), Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; German Center of Diabetes Research, München-Neuherberg, Germany (J.B.G., S.K., P.N.); and Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Germany (P.N.)
| | - Alexander Juerchott
- From the Departments of Neuroradiology (J.M.E.J., C.R., A.H., T.H., A.J., F.P., S.H., M.B., F.T.K.) and Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) (J.B.G., Z.K., S.K., P.N.) and the Division of Experimental Radiology, Department of Neuroradiology (S.H.), Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; German Center of Diabetes Research, München-Neuherberg, Germany (J.B.G., S.K., P.N.); and Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Germany (P.N.)
| | - Fabian Preisner
- From the Departments of Neuroradiology (J.M.E.J., C.R., A.H., T.H., A.J., F.P., S.H., M.B., F.T.K.) and Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) (J.B.G., Z.K., S.K., P.N.) and the Division of Experimental Radiology, Department of Neuroradiology (S.H.), Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; German Center of Diabetes Research, München-Neuherberg, Germany (J.B.G., S.K., P.N.); and Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Germany (P.N.)
| | - Sabine Heiland
- From the Departments of Neuroradiology (J.M.E.J., C.R., A.H., T.H., A.J., F.P., S.H., M.B., F.T.K.) and Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) (J.B.G., Z.K., S.K., P.N.) and the Division of Experimental Radiology, Department of Neuroradiology (S.H.), Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; German Center of Diabetes Research, München-Neuherberg, Germany (J.B.G., S.K., P.N.); and Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Germany (P.N.)
| | - Stefan Kopf
- From the Departments of Neuroradiology (J.M.E.J., C.R., A.H., T.H., A.J., F.P., S.H., M.B., F.T.K.) and Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) (J.B.G., Z.K., S.K., P.N.) and the Division of Experimental Radiology, Department of Neuroradiology (S.H.), Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; German Center of Diabetes Research, München-Neuherberg, Germany (J.B.G., S.K., P.N.); and Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Germany (P.N.)
| | - Peter Nawroth
- From the Departments of Neuroradiology (J.M.E.J., C.R., A.H., T.H., A.J., F.P., S.H., M.B., F.T.K.) and Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) (J.B.G., Z.K., S.K., P.N.) and the Division of Experimental Radiology, Department of Neuroradiology (S.H.), Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; German Center of Diabetes Research, München-Neuherberg, Germany (J.B.G., S.K., P.N.); and Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Germany (P.N.)
| | - Martin Bendszus
- From the Departments of Neuroradiology (J.M.E.J., C.R., A.H., T.H., A.J., F.P., S.H., M.B., F.T.K.) and Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) (J.B.G., Z.K., S.K., P.N.) and the Division of Experimental Radiology, Department of Neuroradiology (S.H.), Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; German Center of Diabetes Research, München-Neuherberg, Germany (J.B.G., S.K., P.N.); and Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Germany (P.N.)
| | - Felix T Kurz
- From the Departments of Neuroradiology (J.M.E.J., C.R., A.H., T.H., A.J., F.P., S.H., M.B., F.T.K.) and Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) (J.B.G., Z.K., S.K., P.N.) and the Division of Experimental Radiology, Department of Neuroradiology (S.H.), Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; German Center of Diabetes Research, München-Neuherberg, Germany (J.B.G., S.K., P.N.); and Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Germany (P.N.)
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Tummanapalli SS, Issar T, Kwai N, Pisarcikova J, Poynten AM, Krishnan AV, Willcox MDP, Markoulli M. A Comparative Study on the Diagnostic Utility of Corneal Confocal Microscopy and Tear Neuromediator Levels in Diabetic Peripheral Neuropathy. Curr Eye Res 2019; 45:921-930. [DOI: 10.1080/02713683.2019.1705984] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | - Tushar Issar
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Natalie Kwai
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Jana Pisarcikova
- School of Optometry & Vision Science, University of New South Wales, Sydney, Australia
| | - Ann M. Poynten
- Department of Endocrinology, Prince of Wales Hospital, Sydney, Australia
| | - Arun V. Krishnan
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Mark D. P. Willcox
- School of Optometry & Vision Science, University of New South Wales, Sydney, Australia
| | - Maria Markoulli
- School of Optometry & Vision Science, University of New South Wales, Sydney, Australia
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Preisner F, Bäumer P, Wehrstein M, Friedmann-Bette B, Hackbusch M, Heiland S, Bendszus M, Kronlage M. Peripheral Nerve Diffusion Tensor Imaging : Interreader and Test-retest Reliability as Quantified by the Standard Error of Measurement. Clin Neuroradiol 2019; 30:679-689. [PMID: 31807812 DOI: 10.1007/s00062-019-00859-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/16/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Diffusion tensor imaging (DTI) is increasingly being used in magnetic resonance neurography (MRN). The purpose of this study was to determine the interreader and test-retest reliability of peripheral nerve DTI in MRN with focus on the sciatic nerve. METHODS In this prospective study 27 healthy volunteers each underwent 3 scans of a short DTI protocol on separate days consisting of a T2-weighted turbo spin-echo and single-shot DTI sequence of the sciatic nerve of the dominant leg. The DTI parameters fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were obtained after manual nerve segmentation by two independent readers. Intraclass correlation coefficients (ICC), standard error of measurement (SEM), and Bland-Altman plots were calculated as measures for both interreader and test-retest agreement for all readout parameters. RESULTS The mean ± standard deviation was 0.507 ± 0.05 for FA, 1308.5 ± 162.4 × 10-6 mm2/s for MD, 905.6 ± 145.4 ×10-6 mm2/s for RD and 2114.1 ± 219.2 × 10-6 mm2/s for AD. The SEM for FA was 0.02 for interreader and test-retest agreement, the SEM for MD, RD, and AD ranged between 46.2 × 10-6 mm2/s (RD) and 70.1 × 10-6 mm2/s (AD) for interreader reliability and between 45.9 × 10-6 mm2/s (RD) and 70.1 × 10-6 mm2/s (AD) for test-retest reliability. The ICC for interreader reliability of DTI parameters ranged between 0.81 and 0.92 and ICC for test-retest reliability between 0.76 and 0.91. CONCLUSION Peripheral nerve DTI of the sciatic nerve is reliable and reproducible. The measures presented here may serve as first orientation values of measurement accuracy when interpreting parameters of sciatic nerve DTI.
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Affiliation(s)
- Fabian Preisner
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Philipp Bäumer
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Center for Radiology Dia.log, Vinzenz-von-Paul Str. 8, 84503, Altötting, Germany
| | - Michaela Wehrstein
- Department of Sports Medicine (Internal Medicine VII), Medical Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Birgit Friedmann-Bette
- Department of Sports Medicine (Internal Medicine VII), Medical Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Matthes Hackbusch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Moritz Kronlage
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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