1
|
Qu JH, Li L, Tian L, Zhang XY, Thomas R, Sun XG. Epithelial changes with corneal punctate epitheliopathy in type 2 diabetes mellitus and their correlation with time to healing. BMC Ophthalmol 2018; 18:1. [PMID: 29301512 PMCID: PMC5753517 DOI: 10.1186/s12886-017-0645-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background To study basal epithelial cell (BEC), sub-basal nerve plexus (SBN) and Langerhans cell (LC) density in patients with type 2 diabetes mellitus (T2DM) with corneal punctate epitheliopathy (CPE) and to assess their association with time to healing of CPE. Methods Retrospective study of in vivo confocal microscopy (IVCM) in 160 eyes from 160 patients with T2DM diagnosed with CPE due to a single cause. Key exclusion criteria included multiple-causes for CPE or treatment with autologous serum. A total of 149 eyes from 149 gender- age- and aetiolgy-matched patients with CPE without T2DM comprised the control group. Electronic records were reviewed for demographic features, history of T2DM and aetiology of CPE. Density of BEC, SBN and LC were compared between the two groups. Results The healing time in days for CPE with different aetiologies in the T2DM and control groups were as follows: dry eye (21.56 ± 2.41; 7.00 ± 2.19; P = 0.001); meibomian gland dysfunction (26.42 ± 6.04; 9.21 ± 2.55; P = 0.001); cataract extraction (38.00 ± 19.62; 25.83 ± 11.49; P = 0.043); drug induced (53.19 ± 18.83; 41.86 ± 23.87; P = 0.018) and exposure (38.25 ± 14.13; 29.00 ± 13.67; P = 0.026). LC density was 38.70 ± 9.65 cells/mm2 in the T2DM group comparedwith 25.53 ± 3.54 cells/mm2 in the controls (P = 0.001). SBN density was 11.76 ± 1.69 mm/mm2 in the T2DM group compared with 20.92 ± 1.43 mm/mm2 in the controls (P = 0.001). BEC density in the T2DM group was 4982 ± 1178 cells/mm2 compared with 5739 ± 394 cells/mm2 in the control group (P = 0.018). Age and duration of T2DM had no relationship with healing time (multiple linear regression, P = 0.618; P = 0.787). The density of LC in the T2DM group showed a negative correlation with SBN density (r = 0.350; R2 = 0.1225; P = 0.034). The density of SBN in the T2DM group showed a positive correlation with BEC density (r = 0.427; R2 = 0.1823; P = 0.008). The density of BEC in the T2DM group showed a negative correlation with healing time (r = 0.931; R2 = 0.8668; P = 0.001). Conclusions Utilising IVCM, we have demonstrated increased LC and decreased SBN in patients with T2DM and CPE. Both may be related to lower BEC density and nuclei enhanced reflection. Furthermore, decreased BEC density may lead to delay in cornea epithelium healing in the T2DM group comparedwith controls. An immune-mediated response may play a role in delayed wound closure in patients with T2DM.
Collapse
Affiliation(s)
- Jing-Hao Qu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China
| | - Li Li
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Lei Tian
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China
| | - Xiao-Yu Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China
| | - Ravi Thomas
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China.,Queensland Eye Institute, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Xu-Guang Sun
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China.
| |
Collapse
|
2
|
Misra SL, Braatvedt GD, Patel DV. Impact of diabetes mellitus on the ocular surface: a review. Clin Exp Ophthalmol 2016; 44:278-88. [DOI: 10.1111/ceo.12690] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/05/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Stuti L Misra
- Department of Ophthalmology, New Zealand National Eye Centre Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - Geoffrey D Braatvedt
- Department of Medicine, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - Dipika V Patel
- Department of Ophthalmology, New Zealand National Eye Centre Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| |
Collapse
|
3
|
Morphometric analysis of connective tissue sheaths of sural nerve in diabetic and nondiabetic patients. BIOMED RESEARCH INTERNATIONAL 2014; 2014:870930. [PMID: 25147820 PMCID: PMC4132315 DOI: 10.1155/2014/870930] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 06/13/2014] [Accepted: 06/27/2014] [Indexed: 02/06/2023]
Abstract
One of the most common complications of diabetes mellitus is diabetic neuropathy. It may be provoked by metabolic and/or vascular factors, and depending on duration of disease, various layers of nerve may be affected. Our aim was to investigate influence of diabetes on the epineurial, perineurial, and endoneurial connective tissue sheaths. The study included 15 samples of sural nerve divided into three groups: diabetic group, peripheral vascular disease group, and control group. After morphological analysis, morphometric parameters were determined for each case using ImageJ software. Compared to the control group, the diabetic cases had significantly higher perineurial index (P < 0.05) and endoneurial connective tissue percentage (P < 0.01). The diabetic group showed significantly higher epineurial area (P < 0.01), as well as percentage of endoneurial connective tissue (P < 0.01), in relation to the peripheral vascular disease group. It is obvious that hyperglycemia and ischemia present in diabetes lead to substantial changes in connective tissue sheaths of nerve, particularly in peri- and endoneurium. Perineurial thickening and significant endoneurial fibrosis may impair the balance of endoneurial homeostasis and regenerative ability of the nerve fibers. Future investigations should focus on studying the components of extracellular matrix of connective tissue sheaths in diabetic nerves.
Collapse
|
4
|
Abstract
As ensheathing and secretory cells, Schwann cells are a ubiquitous and vital component of the endoneurial microenvironment of peripheral nerves. The interdependence of axons and their ensheathing Schwann cells predisposes each to the impact of injury in the other. Further, the dependence of the blood-nerve interface on trophic support from Schwann cells during development, adulthood, and after injury suggests these glial cells promote the structural and functional integrity of nerve trunks. Here, the developmental origin, injury-induced changes, and mature myelinating and nonmyelinating phenotypes of Schwann cells are reviewed prior to a description of nerve fiber pathology and consideration of pathogenic mechanisms in human and experimental diabetic neuropathy. A fundamental role for aldose-reductase-containing Schwann cells in the pathogenesis of diabetic neuropathy, as well as the interrelationship of pathogenic mechanisms, is indicated by the sensitivity of hyperglycemia-induced biochemical alterations, such as polyol pathway flux, formation of reactive oxygen species, generation of advanced glycosylation end products (AGEs) and deficient neurotrophic support, to blocking polyol pathway flux.
Collapse
Affiliation(s)
- Andrew P Mizisin
- Department of Pathology, School of Medicine, University of California San Diego, La Jolla, CA, USA.
| |
Collapse
|
5
|
Duran-Jimenez B, Dobler D, Moffatt S, Rabbani N, Streuli CH, Thornalley PJ, Tomlinson DR, Gardiner NJ. Advanced glycation end products in extracellular matrix proteins contribute to the failure of sensory nerve regeneration in diabetes. Diabetes 2009; 58:2893-903. [PMID: 19720799 PMCID: PMC2780874 DOI: 10.2337/db09-0320] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The goal of this study was to characterize glycation adducts formed in both in vivo extracellular matrix (ECM) proteins of endoneurium from streptozotocin (STZ)-induced diabetic rats and in vitro by glycation of laminin and fibronectin with methylglyoxal and glucose. We also investigated the impact of advanced glycation end product (AGE) residue content of ECM on neurite outgrowth from sensory neurons. RESEARCH DESIGN AND METHODS Glycation, oxidation, and nitration adducts of ECM proteins extracted from the endoneurium of control and STZ-induced diabetic rat sciatic nerve (3-24 weeks post-STZ) and of laminin and fibronectin that had been glycated using glucose or methylglyoxal were examined by liquid chromatography with tandem mass spectrometry. Methylglyoxal-glycated or unmodified ECM proteins were used as substrata for dissociated rat sensory neurons as in vitro models of regeneration. RESULTS STZ-induced diabetes produced a significant increase in early glycation N(epsilon)-fructosyl-lysine and AGE residue contents of endoneurial ECM. Glycation of laminin and fibronectin by methylglyoxal and glucose increased glycation adduct residue contents with methylglyoxal-derived hydroimidazolone and N(epsilon)-fructosyl-lysine, respectively, of greatest quantitative importance. Glycation of laminin caused a significant decrease in both neurotrophin-stimulated and preconditioned sensory neurite outgrowth. This decrease was prevented by aminoguanidine. Glycation of fibronectin also decreased preconditioned neurite outgrowth, which was prevented by aminoguanidine and nerve growth factor. CONCLUSIONS Early glycation and AGE residue content of endoneurial ECM proteins increase markedly in STZ-induced diabetes. Glycation of laminin and fibronectin causes a reduction in neurotrophin-stimulated neurite outgrowth and preconditioned neurite outgrowth. This may provide a mechanism for the failure of collateral sprouting and axonal regeneration in diabetic neuropathy.
Collapse
Affiliation(s)
| | - Darin Dobler
- Clinical Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, U.K
| | - Sarah Moffatt
- Faculty of Life Sciences, University of Manchester, Manchester, U.K
| | - Naila Rabbani
- Clinical Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, U.K
| | | | - Paul J. Thornalley
- Clinical Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, U.K
| | | | - Natalie J. Gardiner
- Faculty of Life Sciences, University of Manchester, Manchester, U.K
- Corresponding author: Natalie J. Gardiner,
| |
Collapse
|
6
|
Abstract
The extracellular matrix of peripheral nerve plays a vital role in terms of normal nerve fibre function and also in the regenerative response following nerve injury. Nerve fibre loss is a major feature of diabetic neuropathy; however, the regenerative response is limited and this may be associated with changes in the composition of the extracellular matrix. Glycoproteins and collagens are major components of the extracellular matrix and are known to be important in terms of axonal growth. This work has therefore examined whether changes in the expression of two major glycoproteins, laminin and tenascin, and three collagen types (IV, V and VI) occur in the endoneurial and perineurial connective tissue compartments of human diabetic nerve. Despite being known to have a positive effect in terms of axonal growth, laminin levels were not elevated in the diabetic nerves. However, the pattern of tenascin expression did differ between the two groups being found in association with axon myelin units in the diabetic samples only. The pattern of collagen IV expression was the same in both tissue groups and was not found to be up-regulated. However, levels of collagen V and VI were both significantly increased in the endoneurium and for collagen VI also in the perineurium.
Collapse
Affiliation(s)
- Rebecca Hill
- The Department of Biological Sciences, The University of Hull, UK.
| |
Collapse
|
7
|
Takahashi N, Wakuta M, Morishige N, Chikama TI, Nishida T, Sumii Y. Development of an instrument for measurement of light scattering at the corneal epithelial basement membrane in diabetic patients. Jpn J Ophthalmol 2007; 51:185-90. [PMID: 17554480 DOI: 10.1007/s10384-007-0427-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 01/16/2007] [Indexed: 01/17/2023]
Abstract
PURPOSE Diabetic complications are associated with abnormality of the basement membranes. We have developed a light-scattering detection system (LSDS) specifically for measurement of light scattering at the corneal epithelial basement membrane, and have determined the reproducibility and clinical significance of the results obtained by the LSDS in diabetic patients. METHODS Thirty nondiabetic controls and 40 diabetic subjects participated in the study. Light scattering at the corneal epithelial basement membrane was measured with the LSDS. RESULTS The measurement of light scattering at the corneal basement membrane was found to be reproducible. The LSDS index (mean +/- SD) was 28.1 +/- 4.8 in controls, 35.7 +/- 6.3 in mild diabetic retinopathy subjects, and 42.7 +/- 8.6 in severe diabetic retinopathy subjects. This demonstrated that the LSDS index at the corneal basement membrane is proportional to the extent of diabetic retinopathy. CONCLUSIONS Measurement of light scattering at the corneal epithelial basement membrane is possible with the LSDS, is relatively easy to perform, and is reproducible. The LSDS may prove suitable for the early detection of diabetic ocular complications.
Collapse
Affiliation(s)
- Norihisa Takahashi
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | | | | | | | | | | |
Collapse
|
8
|
Hill RE, Williams PE. Perineurial cell basement membrane thickening and myelinated nerve fibre loss in diabetic and nondiabetic peripheral nerve. J Neurol Sci 2004; 217:157-63. [PMID: 14706218 DOI: 10.1016/j.jns.2003.09.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Diabetic neuropathy is associated with changes in the extracellular matrix of the perineurium, including thickening of the basement membrane of the perineurial cells. Peripheral vascular disease (PVD) is a common vascular condition that can occur in the absence or presence of diabetes. Thickening of the vascular basement membrane of the vasa nervorum is associated with both diabetes and nondiabetic peripheral vascular disease. However, perineurial cell basement membrane (PCBM) thickening in the nondiabetic PVD state has not, until now, been investigated. In this study, 36 nerve fascicles were examined from three patient groups: a diabetic group, a nondiabetic PVD group, and a group free of both PVD and diabetes (control group). PCBM thickness, fascicle size, and myelinated nerve fibre (MNF) density were measured in all three groups. Endoneurial blood vessels were also observed for evidence of morphological changes. The results showed that the thickness of the PCBM is significantly greater in the diabetic group in comparison with both the control and the nondiabetic PVD group, and this increase in thickness is linearly related to fascicle size. The thickness of the PCBM was not significantly different between the nondiabetic PVD and control groups. Although both the nondiabetic PVD and diabetic groups showed a loss of myelinated nerve fibres in comparison with the control group, this loss was statistically greater in the diabetic group. The endoneurial blood vessels of both the diabetic and nondiabetic PVD groups showed evidence of endothelial cell hyperplasia, hypertrophy, and basement membrane reduplication.
Collapse
Affiliation(s)
- Rebecca E Hill
- School of Nursing, Social Work and Applied Health Studies, The University of Hull, Cottingham Road, HU6 7RX, Hull, UK
| | | |
Collapse
|
9
|
Hill RE, Williams RE. A quantitative analysis of perineurial cell basement membrane collagen IV, laminin and fibronectin in diabetic and non-diabetic human sural nerve. J Anat 2002; 201:185-92. [PMID: 12220126 PMCID: PMC1570905 DOI: 10.1046/j.1469-7580.2002.00083.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The thickness of the perineurial cell basement membrane was examined in diabetic and non-diabetic human sural nerve. A significant increase in thickness was found in the diabetic group. The nature of this thickening was investigated using immunohistochemistry and image analysis in order to semi-quantify three of the major intrinsic components of the perineurial cell basement membrane: collagen IV, laminin and fibronectin. Amounts of all three components were shown to be increased in the diabetic group, but not significantly so. However, significant linear correlations between fascicle size and perineurial collagen IV, laminin and fibronectin were identified in both diabetic and non-diabetic nerve.
Collapse
Affiliation(s)
- R E Hill
- Department of Biological Sciences, The University of Hull, UK.
| | | |
Collapse
|
10
|
Thomas PK, King RH, Workman JM, Schröder JM. Hypertrophic perineurial dysplasia in multifocal and generalized peripheral neuropathies. Neuropathol Appl Neurobiol 2000; 26:536-43. [PMID: 11123720 DOI: 10.1046/j.0305-1846.2000.00289.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Two cases are described, one with a multifocal cranial and limb neuropathy of adult onset associated with optic neuropathy, and the other with a diffuse demyelinating neuropathy characterized by congenital cataract, mental retardation and progressive lower limb paresis with an onset in childhood. Extensive investigation in both failed to establish the causation. No family history of similar disorder was obtained in either case. Nerve biopsy in both showed similar perineurial abnormalities, the endoneurium being compartmentalized by hypertrophic perineurial cells that exhibited dysplastic features. The appearances resemble those described in a previously reported case of multifocal neuropathy and probably represent an unusual but non-specific response to a peripheral neuropathy.
Collapse
Affiliation(s)
- P K Thomas
- University Department of Clinical Neurology, Institute of Neurology, London, UK
| | | | | | | |
Collapse
|
11
|
Williams PE, Lowry A, Hill R, Masson E. Relationship between fascicle size and perineurial collagen IV content in diabetic and control human peripheral nerve. Histopathology 2000; 36:551-5. [PMID: 10849098 DOI: 10.1046/j.1365-2559.2000.00897.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM The relationship between perineurial collagen IV content and fascicle size was determined in diabetic and control human peripheral nerve. METHODS AND RESULTS Age-matched diabetic and control sural nerve samples were immunostained using antibodies to collagen IV. The number of cell layers and the perimeter of the fascicle were measured and the collagen IV content of the perineurium determined. Using this method, a comparison could be made of collagen IV content in the perineuria of fascicles of different size. A positive linear relationship was found between fascicle size and the amount of collagen IV per unit of perineurium. The number of perineurial cell layers and the collagen IV content of the diabetic nerve did not differ from control values. CONCLUSIONS The linear relationship between fascicle size and perineurial collagen IV content per unit of perineurium underlines the importance of taking fascicle size into account when determining changes in basement membrane components associated with neuropathy. The results indicate that increased deposition of collagen IV is not involved in the early changes in the perineurial cell basement membrane and is thus not the primary factor involved in altered nerve function associated with diabetic neuropathy.
Collapse
Affiliation(s)
- P E Williams
- Department of Biological Sciences, University of Hull, UK.
| | | | | | | |
Collapse
|
12
|
Abstract
Better clinical characteristics and a standardized approach to the definition of neuropathy has enabled us to define more precisely the natural history of diabetic neuropathy. Detailed studies on the pathology and pathogenesis have allowed dissection of important pathogenetic pathways. Effective treatment is currently limited, although a number of new and potentially important therapeutic interventions, including modification of the vascular supply and antioxidant status and growth factors, may prove to be of benefit in preventing damage and also promoting repair of peripheral nerves in human diabetic neuropathy.
Collapse
Affiliation(s)
- A J Boulton
- Department of Medicine, University of Manchester, United Kingdom
| | | |
Collapse
|
13
|
Ultrastructural evidence of peripheral neuropathy in spontaneous hyperglycemic Otsuka Long-Evans Tokushima Fatty rats: histopathological similarity to human diabetic neuropathy. Med Mol Morphol 1997. [DOI: 10.1007/bf01545769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|