Absence of autoregulation in peripheral nerve blood flow

Peripheral sensory neuropathy is associated with circulating angiopoietins in type 2 diabetes patients in Ghana

Objective

Peripheral sensory neuropathy (PSN) is a common complication of type 2 diabetes (T2DM) that can lead to frequent ulcerations, lower extremities, and reduced quality of life. Imbalance in the circulating levels of angiogenic growth factors, notably, angiopoietin (Ang)-1, Ang-2 and vascular endothelial growth factor (VEGF) may be among the underlying mechanisms of PSN in T2DM patients. We studied the association between PSN and angiogenic growth factors, Ang-1, Ang-2 and VEGF in T2DM patients in Ghana.

Methods

In a case-control study design, PSN was evaluated in 160 patients with T2DM and 108 nondiabetic controls using vibration perception threshold (VPT) and diabetic neurological examination (DNE). The definition of PSN was abnormal VPT (≥25 mV) or the presence of neuropathic symptoms on examination (DNE score > 3). In addition, fasting venous blood samples were collected to measure circulating levels of Ang-1, Ang-2 and VEGF.

Results

Compared to non-diabetic controls, patients with T2DM had a higher prevalence of PSN using abnormal VPT (20.6 % vs 2.8 %, p < 0.001) or neuropathic symptoms (35.6 % vs 3.7 %, p < 0.001). Compared to nondiabetic controls, patients with T2DM had increased levels of Ang-2 [597 (274 - 1005) vs 838 (473 - 1241) ng/ml, p = 0.018] and VEGF [48.4 (17.4 - 110.1) vs 72.2 (28 - 201.8), p = 0.025] and decreased Ang-1 levels [41.1 (30 - 57.3) vs 36.1 (24.7 - 42.1) ng/ml, p = 0.01]. In regression analyses, an increase in Ang-1 levels was associated with decreased odds, while an increase in Ang-2 levels was associated with increased odds, of abnormal VPT and neuropathic symptoms in T2DM patients.

Conclusion

In our study population, PSN was associated with reduced plasma levels of Ang-1 and increased plasma levels of Ang-2 in patients with T2DM. Therefore, an imbalance of angiopoietins may be associated with PSN in T2DM.

Current Strategies for Engineered Vascular Grafts and Vascularized Tissue Engineering

Blood vessels not only transport oxygen and nutrients to each organ, but also play an important role in the regulation of tissue regeneration. Impaired or occluded vessels can result in ischemia, tissue necrosis, or even life-threatening events. Bioengineered vascular grafts have become a promising alternative treatment for damaged or occlusive vessels. Large-scale tubular grafts, which can match arteries, arterioles, and venules, as well as meso- and microscale vasculature to alleviate ischemia or prevascularized engineered tissues, have been developed. In this review, materials and techniques for engineering tubular scaffolds and vasculature at all levels are discussed. Examples of vascularized tissue engineering in bone, peripheral nerves, and the heart are also provided. Finally, the current challenges are discussed and the perspectives on future developments in biofunctional engineered vessels are delineated.

Baseline extended zone retinal vascular calibres associate with sensory nerve abnormalities in adolescents with type 1 diabetes: A prospective longitudinal study

OBJECTIVE

The relationship between retinal vascular calibres (RVCs) and diabetic neuropathy is unclear. We investigated associations between RVCs and sensory nerve abnormality in adolescents with type 1 diabetes.

RESEARCH DESIGN AND METHODS

In a prospective longitudinal study of 889 adolescents with type 1 diabetes with baseline mean (±SD) age 14.1 ± 1.5 years and HbA_1c IFCC 69.4 ± 14.1 mmol/mol (8.6 ± 1.3%), RVCs were assessed from baseline retinal photographs: 'central zone' calibres, summarized as central retinal arteriolar (CRAE) and venular equivalents (CRVE) and 'extended zone' calibres: mean width of arterioles (MWa) and venules (MWv). Sensory nerve abnormality was defined as at least one abnormal sensory quantitative testing from two thermal and two vibration threshold tests measured at foot every 1-2 years. Associations between baseline RVC and sensory nerve function were examined using generalized estimating equations and cumulative risk by Cox regression analyses.

RESULTS

During a median study follow-up of 6.2 [IQR 3.7-10.4] years, sensory nerve abnormality was found in 27% of adolescents. Narrower extended zone calibre quartiles but not CRAE or CRVE quartiles were independently associated with sensory nerve abnormality: MWa (Q1 vs. Q2-4: OR 1.35 (95% CI 1.02, 1.61) and MWv (Q1 vs. Q2-4: 1.31 (1.03, 1.7)), after adjusting for HbA_1c , duration and blood pressure. Similarly, in Cox regression, the narrowest quartiles were associated with sensory nerve abnormality: MWa hazard ratio (HR) 1.5 (1.3, 1.8) and MWv 1.6 (1.4, 1.9).

CONCLUSIONS

Narrower extended zone retinal calibres were associated with sensory nerve abnormality in adolescents with type 1 diabetes and may present useful biomarkers to understand the pathophysiology of neuropathy.

Morphological and hemodynamic changes of sciatic nerves and their vasa nervorum during circular compression and relaxation

The main aim of this study was to evaluate the biomechanical and hemodynamic responses of vasa nervorum under transverse circular compression. In situ compress-and-hold experiments were performed on the sciatic nerves of healthy and diabetic rats, and the blood flow within the vasa nervorum was observed using Doppler-optical coherence tomography. A new technique was developed to obtain the time-course of the cross sectional area and the morphology of the vasa nervorum from the tomographic images. A quasi-linear viscoelastic model was used to investigate the overall biomechanical properties of the nerves, and a two-dimensional three-layered finite element model was constructed to analyze the distribution of stress and the morphological changes during the compression-relaxation process. The results showed that the lumenal area of vasa nervorum was reduced in the compression stage, especially for the diabetic nerves. The reduction was greater than 70% when the reduction of the nerve diameter was only 10%. The quasi-linear viscoelastic model showed that normal nerves were more elastic but less viscous than the diabetic nerves. The finite element analyses demonstrated that perineurium could sustain more stress than other layers, while epineurium served as a cushion to protect vasa nervora. In addition, there were regions within epineurium with less stress, so that vasa nervora in these saddle regions were less deformed. The vasa nervorum in diabetic rats was more prone to compression and reduction of blood flow than that of the normal rats. The histological studies supported the simulation results.

Evaluation of ameliorative effect of sodium nitrate in experimental model of streptozotocin-induced diabetic neuropathy in male rats

OBJECTIVE

Diabetes induces sensory symptoms of neuropathy as positive (hyperalgesia), negative (hypoalgesia), or both.

METHODS

In the present study, fifty male Wistar rats were allocated to five groups: control, control+nitrate, diabetes, diabetes+insulin, and diabetes+nitrate. Thirty days after diabetes confirmation, insulin (2-4 U/day) was injected subcutaneously in diabetes+insulin group and nitrate (100 mg/l) was added into drinking water of the control+nitrate and diabetes+nitrate groups for a period of 2 months. In order to assess the mechanical and thermal algesia, tail immersion, hot plate, and von Frey tests were performed. The serum insulin levels were determined with insulin ELISA Kit. Serum level of NOx was determined by the Griess method.

RESULTS

Both thermal and mechanical nociceptive thresholds showed a significant decrease (p<0.05) which was followed by a significant increase (p<0.01) in the thermal nociceptive threshold in the diabetes group. Chronic nitrate or insulin treatment led to a significant decrease (p<0.01) in blood glucose levels, as well as a significant (p<0.05) increase in the body weight and serum NOx. Moreover, nitrate treatment significantly increased serum insulin levels (p<0.001) compared to the other groups.

CONCLUSION

Chronic nitrate treatment modified the thermal and mechanical sensitivities in diabetic animals.

Vascularization Strategies for Peripheral Nerve Tissue Engineering

Vascularization plays a significant role in treating nerve injury, especially to avoid the central necrosis observed in nerve grafts for large and long nerve defects. It is known that sufficient vascularization can sustain cell survival and maintain cell integration within tissue‐engineered constructs. Several studies have also shown that vascularization affects nerve regeneration. Motivated by these studies, vascularized nerve grafts have been developed using various different techniques, although donor site morbidity and limited nerve supply remain significant drawbacks. Tissue engineering provides an exciting alternative approach to prefabricate vascularized nerve constructs which could overcome the limitations of grafts. In this review article, we focus on the role of vascularization in nerve regeneration, discussing various approaches to generate vascularized nerve constructs and the contribution of tissue engineering and mathematical modeling to aid in developing vascularized engineered nerve constructs, illustrating these aspects with examples from our research experience. Anat Rec, 301:1657–1667, 2018. © 2018 The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists.

Arterial Stiffness Is Associated with Peripheral Sensory Neuropathy in Diabetes Patients in Ghana

OBJECTIVE

Peripheral sensory neuropathy (PSN) is among microvascular complications of diabetes that make patients prone to ulceration and amputation. Arterial stiffness is a predictor of cardiovascular diseases and microvascular complications associated with diabetes. We investigated the association between PSN and arterial stiffness, measured as aortic pulse wave velocity (PWVao) and cardio-ankle vascular index (CAVI).

METHOD

In a case-control design, arterial stiffness was measured in 240 diabetes patients and 110 nondiabetic control. Large-fibre nerve function was assessed by vibration perception threshold (VPT) using a neurothesiometer. PSN was defined as the VPT > 97.5th percentile from age- and gender-adjusted models in nondiabetic controls.

RESULTS

The overall prevalence of PSN was 16.6% in the entire study participants. Compared to non-PSN participants, PSN patients had higher levels of PWVao (9.5 ± 1.7 versus 8.7 ± 1.2 m/s, p = 0.016) and CAVI (8.4 ± 1.3 versus 7.6 ± 1.1, p = 0.001). In multiple regression models, VPT was associated with PWVao (β = 0.14, p = 0.025) and CAVI (β = 0.12, p = 0.04). PSN patients had increased odds of CAVI (OR = 1.51 (1.02-2.4), p = 0.043), but not PWVao (OR = 1.25 (0.91-1.71), p = 0.173).

CONCLUSION

PWVao and CAVI were associated with VPT and PSN in diabetes patients in Ghana. Patients having PSN have increased odds of CAVI, independent of other conventional risk factors.

Bilateral position-related ulnar neuropathy at elbow in pediatric population and review of the literature

Perioperative ulnar neuropathies attributed to inappropriate arm positioning and padding during surgical procedures are commonly found in adults. However, their extremely rare incidence in the pediatric population may cause absent awareness of the risk of nerve injury in anesthetized pediatric patients. Furthermore, young patients respond to conservative treatment of neuropathy less favorably than adults and their response also depends on the pathomechanism of the ulnar nerve injury. A surgeon's or anesthetist's failure to recognize all of these specifics in children may result in substantial morbidity of young patients leading to lawsuits. Fortunately, with an adequate knowledge of surgical anatomy and types of procedures and positions in which the ulnar nerve is particularly vulnerable, and familiarity with measures to minimize the potential for neuropathy, this serious complication can be prevented. The aims of this review are to highlight personal experience and current knowledge of the rare position-related ulnar neuropathy, both from a clinical and anatomical-pathophysiological perspective, and to raise awareness about this rare but serious complication in the pediatric population.

Glucotoxic Mechanisms and Related Therapeutic Approaches

Neuropathy is the earliest and commonest complication of diabetes. With increasing duration of diabetes, frequency and severity of neuropathy are worsened. Long-term hyperglycemia is therefore implicated in the development of this disorder. Nerve tissues require glucose energy to function and survive. Upon excessive glucose entry into the peripheral nerve, the glycolytic pathway and collateral glucose-utilizing pathways are overactivated and initiate adverse effects on nerve tissues. During hyperglycemia, flux through the polyol pathway, formation of advanced glycation end-products, production of free radicals, flux into the glucosamine pathway, and protein kinase C activity are all enhanced to negatively influence nerve function and structure. Suppression of these aberrant metabolic pathways has succeeded in prevention and inhibition of the development of neuropathy in animal models with diabetes. Satisfactory results were not attained, however, in patients with diabetes and further clinical trials are required. In this review, the author summarizes the hitherto proposed theories on the pathogenesis of diabetic neuropathy related to glucose metabolism and future prospects for the effective treatment of neuropathy.

Characterization of nerve and microvessel damage and recovery in type 1 diabetic mice after permanent femoral artery ligation

Neuropathy is the most common complication of the peripheral nervous system during the progression of diabetes. The pathophysiology is unclear but may involve microangiopathy, reduced endoneurial blood flow, and tissue ischemia. We used a mouse model of type 1 diabetes to study parallel alterations of nerves and microvessels following tissue ischemia. We designed an easily reproducible model of ischemic neuropathy induced by irreversible ligation of the femoral artery. We studied the evolution of behavioral function, epineurial and endoneurial vessel impairment, and large nerve myelinated fiber as well as small cutaneous unmyelinated fiber impairment for 1 month following the onset of ischemia. We observed a more severe hindlimb dysfunction and delayed recovery in diabetic animals. This was associated with reduced density of large arteries in the hindlimb and reduced sciatic nerve epineurial blood flow. A reduction in sciatic nerve endoneurial capillary density was also observed, associated with a reduction in small unmyelinated epidermal fiber number and large myelinated sciatic nerve fiber dysfunction. Moreover, vascular recovery was delayed, and nerve dysfunction was still present in diabetic animals at day 28. This easily reproducible model provides clear insight into the evolution over time of the impact of ischemia on nerve and microvessel homeostasis in the setting of diabetes. © 2015 Wiley Periodicals, Inc.

The relationship between blood pressure and sciatic nerve blood flow velocity in rats with insulin-treated experimental diabetes

Peripheral nerve blood flow (NBF) does not autoregulate but, instead, responds passively to changes in mean arterial pressure (MAP). How this relationship is impacted by insulin-treated experimental diabetes (ITED) is unknown. We tested the hypothesis that ITED will reduce NBF across a range of MAP in Sprague Dawley rats. Following 10 weeks of control or ITED conditions, conscious MAP (tail-cuff) was measured, and under anaesthesia, the MAP (carotid artery catheter, pressure transducer) and NBF (Doppler ultrasound, 40 MHz) responses to sodium nitroprusside (60 µg/kg) and phenylephrine (12 µg/kg) infusion were recorded (regression equations for MAP vs NBF were created for each rodent). Thereafter, motor nerve conduction velocity (MNCV) and nerve vascularization (haematoxylin and eosin stain) were determined. Conscious MAP was higher and MNCV was lower in the ITED group (p < 0.01). In response to drug infusions, the ΔMAP and ΔNBF were similar between groups (p ≥ 0.18). Estimated conscious NBF (based on substituting conscious MAP values into each individual regression equation) was greater in the ITED group (p < 0.01). Sciatic nerve vascularization was similar between groups (p ≥ 0.50). In contrast to the hypothesis, NBF was not reduced across a range of MAP. In spite of increased estimated conscious NBF values, MNCV was reduced in rats with ITED.

Mechanism of diabetic neuropathy: Where are we now and where to go?

Neuropathy is the most common complication of diabetes. As a consequence of longstanding hyperglycemia, a downstream metabolic cascade leads to peripheral nerve injury through an increased flux of the polyol pathway, enhanced advanced glycation end‐products formation, excessive release of cytokines, activation of protein kinase C and exaggerated oxidative stress, as well as other confounding factors. Although these metabolic aberrations are deemed as the main stream for the pathogenesis of diabetic microvascular complications, organ‐specific histological and biochemical characteristics constitute distinct mechanistic processes of neuropathy different from retinopathy or nephropathy. Extremely long axons originating in the small neuronal body are vulnerable on the most distal side as a result of malnutritional axonal support or environmental insults. Sparse vascular supply with impaired autoregulation is likely to cause hypoxic damage in the nerve. Such dual influences exerted by long‐term hyperglycemia are critical for peripheral nerve damage, resulting in distal‐predominant nerve fiber degeneration. More recently, cellular factors derived from the bone marrow also appear to have a strong impact on the development of peripheral nerve pathology. As evident from such complicated processes, inhibition of single metabolic factors might not be sufficient for the treatment of neuropathy, but a combination of several inhibitors might be a promising approach to overcome this serious disorder. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00070.x, 2010)

Vascular mechanism of axonal degeneration in peripheral nerves in hemiplegic sides after cerebral hemorrhage: An experimental study

Background

Though retrograde neuronal death and vascular insufficiency have been well established in plegics following intracerebral hemorrhage, the effects of plegia on arterial nervorums of peripheral nerves have not been reported. In this study, the histopathological effects of the intracerebral hemorrhage on the dorsal root ganglions and sciatic nerves via affecting the arterial nervorums were investigated.

Methods

This study was conducted on 13 male hybrid rabbits. Three animals were taken as control group and did not undergo surgery. The remaining 10 subjects were anesthetized and were injected with 0.50 ml of autologous blood into their right sensory-motor region. All rabbits were followed-up for two months and then sacrificed. Endothelial cell numbers and volume values were estimated a three dimensionally created standardized arterial nervorums model of lumbar 3. Neuron numbers of dorsal root ganglions, and axon numbers in the lumbar 3 nerve root and volume values of arterial nervorums were examined histopathologically. The results were analyzed by using a Mann-Whitney-U test.

Results

Left hemiplegia developed in 8 animals. On the hemiplegic side, degenerative vascular changes and volume reduction in the arterial nervorums of the sciatic nerves, neuronal injury in the dorsal root ganglions, and axonal injury in the lumbar 3 were detected. Statistical analyses showed a significant correlation between the normal or nonplegic sides and plegic sides in terms of the neurodegeneration in the dorsal root ganglions (p < 0.005), axonal degeneration in the lumbar 3 nerve roots (p < 0.005), endothelial cell degeneration in the arterial nervorums (p < 0.001), and volume reduction in the arterial nervorums (p < 0.001).

Conclusion

Intracerebral hemorrhage resulted in neurodegeneration in the dorsal root ganglion and axonolysis in the sciatic nerves, endothelial injury, and volume reduction of the arterial nervorums in the sciatic nerves. The interruption of the neural network connection in the walls of the arterial nervorums in the sciatic nerves may be responsible for circulation disorders of the arterial nervorums, and arterial nervorums degeneration could result in sciatic nerves injury.

Cutaneous sensibility and peripheral nerve function in patients with unmedicated essential hypertension

Sensorimotor deficits in patients with essential hypertension may be due to impaired nerve function. Cutaneous sensory thresholds, median nerve sensory and motor conduction velocities, and median nerve sensory action potential amplitudes were assessed in 30 patients with unmedicated essential hypertension and 29 normotensives. Cutaneous sensory thresholds were higher and sensory action potential amplitudes smaller in hypertensives than normotensives whereas sensory and motor nerve conduction velocities did not differ between groups. These data suggest that hypertension may reduce the number of active sensory nerve fibers without affecting myelination. Sensory action potential amplitudes were inversely related to cutaneous sensory thresholds, suggesting that subclinical axonal neuropathy of sensory afferents may help account for perceptual deficits that characterize hypertension.

Effect of antihypertensive treatment on peripheral nerve vasculature in spontaneously hypertensive rats

The influence of hypertension and of treatment with the dihydropyridine-type Ca+2 antagonist nicardipine on peripheral nerve vasculature were investigated in spontaneously hypertensive rats (SHR). Male SHR were treated from the 16th to the 26th week of age with vehicle (control group), with nicardipine, at the hypotensive dose of 3 mg/kg/day, or at the nonhypotensive dose of 0.1 mg/kg/day or with an equihypotensive dose (10 mg/kg/day) of the nondihydropyridine-type vasodilator hydralazine. Age-matched normotensive Wistar-Kyoto (WKY) rats were left untreated and used as normotensive reference animals. In SHR a significant increase of systolic pressure values accompanied by sciatic nerve microvascular changes, involving primarily interfascicular arteries and to a lesser extent intrafascicular arteries, was observed. Treatment with the hypotensive dose of nicardipine countered hypertension-dependent microvascular changes occurring in both interfascicular and intrafascicular arteries. The nonhypotensive dose of nicardipine and hydralazine displayed a modest activity on interfascicular arteries, but significantly countered hypertension-related changes involving intrafascicular arteries. The above findings indicate the occurrence of hypertension-related changes of peripheral nerve microvasculature and of positive effects induced by appropriate pharmacological treatment. Further work is in progress to identify the functional relevance of microanatomical observations of the present study.

In vivo mechanisms of acetylcholine-induced vasodilation in rat sciatic nerve

We examined the importance of nitric oxide (NO), endothelium-derived hyperpolarizing factor (EDHF), and neurogenic activity in agonist-induced vasodilation and baseline blood flow [i.e., nerve microvascular conductance (NMVC)] in rat sciatic nerve using laser Doppler flowmetry. Agonists were acetylcholine (ACh) and 3-morpholinosydnonimine (SIN-1). Vasodilation occurring despite NO synthase (NOS) and cyclooxygenase inhibition and showing dependence on K(+) channel activity was taken as being mediated by EDHF. NOS and cyclooxygenase inhibition with N(omega)-nitro-L-arginine (L-NNA) + indomethacin (Indo) revealed two phases of ACh-induced vasodilation: an initial, transient L-NNA + Indo-resistant vasodilation, peaking at 23 +/- 6 s and lasting 145 +/- 69 s, followed by sustained L-NNA + Indo-sensitive vasodilation. L-NNA alone did not affect sustained ACh-induced vasodilation but decreased baseline NMVC by 55%. In the presence of L-NNA + Indo, the K(+) channel blocker tetraethylammonium (TEA) inhibited transient ACh-induced vasodilation by 58% and reduced baseline NMVC by 25%. SIN-1-induced vasodilation increased fourfold in the presence of L-NNA, whereas the specific guanylyl cyclase inhibitor 1H-(1, 2, 4)oxadiazolo(4,3-alpha)quinoxalin-1-one abolished it. However, in homogenates of rat sciatic nerve, SIN-1-stimulated soluble guanylyl cyclase (sGC) activity was unaffected by L-NNA. TTX affected neither SIN-1- nor ACh-induced vasodilation. In conclusion, ACh-induced vasodilation consisted of two components, the first partially mediated by EDHF and the second by a vasodilatory prostanoid + NO. Baseline NMVC was dependent on NO and EDHF. Although L-NNA enhanced SIN-1-induced vasodilation, it had no effect on sGC-activity.

Myogenic reactivity of rat epineurial arterioles: potential role in local vasoregulatory events

Local control of neural blood flow is considered to reside in innervation of epineurial and endoneurial arterioles rather than in intrinsic autoregulatory mechanisms. With the use of an isolated vessel preparation and an in vivo approach, the present studies examined intrinsic vasomotor responsiveness of epineurial arterioles. Segments of epineurial arterioles, cannulated on glass micropipettes (40 micrometers) and pressurized in the absence of intraluminal flow, showed sustained pressure-dependent (30-90 mmHg) vasoconstriction and acute myogenic reactivity. Myogenic tone was unaffected by phentolamine (10(-6) M). Removal of extracellular Ca(2+) resulted in loss of spontaneous tone and passive behavior. Concentration-response curves for norepinephrine (10(-9)-3 x 10(-6) M) and relaxation to both acetylcholine (10(-8)-10(-5) M) and adenosine (10(-8)-10(-4) M) were obtained. Acetylcholine dilator responses were inhibited by N(G)-nitro-L-arginine methyl ester. Epineurial blood flow was measured in vivo using a laser-Doppler flow probe. Blood flow declined over a 2-h period after surgery, and during this time preparations developed responsiveness to the dilator acetylcholine. Phentolamine blocked vasoconstrictor responses to exogenous norepinephrine but only partially reversed the in vivo baseline tone. The time-dependent decline in epineurial blood flow was observed despite the presence of tetrodotoxin (1 microM), further confirming that tone was predominantly caused by myogenic rather than neurogenic mechanisms. It is concluded that because epineurial arterioles exhibit intrinsic myogenic reactivity, they have the potential to participate in local regulation of neural hemodynamics independently of their own innervation.

Effects of hindlimb temperature on sciatic nerve laser Doppler vascular conductance in control and streptozotocin-diabetic rats

The effects of hindlimb temperature on sciatic nerve and skeletal muscle laser Doppler vascular conductance (LDVC) were assessed in anesthetized control and streptozotocin (STZ)-diabetic rats. With core temperature at 37 degrees C and exposed hindlimb temperature at 32 degrees C, nerve LDVC was significantly lower in rats after 8 weeks of STZ diabetes than in age-matched control rats. Subsequent warming of the exposed hindlimb of control rats from 32 degrees C to 37 degrees C significantly decreased nerve LDVC by 41% and increased muscle LDVC by 48%. Because nerve LDVC was unchanged by hindlimb warming in STZ-diabetic rats, there was no significant difference between control and diabetic nerve LDVC at 37 degrees C. In a second study, after 6 weeks of STZ diabetes, changes from control nerve LDVC were shown to depend on temperature rather than the duration of surgical exposure. These findings emphasize that information about hindlimb temperature is a prerequisite for interpreting the effects of experimental diabetes on hindlimb nerve blood flow.

Effects of cilostazol on the peripheral nerve function and structure in STZ-induced diabetic rats

We examined the effect of cilostazol (CZ), antiplatelet agent and potent vasoactive compound, which has an inhibitory effect on tissue phosphodiesterase, on peripheral nerve in streptozotocin-induced diabetic rats. Diabetic rats were fed for 12 weeks with a chow containing 0.01% or 0.03% CZ (w/w) and the results were compared with untreated diabetic rats. The 0.03% CZ treatment significantly improved motor nerve-conduction velocity and restored nerve Na+, K(+)-ATPase activity in diabetic rats without affecting body weight and glycated hemoglobin levels, but the effects of 0.01% CZ treatment did not reach statistical difference. Elevated sorbitol and reduced myo-inositol levels in diabetic nerve tissues were not influenced by CZ treatment. Structural analysis of the sural nerve demonstrated a partial but significant effect on decreased mean myelinated fiber area and atrophic changes of the axon in diabetic rats treated with 0.01% CZ. CZ treatment inhibited reduction of pericyte area of endoneurial microvessels in diabetic rats. Expansion of endoneurial microvessels and luminal area in relation to vascular area also tended to be inhibited by CZ treatment. Thus CZ treatment ameliorated, although not completely, functional and structural abnormalities in peripheral nerve of diabetic rats without effecting the polyol pathway. These results support the contention that vascular factors may play an important role in the etiology of experimental diabetic neuropathy and suggest that CZ may have a beneficial therapeutic effect on diabetic neuropathy.

Effects of body and hindlimb temperature on laser Doppler blood flow and vascular conductance in rat sciatic nerve and skeletal muscle

The role of body and hindlimb temperature in the control of blood flow in nerve and muscle was assessed by laser Doppler flowmetry. Following surgical exposure of nerve, initial measurements were taken for 5 min at hindlimb temperatures of 30-31 degrees C. A second set of identical measurements was then made either with or without warming to 37 degrees C. Without warming, nerve laser Doppler flow (NLDF) increased by 14.5+/-3.2% (mean+/-SEM) but, with warming, decreased by 40.9+/-8.2%. In contrast, adduccamerontor magnus muscle laser Doppler flow (MLDF) decreased without warming (14.7+/-1.0%) and increased with warming (20.4+/-12.8%). Because blood pressure was not significantly altered by changes in hindlimb temperature, the patterns of changes in vascular conductance (laser Doppler flow/blood pressure) were not significantly different from that seen with NLDF and MLDF. Thus, warming to physiological temperatures was associated with decreased NLDF and vascular conductance and increased MLDF and vascular conductance. These data may have implications for the interpretation of nerve blood flow data obtained at different hindlimb temperatures.

The vasculature of the peripheral portion of the human eighth cranial nerve

The vasculature of the peripheral portion of the human eighth cranial nerve (VIIIN) was investigated by light and transmission electron microscopy. Arterioles and venules running longitudinally around the VIIIN formed the extrinsic vascular system. The anatomical relationship between these extrinsic vessels and the VIIIN sheath was similar to that between blood vessels on the surface of the brain and the pia mater. In the endoneurium, postcapillary venules and large capillaries were sparsely distributed and longitudinally arranged, and these microvessels formed the intrinsic microvascular system, which was supported by the extrinsic vascular system via anastomosing vessels. The ultrastructural features of the internal auditory artery and its main branches were the same as those of other intracranial arteries. Ultrastructural study also revealed myo-endothelial junctions in anastomosing arterioles, and endothelio-pericytic junctions in extrinsic and anastomosing venules. Microvascular endothelial cells were connected by tight junctions in both the vestibular ganglion and the rest of the VIIIN. These features of the vasculature were considered to be effective for maintenance of the endoneurial fluid and regulation of the circulation in the peripheral portion of the human VIIIN.

Effect of carbon dioxide on facial nerve blood flow in rabbits

We investigated blood flow to the facial nerve, cerebral cortex, brain stem, and dura mater in 16 white rabbits using a nonradioactive microsphere technique at various levels of arterial carbon dioxide tension. The blood flow to the facial nerve in the 32 temporal bones was 59.1 +/- 32.9 microliters/g/min. Unlike cerebral blood flow, blood flow to the facial nerve and dura mater did not show any marked increase upon carbon dioxide inhalation.

Neonatal guanethidine treatment alters endoneurial but not dorsal root ganglion perfusion in the rat

In previous work, we suggested that there were differences in vasoregulation between dorsal root ganglia (DRG) and the endoneurium of peripheral nerve trunks. To investigate sympathetic control of both microvessel beds, we compared local perfusion in the sciatic nerve endoneurium and lumbar DRG of adult Sprague-Dawley rats treated from neonatal day 5 with guanethidine monosulfate to induce adrenergic sympathectomy. Control rats were injected with normal saline. Local blood flow and microvascular resistance were measured using microelectrodes sensitive to the clearance of hydrogen. Guanethidine-sympathectomized rats had higher sciatic endoneurial blood flow and lower endoneurial microvascular resistance than saline-injected controls. In contrast, DRG blood flow was not increased by sympathectomy and was comparable to control values despite the hypotension induced by sympathectomy. The results suggest that sympathetic control of local blood flow and may be less apparent in DRG than endoneurium and that local autoregulation may protect DRG from hypotension.

Vasodilating effect of dipyridamole on rat endoneurial vessels: morphometric study

Ischaemia plays an important role in the pathogenetic mechanism of various neuropathies. To study the possible vasodilating effects of dipyridamole on peripheral nerve vessels, morphometric analysis of endoneurial vessels was undertaken in rat sciatic and tibial nerves after chronic dipyridamole treatment. Each rat was injected with 4 mg/kg of dipyridamole intraperitoneally twice daily for 5 days/week and once daily during the weekend for a period of 6 weeks. The mean luminal area and perimeter of endoneurial vessels in the sciatic nerve were significantly greater in dipyridamole-treated animals than in controls. The total fascicular area and densities of endoneurial vessels were not significantly different between experimental and control groups. This study demonstrated that daily administration of dipyridamole over a 6 week period caused endoneurial vessels to dilate resulting in increased luminal area and perimeter. Dipyridamole might be a potent therapeutic agent for peripheral neuropathies attributed to nerve ischaemia.

Endoneurial blood supply to peripheral nerves is not uniform

Peripheral nerves are not uniformly susceptible to the effects of ischemia in human and experimental ischemic neuropathies. Since endoneurial blood flow is directly proportional to the number of endoneurial capillaries, we studied endoneurial capillary density at multiple levels of the peripheral nerves of normal rats. Capillary density was lowest in the sciatic and proximal tibial nerves and significantly higher in dorsal and ventral roots and distal tibial and plantar nerves. Endoneurial capillary density corresponds to the hierarchy of susceptibility to ischemic nerve damage in human and experimental ischemic neuropathies. These findings suggest that susceptibility of peripheral nerves to ischemia is determined, at least in part, by the density of endoneurial capillaries.

Unique microvascular characteristics of the dorsal root ganglion in the rat

Physiological characteristics of dorsal root ganglia microvessels have not been reported in detail. In this study we examined local blood flow and oxygen tension in the L4 dorsal root ganglion (DRG) of the rat. Under normal physiological conditions, local DRG blood flow measured 36.1 +/- 2.7 ml/100 g/min, over twice that within the endoneurium of the sciatic nerve. DRG blood flow was better maintained during hypotension than endoneurial blood flow suggesting partial autoregulation. Unlike endoneurium, there was relative constancy of flow between mean arterial pressures of 60 and 120 mm Hg. Hypercarbia with acidosis, and hypocarbia with alkalosis did not influence blood flow. The histogram of oxygen tensions within the dorsal root ganglion resembled that in brain but included more values at lower tensions than observed in published endoneurial histograms. Theses findings suggest that the DRG differ from endoneurium in ways that reflect the higher metabolic requirements of neural soma.

Stimulation-induced peripheral nerve hyperemia: mediation by fibers innervating vasa nervorum?

We studied the influence of graded nerve trunk stimulation on endoneurial blood flow (NBF), oxygen tension and pH in the rat sciatic nerve. The purpose of the investigation was to explore changes in the in vivo microenvironment of axons which result from their metabolic activation. Using endoneurial microelectrodes, we made serial measurements before, during and after varying stimulation protocols in curarized animals. NBF was increased by stimulation and the effect was directly related to the frequency, length and intensity of the stimulation train. At an intensity designed to supramaximally recruit myelinated fibers, high frequency (50 and 100 Hz) and prolonged duration (5-15 min) stimulation increased NBF. The effect was partly blocked by infiltration of lidocaine at the stimulating site. High intensity stimulation, designed to also recruit unmyelinated fibers, was particularly effective in enhancing NBF and lowering microvascular resistance. Continuous measurements of endoneurial oxygen and pH tension failed to identify associated declines with stimulation irrespective of the protocol. Both oxygen tension and pH tended to rise with stimulation. These studies confirm the presence of stimulation-induced endoneurial hyperemia but provide no evidence that local hypoxia or acidosis are mechanisms. Stimulation recruitment of vasodilatory axons innervating vasa nervorum may be an alternative explanation.

Adrenergic innervation of blood vessels in rat tibial nerve during Wallerian degeneration

Adrenergic innervation of blood vessels in rat tibial nerve during Wallerian degeneration was examined, using the formaldehyde-induced histo-fluorescence method. The left sciatic nerve was transected at the level of the sciatic notch, whereas the right sciatic nerve was left intact and used as control. At 1, 3, 7, 14, 42, 56 or 84 days after transection, the tibial nerves of the transected and contralateral sides were exposed. Pieces of each nerve were used for light microscopy or for examination of adrenergic innervation with the fluorescence microscope. One day after transection, no adrenergic nerve fiber was observed in the endoneurium of the transected nerve. After 3 days, adrenergic innervation of small- and medium-sized arterioles in the epi-perineurium was absent, and after 7 days no fibers were visible around large arterioles. Fluorescent fibers were not detected even at 84 days post-surgery. It is concluded that adrenergic innervation of blood vessels in the rat tibial nerve is irreversibly lost after permanent axotomy, and that adrenergic regulation of nerve blood flow may also be lost.

Adrenergic control of nerve blood flow

The factors that regulate blood flow within peripheral nerve (NBF) are largely unexplored. The presence of norepinephrine (NE)-containing terminals on vasa nervorum suggests that adrenergic regulation may be important. In this study we investigated the adrenergic responsiveness of NBF to agonist and antagonist agents using three separate techniques: (i) laser doppler flowmetry (LDV) using an epineurial probe, (ii) hydrogen clearance (HC) using an endoneurial microelectrode, and (iii) direct video recording (VA) of epineurial microvessels. Selective intraarterial NE delivery induced a phentolamine-reversible fall in NBF. Phentolamine alone increased NBF and lowered microvascular resistance (MR) as measured by HC. Epineurial microvessels had segmental vasoconstriction to bathing solutions of NE as observed by VA. Our findings suggest that NBF responds to adrenergic manipulation, possibly due to a heterogenous distribution of alpha receptors on epineurial vessels that supply the endoneurium.

Guanethidine-induced adrenergic sympathectomy augments endoneurial perfusion and lowers endoneurial microvascular resistance

Chronic administration of guanethidine sulfate in the rat induces a selective adrenergic neuropathy. We studied the effects of guanethidine-induced adrenergic sympathectomy on rat sciatic nerve blood flow (NBF), microvascular resistance (MR), vessel caliber and norepinephrine (NE) content. A control group of animals was studied following chronic administration of mammalian Ringer's solution. NBF and MR were measured with an endoneurial microelectrode, using the technique of hydrogen clearance (HC). Following HC, the sciatic nerve was perfused with India Ink, removed, frozen and sectioned. Measurements were made of endoneurial microvessel numbers, diameter, circumference and area. The contralateral sciatic nerve was removed for measurements of NE content. In guanethidine-treated animals we observed elevated NBF, reduced MR and dilated microvessels. Numbers of microvessels and fascicular areas were similar to controls. NE content was markedly reduced following sympathectomy. These studies suggest that NBF, unlike cerebral blood flow (CBF), is regulated by its adrenergic input. Removal of adrenergic innervation of the vasa nervorum appears to result in a loss of tonic vasoconstrictive action.

Increased density of perivascular adrenergic innervation in tibial and vagus nerves of spontaneously hypertensive rats

Adrenergic innervation of epiperineurial arterioles and of the endoneurium of the tibial and vagus nerves of spontaneously hypertensive rats (SHR) and normotensive controls (WKY) was studied by glyoxylic acid-induced fluorescence and paraformaldehyde-induced fluorescence methods. Adrenergic perivascular innervation of epiperineurial arterioles in both nerves was denser in SHR than in controls. Mean density in the endoneurium also was higher in SHR in both nerve types. These results suggest that adrenergic perivascular innervation, which may influence nerve blood flow, becomes greater in density in peripheral nerves during chronic hypertension.

Altered blood rheology in the pathogenesis of diabetic and other neuropathies

Although a substantial literature confirms the abnormal flow properties of diabetic blood, only in a few papers has the vasculitis of diabetic neuropathy been considered to have a hemorheological cause. It is proposed that the pathogenesis of nerve lesions involves an interaction between the specialized nerve vascular system and focal ischemic lesions resulting from rheologically induced stasis. The proposition is extended into other conditions with abnormal blood rheology such as hypothyroidism, uremia, dysglobulinemia, polyarteritis nodosa, and lepromatous leprosy. It is concluded that the treatment of such polyneuropathies should include an agent which would improve the flow properties of the blood.

Sciatic nerve blood flow response to carbon dioxide

Sciatic nerve blood flow (NBF) during hypercarbia was examined in unanesthetized decerebrate rats by means of laser Doppler flowmetry (LDF). During inspiration of gas mixtures containing no CO2, followed by either 5, 10 or 20% CO2, arterial pCO2 increased by 13, 18 and 68 mm Hg, respectively. Blood pressure (BP) and the LDF signal, which were measured continuously, increased for 30-40 s following the start of inhalation of CO2 and then decreased. Three min after the start of inhalation of 5 or 10% CO2, BP had returned to the baseline and the LDF signal was increased by 14 and 15%, respectively, compared with preinhalation values. In rats inspiring 20% CO2, systemic BP remained elevated 12% above the baseline and NBF was increased by 18%. The results indicate that dilatation of the vasa nervorum during hypercarbia is less than that at cerebral blood vessels. The nerve vasculature dilates maximally in response to 5% CO2, with a rise in NBF of about 1.1% per mm Hg increase in paCO2.

Enhanced 2-deoxyglucose incorporation in peripheral nerve during ischemia

We examined the effect of acute ischemia on peripheral nerve uptake of the glucose analog 2-deoxyglucose (2-DG). Endoneurial 2-DG incorporation was uniform at rest, but increased focally in areas subjected to moderate levels of ischemia which were not severe enough to impair nerve conduction. We believe these data are indicative of increased endoneurial glucose metabolism probably reflecting a compensatory shift to less efficient anaerobic glycolysis. This mechanism may in part account for peripheral nerve's ability to survive transient interruption of its blood supply.

Blood flow in rat sciatic nerve during hypotension

Laser Doppler flowmetry was utilized to examine blood flow in sciatic nerves of barbiturate-anesthetized and of unanesthetized decerebrate rats, in response to hypotension induced by graded exsanguination or by graded clamping of the descending aorta. Continuous laser Doppler flowmetry signals decreased linearly with decreasing arterial blood pressure. In anesthetized as well as in unanesthetized rats, the signal approached zero at a systemic blood pressure of 14 mm Hg or less. The results do not demonstrate autoregulation of blood flow in the rat sciatic nerve during systemic hypotension.

Effects of changes of blood pressure, respiratory acidosis and hypoxia on blood flow in the sciatic nerve of the rat

Using the hydrogen clearance technique, we have measured blood flow in the sciatic nerves of healthy, anaesthetized rats at rest, at various arterial blood pressures, and during respiratory acidosis and hypoxia. The majority of hydrogen clearance curves were bi-exponential. The slower component appears to reflect nerve blood flow more accurately than either the fast component or the composite value obtained from both components. Mean nerve blood flow estimated from the slow component of the seventeen bi-exponential hydrogen clearance curves and from the seven mono-exponential curves was 15.8 +/- 1.1 ml min-1 100 g-1 (+/- S.E. of the mean). The mean value of the fast component of the bi-exponential curves was 118 +/- 6 ml min-1 100 g-1 and that obtained from both components was 25.9 +/- 2.6 ml min-1 100 g-1. Sciatic nerve blood flow was measured over a range of arterial blood pressures of 60-160 mmHG. There is a curvilinear relationship between pressure and flow suggesting that the nerve vascular bed responds passively to changes in perfusion pressure. Respiratory acidosis resulted in no significant change in nerve blood flow. The mean flow was 15.5 +/- 1.9 ml min-1 100 g-1. During hypoxia, nerve blood flow decreased to 7.5 +/- 1.4 ml min-1 100 g-1 as a result of a reduction in arterial blood pressure and an increase in vascular resistance. These findings suggest that normal nerve blood flow is high in relation to metabolic activity, especially when compared with the brain.