1
|
Ou X, Wang Z, Yu D, Guo W, Zvyagin AV, Lin Q, Qu W. VEGF-loaded ROS-responsive nanodots improve the structure and function of sciatic nerve lesions in type II diabetic peripheral neuropathy. Biomaterials 2025; 315:122906. [PMID: 39488031 DOI: 10.1016/j.biomaterials.2024.122906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 09/27/2024] [Accepted: 10/20/2024] [Indexed: 11/04/2024]
Abstract
Diabetic peripheral neuropathy (DPN) is a prevalent complication of diabetes mellitus (DM), significantly contributing to the risk of amputation and mortality. Reactive oxygen species (ROS) can induce both neurological and structural harm through direct impact and pyroptosis, underscoring the critical role of ROS regulation in mitigating DPN. In this research endeavor, we propose harnessing the inherent antioxidant properties of sulfhydryl groups by grafting them onto gold nanodots through an amidation reaction, resulting in the creation of ROS-responsive AuNDs. Additionally, we aim to synthesize AuNDs-VEGF, wherein VEGF is attached to AuNDs via electrostatic interactions, as a therapeutic strategy for addressing DPN in rat models. The results of in vivo experiments showed that AuNDs and AuNDs-VEGF nanoparticles could increase the nerve conduction velocity, shorten the latency of nerve conduction in the sciatic nerve, promote the regeneration of nerve trophectodermal vessels, improve the structure and function of the sciatic nerve, reduce the apoptosis of neural cells, and alleviate the atrophy of the gastrocnemius muscle. Thus, VEGF-loaded ROS-responsive nanodots present a promising avenue for ameliorating diabetic peripheral neuropathy. This innovative approach not only extends the application possibilities of nanodots but also introduces a novel avenue for the treatment of diabetic neuropathy.
Collapse
Affiliation(s)
- Xiaolan Ou
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China; Department of Plastic and Burn Surgery, the Second Affiliated Hospital of Chengdu Medical College, Nuclear Industry 416 Hospital, Chengdu, 610051, China
| | - Ze Wang
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, Jilin, 130000, China
| | - Daojiang Yu
- Department of Plastic and Burn Surgery, the Second Affiliated Hospital of Chengdu Medical College, Nuclear Industry 416 Hospital, Chengdu, 610051, China
| | - Wenlai Guo
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China
| | - Andrei V Zvyagin
- Australian Research Council Centre of Excellence for Nanoscale Bio-photonics, Macquarie University, Sydney, NSW, 2109, Australia; Institute of Biology and Biomedicine, Lobachevsky Nizhny Novgorod State University, 603105. Nizhny Novgorod, Russia
| | - Quan Lin
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, Jilin, 130000, China.
| | - Wenrui Qu
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China; Joint International Research Laboratory of Ageing Active Strategy and Bionic Health in Northeast Asia of Ministry of Education, Changchun, 130041, China.
| |
Collapse
|
2
|
Cao YH, Zhou YM, Wang SY, Guo J, Cen LS. Promise of the gut microbiota in prevention and traditional Chinese medicine treatment of diabetic peripheral neuropathy. World J Diabetes 2024; 15:2387-2393. [PMID: 39676801 PMCID: PMC11580588 DOI: 10.4239/wjd.v15.i12.2387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 09/22/2024] [Accepted: 10/12/2024] [Indexed: 11/18/2024] Open
Abstract
The pathogenesis of diabetic peripheral neuropathy (DPN) has not been fully elucidated, and treatment options are limited. Currently, the main strategies for treating DPN are strict glycemic control and symptomatic pain relief. In this editorial, we comment on an article by Li et al, which suggested that modulating the gut microbiota using traditional Chinese medicine (TCM) may be a promising strategy for alleviating DPN symptoms. The regulation of the gut microbiota has received widespread attention in the study of various diseases. TCM can participate in the regulation of gut microbiota through multiple mechanisms, and this regulatory effect can alleviate the clinical symptoms of DPN. We briefly analyzed the promise of the gut microbiota in the early diagnosis, treatment, and clinical efficacy of TCM for DPN. The gut microbiota has potential value at multiple nodes in the occurrence and progression of DPN.
Collapse
Affiliation(s)
- Yuan-Hao Cao
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Yi-Mai Zhou
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Si-Yu Wang
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Jing Guo
- Department of Dermatology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, Zhejiang Province, China
| | - Lu-Sha Cen
- Department of Ophthalmology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, Zhejiang Province, China
| |
Collapse
|
3
|
Zhu Z, Guan Y, Gao S, Guo F, Liu D, Zhang H. Impact of natural compounds on peroxisome proliferator-activated receptor: Molecular effects and its importance as a novel therapeutic target for neurological disorders. Eur J Med Chem 2024; 283:117170. [PMID: 39700874 DOI: 10.1016/j.ejmech.2024.117170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 12/10/2024] [Accepted: 12/12/2024] [Indexed: 12/21/2024]
Abstract
Neurological disorders refer to the pathological changes of the nervous system involving multiple pathological mechanisms characterized by complex pathogenesis and poor prognosis. Peroxisome proliferator-activated receptor (PPAR) is a ligand-activated transcription factor that is a member of the nuclear receptor superfamily. PPAR has attracted considerable attention in the past decades as one of the potential targets for the treatment of neurological disorders. Several in vivo and in vitro studies have confirmed that PPARs play a neuroprotective role by regulating multiple pathological mechanisms. Several selective PPAR ligands, such as thiazolidinediones and fibrates, have been approved as pharmacological agonists. Nevertheless, PPAR agonists cause a variety of adverse effects. Some natural PPAR agonists, including wogonin, bergenin, jujuboside A, asperosaponin VI, monascin, and magnolol, have been introduced as safe agonists, as evidenced by clinical or preclinical experiments. This review summarizes the effects of phytochemicals on PPAR receptors in treating various neurological disorders. Further, it summarizes recent advances in phytochemicals as potential, safe, and promising PPAR agonists to provide insights into understanding the PPAR-dependent and independent cascades mediated by phytochemicals. The phytochemicals exhibited potential for treating neurological disorders by inhibiting neuroinflammation, exerting anti-oxidative stress and anti-apoptotic activities, promoting autophagy, preventing demyelination, and reducing brain edema and neurotoxicity. This review presents data that will help clarify the potential mechanisms by which phytochemicals act as pharmacological agonists of PPARs in the treatment of neurological disorders. It also provides insights into developing new drugs, highlighting phytochemicals as potential, safe, and promising PPAR agonists. Additionally, this review aims to enhance understanding of both PPAR-dependent and independent pathways mediated by phytochemicals.
Collapse
Affiliation(s)
- Zhe Zhu
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Yadi Guan
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Songlan Gao
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Feng Guo
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
| | - Dong Liu
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
| | - Honglei Zhang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
| |
Collapse
|
4
|
Pantazopoulos D, Gouveri E, Rizzo M, Papanas N. Cilostazol for the treatment of distal symmetrical polyneuropathy in diabetes mellitus: Where do we stand? J Diabetes Complications 2024; 38:108905. [PMID: 39522391 DOI: 10.1016/j.jdiacomp.2024.108905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 11/04/2024] [Accepted: 11/06/2024] [Indexed: 11/16/2024]
Abstract
INTRODUCTION Diabetic Neuropathy (DN) is one of the most frequent chronic complications of diabetes mellitus. Its commonest form, distal symmetrical polyneuropathy (DSPN), is characterised by slowly progressing length-dependent nerve damage in the lower limbs, increasing the risk of foot ulcerations and leading to symptoms like tingling, pain, or numbness. AIM The aim of this review was to discuss the utility of cilostazol, a phosphodiesterase inhibitor with known antiplatelet, vasodilatory, anti-inflammation properties, in the treatment of DSPN. RESULTS Preclinical studies in animals have demonstrated the ability of cilostazol to improve nerve function and to protect from peripheral nerve disruption and central sensitisation. However, clinical trials in humans are very sparse and have so far not been encouraging. CONCLUSIONS Further research is needed to fully understand the mechanisms and potential efficacy of cilostazol in treating DSPN.
Collapse
Affiliation(s)
- Dimitrios Pantazopoulos
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
| | - Evanthia Gouveri
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
| | - Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), School of Medicine, University of Palermo, Palermo, Italy
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece.
| |
Collapse
|
5
|
Wiegand V, Gao Y, Teusch N. Pharmacological Effects of Paeonia lactiflora Focusing on Painful Diabetic Neuropathy. PLANTA MEDICA 2024; 90:1115-1129. [PMID: 39471979 DOI: 10.1055/a-2441-6488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2024]
Abstract
Painful diabetic neuropathy (PDN) is a highly prevalent complication in patients suffering from diabetes mellitus. Given the inadequate pain-relieving effect of current therapies for PDN, there is a high unmet medical need for specialized therapeutic options. In traditional Chinese medicine (TCM), various herbal formulations have been implemented for centuries to relieve pain, and one commonly used plant in this context is Paeonia lactiflora (P. lactiflora). Here, we summarize the chemical constituents of P. lactiflora including their pharmacological mechanisms-of-action and discuss potential benefits for the treatment of PDN. For this, in silico data, as well as preclinical and clinical studies, were critically reviewed and comprehensively compiled. Our findings reveal that P. lactiflora and its individual constituents exhibit a variety of pharmacological properties relevant for PDN, including antinociceptive, anti-inflammatory, antioxidant, and antiapoptotic activities. Through this multifaceted and complex combination of various pharmacological effects, relevant hallmarks of PDN are specifically addressed, suggesting that P. lactiflora may represent a promising source for novel therapeutic approaches for PDN.
Collapse
Affiliation(s)
- Vanessa Wiegand
- Institute of Pharmaceutical Biology and Biotechnology, Heinrich Heine University Düsseldorf, Germany
| | - Ying Gao
- Institute of Pharmaceutical Biology and Biotechnology, Heinrich Heine University Düsseldorf, Germany
| | - Nicole Teusch
- Institute of Pharmaceutical Biology and Biotechnology, Heinrich Heine University Düsseldorf, Germany
| |
Collapse
|
6
|
Patel P, Thakkar K, Shah D, Shah U, Pandey N, Patel J, Patel A. Decrypting the multifaceted peripheral neuropathy based on molecular pathology and therapeutics: a comprehensive review. Arch Physiol Biochem 2024; 130:886-897. [PMID: 38588401 DOI: 10.1080/13813455.2024.2336916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/28/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
CONTEXT Peripheral neuropathy (PN) is a multifaceted complication characterized by nerve damage due to oxidative stress, inflammatory mediators, and dysregulated metabolic processes. Early PN manifests as sensory changes that develop progressively in a "stocking and glove" pattern. METHODS AND MECHANISMS A thorough review of literature has been done to find the molecular pathology, clinical trials that have been conducted to screen the effects of different drugs, current treatments and novel approaches used in PN therapy. Diabetic neuropathy occurs due to altered protein kinase C activity, elevated polyol pathway activity in neurons, and Schwann cells-induced hyperglycemia. Other causes involve chemotherapy exposure, autoimmune ailments, and chronic ethanol intake. CONCLUSION Symptomatic treatments for neuropathic pain include use of tricyclic antidepressants, anticonvulsants, and acetyl-L-carnitine. Patients will have new hope if clinicians focus on novel therapies including gene therapy, neuromodulation techniques, and cannabidiol as an alternative to traditional medications, as management is still not ideal.
Collapse
Affiliation(s)
- Praysha Patel
- Ramanbhai Patel College of Pharmacy, CHARUSAT, Changa, Gujarat, India
| | - Krishna Thakkar
- Ramanbhai Patel College of Pharmacy, CHARUSAT, Changa, Gujarat, India
| | - Div Shah
- Ramanbhai Patel College of Pharmacy, CHARUSAT, Changa, Gujarat, India
| | - Umang Shah
- Ramanbhai Patel College of Pharmacy, CHARUSAT, Changa, Gujarat, India
| | - Nilesh Pandey
- Health Science Center, Louisiana State University, Shreveport, LA, USA
| | - Jayesh Patel
- Consultant, Vascular surgeon, Shree Krishna Hospital, Karamsad, Gujarat, India
| | - Alkeshkumar Patel
- Ramanbhai Patel College of Pharmacy, CHARUSAT, Changa, Gujarat, India
| |
Collapse
|
7
|
Song W, Zhao B, Wu Q, Gong Y, Jia Y, Zhang Y, Yang Y, Zhang B, Liang X, Zhang Q. Gastrodin alleviates diabetic peripheral neuropathy by regulating energy homeostasis via activating AMPK and inhibiting MMP9. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 135:156033. [PMID: 39306880 DOI: 10.1016/j.phymed.2024.156033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 08/04/2024] [Accepted: 09/07/2024] [Indexed: 12/01/2024]
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is a serious complication of diabetes that lacks effective treatment. Gastrodin, the primary bioactive compound derived from Rhizoma Gastrodiae, has a long history in treating epilepsy and various central nervous system disorders. However, its effect on DPN remains uncertain. PURPOSE This study aims to explore the therapeutic potential and underlying mechanisms of gastrodin in the treatment of DPN. METHOD DPN model rats were induced with streptozotocin (STZ) injection and divided into four groups receiving either gastrodin at two doses (30 and 60 mg kg-1 per day), α-lipoic acid (positive drug, 60 mg kg-1 per day), or placebo. Healthy rats were administrated with placebo. The administrations began eight weeks post-STZ injection and continued for six weeks. Following a comprehensive evaluation of the neuroprotective effects, a systematic pharmacology-based approach was subsequently employed to investigate the underlying mechanism of gastrodin in vivo and in vitro. RESULTS Gastrodin was demonstrated to effectively enhance peripheral nerve function and reduce pathological damages in DPN rats. Furthermore, gastrodin facilitated the expression of remyelination-related proteins and mitigated oxidative stress in DPN rats. Transcriptomic analysis indicated that the modulation of energy metabolism was pivotal in the neuroprotective effect of gastrodin, corroborated by targeted metabolomic analysis using high-performance ion chromatography coupled with mass spectrometry. Using network pharmacology analysis, 12 potential targets of gastrodin were identified. Among these, matrix metallopeptidase 9 (MMP9) was further validated as the primary target through molecular docking and cellular thermal shift assays. Functional Analysis of the potential targets underscored the pivotal role of AMPK signaling, and gastrodin demonstrated the capability to activate AMPK and inhibit MMP9 in vivo. In vitro studies further found that gastrodin enhanced antioxidant capacity and mitochondrial function of high glucose-cultured rat Schwann cells RSC96 in an AMPK-dependent manner. Inhibition of AMPK hindered the decrease of MMP9 induced by gastrodin in vitro. CONCLUSION This study revealed the new role of gastrodin in alleviating DPN by restoring the homeostasis of energy metabolism through activating AMPK and inhibiting MMP9. These findings highlight gastrodin's potential as a novel therapeutic candidate against DPN, and underscores an appealing strategy of regulating energy metabolism for DPN therapy.
Collapse
Affiliation(s)
- Wei Song
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; Institute of Clinical Medicine, National Infrastructures for Translational Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bingjia Zhao
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qunli Wu
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yiyi Gong
- Institute of Clinical Medicine, National Infrastructures for Translational Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yifan Jia
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yamin Zhang
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yunshuang Yang
- Department of Preventive Medicine, Beijing Longfu Hospital, Beijing 100010, China
| | - Bo Zhang
- Institute of Clinical Medicine, National Infrastructures for Translational Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiaochun Liang
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Qian Zhang
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| |
Collapse
|
8
|
Zhang X, Zhong G, Jiang C, Ha X, Yang Q, Wu H. Exploring the potential anti-diabetic peripheral neuropathy mechanisms of Huangqi Guizhi Wuwu Decoction by network pharmacology and molecular docking. Metab Brain Dis 2024; 40:20. [PMID: 39565454 DOI: 10.1007/s11011-024-01474-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 09/02/2024] [Indexed: 11/21/2024]
Abstract
Diabetic peripheral neuropathy (DPN) is the most prevalent microvascular complication of diabetes and Huangqi Guizhi Wuwu Decoction (HGWD) is frequently employed in classical Chinese medicine for treating DPN. This study aims to investigate the potential therapeutic targets and mechanisms of HGWD for treating DPN using network pharmacology and molecular docking methodologies. The intersection targets of DPN and HGWD were retrieved from the databases, with the resulting intersection targets being imported into the STRING database to construct the protein-protein interaction (PPI) network. Cytoscape 3.9.1 was used to screen the core targets and plot the herb-active ingredient-target (H-A-T) network. To identify the pivotal signaling pathways, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed on intersection targets. Molecular docking was subsequently conducted with AutoDock Vina to validate the binding energy between the core active ingredients and the core targets. 91 potential targets of HGWD were identified for the treatment of DPN. Topological analysis revealed core targets, including AKT1, TNF, PPARG, NFKB1, TP53, STAT3, PTGS2, HIF1A, ESR1, and GSK3B, alongside core active ingredients such as protoporphyrin, jaranol, kaempferol, quercetin, and isorhamnetin. GO and KEGG analyses indicated that PI3K/AKT, HIF-1, and AGE/RAGE signaling pathways could be crucial in treating DPN using HGWD. Furthermore, molecular docking results demonstrated robust binding activities between the active ingredients in HGWD and the identified core targets. The above results indicated that HGWD may exerting an anti-DPN effect by modulating the PI3K/AKT, HIF-1, and AGE/RAGE signaling pathways.
Collapse
Affiliation(s)
- Xueying Zhang
- The Eighth Clinical Medical College, Guangzhou University of Chinese Medicine, Foshan, China
| | - Guangcheng Zhong
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chen Jiang
- The Eighth Clinical Medical College, Guangzhou University of Chinese Medicine, Foshan, China
| | - Xiaojun Ha
- The Eighth Clinical Medical College, Guangzhou University of Chinese Medicine, Foshan, China
| | - Qingjiang Yang
- The Eighth Clinical Medical College, Guangzhou University of Chinese Medicine, Foshan, China
| | - Haike Wu
- Department of Neurology, Foshan Hospital of Traditional Chinese Medicine, Foshan, China.
| |
Collapse
|
9
|
Fan X, Cao J, Yan G, Zhao Y, Wang Y, Wang X, Mi J. A protocol for research on the use of acupuncture in the management of diabetic peripheral neuropathy in individuals with type 2 diabetes: A systematic review and meta-analysis. PLoS One 2024; 19:e0310732. [PMID: 39541380 PMCID: PMC11563441 DOI: 10.1371/journal.pone.0310732] [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: 10/27/2023] [Accepted: 09/04/2024] [Indexed: 11/16/2024] Open
Abstract
INTRODUCTION Diabetic peripheral neuropathy (DPN), a prevalent complication among individuals diagnosed with type 2 diabetes, has a significant impact on both the well-being of patients and their financial situation. Acupuncture has been employed for thousands of years within China and is regarded as one of the primary characteristic therapies of traditional Chinese medicine. Research has indicated that acupuncture has the potential to enhance microcirculation, decrease the generation of free radicals, and augment nerve conduction velocity. There had been several meta-analyses of acupuncture on DPN. Nevertheless, there has been inadequate attention given to the assessment of blood glucose control, and scores related to quality of life. Hence, we get additional evidence by enhancing the quantity and quality of studies to draw more distinct findings. METHODS We will conduct a comprehensive search for reports published from the beginning until June 2023 using various databases including Web of Science, Embase, Cochrane Library, PubMed, AMED, Wanfang database, VIP database, China National Knowledge Infrastructure, and Chinese Biomedical Literature database. Only randomized controlled trials will be considered, with no exclusion of quasi-randomized control trials. Articles in both English and Chinese will be taken into account without any limitations on publication dates. The data will be extracted, managed, and analyzed by two researchers working independently. The primary outcomes will include improvement of symptom scores, change of nerve conduction velocity, and quality of life scores. Additional outcomes will encompass blood glucose levels after fasting and 2 hours after eating, levels of glycosylated hemoglobin, and any adverse events associated with acupuncture. We plan to use the RevMan V.5.4 application and the random-effects model for conducting the meta-analysis. The assessment of potential prejudice can be conducted by Cochrane's 'risk of bias' 2 (RoB 2) tool. Registration: PROSPERO (registration number: CRD42023425203). DISCUSSION Our goal is to perform a meta-analysis that offers an unbiased approach to treating individuals with type 2 DPN. At the same time, it also provides doctors with more choices in the treatment of diabetes peripheral neuropathy.
Collapse
Affiliation(s)
- Xuechun Fan
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Jingsi Cao
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Guanchi Yan
- Department of Endocrinology, The First Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Yunyun Zhao
- Department of Endocrinology, The First Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Ying Wang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Xiuge Wang
- Department of Endocrinology, The First Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Jia Mi
- Department of Endocrinology, The First Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| |
Collapse
|
10
|
Fu B, Luo N, Zeng Y, Chen Y, Wie LJ, Fang J. Bibliometric and visualized analysis of 2014-2024 publications on therapy for diabetic peripheral neuropathy. Front Neurosci 2024; 18:1434756. [PMID: 39568669 PMCID: PMC11576440 DOI: 10.3389/fnins.2024.1434756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 10/14/2024] [Indexed: 11/22/2024] Open
Abstract
Background This research aimed to examine the global developing patterns in the treatment of diabetic peripheral neuropathy (DPN) using a bibliometric analysis of published literature. Methods We extracted publication data from papers published between 2014 and 2024 using a specific topic search in the "Web of Science Core Collection" (WoSCC) database. Various metrics, such as the number of papers, citations, authors, countries, institutions, and references, were collected for analysis. To further explore the data, CiteSpace was employed to examine co-citation patterns among authors, identify collaborative efforts between countries and institutions, and uncover emerging trends using burst keywords and reference analysis. Results The study encompassed 2,488 publications that exhibited an increasing trend in annual output. Notably, the journal PAIN, the United States, the Pfizer institution, and the author Feldman, EvaL emerged as the most prolific contributors to this research domain. The term "placebo-controlled trial" was the most prominent burst keyword from 2014 to 2017, whereas "spinal cord stimulation" held this distinction in the recent 5-year span. Furthermore, the publication titled "Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis-2015" demonstrated the highest burst in terms of references. Conclusion This study is the first to objectively reveal the current hotspots and trends in DPN treatment. The results indicate that drug therapy remains the primary first-line treatment for DPN and that future research on DPN treatment will likely focus on "spinal cord stimulation" and "pain management." These findings provide valuable insights into DPN treatment.
Collapse
Affiliation(s)
- Baitian Fu
- The Third Clinical Medical School, Zhejiang Chinese Medicine University, Hangzhou, China
| | - Ning Luo
- The Third Clinical Medical School, Zhejiang Chinese Medicine University, Hangzhou, China
| | - Yichen Zeng
- The Third Clinical Medical School, Zhejiang Chinese Medicine University, Hangzhou, China
| | - Yutian Chen
- The Third Clinical Medical School, Zhejiang Chinese Medicine University, Hangzhou, China
| | - Low Je Wie
- Institute of International Education of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jianqiao Fang
- The Third Clinical Medical School, Zhejiang Chinese Medicine University, Hangzhou, China
| |
Collapse
|
11
|
Wang S, Taledaohan A, Tuohan M, Zhang J, Li Y, Song W, Wang Y, Liang X, Wu Q. Jinmaitong alleviates diabetic neuropathic pain by inhibiting JAK2/STAT3 signaling in microglia of diabetic rats. JOURNAL OF ETHNOPHARMACOLOGY 2024; 333:118442. [PMID: 38852640 DOI: 10.1016/j.jep.2024.118442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/27/2024] [Accepted: 06/05/2024] [Indexed: 06/11/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Jinmaitong (JMT) is a prescription of Traditional Chinese Medicine that is composed of 12 crude drugs. It has been used in the treatment of diabetic neuropathic pain (DNP) for more than 30 years. AIM OF STUDY Microglia are thought to play an important role in neuropathic pain. This study aimed to evaluate the protective effect of JMT against DNP and to investigate the underlying mechanisms in which the microglia and JAK2/STAT3 signaling pathway were mainly involved. MATERIALS AND METHODS The chemical composition of JMT was analyzed using liquid chromatography tandem mass spectrometry. The diabetes model was constructed using 11 to 12-week-old male Zucker diabetic fatty (ZDF) rat (fa/fa). The model rats were divided into 5 groups and were given JMT at three dosages (11.6, 23.2, and 46.4 g/kg, respectively, calculated as the crude drug materials), JAK inhibitor AG490 (positive drug, 10 μg/day), and placebo (deionized water), respectively, for eight weeks (n = 6). Meanwhile, Zucker lean controls (fa/+) were given a placebo (n = 6). Body weight was tested weekly and blood glucose was monitored every 2 weeks. The mechanical allodynia and heat hyperalgesia were assessed using mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) tests. After treatment, the microglia activation marker Iba-1, CD11B, CD68, neuroinflammatory mediators, and mediators of the JAK2/STAT3 signaling pathway were compared between different groups. The mRNA and protein levels of target genes were assessed by quantitative real-time PCR and Western Blot, respectively. RESULTS We found that JMT significantly inhibited the overactivation of microglia in spinal cords, and suppressed neuroinflammation of DNP model rats, thereby ameliorating neurological dysfunction and injuries. Furthermore, these effects of JMT could be attributed to the inhibition of the JAK2/STAT3 signaling pathway. CONCLUSIONS Our findings suggested that JMT effectively ameliorated DNP by modulating microglia activation via inhibition of the JAK2/STAT3 signaling pathway. The present study provided a basis for further research on the therapeutic strategies of DNP.
Collapse
Affiliation(s)
- Shuyu Wang
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Ayijiang Taledaohan
- Department of Medicinal Chemistry, School of Pharmaceutical Sciences of Capital Medical University, Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, Beijing Laboratory of Biomedical Materials, Engineering Research Center of Endogenous Prophylactic of Ministry of Education of China, Beijing, 100069, China.
| | - Maermaer Tuohan
- Department of Medicinal Chemistry, School of Pharmaceutical Sciences of Capital Medical University, Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, Beijing Laboratory of Biomedical Materials, Engineering Research Center of Endogenous Prophylactic of Ministry of Education of China, Beijing, 100069, China.
| | - Jiyi Zhang
- Department of Medicinal Chemistry, School of Pharmaceutical Sciences of Capital Medical University, Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, Beijing Laboratory of Biomedical Materials, Engineering Research Center of Endogenous Prophylactic of Ministry of Education of China, Beijing, 100069, China.
| | - Yaoyang Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Wei Song
- Institute of Clinical Medicine, National Infrastructures for Translational Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Yuji Wang
- Department of Medicinal Chemistry, School of Pharmaceutical Sciences of Capital Medical University, Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, Beijing Laboratory of Biomedical Materials, Engineering Research Center of Endogenous Prophylactic of Ministry of Education of China, Beijing, 100069, China.
| | - Xiaochun Liang
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Qunli Wu
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| |
Collapse
|
12
|
Zhang YY, Chen BX, Wan Q. Association of lipid-lowering drugs with the risk of type 2 diabetes and its complications: a mendelian randomized study. Diabetol Metab Syndr 2024; 16:240. [PMID: 39367514 PMCID: PMC11451088 DOI: 10.1186/s13098-024-01477-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 09/23/2024] [Indexed: 10/06/2024] Open
Abstract
BACKGROUND The pathogenesis of type 2 diabetes mellitus is somewhat associated with lipid metabolism. We aim to assess the impact of lipid-lowering drugs (HMGCR inhibitors, PCSK9 inhibitors, and NPC1L1 inhibitors) on type 2 diabetes mellitus and its complications through a two-sample Mendelian randomization (MR) study. METHOD We identified suitable genetic instruments from the GWAS database that represent the expression levels of three genes, interpreting reduced genetically proxied gene expression as indicative of lipid-lowering drug use. We evaluated the causal relationships among these variables employing a two-sample Mendelian randomization approach, with the Inverse Variance Weighted (IVW) analysis serving as the primary method. Coronary artery disease was utilized as a positive control to validate the reliability of the selected genetic instruments. RESULT Increased genetically proxied HMGCR expression is significantly associated with a reduced risk of type 2 diabetes mellitus (OR = 0.64, 95%CI = 0.55-0.74), which was replicated in the FinnGen study with consistent results (OR = 0.65, 95%CI = 0.53-0.80). Increased genetically proxied HMGCR expression is associated with a reduced risk of diabetic retinopathy (OR = 0.23, 95%CI = 0.12-0.44) and diabetic nephropathy (OR = 0.35, 95%CI = 0.17-0.71). In contrast, increased genetically proxied PCSK9 expression is associated with a decreased risk of diabetic coma (OR = 0.70, 95%CI = 0.50-0.98), diabetic neuropathy (OR = 0.24, 95%CI = 0.14-0.42), diabetic retinopathy (OR = 0.67, 95%CI = 0.48-0.96), diabetic cardiovascular diseases (OR = 0.62, 95%CI = 0.38-0.99), and diabetic nephropathy (OR = 0.62, 95%CI = 0.41-0.95). CONCLUSIONS This Mendelian randomization study suggests an association between HMGCR and the pathogenesis of type 2 diabetes mellitus, with increased genetically proxied HMGCR expression reducing the risk of type 2 diabetes mellitus, while PCSK9 and NPC1L1 show no significant association with type 2 diabetes mellitus. These findings may offer more reasonable lipid-lowering drug options for patients with dyslipidemia.
Collapse
Affiliation(s)
- Yue-Yang Zhang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, 646000, China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, 646000, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, 646000, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, 646000, China
| | - Bing-Xue Chen
- Department of Ultrasound Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Qin Wan
- Department of Endocrinology and Metabolism, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, 646000, China.
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, 646000, China.
- Sichuan Clinical Research Center for Nephropathy, Luzhou, 646000, China.
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, 646000, China.
| |
Collapse
|
13
|
Jiang J, Shen H, Zhang Y, Li Y, Jing Y, Chen X, Wu H, Xie Y, Liu H. Acupuncture treatment of diabetic peripheral neuropathy: an overview of systematic reviews based on evidence mapping. Front Neurol 2024; 15:1420510. [PMID: 39421572 PMCID: PMC11483369 DOI: 10.3389/fneur.2024.1420510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 09/20/2024] [Indexed: 10/19/2024] Open
Abstract
Objective The study attempted to evaluate the meta-analyses (MAs) of the acupuncture treatment of diabetic peripheral neuropathy (DPN) to provide a basis for clinical decision-making. Methods Eight databases, such as PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang Data, CQVIP, and CBM, were searched from database creation to December 22, 2023. The MAs of DPN treatment using acupuncture or acupuncture combined with conventional Western medicine were included. AMSTAR-2 and PRISMA 2020 helped evaluate the methodological and reporting quality of the included studies. The GRADE methodology helped assess the evidence quality of outcome indicators. Evidence mapping was performed to display evaluation results. Results A total of 18 MAs involving 23,240 DPN patients were included. Based on the methodological quality evaluation, four MAs were of "moderate" quality, seven had a quality grade of "low," and another seven were of "critically low" quality. The evidence quality evaluation showed that among studies of acupuncture vs. conventional Western medicine, four had an evidence quality of "moderate," 18 had an evidence quality of "low," and 17 had an evidence quality of "critically low" and that among studies of acupuncture + conventional Western medicine vs. conventional Western medicine, 12 had an evidence quality of "moderate," 29 had an evidence quality of "low," and 33 had an evidence quality of "critically low." Compared with conventional Western medicine, simple acupuncture and acupuncture + conventional Western medicine significantly improved total effective rate (TER) and nerve conduction velocity (NCV). Conclusion Acupuncture treatment of DPN significantly improves TER and NCV with proven safety. However, the MAs of the acupuncture treatment of DPN must strictly refer to relevant standards and specifications regarding methodological and reporting quality, along with the design, execution, and reporting of primary randomized controlled trials (RCTs).
Collapse
Affiliation(s)
- Junjie Jiang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hao Shen
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Zhang
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yuanyuan Li
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanyuan Jing
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xinyi Chen
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hongli Wu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanming Xie
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huan Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
14
|
Yue W, Sun N, Zhang J, Zhang W, Wu Y, Qu X, Zong J, Xu G. Alleviated diabetic osteoporosis and peripheral neuropathic pain by Rehmannia glutinosa Libosch polysaccharide via increasing regulatory T cells. Int J Biol Macromol 2024; 277:134241. [PMID: 39084449 DOI: 10.1016/j.ijbiomac.2024.134241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 07/02/2024] [Accepted: 07/26/2024] [Indexed: 08/02/2024]
Abstract
Diabetic peripheral neuropathy (DPN) and diabetic osteoporosis (DOP) are conditions that significantly impact the quality of life of patients worldwide. Rehmanniae Radix Preparata, a component of traditional Chinese medicine with a history spanning thousands of years, has been utilized in the treatment of osteoporosis and diabetes. Specifically, Rehmannia glutinosa Libosch polysaccharide (RGP), a key bioactive compound of Rehmanniae Radix Preparata, has demonstrated immune-modulating properties and beneficial effects on hyperglycemia, hyperlipidemia, and vascular inflammation in diabetic mice. Despite these known actions, the precise mechanisms of RGP in addressing DOP and DPN remain unclear. Our study aimed to explore the impact of RGP on osteoporosis and peripheral neuropathic pain in diabetic mice induced by streptozotocin (STZ). The findings revealed that RGP not only improved hyperglycemia and osteoporosis in STZ-induced diabetic mice but also enhanced osteogenesis, insulin production, and nerve health. Specifically, RGP alleviated distal pain, improved nerve conduction velocity, nerve fiber integrity, and immune cell balance in the spleen. Mechanistically, RGP was found to upregulate HDAC6 mRNA expression in regulatory T cells, potentially shedding light on novel pathways for preventing DOP and DPN. These results offer promising insights for the development of new therapeutic approaches for diabetic complications.
Collapse
Affiliation(s)
- Wenjie Yue
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Na Sun
- Department of Pharmacy, The Third People's Hospital of Dalian, Dalian 116091, China
| | - Jing Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Wanhao Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Yueshu Wu
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Xiaochen Qu
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China; Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian 116011, Liaoning Province, China
| | - Junwei Zong
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China; Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian 116011, Liaoning Province, China
| | - Gang Xu
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China; Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian 116011, Liaoning Province, China.
| |
Collapse
|
15
|
Jin T, Wang Z, Fan F, Wei W, Zhou C, Zhang Z, Gao Y, Li W, Zhu L, Hao J. HDAC1 Promotes Mitochondrial Pathway Apoptosis and Inhibits the Endoplasmic Reticulum Stress Response in High Glucose-Treated Schwann Cells via Decreased U4 Spliceosomal RNA. Neurochem Res 2024; 49:2699-2724. [PMID: 38916813 DOI: 10.1007/s11064-024-04200-1] [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: 04/05/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024]
Abstract
Dysfunction of Schwann cells, including cell apoptosis, autophagy inhibition, dedifferentiation, and pyroptosis, is a pivotal pathogenic factor in induced diabetic peripheral neuropathy (DPN). Histone deacetylases (HDACs) are an important family of proteins that epigenetically regulate gene transcription by affecting chromatin dynamics. Here, we explored the effect of HDAC1 on high glucose-cultured Schwann cells. HDAC1 expression was increased in diabetic mice and high glucose-cultured RSC96 cells, accompanied by cell apoptosis. High glucose also increased the mitochondrial pathway apoptosis-related Bax/Bcl-2 and cleaved caspase-9/caspase-9 ratios and decreased endoplasmic reticulum response-related GRP78, CHOP, and ATF4 expression in RSC96 cells (P < 0.05). Furthermore, overexpression of HDAC1 increased the ratios of Bax/Bcl-2, cleaved caspase-9/caspase-9, and cleaved caspase-3 and reduced the levels of GRP78, CHOP, and ATF4 in RSC96 cells (P < 0.05). In contrast, knockdown of HDAC1 inhibited high glucose-promoted mitochondrial pathway apoptosis and suppressed the endoplasmic reticulum response. Moreover, RNA sequencing revealed that U4 spliceosomal RNA was significantly reduced in HDAC1-overexpressing RSC96 cells. Silencing of U4 spliceosomal RNA led to an increase in Bax/Bcl-2 and cleaved caspase-9 and a decrease in CHOP and ATF4. Conversely, overexpression of U4 spliceosomal RNA blocked HDAC1-promoted mitochondrial pathway apoptosis and inhibited the endoplasmic reticulum response. In addition, alternative splicing analysis of HDAC1-overexpressing RSC96 cells showed that significantly differential intron retention (IR) of Rpl21, Cdc34, and Mtmr11 might be dominant downstream targets that mediate U4 deficiency-induced Schwann cell dysfunction. Taken together, these findings indicate that HDAC1 promotes mitochondrial pathway-mediated apoptosis and inhibits the endoplasmic reticulum stress response in high glucose-cultured Schwann cells by decreasing the U4 spliceosomal RNA/IR of Rpl21, Cdc34, and Mtmr11.
Collapse
Affiliation(s)
- Tingting Jin
- Department of Pathology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050017, China
- Center of Metabolic Diseases and Cancer Research, Institute of Medical and Health Science, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ziming Wang
- Experimental Center of Clinical College, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Fan Fan
- Department of Investigation, Hebei Vocational College of Public Security Police, Shijiazhuang, Hebei, China
| | - Wandi Wei
- Department of Pathology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050017, China
- Center of Metabolic Diseases and Cancer Research, Institute of Medical and Health Science, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chenming Zhou
- Department of Electron Microscopy, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ziyu Zhang
- Department of Pathology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050017, China
- Center of Metabolic Diseases and Cancer Research, Institute of Medical and Health Science, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yue Gao
- Department of Pathology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050017, China
- Center of Metabolic Diseases and Cancer Research, Institute of Medical and Health Science, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Wenhui Li
- Department of Pathology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050017, China
- Center of Metabolic Diseases and Cancer Research, Institute of Medical and Health Science, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lin Zhu
- Department of Electromyogram, the Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, China.
| | - Jun Hao
- Department of Pathology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050017, China.
- Center of Metabolic Diseases and Cancer Research, Institute of Medical and Health Science, Hebei Medical University, Shijiazhuang, Hebei, China.
- Hebei Key Laboratory of Forensic Medicine, Shijiazhuang, Hebei, China.
| |
Collapse
|
16
|
Zhong J, Li X, Yuan M, Chen D, Li Y, Lian X, Wang M. Metabolomics study of serum from patients with type 2 diabetes: Peripheral neuropathy could be associated with sphingosine and phospholipid molecules. Lipids 2024. [PMID: 39243215 DOI: 10.1002/lipd.12412] [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: 03/29/2024] [Revised: 08/02/2024] [Accepted: 08/09/2024] [Indexed: 09/09/2024]
Abstract
Abnormal lipid metabolism is one of the risk factors for type 2 diabetes mellitus peripheral neuropathy (DPN). This study aimed to determine the differences in lipid metabolism in patients with type 2 diabetes and DPN and the possible pathogenesis caused by this difference. The participants comprised type 2 diabetes mellitus patients with DPN (N = 60) and healthy controls (N = 20). Blood samples were drawn from the participants in the morning in the fasting state, and then changes in serum lipids were explored using targeted metabolomics on the liquid chromatography-electrospray ionization-tandem mass spectrometry platform. Among the 1768 differentially abundant lipid metabolites, the results of orthogonal partial least squares-discriminant analysis combined with random forest analysis showed that the levels of sphingosine (SPH) (d18:0), carnitine 22:1, lysophosphatidylethanolamine (LPE) (18:0/0:0), LPC (16:0/0:0), lysophosphatidylcholine (LPC) (18:1/0:0), LPC (0:0/18:0) and LPE (0:0/18:1) were significantly different between the two groups. Spearman correlation analysis showed that SPH (d18:0), carnitine 22:1, LPE (18:0/0:0), and LPC (0:0/18:0) levels correlated highly with the patients' electromyography results. Kyoto Encyclopedia of Genes and Genomes pathway annotation and enrichment analysis of 538 differentially abundant lipid metabolites revealed that type 2 diabetes mellitus DPN was related to glycerophospholipid metabolism and glycerol metabolism. Our results further identified the dangerous lipid metabolites associated with DPN and abnormal lipid metabolism. The influence of lipid metabolites such as SPH and phospholipid molecules on DPN development in patients with type 2 diabetes mellitus were suggested and the possible pathogenic pathways were clarified, providing new insights into the clinical risk of DPN in patients with type 2 diabetes mellitus.
Collapse
Affiliation(s)
- Jingchen Zhong
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province of Chinese Medicine, Nanjing, China
| | - Xiaojie Li
- College of Integrative Chinese and Western Medicine, Jiangsu Health Vocational College, Nanjing, China
| | - Mengqian Yuan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province of Chinese Medicine, Nanjing, China
| | - Dong Chen
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province of Chinese Medicine, Nanjing, China
| | - Yancai Li
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province of Chinese Medicine, Nanjing, China
| | - Xiaoyang Lian
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province of Chinese Medicine, Nanjing, China
| | - Ming Wang
- Department of Acupuncture and Massage, Jiangsu Province Official Hospital, Nanjing, China
| |
Collapse
|
17
|
He M, Niu J, Cheng H, Guo C. Identification and validation of diagnostic genes associated with neutrophil extracellular traps of type 2 diabetes mellitus. Front Genet 2024; 15:1373807. [PMID: 39296548 PMCID: PMC11408200 DOI: 10.3389/fgene.2024.1373807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 08/20/2024] [Indexed: 09/21/2024] Open
Abstract
Background Neutrophil extracellular traps (NETs) cause delayed wound closed up in type 2 diabetes mellitus (T2DM), but the specific regulatory mechanism of NETs-related genes (NETs-RGs) in T2DM is unclear. Methods We acquired GSE21321 and GSE15932 datasets from gene expression omnibus (GEO) database. First, differentially expressed genes (DEGs) between T2DM and control samples of GSE21321 dataset were sifted out by differential expression analysis. NETs scores were calculated for all samples in GSE21321 dataset, and key module genes associated with NETs scores were screened by constructing co-expression network. Then, DEGs and key module genes were intersected to yield intersection genes, and candidate genes were identified by constructing a protein protein interaction (PPI) network. Least absolute shrinkage and selection operator (LASSO) regression analysis was implemented on candidate genes to screen out diagnostic genes, and they were subjected to single sample gene set enrichment analysis (ssGSEA). Finally, immune characteristic analysis was carried out, and we constructed the gene-drug and transcription factor (TF)-miRNA-mRNA networks. Besides, we validated the expression of diagnostic genes by quantitative real-time polymerase chain reaction (qRT-PCR). Results In total, 23 candidate genes were gained by PPI analysis. The 5 diagnostic genes, namely, inter-trypsin inhibitor heavy chain 3 (ITIH3), fibroblast growth factor 1 (FGF1), neuron cell adhesion molecule (NRCAM), advanced glycosylation end-product-specific receptor (AGER), and calcium voltage-gated channel subunit alpha1 C (CACNA1C), were identified via LASSO analysis, and they were involved in carboxylic acid transport, axonogenesis, etc. M2 Macrophage, Monocyte, Natural killer (NK) cell, and Myeloid dendritic cells (DC) were remarkably different between T2DM and control samples. Diagnostic genes had the strongest and the most significant positive correlation with B cells. The gene-drug network included CACNA1C-Isradipine, CACNA1C-Benidipine and other relationship pairs. Totally 76 nodes and 44 edges constituted the TF-miRNA-mRNA network, including signal transducer and activator of transcription 1(STAT1) -hsa-miR-3170-AGER, CCCTC-binding factor (CTCF)-hsa-miR-455-5p-CACNA1C, etc. Moreover, qRT-PCR suggested that the expression trends of FGF1 and AGER were in keeping with the results of bioinformatic analysis. FGF1 and AGER were markedly regulated downwards in the T2DM group. Conclusion Through bioinformatic analysis, we identified NETs-related diagnostic genes (ITIH3, FGF1, NRCAM, AGER, CACNA1C) in T2DM, and explored their mechanism of action from different aspects, providing new ideas for the studies related to diagnosis and treatment of T2DM.
Collapse
Affiliation(s)
- Meifang He
- Endocrinoloy Department, Peking University First Hospital Taiyuan Hospital (Taiyuan Central Hospital), Taiyuan, China
| | - Jin Niu
- Endocrinoloy Department, Peking University First Hospital Taiyuan Hospital (Taiyuan Central Hospital), Taiyuan, China
| | - Haihua Cheng
- Endocrinoloy Department, Peking University First Hospital Taiyuan Hospital (Taiyuan Central Hospital), Taiyuan, China
| | - Chaoying Guo
- Endocrinoloy Department, Peking University First Hospital Taiyuan Hospital (Taiyuan Central Hospital), Taiyuan, China
| |
Collapse
|
18
|
Chen PF, Huang GX, Gu WT, Zhuang GD, Chen C, Wang SM, Tang D. Exploration of the Mechanisms of Bu-Yang-Huan-Wu Decoction in the Treatment of Diabetic Peripheral Neuropathy by Integrating of Serum Pharmacochemistry and Network Pharmacology. Chem Biodivers 2024; 21:e202400910. [PMID: 39105318 DOI: 10.1002/cbdv.202400910] [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: 04/09/2024] [Indexed: 08/07/2024]
Abstract
Diabetic peripheral neuropathy (DPN) is a significant and frequent complication of diabetes. Bu-Yang-Huan-Wu Decoction (BHD) is a classic traditional Chinese herbal prescription that is commonly used in modern clinical practice for the effective treatment of DPN, but the underlying mechanism is not yet clearly defined. The chemical constituents of BHD were characterized by UPLC-Q-Orbitrap HR MS/MS, and a total of 101 chemical components were identified, including 30 components absorbed into blood. An interaction network of "compound-target-disease" interactions was constructed based on the compounds detected absorbed in blood and their corresponding targets of diabetic neuropathy acquired from disease gene databases, and the possible biological targets and potential signalling pathways of BHD were predicted via network pharmacology analysis. Subsequently, methylglyoxal-induced (MGO-induced) Schwann cells (SCs) were used to identify the active ingredients in blood components of BHD and verify the molecular mechanisms of BHD. Through network topological analysis, 30 shared targets strongly implicated in the anti-DPN effects of BHD were identifed. Combined network pharmacology and in vitro cellular analysis, we found that the active ingredient of BHD may treat DPN by modulating the AGEs/RAGE pathway. This study provides valuable evidence for future mechanistic studies and potential therapeutic applications for patients with DPN.
Collapse
Affiliation(s)
- Peng-Fei Chen
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of State Administration of TCM and Engineering & Technology Research Center for Chinese Materia Medica Quality of Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Guang-Xiao Huang
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of State Administration of TCM and Engineering & Technology Research Center for Chinese Materia Medica Quality of Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Wen-Ting Gu
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of State Administration of TCM and Engineering & Technology Research Center for Chinese Materia Medica Quality of Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Guo-Dong Zhuang
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of State Administration of TCM and Engineering & Technology Research Center for Chinese Materia Medica Quality of Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Chong Chen
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of State Administration of TCM and Engineering & Technology Research Center for Chinese Materia Medica Quality of Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Shu-Mei Wang
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of State Administration of TCM and Engineering & Technology Research Center for Chinese Materia Medica Quality of Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Dan Tang
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of State Administration of TCM and Engineering & Technology Research Center for Chinese Materia Medica Quality of Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| |
Collapse
|
19
|
Zhong J, Lin X, Zheng X, Zhou Y, Huang H, Xu L. Diminished levels of insulin-like growth factor-1 may be a risk factor for peripheral neuropathy in type 2 diabetes patients. J Diabetes Investig 2024; 15:1259-1265. [PMID: 38923403 PMCID: PMC11363116 DOI: 10.1111/jdi.14260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/03/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
AIMS/INTRODUCTION To investigate risk factors for diabetic peripheral neuropathy (DPN) and to explore the connection between insulin-like growth factor-1 (IGF-1) and DPN in individuals with type 2 diabetes. MATERIALS AND METHODS A total of 790 patients with type 2 diabetes participated in a cross-sectional study, divided into two groups: those with DPN (DPN) and those without DPN (non-DPN). Blood samples were taken to measure IGF-1 levels and other biochemical markers. Participants underwent nerve conduction studies and quantitative sensory testing. RESULTS Patients with DPN exhibited significantly lower levels of IGF-1 compared with non-DPN patients (P < 0.001). IGF-1 was positively correlated with the average amplitude of both motor (P < 0.05) and sensory nerves (P < 0.05), but negatively correlated with the vibration perception threshold (P < 0.05). No significant difference was observed between IGF-1 and nerve conduction velocity (P > 0.05), or the temperature detection threshold (P > 0.05). Multivariate regression analysis identified diabetes duration, HbA1c, and the low levels of IGF-1 as independent risk factors (P < 0.001). Receiver operating characteristic analysis determined that at 8 years duration of diabetes, 8.5% (69.4 mmol/mol) HbA1c and 120 ng/mL IGF-1, the optimal cut-off points, indicated DPN (P < 0.001). CONCLUSIONS A reduction of IGF-1 in patients with DPN suggests a potential protective role against axon injury in large fiber nerves of type 2 diabetes patients.
Collapse
Affiliation(s)
- Jingyi Zhong
- Department of Endocrinology, Shenzhen HospitalSouthern Medical UniversityShenzhenGuangdongChina
- The Third School of Clinical MedicineSouthern Medical UniversityGuangzhouGuangdongChina
| | - Xiaopu Lin
- Department of Huiqiao Medical Centre, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Xiaobin Zheng
- Department of Endocrinology, Shenzhen HospitalSouthern Medical UniversityShenzhenGuangdongChina
- The Third School of Clinical MedicineSouthern Medical UniversityGuangzhouGuangdongChina
| | - Yanting Zhou
- Department of Endocrinology, Shenzhen HospitalSouthern Medical UniversityShenzhenGuangdongChina
- The Third School of Clinical MedicineSouthern Medical UniversityGuangzhouGuangdongChina
| | - Haishan Huang
- Department of Endocrinology, Shenzhen HospitalSouthern Medical UniversityShenzhenGuangdongChina
- The Third School of Clinical MedicineSouthern Medical UniversityGuangzhouGuangdongChina
| | - Lingling Xu
- Department of Endocrinology, Shenzhen HospitalSouthern Medical UniversityShenzhenGuangdongChina
- The Third School of Clinical MedicineSouthern Medical UniversityGuangzhouGuangdongChina
| |
Collapse
|
20
|
Li J, Liu Q, Liu S, Xin H, Zhang X, Guo N. Maltol Improves Peripheral Nerve Function by Inhibiting Schwann Cell Apoptosis via the PERK/eIF2α/CHOP Pathway and MME Upregulation in Diabetic Peripheral Neuropathy. Pharmaceuticals (Basel) 2024; 17:1139. [PMID: 39338303 PMCID: PMC11435048 DOI: 10.3390/ph17091139] [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: 07/15/2024] [Revised: 08/12/2024] [Accepted: 08/27/2024] [Indexed: 09/30/2024] Open
Abstract
Diabetic peripheral neuropathy (DPN) is the most prevalent chronic complication among diabetic patients and a primary risk factor contributing to the deterioration of diabetic foot conditions. The pathogenesis of DPN remains complex and not fully understood, and there are hardly any effective treatment drugs. Maltol (3-hydroxy-2-methyl-4-pyranone) has demonstrated antioxidant and anti-inflammatory properties. However, the potential role of maltol in the treatment of DPN remains unclear. This study aimed to assess maltol's effects on DPN rats and high glucose (HG)/palmitic acid (PA)-induced rat Schwann cells (RSC96). The results indicated maltol's capacity to enhance peripheral nerve function in DPN rats. In RSC96 cells stimulated with high HG and PA, maltol treatment reduced DPN markers and apoptosis-related proteins. Functional enrichment analysis of differentially expressed genes revealed that endoplasmic reticulum (ER) stress pathways were involved in this process. Western blot results demonstrated the activation of ER stress pathway in HG/PA-induced RSC96 cells, with maltol attenuating ER stress-related protein expression. Furthermore, the knockdown of Membrane metallo-endopeptidase (MME) reversed maltol's effects on apoptosis-related protein expression, suggesting a potential therapeutic role for maltol via MME in treating DPN. These findings indicate that maltol may hold promise as a therapeutic agent for DPN treatment.
Collapse
Affiliation(s)
- Jiawei Li
- Minhang Hospital, School of Pharmacy, Fudan University, Shanghai 201203, China; (J.L.); (H.X.)
| | - Quan Liu
- Key Laboratory of Polymorphic Drugs of Beijing, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China; (Q.L.); (S.L.)
| | - Shuainan Liu
- Key Laboratory of Polymorphic Drugs of Beijing, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China; (Q.L.); (S.L.)
| | - Hong Xin
- Minhang Hospital, School of Pharmacy, Fudan University, Shanghai 201203, China; (J.L.); (H.X.)
| | - Xuemei Zhang
- Minhang Hospital, School of Pharmacy, Fudan University, Shanghai 201203, China; (J.L.); (H.X.)
| | - Nan Guo
- Minhang Hospital, School of Pharmacy, Fudan University, Shanghai 201203, China; (J.L.); (H.X.)
| |
Collapse
|
21
|
Li YY, Guan RQ, Hong ZB, Wang YL, Pan LM. Advances in the treatment of diabetic peripheral neuropathy by modulating gut microbiota with traditional Chinese medicine. World J Diabetes 2024; 15:1712-1716. [PMID: 39192853 PMCID: PMC11346088 DOI: 10.4239/wjd.v15.i8.1712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/06/2024] [Accepted: 06/20/2024] [Indexed: 07/25/2024] Open
Abstract
Diabetic peripheral neuropathy (DPN) is one of the strongest risk factors for diabetic foot ulcers (neuropathic ulcerations) and the existing ulcers may further deteriorate due to the damage to sensory neurons. Moreover, the resulting numbness in the limbs causes difficulty in discovering these ulcerations in a short time. DPN is associated with gut microbiota dysbiosis. Traditional Chinese medicine (TCM) compounds such as Shenqi Dihuang Decoction, Huangkui Capsules and Qidi Tangshen Granules can reduce the clinical symptoms of diabetic nephropathy by modulating gut microbiota. The current review discusses whether TCM compounds can reduce the risk of DPN by improving gut mic-robiota.
Collapse
Affiliation(s)
- Ye-Yao Li
- Department of Endocrinology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150001, Heilongjiang Province, China
| | - Rui-Qian Guan
- Department of Tuina, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150001, Heilongjiang Province, China
| | - Zhi-Bo Hong
- Department of Endocrinology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150001, Heilongjiang Province, China
| | - Yao-Lei Wang
- Department of Endocrinology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150001, Heilongjiang Province, China
| | - Li-Min Pan
- Department of Endocrinology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150001, Heilongjiang Province, China
| |
Collapse
|
22
|
Mittal R, McKenna K, Keith G, McKenna E, Sinha R, Lemos JRN, Hirani K. Systematic review of translational insights: Neuromodulation in animal models for Diabetic Peripheral Neuropathy. PLoS One 2024; 19:e0308556. [PMID: 39116099 PMCID: PMC11309513 DOI: 10.1371/journal.pone.0308556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024] Open
Abstract
Diabetic Peripheral Neuropathy (DPN) is a prevalent and debilitating complication of diabetes, affecting a significant proportion of the diabetic population. Neuromodulation, an emerging therapeutic approach, has shown promise in the management of DPN symptoms. This systematic review aims to synthesize and analyze the current advancements in neuromodulation techniques for the treatment of DPN utilizing studies with preclinical animal models. A comprehensive search was conducted across multiple databases, including PubMed, Scopus, and Web of Science. Inclusion criteria were focused on studies utilizing preclinical animal models for DPN that investigated the efficacy of various neuromodulation techniques, such as spinal cord stimulation, transcranial magnetic stimulation, and peripheral nerve stimulation. The findings suggest that neuromodulation significantly alleviated pain symptoms associated with DPN. Moreover, some studies reported improvements in nerve conduction velocity and reduction in nerve damage. The mechanisms underlying these effects appeared to involve modulation of pain pathways and enhancement of neurotrophic factors. However, the review also highlights the variability in methodology and stimulation parameters across studies, highlighting the need for standardization in future research. Additionally, while the results are promising, the translation of these findings from animal models to human clinical practice requires careful consideration. This review concludes that neuromodulation presents a potentially effective therapeutic strategy for DPN, but further research is necessary to optimize protocols and understand the underlying molecular mechanisms. It also emphasizes the importance of bridging the gap between preclinical findings and clinical applications to improve the management of DPN in diabetic patients.
Collapse
Affiliation(s)
- Rahul Mittal
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Keelin McKenna
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Grant Keith
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Evan McKenna
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Rahul Sinha
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Joana R. N. Lemos
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Khemraj Hirani
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| |
Collapse
|
23
|
Wu Y, Dong D, Zhu L, Luo Z, Liu Y, Xie X. Interpretable machine learning models for detecting peripheral neuropathy and lower extremity arterial disease in diabetics: an analysis of critical shared and unique risk factors. BMC Med Inform Decis Mak 2024; 24:200. [PMID: 39039521 PMCID: PMC11265186 DOI: 10.1186/s12911-024-02595-z] [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: 11/09/2023] [Accepted: 07/01/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) and lower extremity arterial disease (LEAD) are significant contributors to diabetic foot ulcers (DFUs), which severely affect patients' quality of life. This study aimed to develop machine learning (ML) predictive models for DPN and LEAD and to identify both shared and distinct risk factors. METHODS This retrospective study included 479 diabetic inpatients, of whom 215 were diagnosed with DPN and 69 with LEAD. Clinical data and laboratory results were collected for each patient. Feature selection was performed using three methods: mutual information (MI), random forest recursive feature elimination (RF-RFE), and the Boruta algorithm to identify the most important features. Predictive models were developed using logistic regression (LR), random forest (RF), and eXtreme Gradient Boosting (XGBoost), with particle swarm optimization (PSO) used to optimize their hyperparameters. The SHapley Additive exPlanation (SHAP) method was applied to determine the importance of risk factors in the top-performing models. RESULTS For diagnosing DPN, the XGBoost model was most effective, achieving a recall of 83.7%, specificity of 86.8%, accuracy of 85.4%, and an F1 score of 83.7%. On the other hand, the RF model excelled in diagnosing LEAD, with a recall of 85.7%, specificity of 92.9%, accuracy of 91.9%, and an F1 score of 82.8%. SHAP analysis revealed top five critical risk factors shared by DPN and LEAD, including increased urinary albumin-to-creatinine ratio (UACR), glycosylated hemoglobin (HbA1c), serum creatinine (Scr), older age, and carotid stenosis. Additionally, distinct risk factors were pinpointed: decreased serum albumin and lower lymphocyte count were linked to DPN, while elevated neutrophil-to-lymphocyte ratio (NLR) and higher D-dimer levels were associated with LEAD. CONCLUSIONS This study demonstrated the effectiveness of ML models in predicting DPN and LEAD in diabetic patients and identified significant risk factors. Focusing on shared risk factors may greatly reduce the prevalence of both conditions, thereby mitigating the risk of developing DFUs.
Collapse
Affiliation(s)
- Ya Wu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Danmeng Dong
- School of Medicine, Anhui University of Science and Technology, Huainan, China
| | - Lijie Zhu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zihong Luo
- School of Advanced Technology, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Yang Liu
- Department of Geriatrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoyun Xie
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| |
Collapse
|
24
|
Jiang W, Liao L, Lai Z, Li K, Luo W, Shen H. Ultrasound evaluation and grading of neuromuscular disease in lower extremities among diabetic patients. Am J Transl Res 2024; 16:3280-3288. [PMID: 39114677 PMCID: PMC11301481 DOI: 10.62347/wnsl1894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/25/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To explore the clinical utility of ultrasound in evaluating and grading neuromuscular diseases in the lower extremities of patients with diabetes mellitus. METHODS A total of 126 inpatients from the Department of Diabetes at Zhangzhou Affiliated Hospital of Fujian Medical University, China, were recruited from June 2020 to December 2022. The cohort included 69 patients with type 2 diabetes mellitus (T2DM) and diabetic peripheral neuropathy (DPN group) and 57 patients with T2DM but without DPN (non-DPN group). Additionally, 80 healthy controls were included. High-frequency ultrasound was used to scan the common peroneal, sural, and tibial nerves, measuring their transverse (D1) and anteroposterior (D2) diameters, and calculating the cross-sectional area (CSA). Changes in the internal echo of the extensor digitorum brevis (EDB) muscle, including maximum thickness and CSA, were also recorded. The DPN group was further subdivided based on disease duration to assess ultrasonic changes over time and the statistical significance of these variations. RESULTS Ultrasonic changes such as uneven internal echo reduction, ill-defined epineurial boundaries, and obscured cribriform structures were most prevalent in the DPN group. Significant differences in ultrasound parameters (D1, D2, CSA) were observed among the groups (all P<0.05), with the most pronounced changes in the DPN group. In patients with a disease duration of over 15 years, a significant increase in CSA of lower extremity nerves and a decrease in CSA of the EDB were noted compared to those in the 5-10 years subgroup (19.89±0.98 vs 19.00±0.94; 5.25±0.74 vs 5.93±0.94; all P<0.05). CONCLUSIONS High-frequency ultrasound provides a valuable imaging basis for diagnosing and monitoring DPN, demonstrating significant changes in nerve and muscle parameters among diabetic patients.
Collapse
Affiliation(s)
- Wenting Jiang
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical UniversityZhangzhou 363000, Fujian, China
| | - Liping Liao
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical UniversityZhangzhou 363000, Fujian, China
| | - Zhenhan Lai
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical UniversityZhangzhou 363000, Fujian, China
| | - Kaiwu Li
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical UniversityZhangzhou 363000, Fujian, China
| | - Weiwen Luo
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical UniversityZhangzhou 363000, Fujian, China
| | - Haolin Shen
- Science and Education Section, Zhangzhou Affiliated Hospital of Fujian Medical UniversityZhangzhou 363000, Fujian, China
| |
Collapse
|
25
|
Zhang X, Zhang X, Li X, Zhao X, Wei G, Shi J, Yang Y, Fan S, Zhao J, Zhu K, Du J, Guo J, Cao W. Association between serum uric acid levels and diabetic peripheral neuropathy in type 2 diabetes: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1416311. [PMID: 39072278 PMCID: PMC11272597 DOI: 10.3389/fendo.2024.1416311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Background The evidence supporting a connection between elevated serum uric acid (SUA) levels and diabetic peripheral neuropathy (DPN) is controversial. The present study performed a comprehensive evaluation of this correlation by conducting a systematic review and meta-analysis of relevant research. Method PubMed, Web of Science (WOS), Embase, and the Cochrane Library were searched for published literature from the establishment of each database to January 8, 2024. In total, 5 cohort studies and 15 cross-sectional studies were included, and 2 researchers independently screened and extracted relevant data. R 4.3.0 was used to evaluate the included literature. The present meta-analysis evaluated the relationship between SUA levels and the risk of DPN in type 2 diabetes (T2DM) by calculating the ratio of means (RoM) and 95% confidence intervals (CIs) using the method reported by JO Friedrich, and it also analyzed continuous outcome measures using standardized mean differences (SMDs) and 95% CIs to compare SUA levels between DPN and non-DPN groups. Funnel plot and Egger's test were used to assess publication bias. Sensitivity analysis was conducted by sequentially removing each study one-by-one. Results The meta-analysis included 20 studies, with 12,952 T2DM patients with DPN and 16,246 T2DM patients without DPN. There was a significant correlation between SUA levels and the risk of developing DPN [odds ratio (OR) = 1.23; 95% CI: 1.07-1.41; p = 0.001]. Additionally, individuals with DPN had higher levels of SUA compared to those without DPN (SMD = 0.4; 95% CI: -0.11-0.91; p < 0.01). Conclusion T2DM patients with DPN have significantly elevated SUA levels, which correlate with a heightened risk of peripheral neuropathy. Hyperuricemia (HUA) may be a risk indicator for assessing the risk of developing DPN in T2DM patients. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024500373.
Collapse
Affiliation(s)
- Xieyu Zhang
- Department of Rheumatology, Wangjing Hospital, China Academy of Chinese Medicine Science, Beijing, China
| | - Xinwen Zhang
- Department of Rheumatology, Wangjing Hospital, China Academy of Chinese Medicine Science, Beijing, China
| | - Xiaoxu Li
- Department of Rheumatology, Wangjing Hospital, China Academy of Chinese Medicine Science, Beijing, China
| | - Xin Zhao
- Department of Rheumatology, Wangjing Hospital, China Academy of Chinese Medicine Science, Beijing, China
| | - Guangcheng Wei
- Department of Rheumatology, Wangjing Hospital, China Academy of Chinese Medicine Science, Beijing, China
| | - Jinjie Shi
- Department of Rheumatology, Wangjing Hospital, China Academy of Chinese Medicine Science, Beijing, China
| | - Yue Yang
- Department of Rheumatology, Wangjing Hospital, China Academy of Chinese Medicine Science, Beijing, China
| | - Su Fan
- Department of Rheumatology, Wangjing Hospital, China Academy of Chinese Medicine Science, Beijing, China
| | - Jiahe Zhao
- Department of Rheumatology, Wangjing Hospital, China Academy of Chinese Medicine Science, Beijing, China
| | - Ke Zhu
- Department of Rheumatology, Wangjing Hospital, China Academy of Chinese Medicine Science, Beijing, China
| | - Jieyang Du
- Department of Rheumatology, Wangjing Hospital, China Academy of Chinese Medicine Science, Beijing, China
| | - Junyi Guo
- Robotics Movement Department, Amazon, Boston, MA, United States
| | - Wei Cao
- Department of Rheumatology, Wangjing Hospital, China Academy of Chinese Medicine Science, Beijing, China
| |
Collapse
|
26
|
Guo Y, Zeng J, Zhuang Y, Jiang C, Xie W. MiR-503-5p alleviates peripheral neuropathy-induced neuropathic pain in T2DM mice by regulating SEPT9 to inhibit astrocyte activation. Sci Rep 2024; 14:14361. [PMID: 38906977 PMCID: PMC11192719 DOI: 10.1038/s41598-024-65096-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 06/17/2024] [Indexed: 06/23/2024] Open
Abstract
Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (T2DM) that causes peripheral and autonomic nervous system dysfunction. Dysregulation of miRNAs plays a crucial role in DPN development. However, the role of miR-503-5p in DPN remains unknown. Herein, T2DM mice (db/db) were used as a DPN model in vivo, and astrocytes isolated from db/db mice were induced with high glucose levels as a DPN model in vitro. MiR-503-5p expression was analyzed using qRT-PCR. GFAP, MCP-1, and SEPT9 protein levels were analyzed using western blotting and immunofluorescence. Luciferase assays were performed to investigate the interaction between miR-503-5p and SEPT9. We found that miR-503-5p expression decreased in the spinal cord of DPN model mice and astrocytes treated with high glucose (HG). The db/db mice displayed higher body weight and blood glucose, lower mechanical withdrawal threshold and thermal withdrawal latency, and higher GFAP and MCP-1 protein levels than db/m mice. However, tail vein injection of agomiR-503-5p remarkably reversed these parameters, whereas antigomiR-503-5p enhanced them. HG markedly facilitated GFAP and MCP-1 protein expression in astrocytes, whereas miR-503-5p mimic or inhibitor transfection markedly blocked or elevated GFAP and MCP-1 protein expression, respectively, in astrocytes with HG. SEPT9 was a target of miR-503-5p. In addition, SEPT9 protein levels were found to be elevated in db/db mice and astrocytes treated with HG. Treatment with agomiR-503-5p and miR-503-5p mimic was able to reduce SEPT9 protein levels, whereas treatment with antigomiR-503-5p and miR-503-5p inhibitor led to inhibition of the protein. Furthermore, SEPT9 overexpression suppressed the depressing effect of miR-503-5p overexpression in astrocytes subjected to HG doses. In conclusion, miR-503-5p was found to alleviate peripheral neuropathy-induced neuropathic pain in T2DM mice by regulating SEPT9 expression.
Collapse
Affiliation(s)
- Yuqing Guo
- Department of Anesthesiology, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 250, East Street, Licheng District, Quanzhou, 362800, Fujian, China
| | - Jingyang Zeng
- Department of Anesthesiology, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 250, East Street, Licheng District, Quanzhou, 362800, Fujian, China
| | - Yuanzhao Zhuang
- Department of Anesthesiology, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 250, East Street, Licheng District, Quanzhou, 362800, Fujian, China
| | - Changcheng Jiang
- Department of Anesthesiology, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 250, East Street, Licheng District, Quanzhou, 362800, Fujian, China
| | - Wenqin Xie
- Department of Anesthesiology, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 250, East Street, Licheng District, Quanzhou, 362800, Fujian, China.
| |
Collapse
|
27
|
Xu H, Xiang QY, Zhan JK, Wang Y, Wang YJ, Li S, Liu YS. Association between macro- and microvascular damage and sarcopenia index in individuals with type 2 diabetes mellitus. Appl Physiol Nutr Metab 2024; 49:762-772. [PMID: 38346295 DOI: 10.1139/apnm-2023-0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Sarcopenia was recently reported to be relevant to an increased macro-and microvascular disease risk. Sarcopenia index (SI) has been identified as a surrogate marker for sarcopenia. The aim of the present study was to investigate the association between macro- and microvascular disease and SI in patients with type 2 diabetes mellitus (T2DM). A total of 783 patients with T2DM were enrolled in this cross-sectional study. The SI was calculated by (serum creatinine [mg/dL]/cystatin C [mg/L]) × 100. The subjects were divided into three groups according to SI tertiles: T1 (41.27-81.37), T2 (81.38- 99.55), and T3 (99.56-192.31). Parameters of macro- and microvascular complications, including diabetic retinopathy (DR), micro- and macroalbuminuria (MAU), diabetic peripheral neuropathy (DPN), and lower extremity peripheral artery disease (LEAD) were evaluated. Multivariate logistic regression analysis revealed that when taking the top tertile of SI as a reference, an increasing trend of the prevalence of DR, MAU, DPN, and LEAD were presented (all P for trend < 0.05), where the OR (95% CI) for DR prevalence was 1.967 (1.252-3.090) in T2, 2.195 (1.278-3.769) in T1, for MAU was 1.805 (1.149-2.837) in T2, 2.537 (1.490-4.320) in T1, for DPN was 2.244 (1.485-3.391) in T2, 3.172 (1.884-5.341) in T1, and for LEAD was 2.017 (1.002-4.057) in T2, 2.405 (1.107-5.225) in T1 (all P < 0.05). Patients with lower SI were more inclined to have an increased risk of macro- and microvascular damage in T2DM population, which may be related to sarcopenia.
Collapse
Affiliation(s)
- Hui Xu
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, China
- Institute of Aging and Age-related Disease Research, Central South University, Changsha, Hunan, 410011, China
| | - Qun-Yan Xiang
- Institute of Aging and Age-related Disease Research, Central South University, Changsha, Hunan, 410011, China
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Jun-Kun Zhan
- Institute of Aging and Age-related Disease Research, Central South University, Changsha, Hunan, 410011, China
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Yi Wang
- Institute of Aging and Age-related Disease Research, Central South University, Changsha, Hunan, 410011, China
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Yan-Jiao Wang
- Institute of Aging and Age-related Disease Research, Central South University, Changsha, Hunan, 410011, China
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Shuang Li
- Institute of Aging and Age-related Disease Research, Central South University, Changsha, Hunan, 410011, China
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - You-Shuo Liu
- Institute of Aging and Age-related Disease Research, Central South University, Changsha, Hunan, 410011, China
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| |
Collapse
|
28
|
Liu F, You F, Yang L, Wang S, Xie D. Metformin improves diabetic neuropathy by reducing inflammation through up-regulating the expression of miR-146a and suppressing oxidative stress. J Diabetes Complications 2024; 38:108737. [PMID: 38642448 DOI: 10.1016/j.jdiacomp.2024.108737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE Diabetic neuropathy (DN) is a notable complication of diabetes mellitus. The potential involvement of miR-146a in DN regulation is presently under investigation. Metformin, a commonly prescribed medication for diabetes, is the primary therapeutic intervention. This study aimed to unveil the potential protective effects of metformin on diabetic neuropathy and explore the mechanisms underlying its action. METHOD Six-weeks male Sprague Dawley rats (n = 40) were randomly divided into 5 groups. The rat model of diabetic neuropathy (DN) was established by administering streptozotocin (STZ). To investigate the effects on the sciatic nerve and resident Schwann cells (RSCs), metformin and miR-146a mimics were administered, and our research explored the potential underlying mechanism. RESULT The sciatic nerve samples obtained from diabetic rats exhibited noticeable morphological damage, accompanied by decreased miR-146a expression (2.61 ± 0.11 vs 5.0 ± 0.3, p < 0.01) and increased inflammation levels (p65: 1.89 ± 0.04 vs 0.82 ± 0.05, p < 0.01; TNF-α: 0.93 ± 0.03 vs 0.33 ± 0.03, p < 0.01). Notably, the administration of metformin effectively ameliorated the structural alterations in the sciatic nerve by suppressing the inflammatory pathway (p65: 1.15 ± 0.05 vs 1.89 ± 0.04, p < 0.01; TNF-α: 0.67 ± 0.04 vs 0.93 ± 0.03, p < 0.01) and reducing oxidative stress (NO: 0.062 ± 0.004 vs 0.154 ± 0.004umol/mg, p < 0.01; SOD: 3.08 ± 0.09 vs 2.46 ± 0.09 U/mg, p < 0.01). The miR-146a mimics intervention group exhibited comparable findings. CONCLUSION This study's findings implied that metformin can potentially mitigate diabetic neuropathy in rats through the modulation of miR-146a expression.
Collapse
Affiliation(s)
- Fengmin Liu
- Department of Endocrinology, Fuzhou First General Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Fangqin You
- Department of General Surgery, Fuzhou First General Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Lihang Yang
- Department of Endocrinology, Fuzhou First General Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Siyun Wang
- Department of Endocrinology, Fuzhou First General Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Diya Xie
- Department of General Surgery, Fuzhou First General Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian 350000, China.
| |
Collapse
|
29
|
Stasiłowicz-Krzemień A, Nogalska W, Maszewska Z, Maleszka M, Dobroń M, Szary A, Kępa A, Żarowski M, Hojan K, Lukowicz M, Cielecka-Piontek J. The Use of Compounds Derived from Cannabis sativa in the Treatment of Epilepsy, Painful Conditions, and Neuropsychiatric and Neurodegenerative Disorders. Int J Mol Sci 2024; 25:5749. [PMID: 38891938 PMCID: PMC11171823 DOI: 10.3390/ijms25115749] [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: 03/12/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Neurological disorders present a wide range of symptoms and challenges in diagnosis and treatment. Cannabis sativa, with its diverse chemical composition, offers potential therapeutic benefits due to its anticonvulsive, analgesic, anti-inflammatory, and neuroprotective properties. Beyond cannabinoids, cannabis contains terpenes and polyphenols, which synergistically enhance its pharmacological effects. Various administration routes, including vaporization, oral ingestion, sublingual, and rectal, provide flexibility in treatment delivery. This review shows the therapeutic efficacy of cannabis in managing neurological disorders such as epilepsy, neurodegenerative diseases, neurodevelopmental disorders, psychiatric disorders, and painful pathologies. Drawing from surveys, patient studies, and clinical trials, it highlights the potential of cannabis in alleviating symptoms, slowing disease progression, and improving overall quality of life for patients. Understanding the diverse therapeutic mechanisms of cannabis can open up possibilities for using this plant for individual patient needs.
Collapse
Affiliation(s)
- Anna Stasiłowicz-Krzemień
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
| | - Wiktoria Nogalska
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
| | - Zofia Maszewska
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
| | - Mateusz Maleszka
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
| | - Maria Dobroń
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
| | - Agnieszka Szary
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
| | - Aleksandra Kępa
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
| | - Marcin Żarowski
- Department of Developmental Neurology, Poznan University of Medical Sciences, Przybyszewski 49, 60-355 Poznan, Poland;
| | - Katarzyna Hojan
- Department of Occupational Therapy, Poznan University of Medical Sciences, Swięcickiego 6, 61-847 Poznan, Poland;
- Department of Rehabilitation, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
| | - Malgorzata Lukowicz
- Department of Rehabilitation, Centre of Postgraduate Medical Education, Konarskiego 13, 05-400 Otwock, Poland;
| | - Judyta Cielecka-Piontek
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
- Department of Pharmacology and Phytochemistry, Institute of Natural Fibres and Medicinal Plants, Wojska Polskiego 71b, 60-630 Poznan, Poland
| |
Collapse
|
30
|
Guo L, Pan Q, Cheng Z, Li Z, Jiang H, Zhang F, Li Y, Qiu W, Lu S, Tian J, Fu Y, Li F, Li D. Acetyllevocarnitine Hydrochloride for the Treatment of Diabetic Peripheral Neuropathy: A Phase 3 Randomized Clinical Trial in China. Diabetes 2024; 73:797-805. [PMID: 38320260 PMCID: PMC11043058 DOI: 10.2337/db23-0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 02/01/2024] [Indexed: 02/08/2024]
Abstract
Diabetic peripheral neuropathy (DPN) is a highly prevalent chronic complication in type 2 diabetes (T2D) for which no effective treatment is available. In this multicenter, randomized, double-blind, placebo-controlled phase 3 clinical trial in China, patients with T2D with DPN received acetyllevocarnitine hydrochloride (ALC; 1,500 mg/day; n = 231) or placebo (n = 227) for 24 weeks, during which antidiabetic therapy was maintained. A significantly greater reduction in modified Toronto clinical neuropathy score (mTCNS) as the primary end point occurred in the ALC group (-6.9 ± 5.3 points) compared with the placebo group (-4.7 ± 5.2 points; P < 0.001). Effect sizes (ALC 1.31 and placebo 0.85) represented a 0.65-fold improvement in ALC treatment efficacy. The mTCNS values for pain did not differ significantly between the two groups (P = 0.066), whereas the remaining 10 components of mTCNS showed significant improvement in the ALC group compared with the placebo group (P < 0.05 for all). Overall results of electrophysiological measurements were inconclusive, with significant improvement in individual measurements limited primarily to the ulnar and median nerves. Incidence of treatment-emergent adverse events was 51.2% in the ALC group, among which urinary tract infection (5.9%) and hyperlipidemia (7.9%) were most frequent. ARTICLE HIGHLIGHTS
Collapse
Affiliation(s)
- Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhifeng Cheng
- Department of Endocrinology, Fourth Hospital of Harbin Medical University, Harbin, China
| | - Zhiyong Li
- Department of Endocrinology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Hongwei Jiang
- Department of Endocrinology, First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Fang Zhang
- Department of Endocrinology, Kaifeng Hospital of Traditional Chinese Medicine, Kaifeng, China
| | - Yufeng Li
- Department of Endocrinology, Beijing Pinggu Hospital, Beijing, China
| | - Wei Qiu
- Department of Endocrinology, Xinxiang First People’s Hospital, Affiliated People’s Hospital of Xinxiang Medical University, Xinxiang, China
| | - Song Lu
- Department of Endocrinology, Chongqing General Hospital, Chongqing, China
| | - Junhang Tian
- Department of Endocrinology, Luoyang Third People’s Hospital, Luoyang, China
| | - Yanqin Fu
- Department of Endocrinology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fangqiong Li
- Haisco Pharmaceutical Group Co., Ltd., Chengdu, China
| | - Danqing Li
- Haisco Pharmaceutical Group Co., Ltd., Chengdu, China
| |
Collapse
|
31
|
Yang D, Wang X, Duan Y, Xu Y, Ruan Z, Jiang B, Lou H, Chen J. Bioequivalence Study of Epalrestat for Healthy Chinese Subjects. Clin Pharmacol Drug Dev 2024; 13:485-490. [PMID: 37971280 DOI: 10.1002/cpdd.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
Epalrestat is a reversible noncompetitive inhibitor of aldose reductase with selective inhibition of aldose reductase. It can inhibit the accumulation of sorbitol in red blood cells in patients with diabetic peripheral neuropathy and can improve patients' conscious symptoms and neurological dysfunction. This study was designed to evaluate the bioequivalence in healthy Chinese subjects of a new test formulation and reference formulation of oral epalrestat (50 mg) in the fasting state. The study was performed with 44 healthy Chinese subjects according to a randomized 2-way crossover design. The main pharmacokinetic parameters of test formulation and reference formulation as follows: 4793 and 4781 ng/mL for maximum plasma concentration, 8556 and 8431 ng h/mL for area under the plasma concentration-time curve extrapolated to infinity. The test formulation of epalrestat was bioequivalent to the reference formulation. The bioequivalence study of epalrestat in healthy Chinese subjects suggests that the test and reference formulations have similar pharmacokinetics and both formulations are well tolerated in the dose range studied in healthy Chinese subjects. All these findings provided valuable pharmacokinetic knowledge for further clinical development.
Collapse
Affiliation(s)
- Dandan Yang
- Center of Clinical Pharmacology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaodan Wang
- Center of Clinical Pharmacology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Yi Duan
- Center of Clinical Pharmacology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Yichao Xu
- Center of Clinical Pharmacology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Zourong Ruan
- Center of Clinical Pharmacology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Bo Jiang
- Center of Clinical Pharmacology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Honggang Lou
- Center of Clinical Pharmacology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Jinliang Chen
- Center of Clinical Pharmacology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| |
Collapse
|
32
|
Zhuang R, Xiong Z, Yan S, Zhang H, Dong Q, Liu W, Miao J, Zhuo Y, Fan X, Zhang W, Wang X, Liu L, Cao J, Zhang T, Hao C, Huang X, Jiang L. Efficacy of electro-acupuncture versus sham acupuncture for diabetic peripheral neuropathy: study protocol for a three-armed randomised controlled trial. BMJ Open 2024; 14:e079354. [PMID: 38569706 PMCID: PMC10989182 DOI: 10.1136/bmjopen-2023-079354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Specific treatment for diabetic peripheral neuropathy (DPN) is still lacking, and acupuncture may relieve the symptoms. We intend to investigate the efficacy and safety of electro-acupuncture (EA) in alleviating symptoms associated with DPN in diabetes. METHODS AND ANALYSIS This multicentre, three-armed, participant- and assessor-blind, randomised, sham-controlled trial will recruit 240 eligible participants from four hospitals in China and will randomly assign (1:1:1) them to EA, sham acupuncture (SA) or usual care (UC) group. Participants in the EA and SA groups willl receive either 24-session EA or SA treatment over 8 weeks, followed by an 8-week follow-up period, while participants in the UC group will be followed up for 16 weeks. The primary outcome of this trial is the change in DPN symptoms from baseline to week 8, as rated by using the Total Symptom Score. The scale assesses four symptoms: pain, burning, paraesthesia and numbness, by evaluating the frequency and severity of each. All results will be analysed with the intention-to-treat population. ETHICS AND DISSEMINATION The protocol has been approved by the Ethics Committee of the Beijing University of Chinese Medicine (Identifier: 2022BZYLL0509). Every participant will be informed of detailed information about the study before signing informed consent. The results of this trial will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ChiCTR2200061408.
Collapse
Affiliation(s)
- Rong Zhuang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Zhiyi Xiong
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Shiyan Yan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Haoran Zhang
- College of Preschool Education, Beijing Youth Politics College, Beijing, China
| | - Qi Dong
- Department of Metabolic Diseases, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Weiai Liu
- Department of Acupuncture and Massage Rehabilitation, The Second Hospital of Hunan University of Traditional Chinese Medicine, Changsha, Hunan, China
| | - Jinling Miao
- Acupuncture and Moxibustion Department, Shanxi Provincial Acupuncture and Moxibustion Hospital, Taiyuan, Shanxi, China
| | - Yuanyuan Zhuo
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong, China
| | - Xiaohong Fan
- Department of Metabolic Diseases, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Weiliang Zhang
- Department of Metabolic Diseases, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Xiaomei Wang
- Department of Metabolic Diseases, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Lian Liu
- Department of Acupuncture and Massage Rehabilitation, The Second Hospital of Hunan University of Traditional Chinese Medicine, Changsha, Hunan, China
| | - Jianan Cao
- Department of Acupuncture and Massage Rehabilitation, The Second Hospital of Hunan University of Traditional Chinese Medicine, Changsha, Hunan, China
| | - Tiansheng Zhang
- Acupuncture and Moxibustion Department, Shanxi Provincial Acupuncture and Moxibustion Hospital, Taiyuan, Shanxi, China
| | - Chongyao Hao
- Acupuncture and Moxibustion Department, Shanxi Provincial Acupuncture and Moxibustion Hospital, Taiyuan, Shanxi, China
| | - Xingxian Huang
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong, China
| | - Lijiao Jiang
- The fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| |
Collapse
|
33
|
Wang Q, Ye Y, Yang L, Xiao L, Liu J, Zhang W, Du G. Painful diabetic neuropathy: The role of ion channels. Biomed Pharmacother 2024; 173:116417. [PMID: 38490158 DOI: 10.1016/j.biopha.2024.116417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
Painful diabetic neuropathy (PDN) is a common chronic complication of diabetes that causes neuropathic pain and negatively affects the quality of life. The management of PDN is far from satisfactory. At present, interventions are primarily focused on symptomatic treatment. Ion channel disorders are a major cause of PDN, and a complete understanding of their roles and mechanisms may provide better options for the clinical treatment of PDN. Therefore, this review summarizes the important role of ion channels in PDN and the current drug development targeting these ion channels.
Collapse
Affiliation(s)
- Qi Wang
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Centre, West China Hospital, Sichuan University, Chengdu, China; National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yifei Ye
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Centre, West China Hospital, Sichuan University, Chengdu, China; National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Linghui Yang
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Centre, West China Hospital, Sichuan University, Chengdu, China; National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lifan Xiao
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Centre, West China Hospital, Sichuan University, Chengdu, China; National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Liu
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Centre, West China Hospital, Sichuan University, Chengdu, China; National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wensheng Zhang
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Centre, West China Hospital, Sichuan University, Chengdu, China; National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Guizhi Du
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Centre, West China Hospital, Sichuan University, Chengdu, China; National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
34
|
Fu Y, Wang Y, Li Z, Huang K, Gao Y, Xu S, Li Q, Liu X, Zhang G. Evidence mapping of traditional Chinese medicine in diabetic peripheral neuropathy treatment. Front Pharmacol 2024; 15:1325607. [PMID: 38606175 PMCID: PMC11006961 DOI: 10.3389/fphar.2024.1325607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
Objective: Diabetic peripheral neuropathy (DPN) stands as a crucial complication of diabetes, significantly affecting patients' quality of life. This study aims to elucidate the evidence distribution from clinical randomized controlled trials (RCTs) on DPN treatment with traditional Chinese medicine (TCM) through evidence mapping. Methods: A comprehensive search was conducted from January 2017 to October 2022 in databases such as Wanfang (China Online Journals), CNKI (China National Knowledge Infrastructure), VIP (China Science and Technology Journal Database), SinoMed (Chinese Biomedical Literature Database), PubMed, Web of Science, and Cochrane Library. Literature related to the treatment of DPN with TCM was selected. From the 1,229 RCTs identified over the past 6 years, relevant data were extracted. The evidence mapping approach was utilized, and trends in publications, study scales, intervention types, and evaluation indicators were analyzed using descriptive text combined with tables and bubble charts. Results: Research on the treatment of DPN with TCM is extensive. The publication trend remains relatively stable with predominantly smaller sample sizes. The main treatments encompass oral Chinese medicine and traditional external treatments. The most common evaluation indicators are neurophysiological, efficiency rate, symptom signs, neuropathy scores, and traditional Chinese symptoms, with less focus on psychological status and the ankle-brachial index (ABI). Conclusion: Shedding light on contemporary research, this study explores the current RCTs evaluating TCM's efficacy in treating DPN. The findings not only highlight the potential role of TCM in addressing diabetic complications but also underscore areas that could benefit from refined research approaches, expanded intervention methods, and broader assessment criteria. Our observations aim to inform and inspire future research directions and clinical practices concerning TCM's role in managing diabetes-associated complications.
Collapse
Affiliation(s)
- Yujie Fu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yiming Wang
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhenghong Li
- Research Department, Swiss University of Traditional Chinese Medicine, Bad Zurzach, Switzerland
| | - Ke Huang
- Institute of Endocrinology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yating Gao
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Shanqiong Xu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Qingna Li
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xingfang Liu
- Research Department, Swiss University of Traditional Chinese Medicine, Bad Zurzach, Switzerland
| | - Guangde Zhang
- Institute of Endocrinology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
35
|
Chen M, Pu L, Gan Y, Wang X, Kong L, Guo M, Yang H, Li Z, Xiong Z. The association between variability of risk factors and complications in type 2 diabetes mellitus: a retrospective study. Sci Rep 2024; 14:6357. [PMID: 38491155 PMCID: PMC10943073 DOI: 10.1038/s41598-024-56777-w] [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: 08/10/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
The variability in diabetes risk factors, such as uric acid and lipids, may influence the development of complications. This study aimed to investigate the influence of such variability on the occurrence of diabetic complications. A retrospective analysis of electronic medical records was conducted with type 2 diabetic patients who received treatment at a tertiary care hospital in Chengdu, Sichuan Province, between 2013 and 2022. The risk factor variability is presented as the standard deviation (SD). The associations between the variability and complications were examined using a binary logistic regression model. The study included 369 patients with type 2 diabetes. The findings revealed that outpatient special disease management served as a protective factor against the development of complications [OR = 0.53, 95% confidence interval (CI) (0.29-0.10)], particularly for the prevention of diabetic peripheral neuropathy [OR = 0.51, 95% CI (0.30-0.86)]. Variability in total cholesterol (TC-SD) was found to be a risk factor for the development of complications [OR = 2.42, 95% CI (1.18-4.97)] and acted as a risk factor for diabetic peripheral vasculopathy [OR = 2.50, 95% CI (1.25-5.02)]. TC-SD is a risk factor for the occurrence of diabetic peripheral neuropathy and diabetic peripheral vasculopathy, whereas outpatient special disease management functions as a protective factor against complications and diabetic peripheral neuropathy. Thus, in addition to glycaemic control, the regulation of lipid levels should be emphasized, particularly among patients without outpatient special disease management, to delay the onset of complications.
Collapse
Affiliation(s)
- Mengjie Chen
- School of Nursing, Chengdu Medical College, No. 601 Tian Hui Road, Rong Du Avenue, Chengdu, 610083, Sichuan, China
| | - Lihui Pu
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, 4111, Australia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Erasmus MC, University Medical Centre Rotterdam, Department Internal Medicine, Section Nursing Science, Rotterdam, The Netherlands
| | - Yuqin Gan
- School of Nursing, Chengdu Medical College, No. 601 Tian Hui Road, Rong Du Avenue, Chengdu, 610083, Sichuan, China
| | - Xiaoxia Wang
- School of Nursing, Chengdu Medical College, No. 601 Tian Hui Road, Rong Du Avenue, Chengdu, 610083, Sichuan, China
| | - Laixi Kong
- School of Nursing, Chengdu Medical College, No. 601 Tian Hui Road, Rong Du Avenue, Chengdu, 610083, Sichuan, China
| | - Maoting Guo
- School of Nursing, Chengdu Medical College, No. 601 Tian Hui Road, Rong Du Avenue, Chengdu, 610083, Sichuan, China
| | - Huiqi Yang
- Nanbu County People's Hospital, Nanchong, 637300, Sichuan, China
| | - Zhe Li
- Mental Health Center, West China Hospital, Sichuan University, No. 28 Dianxin South Road, Chengdu, 610041, Sichuan, China.
- Sichuan Clinical Medical Research Center for Mental Disorders, No. 28 Dianxin South Road, Chengdu, 610041, Sichuan, China.
| | - Zhenzhen Xiong
- School of Nursing, Chengdu Medical College, No. 601 Tian Hui Road, Rong Du Avenue, Chengdu, 610083, Sichuan, China.
| |
Collapse
|
36
|
Wu C, Wu Z, Chen Y, Xu H, Li K. The relationship between dietary phosphorus and peripheral neuropathy in the general population of the United States: A preliminary research. PLoS One 2024; 19:e0299566. [PMID: 38489279 PMCID: PMC10942028 DOI: 10.1371/journal.pone.0299566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Dietary phosphorus intake may serve as a potential predictor for peripheral neuropathy (PN). While past research has predominantly focused on the relationship between dietary phosphorus and bone health, relatively little is known about its role in the nervous system, particularly its association with PN. METHODS A cross-sectional study was conducted using data from NHANES 1999-2004. Participants were categorized into different dietary phosphorus intake groups, and the relationship between dietary phosphorus and PN was explored using multifactorial logistic regression, restricted cubic splines (RCS) analysis, and threshold effect analysis based on dietary intake. RESULTS The final study included 7726 participants, with 1378 diagnosed with PN and 6348 without. The study revealed a U-shaped non-linear relationship between dietary calcium and magnesium intake levels and PN, indicating that both excessive and insufficient dietary phosphorus intake may increase the risk of PN. Specifically, the incidence rates in the first quintile (1.433, 95% CI: 1.080-1.901), the fourth quintile (1.284, 95% CI: 1.000-1.648), and the fifth quintile (1.533, 95% CI: 1.155-2.035) significantly higher than the second quintile, with an overall trend showing a decrease followed by an increase in incidence rates. The results of RCS and threshold effect analysis indicate that when dietary phosphorus intake is below 939.44mg, the risk of PN decreases with increasing dietary phosphorus intake. On the contrary, when dietary phosphorus intake exceeds 939.44mg, the risk of PN increases with increasing dietary phosphorus intake. CONCLUSION This study reveals a U-shaped correlation between dietary phosphorus intake and PN. Future research should further elucidate the molecular mechanisms underlying this association, providing guidance for more scientifically informed dietary adjustments to prevent the occurrence of PN.
Collapse
Affiliation(s)
- Chunli Wu
- The Traditional Chinese Medicine College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Endocrinology, Jinan City Hospital of Integrated Traditional Chinese and Western Medicine, Jinan, China
| | - Zhe Wu
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yanling Chen
- Department of Endocrinology, Jinan City Hospital of Integrated Traditional Chinese and Western Medicine, Jinan, China
| | - Huirong Xu
- The Traditional Chinese Medicine College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Kejian Li
- The Traditional Chinese Medicine College, Shandong University of Traditional Chinese Medicine, Jinan, China
| |
Collapse
|
37
|
Huang HY, Lin YP, Wei H, Fu Y, Zhou YH, Fang ZH, Qiu XT, Wang M, Li QB, Li SS, Wang SD, Dai F, Liu ZJ, Zhao L, Wen JX, Wu LY, Zeng HY, Zhang JM, Lu QY, He L, Song W, Sun L, Luo LL, He JL, Xie WW, Liang QS, Huang Y, Zhu SL, Long JE, Gao ZJ, Wen ZH, Li CJ, Ouyang WW, Li G, Wu MH, Li AX, Huang JZ, Paul SK, Tang XY, Fan GJ. Effect and Safety of Herbal Medicine Foot Baths in Patients with Diabetic Peripheral Neuropathy: A Multicenter Double-Blind Randomized Controlled Trial. Chin J Integr Med 2024; 30:195-202. [PMID: 38374490 DOI: 10.1007/s11655-024-3900-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To evaluate the effect and safety of foot baths with Tangbi Waixi Decoction (TW) in treating patients with diabetic peripheral neuropathy (DPN). METHODS It is a multicenter double-blinded randomized controlled trial. Participants with DPN were recruited between November 18, 2016 and May 30, 2018 from 8 hospitals in China. All patients received basic treatments for glycemic management. Patients received foot baths with TW herbal granules either 66.9 g (intervention group) or 6.69 g (control group) for 30 min once a day for 2 weeks and followed by a 2-week rest, as a therapeutic course. If the Toronto Clinical Scoring System total score (TCSS-TS) ⩾6 points, the patients received a total of 3 therapeutic courses (for 12 weeks) and were followed up for 12 weeks. The primary outcome was change in TCSS-TS score at 12 and 24 weeks. Secondary outcomes included changes in bilateral motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of the median and common peroneal nerve. Safety was also assessed. RESULTS Totally 632 patients were enrolled, and 317 and 315 were randomized to the intervention and control groups, respectively. After the 12-week intervention, patients in both groups showed significant declines in TCSSTS scores, and significant increases in MNCV and SNCV of the median and common peroneal nerves compared with pre-treatment (P<0.05). The reduction of TCSS-TS score at 12 weeks and the increase of SNCV of median nerve at 24 weeks in the control group were greater than those in the intervention group (P<0.05). The number of adverse events did not differ significantly between groups (P>0.05), and no serious adverse event was related with treatment. CONCLUSION Treatment of TW foot baths was safe and significantly benefitted patients with DPN. A low dose of TW appeared to be more effective than a high dose. (Registry No. ChiCTR-IOR-16009331).
Collapse
Affiliation(s)
- Hao-Yue Huang
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Yu-Ping Lin
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Hua Wei
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Yu Fu
- Department of Endocrinology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, China
| | - Yue-Hong Zhou
- Department of Endocrinology, Liuyang Hospital of Chinese Medicine, Changsha, 410000, China
| | - Zhao-Hui Fang
- Department of Endocrinology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230000, China
| | - Xiao-Tang Qiu
- Department of Endocrinology, Hainan Provincial Hospital of Traditional Chinese Medicine, Haikou, 570100, China
| | - Mei Wang
- Department of Endocrinology, The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, 110000, China
| | - Qing-Bo Li
- Department of Geriatric, Luoyang No.1 Hospital of Traditional Chinese Medicine, Luoyang, Henan Province, 471000, China
| | - Shan-Shan Li
- Department of Endocrinology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, 550000, China
| | - Shi-Dong Wang
- Department of Endocrinology, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, 100000, China
| | - Fang Dai
- Department of Endocrinology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, 550000, China
| | - Zhen-Jie Liu
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Ling Zhao
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Jian-Xuan Wen
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Li-Yan Wu
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Hui-Yan Zeng
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Jin-Ming Zhang
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Qi-Yun Lu
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Liu He
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Wei Song
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Lu Sun
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Lu-Lu Luo
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Jia-Li He
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Wen-Wen Xie
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Qing-Shun Liang
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Yuan Huang
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Sheng-Ling Zhu
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Jie-Er Long
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Zhi-Juan Gao
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Ze-Huai Wen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Chun-Ji Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Wen-Wei Ouyang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Geng Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Ming-Hui Wu
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - An-Xiang Li
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Jin-Zhu Huang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Sanjoy K Paul
- Melbourne EpiCentre, The University of Melbourne and Melbourne Health, Melbourne, 3013, Australia
| | - Xian-Yu Tang
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China.
| | - Guan-Jie Fan
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China.
| |
Collapse
|
38
|
Berry D, Ene J, Nathani A, Singh M, Li Y, Zeng C. Effects of Physical Cues on Stem Cell-Derived Extracellular Vesicles toward Neuropathy Applications. Biomedicines 2024; 12:489. [PMID: 38540102 PMCID: PMC10968089 DOI: 10.3390/biomedicines12030489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/12/2024] [Accepted: 02/17/2024] [Indexed: 11/28/2024] Open
Abstract
The peripheral nervous system undergoes sufficient stress when affected by diabetic conditions, chemotherapeutic drugs, and personal injury. Consequently, peripheral neuropathy arises as the most common complication, leading to debilitating symptoms that significantly alter the quality and way of life. The resulting chronic pain requires a treatment approach that does not simply mask the accompanying symptoms but provides the necessary external environment and neurotrophic factors that will effectively facilitate nerve regeneration. Under normal conditions, the peripheral nervous system self-regenerates very slowly. The rate of progression is further hindered by the development of fibrosis and scar tissue formation, which does not allow sufficient neurite outgrowth to the target site. By incorporating scaffolding supplemented with secretome derived from human mesenchymal stem cells, it is hypothesized that neurotrophic factors and cellular signaling can facilitate the optimal microenvironment for nerve reinnervation. However, conventional methods of secretory vesicle production are low yield, thus requiring improved methods to enhance paracrine secretions. This report highlights the state-of-the-art methods of neuropathy treatment as well as methods to optimize the clinical application of stem cells and derived secretory vesicles for nerve regeneration.
Collapse
Affiliation(s)
- Danyale Berry
- Department of Industrial and Manufacturing Engineering, FAMU-FSU College of Engineering, Florida Agricultural and Mechanical University, Tallahassee, FL 32310, USA;
- High Performance Materials Institute, FAMU-FSU College of Engineering, Florida State University, Tallahassee, FL 23210, USA
| | - Justice Ene
- Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, FL 32310, USA;
| | - Aakash Nathani
- College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, Tallahassee, FL 32307, USA; (A.N.); (M.S.)
| | - Mandip Singh
- College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, Tallahassee, FL 32307, USA; (A.N.); (M.S.)
| | - Yan Li
- Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, FL 32310, USA;
| | - Changchun Zeng
- Department of Industrial and Manufacturing Engineering, FAMU-FSU College of Engineering, Florida Agricultural and Mechanical University, Tallahassee, FL 32310, USA;
- High Performance Materials Institute, FAMU-FSU College of Engineering, Florida State University, Tallahassee, FL 23210, USA
| |
Collapse
|
39
|
Zhang Y, Wu C, Jiang W, Cao Y, Chen D. VGLUT2 and APP family: unraveling the neurobiochemical mechanisms of neurostimulation therapy to STZ-induced diabetes and neuropathy. Front Endocrinol (Lausanne) 2024; 15:1336854. [PMID: 38370359 PMCID: PMC10869491 DOI: 10.3389/fendo.2024.1336854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Diabetic Peripheral Neuropathy (DPN) poses an escalating threat to public health, profoundly impacting well-being and quality of life. Despite its rising prevalence, the pathogenesis of DPN remains enigmatic, and existing clinical interventions fall short of achieving meaningful reversals of the condition. Notably, neurostimulation techniques have shown promising efficacy in alleviating DPN symptoms, underscoring the imperative to elucidate the neurobiochemical mechanisms underlying DPN. This study employs an integrated multi-omics approach to explore DPN and its response to neurostimulation therapy. Our investigation unveiled a distinctive pattern of vesicular glutamate transporter 2 (VGLUT2) expression in DPN, rigorously confirmed through qPCR and Western blot analyses in DPN C57 mouse model induced by intraperitoneal Streptozotocin (STZ) injection. Additionally, combining microarray and qPCR methodologies, we revealed and substantiated variations in the expression of the Amyloid Precursor Protein (APP) family in STZ-induced DPN mice. Analyzing the transcriptomic dataset generated from neurostimulation therapy for DPN, we intricately explored the differential expression patterns of VGLUT2 and APPs. Through correlation analysis, protein-protein interaction predictions, and functional enrichment analyses, we predicted the key biological processes involving VGLUT2 and the APP family in the pathogenesis of DPN and during neurostimulation therapy. This comprehensive study not only advances our understanding of the pathogenesis of DPN but also provides a theoretical foundation for innovative strategies in neurostimulation therapy for DPN. The integration of multi-omics data facilitates a holistic view of the molecular intricacies of DPN, paving the way for more targeted and effective therapeutic interventions.
Collapse
Affiliation(s)
- Yitong Zhang
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Chenxuan Wu
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Wenqi Jiang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yan Cao
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Dongtai Chen
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
40
|
Ran GL, Li YP, Lu LC, Lan SH. Disease-modifying therapies for diabetic peripheral neuropathy: A systematic review and meta-analysis of randomized controlled trials. J Diabetes Complications 2024; 38:108691. [PMID: 38330524 DOI: 10.1016/j.jdiacomp.2024.108691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 12/15/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Alpha-lipoic acid, epalrestat, and mecobalamin are widely used as monotherapies for diabetic peripheral neuropathy. However, whether a triple-combination therapy with these three drugs is superior to monotherapy or dual therapy remains debatable. METHODS Nine randomized controlled trials were identified through a search on electronic databases such as PubMed, Web of Science, and Cochrane Library. The trial participants (N = 1153) were divided into the experimental group who received the triple-combination therapy and the control group who received conventional or dual therapy with the aforementioned drugs. RESULTS Therapeutic outcomes were better in the experimental group than in the control group (odds ratio: 3.74; 95 % confidence interval: 2.57-5.45; I2 = 0 %; p < 0.00001). No statistic difference was noted in adverse effects. Compared with the control group, the experimental group exhibited significant improvements in median motor nerve conduction velocity (MNCV), sensory nerve conduction velocity (SNCV), peroneal MNCV, peroneal SNCV, and vibration perception thresholds (VPT) in the left and right lower limbs. In the control group, a subgroup analysis by treatment strategy revealed similar improvements in total efficacy, MNCV, and SNCV. CONCLUSIONS For diabetic peripheral neuropathy, the triple-combination therapy may be more effective than monotherapy or dual therapy.
Collapse
Affiliation(s)
- Gui-Lin Ran
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
| | - Yan-Ping Li
- Affiliated Hospital of Putian University, Putian 351100, China
| | - Li-Chin Lu
- School of Management, Putian University, Putian 351100, China
| | - Shao-Huan Lan
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China; School of Pharmaceutical Sciences and Medical Technology, Putian University, Putian 351100, China.
| |
Collapse
|
41
|
Zhan T, Tang S, Du J, Liu J, Yu B, Yang Y, Xie Y, Qiu Y, Li G, Gao Y. Implication of lncRNA MSTRG.81401 in Hippocampal Pyroptosis Induced by P2X7 Receptor in Type 2 Diabetic Rats with Neuropathic Pain Combined with Depression. Int J Mol Sci 2024; 25:1186. [PMID: 38256257 PMCID: PMC10816120 DOI: 10.3390/ijms25021186] [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: 11/12/2023] [Revised: 01/02/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Major depressive disorder (MDD) is a common complication of diabetes and is often observed alongside diabetic neuropathic pain (DNP) as a comorbidity in diabetic patients. Long non-coding RNA (lncRNA) plays an important role in various pathophysiological processes. The P2X7 receptor is responsible for triggering inflammatory responses, such as pyroptosis, linked to pain and depression. The aim of this study was to investigate the effect of lncRNA MSTRG.81401 on hippocampal pyroptosis induced by the P2X7 receptor in diabetic rats with DNP combined with MDD (DNP + MDD). Our results showed that the expression of lncRNA MSTRG.81401 was significantly elevated in the hippocampus of DNP + MDD rats compared with the control group. Following the administration of shRNA targeting lncRNA MSTRG.81401, a notable elevation in mechanical and thermal pain thresholds was observed in rats with comorbid DNP and MDD. Additionally, significant improvements in depression-like behaviors were evident in the open-field test (OFT), sucrose preference test (SPT), and forced swim test (FST). In the DNP + MDD rats, elevated levels in hippocampal P2X7 receptor mRNA and protein were observed, along with increased co-expression of P2X7 and the astrocytic marker glial fibrillary acidic protein (GFAP). Meanwhile, in DNP + MDD rats, the heightened mRNA expression of NOD-like receptor protein 3 (NLRP3), apoptosis-associated speck-like protein (ASC), pyroptosis-related protein Gasdermin D (GSDMD), caspase-1, IL-1β, IL-18, and TNF-α was detected, in addition to increased serum levels of IL-1β, IL-18 and TNF-α. After shRNA treatment with lncRNA MSTRG.81401, the above abnormal changes in indicators for pyroptosis and inflammation were improved. Therefore, our study demonstrates that shRNA of lncRNA MSTRG.81401 can alleviate the pain and depression-like behaviors in diabetic rats associated with the comorbidity of DNP and MDD by inhibiting the hippocampal P2X7 receptor-mediated pyroptosis pathway and pro-inflammatory responses. This suggests that the P2X7R/NLRP3/caspase-1 implicated pyroptosis and inflammatory scenario may serve as a potential target for the management of comorbid DNP and MDD in diabetes.
Collapse
Affiliation(s)
- Ting Zhan
- Department of Physiology, Basic Medical College, Nanchang University, Nanchang 330006, China; (T.Z.); (S.T.); (J.D.); (Y.Y.); (Y.X.); (Y.Q.); (G.L.)
| | - Shanshan Tang
- Department of Physiology, Basic Medical College, Nanchang University, Nanchang 330006, China; (T.Z.); (S.T.); (J.D.); (Y.Y.); (Y.X.); (Y.Q.); (G.L.)
| | - Junpei Du
- Department of Physiology, Basic Medical College, Nanchang University, Nanchang 330006, China; (T.Z.); (S.T.); (J.D.); (Y.Y.); (Y.X.); (Y.Q.); (G.L.)
| | - Jingshuang Liu
- Joint Program of Nanchang University and Queen Mary University of London, Nanchang University, Nanchang 330006, China;
| | - Bodong Yu
- Second Clinical Medical College, Nanchang University, Nanchang 330006, China;
| | - Yuxin Yang
- Department of Physiology, Basic Medical College, Nanchang University, Nanchang 330006, China; (T.Z.); (S.T.); (J.D.); (Y.Y.); (Y.X.); (Y.Q.); (G.L.)
| | - Yuting Xie
- Department of Physiology, Basic Medical College, Nanchang University, Nanchang 330006, China; (T.Z.); (S.T.); (J.D.); (Y.Y.); (Y.X.); (Y.Q.); (G.L.)
| | - Yanting Qiu
- Department of Physiology, Basic Medical College, Nanchang University, Nanchang 330006, China; (T.Z.); (S.T.); (J.D.); (Y.Y.); (Y.X.); (Y.Q.); (G.L.)
| | - Guodong Li
- Department of Physiology, Basic Medical College, Nanchang University, Nanchang 330006, China; (T.Z.); (S.T.); (J.D.); (Y.Y.); (Y.X.); (Y.Q.); (G.L.)
| | - Yun Gao
- Department of Physiology, Basic Medical College, Nanchang University, Nanchang 330006, China; (T.Z.); (S.T.); (J.D.); (Y.Y.); (Y.X.); (Y.Q.); (G.L.)
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang 330006, China
| |
Collapse
|
42
|
Yang X, Xue C, Chen K, Gao D, Wang H, Tang C. Characteristics of elderly diabetes patients: focus on clinical manifestation, pathogenic mechanism, and the role of traditional Chinese medicine. Front Pharmacol 2024; 14:1339744. [PMID: 38273819 PMCID: PMC10808572 DOI: 10.3389/fphar.2023.1339744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Diabetes mellitus has become a major public health issue globally, putting an enormous burden on global health systems and people. Among all diseased groups, a considerable part of patients are elderly, while their clinical features, pathogenic processes, and medication regimens are different from patients of other ages. Despite the availability of multiple therapies and techniques, there are still numerous elderly diabetes patients suffering from poor blood glucose control, severe complications, and drug adverse effects, which negatively affect the quality of life in their golden years. Traditional Chinese Medicine (TCM) has been widely used in the treatment of diabetes for several decades, and its relevant clinical practice has confirmed that it has a satisfactory effect on alleviating clinical symptoms and mitigating the progression of complications. Chinese herbal medicine and its active components were used widely with obvious clinical advantages by multiple targets and signaling pathways. However, due to the particular features of elderly diabetes, few studies were conducted to explore Traditional Chinese Medicine intervention on elderly diabetic patients. This study reviews the research on clinical features, pathogenic processes, treatment principles, and TCM treatments, hoping to provide fresh perspectives on the prevention and management strategies for elderly diabetes.
Collapse
Affiliation(s)
- Xiaofei Yang
- Beijing University of Chinese Medicine, Beijing, China
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chongxiang Xue
- Beijing University of Chinese Medicine, Beijing, China
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Keyu Chen
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dongyang Gao
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Han Wang
- Beijing University of Chinese Medicine, Beijing, China
| | - Cheng Tang
- Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
43
|
Mehra A, Mittal A, Vishwakarma PK. Prediction of Protein-Drug Interactions, Pharmacophore Modeling, and Toxicokinetics of Novel Leads for Type 2 Diabetes Treatment. Curr Drug Metab 2024; 25:355-380. [PMID: 39108115 DOI: 10.2174/0113892002321919240801065905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/23/2024] [Accepted: 07/05/2024] [Indexed: 11/08/2024]
Abstract
BACKGROUND Small heterocyclic compounds have been crucial in pioneering advances in type 2 diabetes treatment. There has been a dramatic increase in the pharmacological development of novel heterocyclic derivatives aimed at stimulating the activation of Glucokinase (GK). A pharmaceutical intervention for diabetes is increasingly targeting GK as a legitimate target. Diabetes type 2 compromises Glucokinase's function, an enzyme vital for maintaining the balance of blood glucose levels. Medicinal substances strategically positioned to improve type 2 diabetes management are used to stimulate the GK enzyme using heterocyclic derivatives. OBJECTIVE The research endeavor aimed to craft novel compounds, drawing inspiration from the inherent coumarin nucleus found in nature. The goal was to evoke the activity of the glucokinase enzyme, offering a tailored approach to mitigate the undesired side effects typically associated with conventional therapies employed in the treatment of type 2 diabetes. METHODS Coumarin, sourced from nature's embrace, unfolds as a potent and naturally derived ally in the quest for innovative antidiabetic interventions. Coumarin was extracted from a variety of botanical origins, including Artemisia keiskeana, Mallotus resinosus, Jatropha integerrima, Ferula tingitana, Zanthoxylum schinifolium, Phebalium clavatum, and Mammea siamensis. This inclusive evaluation was conducted on Muybridge's digital database containing 53,000 hit compounds. The presence of the coumarin nucleus was found in 100 compounds, that were selected from this extensive repository. Utilizing Auto Dock Vina 1.5.6 and ChemBioDraw Ultra, structures generated through this process underwent docking analysis. Furthermore, these compounds were accurately predicted online log P using the Swiss ADME algorithm. A predictive analysis was conducted using PKCSM software on the primary compounds to assess potential toxicity. RESULTS Using Auto Dock Vina 1.5.6, 100 coumarin derivatives were assessed for docking. Glucokinase (GK) binding was significantly enhanced by most of these compounds. Based on superior binding characteristics compared with Dorzagliatin (standard GKA) and MRK (co-crystallized ligand), the top eight molecules were identified. After further evaluation through ADMET analysis of these eight promising candidates, it was confirmed that they met the Lipinski rule of five and their pharmacokinetic profile was enhanced. The highest binding affinity was demonstrated by APV16 at -10.6 kcal/mol. A comparison between the APV16, Dorzagliatin and MRK in terms of toxicity predictions using PKCSM indicated that the former exhibited less skin sensitization, AMES toxicity, and hepatotoxicity. CONCLUSION Glucokinase is most potently activated by 100 of the compound leads in the database of 53,000 compounds that contain the coumarin nucleus. APV12, with its high binding affinity, favorable ADMET (adjusted drug metabolic equivalents), minimal toxicity, and favorable pharmacokinetic profile warrants consideration for progress to in vitro testing. Nevertheless, to uncover potential therapeutic implications, particularly in the context of type 2 diabetes, thorough investigations and in-vivo evaluations are necessary for benchmarking before therapeutic use, especially experiments involving the STZ diabetic rat model.
Collapse
Affiliation(s)
- Anuradha Mehra
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar-Delhi G.T. Road (NH-1), Phagwara (Punjab), 144411, India
| | - Amit Mittal
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar-Delhi G.T. Road (NH-1), Phagwara (Punjab), 144411, India
| | - Prakhar Kumar Vishwakarma
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar-Delhi G.T. Road (NH-1), Phagwara (Punjab), 144411, India
| |
Collapse
|
44
|
Abdulrhaman D, Fahad H, Khalil N. Association of serum biomarkers level transforming growth factor-β and tumor necrosis factor-α with diabetic neuropathy. Hum Antibodies 2024; 32:193-199. [PMID: 39093067 DOI: 10.3233/hab-240031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
BACKGROUND Many studies have examined the role of inflammation in the development of diabetic neuropathy (DPN). OBJECTIVE Evaluate the relation of the serum level of Transforming Growth Factor-β and Tumor Necrosis Factor-α and development of diabetic peripheral neuropathy DPN. METHODS In a case-control study, randomly selected 140 diabetic patients were included, the randomly selected patients were divided equally and matched into a case group who have diabetic peripheral neuropathy and diabetic neuropathy-free patients as a control group. For both groups whole blood sample was examined to compare for (TGF-β), and (TNF-α) levels determination by ELISA technique. RESULTS The age of the study samples ranged from 25 to 80 years with a male ratio of 1.45:1 although the sex differences between both groups were not significant. The mean levels of (TNF-α) and (TGF-β) was significantly higher among cases group than that of controls group (254.86 ± 75.9 vs158.01 ± 50.600) for TNF-α and for TGF- β (312.85 ± 62.27 vs. 217.82 ± 52.95) respectively. Both TNF-α and TGF-β have high sensitivity and specificity in detection of DPN. The sensitivity of TNF-α was 95.7% and specificity of 61.4% area under the ROC curve (AUC) of 0.870 ± 0.029, while the sensitivity of TGF-β was 91.4%, and specificity of 67.1 with good area under the ROC curve (AUC) of 0.891 ± 0.026 (P=0.000). CONCLUSIONS TNF-α and TGF -β are significantly elevated levels in patients with DPN, these cytokines could be used as indicators for the development of DPN.
Collapse
Affiliation(s)
- Dhifaf Abdulrhaman
- Department of Microbiology, College of Medicine, Al-Iraqia University, Baghdad, Iraq
| | - Hayfaa Fahad
- Department of Microbiology, College of Medicine, Al-Iraqia University, Baghdad, Iraq
| | - Nawar Khalil
- Department of Family and Community Medicine, College of Medicine, Al-Iraqia University, Baghdad, Iraq
| |
Collapse
|
45
|
Li J, Zhang X, Zhang Y, Dan X, Wu X, Yang Y, Chen X, Li S, Xu Y, Wan Q, Yan P. Increased Systemic Immune-Inflammation Index Was Associated with Type 2 Diabetic Peripheral Neuropathy: A Cross-Sectional Study in the Chinese Population. J Inflamm Res 2023; 16:6039-6053. [PMID: 38107379 PMCID: PMC10723178 DOI: 10.2147/jir.s433843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
Background Systemic immune-inflammation index (SII), a novel inflammatory marker, has been demonstrated to be associated with type 2 diabetes mellitus (T2DM) and its vascular complications, however, the relation between SII and diabetic peripheral neuropathy (DPN) has been never reported. We aimed to explore whether SII is associated with DPN in Chinese population. Methods A cross-sectional study was conducted among 1460 hospitalized patients with T2DM. SII was calculated as the platelet count × neutrophil count/lymphocyte count, and its possible association with DPN was investigated by correlation and multivariate logistic regression analysis, and subgroup analyses. Results Patients with higher SII quartiles had higher vibration perception threshold and prevalence of DPN (all P<0.01), and SII was independently positively associated with the prevalence of DPN (P<0.01). Multivariate logistic regression analysis showed that the risk of prevalence of DPN increased progressively across SII quartiles (P for trend <0.01), and participants in the highest quartile of SII was at a significantly increased risk of prevalent DPN compared to those in the lowest quartile after adjustment for potential confounding factors (odds rate: 1.211, 95% confidence intervals 1.045-1.404, P<0.05). Stratified analysis revealed positive associations of SII quartiles with risk of prevalent DPN only in men, people less than 65 years old, with body mass index <24 kg/m2, duration of diabetes >5 years, hypertension, dyslipidaemia, poor glycaemic control, and estimated glomerular filtration rate <90 mL/min/1.73 m2 (P for trend <0.01 or P for trend <0.05). The receiver operating characteristic curve analysis revealed that the optimal cut-off point of SII for predicting DPN was 617.67 in patients with T2DM, with a sensitivity of 45.3% and a specificity of 73%. Conclusion The present study showed that higher SII is independently associated with increased risk of DPN, and SII might serve as a new risk biomarker for DPN in Chinese population.
Collapse
Affiliation(s)
- Jia Li
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, China, Luzhou, People’s Republic of China
| | - Xing Zhang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, China, Luzhou, People’s Republic of China
| | - Yi Zhang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, China, Luzhou, People’s Republic of China
| | - Xiaofang Dan
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, China, Luzhou, People’s Republic of China
| | - Xian Wu
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, China, Luzhou, People’s Republic of China
| | - Yuxia Yang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, China, Luzhou, People’s Republic of China
| | - Xiping Chen
- Clinical medical college, Southwest Medical University, Luzhou, People’s Republic of China
| | - Shengxi Li
- Basic Medical College, Southwest Medical University, Luzhou, People’s Republic of China
| | - Yong Xu
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, China, Luzhou, People’s Republic of China
| | - Qin Wan
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, China, Luzhou, People’s Republic of China
| | - Pijun Yan
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, China, Luzhou, People’s Republic of China
| |
Collapse
|
46
|
Bao T, Zhang X, Xie W, Wang Y, Li X, Tang C, Yang Y, Sun J, Gao J, Yu T, Zhao L, Tong X. Natural compounds efficacy in complicated diabetes: A new twist impacting ferroptosis. Biomed Pharmacother 2023; 168:115544. [PMID: 37820566 DOI: 10.1016/j.biopha.2023.115544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
Ferroptosis, as a way of cell death, participates in the body's normal physiological and pathological regulation. Recent studies have shown that ferroptosis may damage glucose-stimulated islets β Insulin secretion and programmed cell death of T2DM target organs are involved in the pathogenesis of T2DM and its complications. Targeting suppression of ferroptosis with specific inhibitors may provide new therapeutic opportunities for previously untreated T2DM and its target organs. Current studies suggest that natural bioactive compounds, which are abundantly available in drugs, foods, and medicinal plants for the treatment of T2DM and its target organs, have recently received significant attention for their various biological activities and minimal toxicity, and that many natural compounds appear to have a significant role in the regulation of ferroptosis in T2DM and its target organs. Therefore, this review summarized the potential treatment strategies of natural compounds as ferroptosis inhibitors to treat T2DM and its complications, providing potential lead compounds and natural phytochemical molecular nuclei for future drug research and development to intervene in ferroptosis in T2DM.
Collapse
Affiliation(s)
- Tingting Bao
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No.5 BeiXianGe Street, Xicheng District, Beijing 100053, China; Graduate school, Beijing University of Traditional Chinese Medicine, Beijing 100029, China
| | - Xiangyuan Zhang
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No.5 BeiXianGe Street, Xicheng District, Beijing 100053, China; Graduate school, Beijing University of Traditional Chinese Medicine, Beijing 100029, China
| | - Weinan Xie
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No.5 BeiXianGe Street, Xicheng District, Beijing 100053, China; Graduate school, Beijing University of Traditional Chinese Medicine, Beijing 100029, China
| | - Ying Wang
- Changchun University of Chinese Medicine, No. 1035, Boshuo Road, Jingyue National High-tech Industrial Development Zone, Changchun 130117, China
| | - Xiuyang Li
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No.5 BeiXianGe Street, Xicheng District, Beijing 100053, China
| | - Cheng Tang
- Changchun University of Chinese Medicine, No. 1035, Boshuo Road, Jingyue National High-tech Industrial Development Zone, Changchun 130117, China
| | - Yingying Yang
- National Center for Integrated Traditional and Western Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jun Sun
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, No. 1478, Gongnong Road, Chaoyang District, Changchun 130021, China
| | - Jiaqi Gao
- School of Qi-Huang Chinese Medicine, Beijing University of Chinese Medicine, No. 11, North 3rd Ring East Roa, Chaoyang Distric, Beijing 10010, China
| | - Tongyue Yu
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No.5 BeiXianGe Street, Xicheng District, Beijing 100053, China
| | - Linhua Zhao
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No.5 BeiXianGe Street, Xicheng District, Beijing 100053, China.
| | - Xiaolin Tong
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No.5 BeiXianGe Street, Xicheng District, Beijing 100053, China.
| |
Collapse
|
47
|
Sharma S, Kalia V. Effect of tibial nerve mobilization on balance & gait functions in subjects with subclinical diabetic neuropathy: A randomized clinical trial. J Diabetes Metab Disord 2023; 22:1283-1290. [PMID: 37975109 PMCID: PMC10638326 DOI: 10.1007/s40200-023-01246-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/04/2023] [Indexed: 11/19/2023]
Abstract
Introduction With advancing age, balance control diminishes as a result of cognitive impairment, decreased muscle strength, and impairment in visual, vestibular, and somatosensory systems. Besides aforesaid factors, the addition of diabetes to all these leads to balance and gait-related issues such as falls and fall-related injuries. Impaired balance and gait performance in diabetics are primarily attributed to the diminished sensory function of the foot and ankle region owing to diabetic neuropathy. The purpose of this study was to explicitly examine the impact of neural mobilization on the balance & gait functions of subjects having subclinical diabetic neuropathy. Methods 40 individuals with subclinical diabetic neuropathy, ranging in age from 50 to 75 years, were assigned to two groups at random: Group 1 received the concurrent application of Tibial nerve mobilization and Balance-Gait training whereas Group 2 received only Balance-Gait training. The therapy was administered five times each week, for four weeks. On the first and last day of treatment, measurements of VPT, BBS, TUG, and DGI were taken from each subject. Results The results of the study found that post neural mobilization and Balance-Gait training, scores of VPT, BBS, DGI, and TUG showed improvement but it was not significant. As it is evident that diabetic neuropathy is progressive in nature, even small changes can be helpful. Conclusion Neural mobilization integrated with balance-gait training of subclinical diabetic neuropathic individuals resulted in improved sensory functions along with enhanced balance-gait functions. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01246-w.
Collapse
Affiliation(s)
- Shanika Sharma
- Department of Physiotherapy, Lovely Professional University, Jalandhar-Delhi, Grand Trunk Road, Phagwara, 144001 India
| | - Varun Kalia
- Department of Physiotherapy, Lovely Professional University, Jalandhar-Delhi, Grand Trunk Road, Phagwara, 144001 India
| |
Collapse
|
48
|
Yao Y, Lei X, Wang Y, Zhang G, Huang H, Zhao Y, Shi S, Gao Y, Cai X, Gao S, Lin Y. A Mitochondrial Nanoguard Modulates Redox Homeostasis and Bioenergy Metabolism in Diabetic Peripheral Neuropathy. ACS NANO 2023; 17:22334-22354. [PMID: 37782570 DOI: 10.1021/acsnano.3c04462] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
As a major late complication of diabetes, diabetic peripheral neuropathy (DPN) is the primary reason for amputation. Nevertheless, there are no wonder drugs available. Regulating dysfunctional mitochondria is a key therapeutic target for DPN. Resveratrol (RSV) is widely proven to guard mitochondria, yet the unsatisfactory bioavailability restricts its clinical application. Tetrahedral framework nucleic acids (tFNAs) are promising carriers due to their excellent cell entrance efficiency, biological safety, and structure editability. Here, RSV was intercalated into tFNAs to form the tFNAs-RSV complexes. tFNAs-RSV achieved enhanced stability, bioavailability, and biocompatibility compared with tFNAs and RSV alone. With its treatment, reactive oxygen species (ROS) production was minimized and reductases were activated in an in vitro model of DPN. Besides, respiratory function and adenosine triphosphate (ATP) production were enhanced. tFNAs-RSV also exhibited favorable therapeutic effects on sensory dysfunction, neurovascular deterioration, demyelination, and neuroapoptosis in DPN mice. Metabolomics analysis revealed that redox regulation and energy metabolism were two principal mechanisms that were impacted during the process. Comprehensive inspections indicated that tFNAs-RSV inhibited nitrosation and oxidation and activated reductase and respiratory chain. In sum, tFNAs-RSV served as a mitochondrial nanoguard (mito-guard), representing a viable drilling target for clinical drug development of DPN.
Collapse
Affiliation(s)
- Yangxue Yao
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Xiaoyu Lei
- Research Center for Nano Biomaterials, and Analytical & Testing Center, Sichuan University, Chengdu 610064, P. R. China
| | - Yun Wang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Geru Zhang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Hongxiao Huang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Yuxuan Zhao
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Sirong Shi
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Yang Gao
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Xiaoxiao Cai
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Shaojingya Gao
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Yunfeng Lin
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
- Sichuan Provincial Engineering Research Center of Oral Biomaterials, Chengdu, Sichuan 610041, China
| |
Collapse
|
49
|
Li J, Wu G, Li W, Zhou X, Li W, Xu X, Xu K, Cao R, Cui S. Plasma exosomes improve peripheral neuropathy via miR-20b-3p/Stat3 in type I diabetic rats. J Nanobiotechnology 2023; 21:447. [PMID: 38001489 PMCID: PMC10675980 DOI: 10.1186/s12951-023-02222-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes and the main cause of non-traumatic amputation, with no ideal treatment. Multiple cell-derived exosomes have been reported to improve the progression of DPN. Blood therapy is thought to have a powerful repairing effect. However, whether it could also improve DPN remains unclear. RESULTS In this study, we found that microRNA (miRNA) expression in plasma-derived exosomes of healthy rats (hplasma-exos) was significantly different from that of age-matched DPN rats. By injection of hplasma-exos into DPN rats, the mechanical sensitivity of DPN rats was decreased, the thermal sensitivity and motor ability were increased, and the nerve conduction speed was accelerated. Histological analysis showed myelin regeneration of the sciatic nerve, increased intraepidermal nerve fibers, distal local blood perfusion, and enhanced neuromuscular junction and muscle spindle innervation after hplasma-exos administration. Compared with plasma exosomes in DPN, miR-20b-3p was specifically enriched in exosomes of healthy plasma and was found to be re-upregulated in the sciatic nerve of DPN rats after hplasma-exos treatment. Moreover, miR-20b-3p agomir improved DPN symptoms to a level similar to hplasma-exos, both of which also alleviated autophagy impairment induced by high glucose in Schwann cells. Mechanistic studies found that miR-20b-3p targeted Stat3 and consequently reduced the amount of p-Stat3, which then negatively regulated autophagy processes and contributed to DPN improvement. CONCLUSIONS This study demonstrated that miRNA of plasma exosomes was different between DPN and age-matched healthy rats. MiR-20b-3p was enriched in hplasma-exos, and both of them could alleviated DPN symptoms. MiR-20b-3p regulated autophagy of Schwann cells in pathological states by targeting Stat3 and thereby inhibited the progression of DPN.
Collapse
Affiliation(s)
- Jiayang Li
- Department of Hand and Foot Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
- Key Laboratory of Peripheral Nerve Injury and Regeneration of Jilin Province, Changchun, China
| | - Guangzhi Wu
- Department of Hand and Foot Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
- Key Laboratory of Peripheral Nerve Injury and Regeneration of Jilin Province, Changchun, China
| | - Weiye Li
- Department of Hand and Foot Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
- Key Laboratory of Peripheral Nerve Injury and Regeneration of Jilin Province, Changchun, China
| | - Xiongyao Zhou
- Department of Hand and Foot Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
- Key Laboratory of Peripheral Nerve Injury and Regeneration of Jilin Province, Changchun, China
| | - Weizhen Li
- Department of Hand and Foot Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
- Key Laboratory of Peripheral Nerve Injury and Regeneration of Jilin Province, Changchun, China
| | - Xiong Xu
- Department of Hand and Foot Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
- Key Laboratory of Peripheral Nerve Injury and Regeneration of Jilin Province, Changchun, China
| | - Ke Xu
- Department of Hand and Foot Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
- Key Laboratory of Peripheral Nerve Injury and Regeneration of Jilin Province, Changchun, China
| | - Rangjuan Cao
- Department of Hand and Foot Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.
- Key Laboratory of Peripheral Nerve Injury and Regeneration of Jilin Province, Changchun, China.
- Department of Hand and Foot Surgery, The Third Bethune Hospital of Jilin University, Changchun, China.
| | - Shusen Cui
- Department of Hand and Foot Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.
- Key Laboratory of Peripheral Nerve Injury and Regeneration of Jilin Province, Changchun, China.
- Department of Hand and Foot Surgery, The Third Bethune Hospital of Jilin University, Changchun, China.
| |
Collapse
|
50
|
Li D, Jin X, Wang C, Zhang N, Jin D, Zhang H. Correlation Between Corneal Whorl-Like Nerve and Retinal Neurodegenerative Changes and Their Association With Microvessel Perfusion in Diabetes. Invest Ophthalmol Vis Sci 2023; 64:44. [PMID: 38019489 PMCID: PMC10691402 DOI: 10.1167/iovs.64.14.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023] Open
Abstract
Purpose The purpose of this study was to compare the evolution of changes in the corneal nerves, retinal nerves, and cells and blood vessels at a single time point in early diabetic retinopathy (DR). Methods Eighty participants (60 with diabetes and 20 nondiabetic controls) were examined. DR was graded according to the International Classification of Diabetic Retinopathy. Inferior whorl length (IWL), spiral orientation, central nerve fiber length (CNFL), retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) layer thickness, global loss volume (GLV), focal loss volume (FLV) indices, superficial (sVD), and deep vessel densities (dVD) were examined. Results Compared with those of healthy controls, the IWL, CNFL, and FLV were decreased in the diabetic groups (P < 0.001). The IWL was significantly positively correlated with the RNFL and GCC thicknesses in the diabetic group (r = 0.248, P = 0.006 and r = 0.207, P = 0.023, respectively) and significantly negatively correlated with the FLV (r = -0.535, P < 0.001). The sVD was significantly positively correlated with the RNFL thickness (r = 0.314, P < 0.001) and negatively correlated with the GLV (r = -0.229, P = 0.012). Conclusions Our findings suggest a correlation between corneal whorl-like nerve plexus and retinal nerve changes in the early stages of DR and that the IWL of the cornea may be able to indicate the extent of DR. Retinal nerve changes are associated with retinal microvessel perfusion, and nerve changes may precede vessel lesions.
Collapse
Affiliation(s)
- Dongyu Li
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, China
| | - Xin Jin
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, China
| | - Chao Wang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, China
| | - Nan Zhang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, China
| | - Di Jin
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, China
| | - Hong Zhang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, China
| |
Collapse
|