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Mooshage CM, Schimpfle L, Kender Z, Tsilingiris D, Aziz-Safaie T, Hohmann A, Szendroedi J, Nawroth P, Sturm V, Heiland S, Bendszus M, Kopf S, Kurz FT, Jende JME. Association of Small Fiber Function with Microvascular Perfusion of Peripheral Nerves in Patients with Type 2 Diabetes : Study using Quantitative Sensory Testing and Magnetic Resonance Neurography. Clin Neuroradiol 2024; 34:55-66. [PMID: 37548682 PMCID: PMC10881621 DOI: 10.1007/s00062-023-01328-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION/AIMS Diabetic small fiber neuropathy (SFN) is caused by damage to thinly myelinated A‑fibers (δ) and unmyelinated C‑fibers. This study aimed to assess associations between quantitative sensory testing (QST) and parameters of peripheral nerve perfusion obtained from dynamic contrast enhanced (DCE) magnetic resonance neurography (MRN) in type 2 diabetes patients with and without SFN. METHODS A total of 18 patients with type 2 diabetes (T2D, 8 with SFN, 10 without SFN) and 10 healthy controls (HC) took part in this cross-sectional single-center study and underwent QST of the right leg and DCE-MRN of the right thigh with subsequent calculation of the sciatic nerve constant of capillary permeability (Ktrans), extravascular extracellular volume fraction (Ve), and plasma volume fraction (Vp). RESULTS The Ktrans (HC 0.031 min-1 ± 0.009, T2D 0.043 min-1 ± 0.015; p = 0.033) and Ve (HC 1.2% ± 1.5, T2D: 4.1% ± 5.1; p = 0.027) were lower in T2D patients compared to controls. In T2D patients, compound z‑scores of thermal and mechanical detection correlated with Ktrans (r = 0.73; p = 0.001, and r = 0.57; p = 0.018, respectively) and Ve (r = 0.67; p = 0.002, and r = 0.69; p = 0.003, respectively). Compound z‑scores of thermal pain and Vp (r = -0.57; p = 0.015) correlated negatively. DISCUSSION The findings suggest that parameters of peripheral nerve microcirculation are related to different symptoms in SFN: A reduced capillary permeability may result in a loss of function related to insufficient nutritional supply, whereas increased capillary permeability may be accompanied by painful symptoms related to a gain of function.
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Affiliation(s)
- Christoph M Mooshage
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Lukas Schimpfle
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, Neuherberg, Munich, Germany
| | - Zoltan Kender
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, Neuherberg, Munich, Germany
| | - Dimitrios Tsilingiris
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Taraneh Aziz-Safaie
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Anja Hohmann
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Julia Szendroedi
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany
| | - Volker Sturm
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Department of Neuroradiology, Division of Experimental Radiology, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Division of Experimental Radiology, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, Neuherberg, Munich, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- German Cancer Research Center, Heidelberg, Germany
| | - Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Picconi F, Ryan CP, Russo B, Ciotti S, Pepe A, Menduni M, Lacquaniti F, Frontoni S, Moscatelli A. The evaluation of tactile dysfunction in the hand in type 1 diabetes: a novel method based on haptics. Acta Diabetol 2022; 59:1073-1082. [PMID: 35641837 PMCID: PMC9242965 DOI: 10.1007/s00592-022-01903-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
AIMS We present an innovative method based on haptics for the evaluation of the sense of touch in the hand, in people affected by type 1 diabetes. METHODS Forty individuals affected by diabetes and 20 healthy controls took part in the study; the diabetes group was further divided into two subgroups based on vibration sensitivity in the lower limb. By means of a novel haptic device, tactile sensitivity in the fingertip was measured as the ability of the participants to discriminate slip motion speed. RESULTS Tactile sensitivity was significantly lower in individuals affected by diabetes as compared to controls. Depending on the subgroup, the difference from the controls was equal to 0.11 (95% CI from 0.029 to 0.186) and to 0.267 (95% CI from 0.198 to 0.336). Within the diabetes group, tactile sensitivity correlated with vibration sensitivity in the upper (p = 0.001) and lower limb (p = 0.003). A significant relationship between nerve conduction parameters and tactile sensitivity was found (p = 0.03). Finally, we combined the different predictors (clinical, vibratory and electroneurography data) by using cluster analysis; tactile sensitivity was found to be significantly different between different clusters (p = 0.004). CONCLUSIONS Early signs of tactile dysfunction in the hand were found in individuals affected by diabetes, even in absence of diabetic neuropathy. The protocol presented in this study is a promising tool for the assessment of tactile dysfunction in the hand in people affected by type 1 diabetes.
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Affiliation(s)
- F Picconi
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, Rome, Italy
| | - C P Ryan
- Department of Systems Medicine and Centre of Space Biomedicine, University of Rome Tor Vergata, Rome, Italy
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - B Russo
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - S Ciotti
- Department of Systems Medicine and Centre of Space Biomedicine, University of Rome Tor Vergata, Rome, Italy
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, Rome, Italy
- Research Centre "E. Piaggio" and Department of Information Engineering, University of Pisa, Pisa, Italy
| | - A Pepe
- Unit of Neurology, S. Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - M Menduni
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - F Lacquaniti
- Department of Systems Medicine and Centre of Space Biomedicine, University of Rome Tor Vergata, Rome, Italy
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - S Frontoni
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, Rome, Italy.
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
| | - A Moscatelli
- Department of Systems Medicine and Centre of Space Biomedicine, University of Rome Tor Vergata, Rome, Italy
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, Rome, Italy
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Metea M, Palmero-Soler E, Crum L. Preclinical nerve conduction: Nerve battery options for primate studies. J Pharmacol Toxicol Methods 2022; 116:107187. [PMID: 35636693 DOI: 10.1016/j.vascn.2022.107187] [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: 03/06/2022] [Revised: 04/23/2022] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
Abstract
Electrophysiological neurodiagnostic tests of nerve conduction (NC) are key assays included in preclinical safety and toxicology programs to assess the peripheral neuropathy (PN) liability of a new drug. Despite their increased use, standardization of nerve conduction studies (NCS) is lacking in the preclinical space, with limited regulatory guidelines stipulating type and number of nerves or minimum combinations appropriate for each stage of drug development or indication. Detection of subtle peripheral toxicities depends on choosing appropriate nerve targets for testing, especially when functional changes remain above the lower limit of normal values. To support robust preclinical toxicology study designs, the current short communication provides options and recommendations for selecting peripheral nerves for clinically translatable nerve conduction batteries applicable to toxicology and gene therapy, with a focus on clinically translatable primate models. A comprehensive compilation of accessible nerve locations is offered including lower and upper extremity motor nerves, and sensory nerves with origin at multiple DRG levels. Rankings of technique difficulty and repeatability across serial collections are presented for each assay informed by serial nerve conduction from 500 adult primates. The goal of this communication is to support the standardization and preclinical implementation of this important assay.
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Affiliation(s)
- Monica Metea
- Preclinical Electrophysiology Consulting, LLC, Mattapoisett, MA, USA.
| | | | - Lucas Crum
- Preclinical Electrophysiology Consulting, LLC, Mattapoisett, MA, USA
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Gibbons CH, Zhu J, Zhang X, Habboubi N, Hariri R, Veves A. Phase 2a randomized controlled study investigating the safety and efficacy of PDA-002 in diabetic peripheral neuropathy. J Peripher Nerv Syst 2021; 26:276-289. [PMID: 34169613 DOI: 10.1111/jns.12457] [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: 10/04/2020] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
Neuropathy is a major cause of morbidity and mortality in individuals with diabetes, with no effective therapy to alter the inevitable progression of nerve damage. We hypothesized that mesenchymal stroma cell-like populations, that are characterized as immune modulators also have the potential of inducing angiogenesis and neurite outgrowth, might be useful in treating diabetic peripheral neuropathy (DPN). The aims of this study were to investigate the efficacy and safety of mesenchymal stem cell-like product (PDA-002) in treating DPN. A phase-2 randomized placebo-controlled trial was conducted in 26 patients with DPN. Treatment consisted of three rounds of intramuscular injections in one lower limb using one of the three randomized treatment arms PDA-002 (low-dose 3 × 106 cells), PDA-002 (high-dose 30 × 106 cells), or placebo. Three treatments per patient occurred on days 1, 29, and 57. Study endpoints included efficacy and safety of PDA-002 in treating DPN in both lower extremities following unilateral local injection. Outcome measures included intra-epidermal nerve fiber density (IENFD) up to 1 year from the day of treatment with 6-month as the primary outcome measurement. In this phase 2 study of DPN, PDA-002 was well tolerated in both doses. No significant changes were noted in IENFD in both the treated and untreated leg in the NIS-LL, NTSS-6, or UENS. Mesenchymal stem cells represent a novel mechanism for treating diabetic neuropathy and are well tolerated. Preliminary results highlight the need of further investigation of PDA-001 as a disease modifying agent for treatment of DPN.
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Affiliation(s)
- Christopher H Gibbons
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Aristidis Veves
- Department of Surgery, The Rongxiang Xu, Center for Regenerative Therapeutics at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Ando A, Miyamoto M, Saito N, Kotani K, Kamiya H, Ishibashi S, Tavakoli M. Small Fibre Neuropathy Is Associated With Impaired Vascular Endothelial Function in Patients With Type 2 Diabetes. Front Endocrinol (Lausanne) 2021; 12:653277. [PMID: 33935969 PMCID: PMC8079951 DOI: 10.3389/fendo.2021.653277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/18/2021] [Indexed: 12/27/2022] Open
Abstract
Diabetic polyneuropathy (DPN) and endothelial dysfunction are prevalent complications of diabetes mellitus. Currently, there are two non-invasive markers for endothelial dysfunction: flow-mediated dilation and reactive hyperaemia peripheral arterial tonometry (RH-PAT). However, the relationship between diabetic small fibre neuropathy and macroangiopathy remains obscure thus far. Corneal confocal microscopy (CCM) has emerged as a new diagnostic modality to assess DPN, especially of small fibre. To clarify the relationship between diabetic small fibre neuropathy and vascular dysfunction, we aimed to determine the functions of peripheral nerves and blood vessels through clinical tests such as nerve conduction study, coefficient of variation in the R-R interval, CCM, and RH-PAT in 82 patients with type 2 diabetes. Forty healthy control subjects were also included to study corneal nerve parameters. Correlational and multiple linear regression analyses were performed to determine the associations between neuropathy indices and markers for vascular functions. The results revealed that patients with type 2 diabetes had significantly lower values for most variables of CCM than healthy control subjects. RH-PAT solely remained as an explanatory variable significant in multiple regression analysis for several CCM parameters and vice versa. Other vascular markers had no significant multiple regression with any CCM parameters. In conclusion, endothelial dysfunction as revealed by impaired RH-PAT was significantly associated with CCM parameters in patients with type 2 diabetes. This association may indicate that small fibre neuropathy results from impaired endothelial dysfunction in type 2 diabetes. CCM parameters may be considered surrogate markers of autonomic nerve damage, which is related to diabetic endothelial dysfunction. This study is the first to report the relationship between corneal nerve parameter as small fibre neuropathy in patients with type 2 diabetes and RH-PAT as a marker of endothelial dysfunction.
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Affiliation(s)
- Akihiko Ando
- Department of Internal Medicine, Nishio Hospital, Nishio, Japan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University, Nagakute, Japan
- *Correspondence: Akihiko Ando,
| | - Michiaki Miyamoto
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
- Department of Internal Medicine, Aiseikai Clinic for Internal Medicine and Gynecology, Kuki, Japan
- Department of Laboratory Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Naoko Saito
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Centre for Community Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Hideki Kamiya
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University, Nagakute, Japan
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Mitra Tavakoli
- Diabetes and Vascular Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom
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Himeno T, Kamiya H, Nakamura J. Lumos for the long trail: Strategies for clinical diagnosis and severity staging for diabetic polyneuropathy and future directions. J Diabetes Investig 2020; 11:5-16. [PMID: 31677343 PMCID: PMC6944828 DOI: 10.1111/jdi.13173] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023] Open
Abstract
Diabetic polyneuropathy, which is a chronic symmetrical length-dependent sensorimotor polyneuropathy, is the most common form of diabetic neuropathy. Although diabetic polyneuropathy is the most important risk factor in cases of diabetic foot, given its poor prognosis, the criteria for diagnosis and staging of diabetic polyneuropathy has not been established; consequently, no disease-modifying treatment is available. Most criteria and scoring systems that were previously proposed consist of clinical signs, symptoms and quantitative examinations, including sensory function tests and nerve conduction study. However, in diabetic polyneuropathy, clinical symptoms, including numbness, pain and allodynia, show no significant correlation with the development of pathophysiological changes in the peripheral nervous system. Therefore, these proposed criteria and scoring systems have failed to become a universal clinical end-point for large-scale clinical trials evaluating the prognosis in diabetes patients. We should use quantitative examinations of which validity has been proven. Nerve conduction study, for example, has been proven effective to evaluate dysfunctions of large nerve fibers. Baba's classification, which uses a nerve conduction study, is one of the most promising diagnostic methods. Loss of small nerve fibers can be determined using corneal confocal microscopy and intra-epidermal nerve fiber density. However, no staging criteria have been proposed using these quantitative evaluations for small fiber neuropathy. To establish a novel diagnostic and staging criteria of diabetic polyneuropathy, we propose three principles to be considered: (i) include only generalizable objective quantitative tests; (ii) exclude clinical symptoms and signs; and (iii) do not restrictively exclude other causes of polyneuropathy.
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Affiliation(s)
- Tatsuhito Himeno
- Division of DiabetesDepartment of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Hideki Kamiya
- Division of DiabetesDepartment of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Jiro Nakamura
- Division of DiabetesDepartment of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
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7
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Sloan G, Shillo P, Selvarajah D, Wu J, Wilkinson ID, Tracey I, Anand P, Tesfaye S. A new look at painful diabetic neuropathy. Diabetes Res Clin Pract 2018; 144:177-191. [PMID: 30201394 DOI: 10.1016/j.diabres.2018.08.020] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023]
Abstract
The prevalence of diabetes mellitus and its chronic complications continue to increase alarmingly. Consequently, the massive expenditure on diabetic distal symmetrical polyneuropathy (DSPN) and its sequelae, will also likely rise. Up to 50% of patients with diabetes develop DSPN, and about 20% develop neuropathic pain (painful-DSPN). Painful-DSPN can cast a huge burden on sufferers' lives with increased rates of unemployment, mental health disorders and physical co-morbidities. Unfortunately, due to limited understanding of the mechanisms leading to painful-DSPN, current treatments remain inadequate. Recent studies examining the pathophysiology of painful-DSPN have identified maladaptive alterations at the level of both the peripheral and central nervous systems. Additionally, genetic studies have suggested that patients with variants of voltage gated sodium channels may be more at risk of developing neuropathic pain in the presence of a disease trigger such as diabetes. We review the recent advances in genetics, skin biopsy immunohistochemistry and neuro-imaging, which have the potential to further our understanding of the condition, and identify targets for new mechanism based therapies.
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Affiliation(s)
- Gordon Sloan
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust & Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Pallai Shillo
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust & Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Dinesh Selvarajah
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust & Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Jing Wu
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Iain D Wilkinson
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust & Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Irene Tracey
- FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Praveen Anand
- Peripheral Neuropathy Unit, Centre for Clinical Translation, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust & Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom.
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Sun B, Liu LZ, Li YF, Chen ZH, Ling L, Yang F, Cui F, Huang XS. Clinical Characteristics, Electrophysiology, and Skin Biopsy of 38 Peripheral Neuropathy Cases with Small Fiber Involvement of Various Etiologies. Chin Med J (Engl) 2018; 130:1683-1688. [PMID: 28685718 PMCID: PMC5520555 DOI: 10.4103/0366-6999.209897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: In small fiber neuropathy (SFN), thinly myelinated Aδ and unmyelinated C fibers are primarily affected, resulting in sensory and/or autonomic symptoms. Various etiologies have been shown to be associated with SFN. This study was aimed to analyze a variety of features in peripheral neuropathy (PN) with small fiber involvement, and to compare disease severity among patients with idiopathic PN, PN associated with impaired glucose tolerance (IGT), and metabolic syndrome (MS) PN. Methods: Thirty-eight PN patients with small fiber involvement were enrolled from December 20, 2013 to May 31, 2016. Patients were divided into idiopathic PN, IGT-related PN, and MS-related PN groups. Detailed medical history and small fiber neuropathy were investigated, and symptom inventory questionnaire was conducted, as well as the visual analog scale. Nerve conduction studies and skin biopsies were also performed. The differences among the groups were analyzed using analysis of variance and Kruskal-Wallis test. Results: Eight patients were diagnosed with pure SFN. Intraepidermal nerve fiber density (IENFD) weakly correlated with motor conduction velocity (MCV) (r = 0.372, P = 0.025), and proximal (r = 0.383, P = 0.021) and distal (r = 0.358, P = 0.032) compound muscle action potential (CMAP) of the tibial nerve. IENFD also weakly correlated with MCV of the peroneal nerve (r = 0.399, P = 0.016). IENFD was shown to be significantly different among all groups (χ2 = 9.901, P = 0.007). IENFD was significantly decreased (χ2 = 23.000, P = 0.003) in the MS-related PN group compared to the idiopathic PN group. The MCV of the tibial nerve was significantly different among all groups (χ2 = 8.172, P < 0.017). The proximal (F = 4.336, P = 0.021) and distal (F = 3.262, P = 0.049) CMAP of the tibial nerve was also significantly different among all groups. Conclusions: IENFD of patients included in the present study weakly correlated with various electrophysiological parameters. Small and large fibers are more involved in patients with MS-related PN than in patients with idiopathic PN.
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Affiliation(s)
- Bo Sun
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Li-Zhi Liu
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Yi-Fan Li
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Zhao-Hui Chen
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Li Ling
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Fei Yang
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Fang Cui
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Xu-Sheng Huang
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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9
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Sun B, Li Y, Liu L, Chen Z, Ling L, Yang F, Liu J, Liu H, Huang X. SFN-SIQ, SFNSL and skin biopsy of 55 cases with small fibre involvement. Int J Neurosci 2017; 128:442-448. [PMID: 29077516 DOI: 10.1080/00207454.2017.1398152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose/aim of the study: To date, there are no validated screening scales for small fibre neuropathy. This study investigated the small-fibre neuropathy and the symptom inventory questionnaire as well as the small fibre neuropathy screening list for small fibre neuropathy diagnosis. METHODS Fifty-five patients were divided into small fibre neuropathy and mixed fibre damage groups. Relevant scales, nerve conduction studies and skin biopsies were performed. Relationships between the intraepidermal nerve fibre density and different scales as well as the diagnostic and cut-off values (score at which Youden's index is largest) were determined. RESULTS Compared with healthy Chinese participants, 20 patients were diagnosed with small fibre neuropathy. Intraepidermal nerve fibre density was moderately and highly correlated with the small fibre neuropathy-symptom inventory questionnaire and small fibre neuropathy screening list, respectively. The diagnostic values were moderate and high for the small fibre neuropathy-symptom inventory questionnaire (cut-off value = 5, sensitivity = 80%, specificity = 81.8%) and small fibre neuropathy screening list (cut-off value = 8, sensitivity = 94.1%, specificity = 90.9%), respectively. There were no significant differences in the visual analogue scale between the small fibre neuropathy group, mixed small and large fibre neuropathy group, pure large fibre neuropathy group and the normal group. CONCLUSION Small fibre neuropathy-symptom inventory questionnaire and small fibre neuropathy screening list represent potential small fibre neuropathy screening tools. Abbreviations EMG electromyography ENA anti-extractable nuclear antigens ESR erythrocyte sedimentation rate IENFD intraepidermal nerve fibre density IGT impaired glucose tolerance NCS nerve conduction studies NDS neuropathy disability score OGTT oral glucose tolerance test PGP protein gene product PN peripheral neuropathy ROC receiver operating characteristic curve ROC-AUC area under the ROC curve SFN small fibre neuropathy SFN-SIQ small-fibre neuropathy and symptom inventory questionnaire SFNSL small fibre neuropathy screening list VAS visual analogue scale WHO World Health Organization.
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Affiliation(s)
- Bo Sun
- a Department of Neurology , Chinese PLA General Hospital , Beijing , China
| | - Yifan Li
- a Department of Neurology , Chinese PLA General Hospital , Beijing , China
| | - Lizhi Liu
- a Department of Neurology , Chinese PLA General Hospital , Beijing , China
| | - Zhaohui Chen
- a Department of Neurology , Chinese PLA General Hospital , Beijing , China
| | - Li Ling
- a Department of Neurology , Chinese PLA General Hospital , Beijing , China
| | - Fei Yang
- a Department of Neurology , Chinese PLA General Hospital , Beijing , China
| | - Jiexiao Liu
- a Department of Neurology , Chinese PLA General Hospital , Beijing , China
| | - Hong Liu
- a Department of Neurology , Chinese PLA General Hospital , Beijing , China
| | - Xusheng Huang
- a Department of Neurology , Chinese PLA General Hospital , Beijing , China
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Maekawa T, Tadaki H, Sasase T, Motohashi Y, Miyajima K, Ohta T, Kume S. Pathophysiological profiles of SDT fatty rats, a potential new diabetic peripheral neuropathy model. J Pharmacol Toxicol Methods 2017; 88:160-166. [DOI: 10.1016/j.vascn.2017.09.257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/21/2017] [Accepted: 09/26/2017] [Indexed: 01/25/2023]
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11
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Niemi JP, Filous AR, DeFrancesco A, Lindborg JA, Malhotra NA, Wilson GN, Zhou B, Crish SD, Zigmond RE. Injury-induced gp130 cytokine signaling in peripheral ganglia is reduced in diabetes mellitus. Exp Neurol 2017. [PMID: 28645526 DOI: 10.1016/j.expneurol.2017.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Neuropathy is a major diabetic complication. While the mechanism of this neuropathy is not well understood, it is believed to result in part from deficient nerve regeneration. Work from our laboratory established that gp130 family of cytokines are induced in animals after axonal injury and are involved in the induction of regeneration-associated genes (RAGs) and in the conditioning lesion response. Here, we examine whether a reduction of cytokine signaling occurs in diabetes. Streptozotocin (STZ) was used to destroy pancreatic β cells, leading to chronic hyperglycemia. Mice were injected with either low doses of STZ (5×60mg/kg) or a single high dose (1×200mg/kg) and examined after three or one month, respectively. Both low and high dose STZ treatment resulted in sustained hyperglycemia and functional deficits associated with the presence of both sensory and autonomic neuropathy. Diabetic mice displayed significantly reduced intraepidermal nerve fiber density and sudomotor function. Furthermore, low and high dose diabetic mice showed significantly reduced tactile touch sensation measured with Von Frey monofilaments. To look at the regenerative and injury-induced responses in diabetic mice, neurons in both superior cervical ganglia (SCG) and the 4th and 5th lumbar dorsal root ganglia (DRG) were unilaterally axotomized. Both high and low dose diabetic mice displayed significantly less axonal regeneration in the sciatic nerve, when measured in vivo, 48h after crush injury. Significantly reduced induction of two gp130 cytokines, leukemia inhibitory factor and interleukin-6, occurred in diabetic animals in SCG 6h after injury compared to controls. Injury-induced expression of interleukin-6 was also found to be significantly reduced in the DRG at 6h after injury in low and high dose diabetic mice. These effects were accompanied by reduced phosphorylation of signal transducer and activator of transcription 3 (STAT3), a downstream effector of the gp130 signaling pathway. We also found decreased induction of several gp130-dependent RAGs, including galanin and vasoactive intestinal peptide. Together, these data suggest a novel mechanism for the decreased response of diabetic sympathetic and sensory neurons to injury.
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Affiliation(s)
- Jon P Niemi
- Department of Neurosciences, Case Western Reserve University, Cleveland, OH, USA
| | - Angela R Filous
- Department of Neurosciences, Case Western Reserve University, Cleveland, OH, USA
| | - Alicia DeFrancesco
- Department of Neurosciences, Case Western Reserve University, Cleveland, OH, USA
| | - Jane A Lindborg
- Department of Neurosciences, Case Western Reserve University, Cleveland, OH, USA
| | - Nisha A Malhotra
- Department of Neurosciences, Case Western Reserve University, Cleveland, OH, USA
| | - Gina N Wilson
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA; School of Biomedical Sciences, Kent State University, Kent, OH, USA
| | - Bowen Zhou
- Department of Neurosciences, Case Western Reserve University, Cleveland, OH, USA
| | - Samuel D Crish
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Richard E Zigmond
- Department of Neurosciences, Case Western Reserve University, Cleveland, OH, USA.
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12
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Neuropatia nei diabetici. Neurologia 2017. [DOI: 10.1016/s1634-7072(16)81776-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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13
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Ando A, Miyamoto M, Kotani K, Okada K, Nagasaka S, Ishibashi S. Cardio-Ankle Vascular Index and Indices of Diabetic Polyneuropathy in Patients with Type 2 Diabetes. J Diabetes Res 2017; 2017:2810914. [PMID: 28573145 PMCID: PMC5441120 DOI: 10.1155/2017/2810914] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/20/2017] [Accepted: 03/14/2017] [Indexed: 11/22/2022] Open
Abstract
The cardio-ankle vascular index (CAVI) is used to test vascular function and is an arterial stiffness marker and potential predictor of cardiovascular events. This study aimed to analyze the relation between objective indices of diabetic polyneuropathy (DPN) and the CAVI. One hundred sixty-six patients with type 2 diabetes mellitus were included in this study. We used nerve conduction studies (NCSs) and the coefficient of variation of the R-R interval to evaluate DPN. We estimated arteriosclerosis by the CAVI. Simple and multiple linear regression analyses were performed between neuropathy indices and the CAVI. In univariate analysis, the CAVI showed significant associations with sural sensory nerve conduction velocity and median F-wave conduction velocity. Multiple linear regression analysis for the CAVI showed that sural nerve conduction velocity and median F-wave conduction velocity were significant explanatory variables second only to age. In multiple linear regression analysis for sural nerve conduction velocity among neuropathy indices, the CAVI remained the most significant explanatory variable. In multiple linear regression analysis for median nerve F-wave conduction velocity among neuropathy indices, the CAVI remained the second most significant explanatory variable following HbA1c. These results suggest a close relationship between macroangiopathy and DPN.
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Affiliation(s)
- Akihiko Ando
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Tochigi 329-0498, Japan
- *Akihiko Ando:
| | - Michiaki Miyamoto
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Tochigi 329-0498, Japan
- Department of Laboratory Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Centre for Community Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Kenta Okada
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Shoichiro Nagasaka
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Tochigi 329-0498, Japan
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Yorek MS, Obrosov A, Shevalye H, Coppey LJ, Kardon RH, Yorek MA. Early vs. late intervention of high fat/low dose streptozotocin treated C57Bl/6J mice with enalapril, α-lipoic acid, menhaden oil or their combination: Effect on diabetic neuropathy related endpoints. Neuropharmacology 2016; 116:122-131. [PMID: 28025096 DOI: 10.1016/j.neuropharm.2016.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/28/2016] [Accepted: 12/21/2016] [Indexed: 01/06/2023]
Abstract
We have previously demonstrated that enalapril, α-lipoic acid and menhaden (fish) oil has potential as a treatment for diabetic peripheral neuropathy. In this study we sought to determine the efficacy of these treatments individually or in combination on multiple neuropathic endpoints in a high fat fed low dose streptozotocin treated mouse, a model of type 2 diabetes, following early or late intervention. Four or twelve weeks after the onset of hyperglycemia, diabetic mice were treated with enalapril, α-lipoic acid, menhaden oil or their combination for 12 weeks. Afterwards, endpoints including glucose tolerance, motor and sensory nerve conduction velocity, thermal nociception, and intraepidermal and cornea nerve fiber density was determined. Glucose clearance was impaired in diabetic mice and significantly improved only with combination treatment and early intervention. Diabetes caused steatosis, slowing of motor and sensory nerve conduction velocity, thermal hypoalgesia and reduction in intraepidermal and cornea nerve fiber density. Treating diabetic mice with enalapril, α-lipoic acid or menhaden oil partially protected diabetic mice from these deficits, whereas the combination of these three treatments was more efficacious following early or late intervention. These studies suggest that a combination therapy may be more effective for treating neural complications of type 2 diabetes.
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Affiliation(s)
- Matthew S Yorek
- Department of Veterans Affairs Iowa City Health Care System, Iowa City, IA, 52246, USA; Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, 52246, USA.
| | - Alexander Obrosov
- Department of Internal Medicine, University of Iowa, Iowa City, IA, 52242, USA.
| | - Hanna Shevalye
- Department of Internal Medicine, University of Iowa, Iowa City, IA, 52242, USA.
| | - Lawrence J Coppey
- Department of Internal Medicine, University of Iowa, Iowa City, IA, 52242, USA.
| | - Randy H Kardon
- Department of Veterans Affairs Iowa City Health Care System, Iowa City, IA, 52246, USA; Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, 52242, USA; Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, 52246, USA.
| | - Mark A Yorek
- Department of Veterans Affairs Iowa City Health Care System, Iowa City, IA, 52246, USA; Department of Internal Medicine, University of Iowa, Iowa City, IA, 52242, USA; Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, 52246, USA; Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, 52242, USA.
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15
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Kobori M, Yagihashi S, Shiina N, Shiozawa N, Haginoya A, Ojima M, Douguchi S, Tamasawa A, Saitou M, Baba M, Osonoi T. Four-year sequential nerve conduction changes since first visit in Japanese patients with early type 2 diabetes. J Diabetes Investig 2016; 8:369-376. [PMID: 27736033 PMCID: PMC5415466 DOI: 10.1111/jdi.12583] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/08/2016] [Accepted: 09/19/2016] [Indexed: 01/24/2023] Open
Abstract
Aims/Introduction Despite being the most common complication of diabetes, the pattern of clinical development of diabetic neuropathy is not well‐known. In the present study, we retrospectively examined sequential changes in nerve conduction studies (NCS) for 4 years to characterize the way neuropathic changes develop in patients with type 2 diabetes. Materials and Methods We randomly selected 158 patients with type 2 diabetes who newly visited Naka Memorial Clinic, Ibaraki, Japan, and underwent serial 4‐year NCS. Records of clinical profile, signs and symptoms of neuropathy, and NCS data from median and tibial nerves were extracted to determine the progression of neuropathy. NCS data were represented by motor nerve conduction velocities, amplitudes of compound muscle action potentials (CMAPs) and minimal latencies of F‐wave. Results The prevalence of clinical neuropathy in 158 cases was 30% at baseline and 29% at the end of the study, with improvement of glycated hemoglobin (8.6–6.9%). Over 4 years, there were no changes of the signs and symptoms of neuropathy. Motor nerve conduction velocities were slightly improved or consistent at the fourth year compared with those at the beginning (+1.5% in median nerve, P < 0.05; +0.8%, not significant in the tibial nerve). The extent of the glycated hemoglobin correction correlated with the improvement of motor nerve conduction velocity. In contrast, CMAPs of both median and tibial nerves were decreased (−11.6%, P < 0.01; −3.7%, P < 0.05, respectively). For the decrease in CMAPs, no specific risk factors were identified by logistic regression analysis. Conclusions The present study showed progressive decline of CMAPs despite improved glycemic controls or the lack of NCV slowing in patients with early type 2 diabetes.
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Affiliation(s)
- Mariko Kobori
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan
| | - Soroku Yagihashi
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan.,Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Norie Shiina
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan
| | - Nana Shiozawa
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan
| | - Akiko Haginoya
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan
| | - Misato Ojima
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan
| | | | | | - Miyoko Saitou
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan
| | - Masayuki Baba
- Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Takeshi Osonoi
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan
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16
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Greig M, Tesfaye S, Selvarajah D, Wilkinson ID. Insights into the pathogenesis and treatment of painful diabetic neuropathy. HANDBOOK OF CLINICAL NEUROLOGY 2016; 126:559-78. [PMID: 25410244 DOI: 10.1016/b978-0-444-53480-4.00037-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Painful diabetic distal symmetrical polyneuropathy (painful DPN) is a puzzle with two important missing pieces: Firstly we still do not understand why only some patients with neuropathy experience painful symptoms; Secondly we still do not have a complete understanding of how nociception generated in the peripheral nervous system is processed by the central nervous system (CNS). Available treatments offer only symptom relief and there is currently no effective treatment based on arresting or reversing the progression of disease. Therefore the management of painful DPN remains less than optimal because the complex pathophysiology of nociception and pain perception in health and disease is incompletely understood. Studies of the peripheral nervous system are investigating the molecular processes involved in signal transduction that have the potential to be interrupted or modified to ease pain. Magnetic resonance imaging techniques are helping to elucidate central pain processing pathways and describe the translation of nociception to pain. Combining the knowledge from these two streams of enquiry we will soon be able to predict accurately who will develop painful DPN, how we can halt or reverse the condition, or who will respond to symptomatic treatments. Future developments in the treatment of painful DPN will be underpinned by decoding the peripheral and central mechanisms of pain. Research is focusing on these areas of enquiry in the hope that answers will lead to effective treatments to alleviate pain and reverse pathology for those suffering from painful DPN.
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Affiliation(s)
- Marni Greig
- Diabetes Department, Royal Hallamshire Hospital, Sheffield, UK
| | - Solomon Tesfaye
- Diabetes Department, Royal Hallamshire Hospital, Sheffield, UK.
| | | | - Iain D Wilkinson
- Academic Radiology, Department of Cardiovascular Science, Royal Hallamshire Hospital, Sheffield, UK
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17
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Vascular endothelial growth factor-A165b prevents diabetic neuropathic pain and sensory neuronal degeneration. Clin Sci (Lond) 2015. [PMID: 26201024 DOI: 10.1042/cs20150124] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Diabetic peripheral neuropathy affects up to half of diabetic patients. This neuronal damage leads to sensory disturbances, including allodynia and hyperalgesia. Many growth factors have been suggested as useful treatments for prevention of neurodegeneration, including the vascular endothelial growth factor (VEGF) family. VEGF-A is generated as two alternative splice variant families. The most widely studied isoform, VEGF-A165a is both pro-angiogenic and neuroprotective, but pro-nociceptive and increases vascular permeability in animal models. Streptozotocin (STZ)-induced diabetic rats develop both hyperglycaemia and many of the resulting diabetic complications seen in patients, including peripheral neuropathy. In the present study, we show that the anti-angiogenic VEGF-A splice variant, VEGF-A165b, is also a potential therapeutic for diabetic neuropathy. Seven weeks of VEGF-A165b treatment in diabetic rats reversed enhanced pain behaviour in multiple behavioural paradigms and was neuroprotective, reducing hyperglycaemia-induced activated caspase 3 (AC3) levels in sensory neuronal subsets, epidermal sensory nerve fibre loss and aberrant sciatic nerve morphology. Furthermore, VEGF-A165b inhibited a STZ-induced increase in Evans Blue extravasation in dorsal root ganglia (DRG), saphenous nerve and plantar skin of the hind paw. Increased transient receptor potential ankyrin 1 (TRPA1) channel activity is associated with the onset of diabetic neuropathy. VEGF-A165b also prevented hyperglycaemia-enhanced TRPA1 activity in an in vitro sensory neuronal cell line indicating a novel direct neuronal mechanism that could underlie the anti-nociceptive effect observed in vivo. These results demonstrate that in a model of Type I diabetes VEGF-A165b attenuates altered pain behaviour and prevents neuronal stress, possibly through an effect on TRPA1 activity.
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18
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Ling L, Xue J, Liu Y, Su L, Li H, Jiang Y, Cai Y, Zhang H. Quantitative and morphological study of intraepidermal nerve fibre in healthy individuals. Neurol Res 2015. [PMID: 26217932 DOI: 10.1179/1743132815y.0000000082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The study was aimed to observe the morphology of intraepidermal nerve fibre (IENF) and to explore the relationships between intraepidermal nerve fibre density (IENFD) and anatomic sites, age, genders and races. Intraepidermal nerve fibre was observed using immunohistochemistry. The relationships between IENFD and anatomic sites, ages, genders and races were analysed by quantitative analysis of IENFD. Five patterns of the IENFs were observed according to the morphological classification. A significant difference was observed in IENFD between different anatomic sites (P < 0.05). A linear negative correlation was observed between IENFD and age (r = - 0.2931, P < 0.01). No significant difference was found between IENFD and genders. Intraepidermal nerve fibre density at distal leg of Chinese (395.54 ± 166.92) was higher than that of Finnish (114.62 ± 32.32, P < 0.01). Skin biopsy may be an effective tool in quantitation of IENFD in healthy individuals. Intraepidermal nerve fibre density is independent of genders, and closely associated with anatomic sites, races and ages.
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19
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A novel sensory nerve conduction study technique to evaluate the sural nerve from the forefoot to the knee. J Clin Neurophysiol 2015; 32:175-9. [PMID: 25761261 DOI: 10.1097/wnp.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Length-dependent polyneuropathy is common. Current electrophysiological methods cannot assess sensory nerve function proximal to the distal calf, limiting their utility in the quantification of severity of length-dependent polyneuropathy. METHODS The authors developed a novel electrophysiological approach for distal to proximal assessment of the sural nerve between the forefoot and the knee and tested it on 63 healthy young, middle-aged, and old adults. RESULTS It was feasible to elicit sensory nerve action potentials in the forefoot, ankle, and knee segments of the sural nerve in all subjects. Intraobserver (r = 0.87) and interobserver (r = 0.87) reliability were high. Sensory nerve action potential amplitudes were greatest at the ankle, followed by the knee and forefoot. Sensory nerve action potential amplitudes in the forefoot and ankle were significantly smaller in the old age group (>60 years) compared with the young age group (20-39 years) (P < 0.05). In contrast, neither age nor gender had a significant impact on sensory nerve action potential conduction velocities. CONCLUSIONS The authors demonstrated that reliable electrophysiological recordings of the sural nerve as proximal as the knee are feasible. This novel technique may be useful in patients with length-dependent polyneuropathy to monitor progression and to evaluate treatment response.
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20
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Singleton JR, Marcus RL, Jackson JE, K Lessard M, Graham TE, Smith AG. Exercise increases cutaneous nerve density in diabetic patients without neuropathy. Ann Clin Transl Neurol 2014; 1:844-9. [PMID: 25493275 PMCID: PMC4241811 DOI: 10.1002/acn3.125] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/15/2014] [Accepted: 08/19/2014] [Indexed: 12/16/2022] Open
Abstract
Early diabetic neuropathy is characterized by loss of unmyelinated axons, resulting in pain, numbness, and progressive decline in intraepidermal nerve fiber density. Patients with type 2 diabetes, without neuropathy, were assigned to quarterly lifestyle counseling (N = 40) or structured, supervised weekly exercise (N = 60) for 1 year. Distal leg IENFD significantly increased in the exercise cohort and remained unchanged in the counseling cohort (1.5 ± 3.6 vs. -0.1 ± 3.2 fibers/mm, P = 0.03). These results suggest preclinical injury to unmyelinated axons is potentially reversible, and that IENFD may be a responsive biomarker useful in future neuropathy prevention clinical trials.
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Affiliation(s)
- John R Singleton
- Department of Neurology, University of Utah Salt Lake City, Utah
| | - Robin L Marcus
- Department of Physical Therapy, University of Utah Salt Lake City, Utah
| | - Justin E Jackson
- Department of Physical Therapy, University of Utah Salt Lake City, Utah
| | | | - Timothy E Graham
- Department of Internal Medicine, University of Utah Salt Lake City, Utah
| | - Albert G Smith
- Department of Neurology, University of Utah Salt Lake City, Utah
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21
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Zhang Y, Li J, Wang T, Wang J. Amplitude of sensory nerve action potential in early stage diabetic peripheral neuropathy: an analysis of 500 cases. Neural Regen Res 2014; 9:1389-94. [PMID: 25221597 PMCID: PMC4160871 DOI: 10.4103/1673-5374.137593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 12/17/2022] Open
Abstract
Early diagnosis of diabetic peripheral neuropathy is important for the successful treatment of diabetes mellitus. In the present study, we recruited 500 diabetic patients from the Fourth Affiliated Hospital of Kunming Medical University in China from June 2008 to September 2013: 221 cases showed symptoms of peripheral neuropathy (symptomatic group) and 279 cases had no symptoms of peripheral impairment (asymptomatic group). One hundred healthy control subjects were also recruited. Nerve conduction studies revealed that distal motor latency was longer, sensory nerve conduction velocity was slower, and sensory nerve action potential and amplitude of compound muscle action potential were significantly lower in the median, ulnar, posterior tibial and common peroneal nerve in the diabetic groups compared with control subjects. Moreover, the alterations were more obvious in patients with symptoms of peripheral neuropathy. Of the 500 diabetic patients, neural conduction abnormalities were detected in 358 cases (71.6%), among which impairment of the common peroneal nerve was most prominent. Sensory nerve abnormality was more obvious than motor nerve abnormality in the diabetic groups. The amplitude of sensory nerve action potential was the most sensitive measure of peripheral neuropathy. Our results reveal that varying degrees of nerve conduction changes are present in the early, asymptomatic stage of diabetic peripheral neuropathy.
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Affiliation(s)
- Yunqian Zhang
- Department of Neurology, the Fourth Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Jintao Li
- Neuroscience Institute, Kunming Medical University, Kunming, Yunnan Province, China
| | - Tingjuan Wang
- Department of Neurology, the Fourth Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Jianlin Wang
- Department of Neurology, the Fourth Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
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22
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Celikbilek A, Tanik N, Sabah S, Borekci E, Akyol L, Ak H, Adam M, Suher M, Yilmaz N. Elevated neurofilament light chain (NFL) mRNA levels in prediabetic peripheral neuropathy. Mol Biol Rep 2014; 41:4017-22. [PMID: 24733614 DOI: 10.1007/s11033-014-3270-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 02/12/2014] [Indexed: 11/25/2022]
Abstract
Evidence suggests that peripheral nerve injury occurs during the early stages of disease with mild glycemic dysregulation. Two proteins, neuron-specific enolase (NSE) and neurofilament light chain (NFL), have been examined previously as possible markers of neuronal damage in the pathophysiology of neuropathies. Herein, we aimed to determine the potential value of circulatory NSE and NFL mRNA levels in prediabetic patients and in those with peripheral neuropathy. This prospective clinical study included 45 prediabetic patients and 30 age- and sex-matched controls. All prediabetic patients were assessed with respect to diabetes-related microvascular complications, such as peripheral neuropathy, retinopathy and nephropathy. mRNA levels of NSE and NFL were determined in the blood by real-time polymerase chain reaction. NSE mRNA levels were similar between prediabetic and control groups (p > 0.05), whereas NFL mRNA levels were significantly higher in prediabetics than in controls (p < 0.001). NSE mRNA levels did not significantly differ between prediabetic patients with and without peripheral neuropathy (p > 0.05), while NFL mRNA levels were significantly higher in prediabetics with peripheral neuropathy than in those without (p = 0.038). According to correlation analysis, NFL mRNA levels were positively correlated with the Douleur Neuropathique 4 questionnaire score in prediabetic patients (r = 0.302, p = 0.044). This is the first study to suggest blood NFL mRNA as a surrogate marker for early prediction of prediabetic peripheral neuropathy, while NSE mRNA levels may be of no diagnostic value in prediabetic patients.
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Affiliation(s)
- Asuman Celikbilek
- Department of Neurology, Medical School, Bozok University, 66200, Yozgat, Turkey,
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