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Delle C, Wang X, Giannetto M, Newbold E, Peng W, Gomolka RS, Ladrón-de-Guevara A, Cankar N, Schiøler Nielsen E, Kjaerby C, Weikop P, Mori Y, Nedergaard M. Transient but not chronic hyperglycemia accelerates ocular glymphatic transport. Fluids Barriers CNS 2024; 21:26. [PMID: 38475818 DOI: 10.1186/s12987-024-00524-w] [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: 12/17/2023] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Glymphatic transport is vital for the physiological homeostasis of the retina and optic nerve. Pathological alterations of ocular glymphatic fluid transport and enlarged perivascular spaces have been described in glaucomatous mice. It remains to be established how diabetic retinopathy, which impairs vision in about 50% of diabetes patients, impacts ocular glymphatic fluid transport. Here, we examined ocular glymphatic transport in chronic hyperglycemic diabetic mice as well as in healthy mice experiencing a daily transient increase in blood glucose. Mice suffering from severe diabetes for two and four months, induced by streptozotocin, exhibited no alterations in ocular glymphatic fluid transport in the optic nerve compared to age-matched, non-diabetic controls. In contrast, transient increases in blood glucose induced by repeated daily glucose injections in healthy, awake, non-diabetic mice accelerated antero- and retrograde ocular glymphatic transport. Structural analysis showed enlarged perivascular spaces in the optic nerves of glucose-treated mice, which were absent in diabetic mice. Thus, transient repeated hyperglycemic events, but not constant hyperglycemia, ultimately enlarge perivascular spaces in the murine optic nerve. These findings indicate that fluid transport in the mouse eye is vulnerable to fluctuating glycemic levels rather than constant hyperglycemia, suggesting that poor glycemic control drives glymphatic malfunction and perivascular enlargement in the optic nerve.
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Affiliation(s)
- Christine Delle
- Center for Translational Neuromedicine, Faculty of Medical and Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Xiaowei Wang
- Center for Translational Neuromedicine, University of Rochester Medical School, Elmwood Avenue 601, 14642, Rochester, NY, USA
- School of Medicine, University of California, San Francisco, 10 Koret Way, 94117, San Francisco, CA, USA
| | - Michael Giannetto
- Center for Translational Neuromedicine, University of Rochester Medical School, Elmwood Avenue 601, 14642, Rochester, NY, USA
| | - Evan Newbold
- Center for Translational Neuromedicine, University of Rochester Medical School, Elmwood Avenue 601, 14642, Rochester, NY, USA
| | - Weiguo Peng
- Center for Translational Neuromedicine, University of Rochester Medical School, Elmwood Avenue 601, 14642, Rochester, NY, USA
| | - Ryszard Stefan Gomolka
- Center for Translational Neuromedicine, Faculty of Medical and Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Antonio Ladrón-de-Guevara
- Center for Translational Neuromedicine, University of Rochester Medical School, Elmwood Avenue 601, 14642, Rochester, NY, USA
| | - Neža Cankar
- Center for Translational Neuromedicine, Faculty of Medical and Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Elise Schiøler Nielsen
- Center for Translational Neuromedicine, Faculty of Medical and Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Celia Kjaerby
- Center for Translational Neuromedicine, Faculty of Medical and Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Pia Weikop
- Center for Translational Neuromedicine, Faculty of Medical and Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Yuki Mori
- Center for Translational Neuromedicine, Faculty of Medical and Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Maiken Nedergaard
- Center for Translational Neuromedicine, Faculty of Medical and Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
- Center for Translational Neuromedicine, University of Rochester Medical School, Elmwood Avenue 601, 14642, Rochester, NY, USA.
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Dolatshahi M, Sanjari Moghaddam H, Saberi P, Mohammadi S, Aarabi MH. Central nervous system microstructural alterations in Type 1 diabetes mellitus: A systematic review of diffusion Tensor imaging studies. Diabetes Res Clin Pract 2023; 205:110645. [PMID: 37004976 DOI: 10.1016/j.diabres.2023.110645] [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: 03/29/2022] [Revised: 02/18/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023]
Abstract
AIMS Type 1 diabetes mellitus (T1DM) is a chronic childhood disease with potentially persistent CNS disruptions. In this study, we aimed to systematically review diffusion tensor imaging studies in patients with T1DM to understand the microstructural effects of this entity on individuals' brains METHODS: We performed a systematic search and reviewed the studies to include the DTI studies in individuals with T1DM. The data for the relevant studies were extracted and a qualitative synthesis was performed. RESULTS A total of 19 studies were included, most of which showed reduced FA widespread in optic radiation, corona radiate, and corpus callosum, as well as other frontal, parietal, and temporal regions in the adult population, while most of the studies in the juvenile patients showed non-significant differences or a non-persistent pattern of changes. Also, reduced AD and MD in individuals with T1DM compared to controls and non-significant differences in RD were noted in the majority of studies. Microstructural alterations were associated with clinical profile, including age, hyperglycemia, diabetic ketoacidosis and cognitive performance. CONCLUSION T1DM is associated with microstructural brain alterations including reduced FA, MD, and AD in widespread brain regions, especially in association with glycemic fluctuations and in adult age.
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Affiliation(s)
- Mahsa Dolatshahi
- NeuroImaging Laboratories, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, United States; NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | | | - Parastoo Saberi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Soheil Mohammadi
- NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Hadi Aarabi
- Department of Neuroscience and Padova Neuroscience Center (PNC), University of Padova, Padova, Italy.
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Yu YH, Yu YS, Cheng XH. Clinical effects of a traditional Chinese medicine nursing programme to intervene in gastric pain of the spleen and stomach with Qi deficiency. World J Clin Cases 2023; 11:5056-5062. [PMID: 37583847 PMCID: PMC10424014 DOI: 10.12998/wjcc.v11.i21.5056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/05/2023] [Accepted: 07/03/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Gastroparesis is a common digestive disorder characterized by delayed gastric emptying, which can lead to symptoms such as nausea, vomiting, abdominal pain, and poor appetite. Traditional Chinese medicine (TCM) has been used for centuries to treat gastrointestinal disorders, including gastroparesis. TCM theory suggests that spleen and stomach qi deficiency syndrome is one of the main pathogenic factors in gastroparesis. Nursing care plays an important role in the treatment of gastroparesis, and TCM nursing interventions have shown promising results in improving patient outcomes. However, there is limited research on the clinical effectiveness of TCM nursing interventions for gastroparesis with spleen stomach deficiency syndrome. This study aimed to evaluate the clinical effect of TCM nursing intervention in the treatment of gastroparesis with spleen stomach deficiency syndrome and to compare it with routine nursing interventions. AIM To analyze the clinical effect of traditional Chinese medicine nursing intervention in the treatment of gastric paraplegia with spleen stomach deficiency syndrome. METHODS From January 2020 to July 2021, 80 patients with gastroparesis of spleen stomach qi deficiency type diagnosed in our hospital were selected for the study. The 80 patients were randomly divided into a control group and an experimental group, with 40 cases in each group. During the treatment period, the control group received routine nursing interventions, while the experimental group received traditional Chinese medicine nursing procedures. Compare the nursing effects of the two groups and observe the changes in traditional Chinese medicine symptom scores, pain levels, and sleep quality before and after treatment. RESULTS After treatment, comparing the treatment effects of the two groups, the total effective rate of the experimental group was significantly higher than that of the control group, with statistical significance (P < 0.05). There was no statistically significant difference in the TCM symptom score, visual analogue scale (VAS) score, and Pittsburgh sleep quality index (PSQI) score between the two groups before treatment (P > 0.05). However, after treatment, the TCM syndrome scores, VAS scores, and PSQI scores of the experimental group were significantly lower than those of the control group, with a statistically significant difference (P < 0.05). CONCLUSION In the clinical nursing intervention of patients with mild gastroparesis due to spleen and stomach qi deficiency, the traditional Chinese medicine nursing plan has good clinical application value and nursing effect, and has a good effect on improving patients' pain and sleep quality.
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Affiliation(s)
- Yin-Hong Yu
- Spleen and Stomach Diseases Department, Zhejiang Province Chun’an County Traditional Chinese Medicine Hospital, Chun’an County 311700, Zhejiang Province, China
| | - Yu-Shuang Yu
- Spleen and Stomach Diseases Department, Zhejiang Province Chun’an County Traditional Chinese Medicine Hospital, Chun’an County 311700, Zhejiang Province, China
| | - Xiao-He Cheng
- Spleen and Stomach Diseases Department, Zhejiang Province Chun’an County Traditional Chinese Medicine Hospital, Chun’an County 311700, Zhejiang Province, China
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Wu H, Chen X, Yu B, Zhang J, Gu X, Liu W, Mei F, Ye J, Xiao L. Deficient deposition of new myelin impairs adult optic nerve function in a murine model of diabetes. Glia 2023; 71:1333-1345. [PMID: 36661098 DOI: 10.1002/glia.24341] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/21/2023]
Abstract
Visual impairment in diabetes is a growing public health concern. Apart from the well-defined diabetic retinopathy, disturbed optic nerve function, which is dependent on the myelin sheath, has recently been recognized as an early feature of visual impairment in diabetes. However, the underlying cellular mechanisms remain unclear. Using a streptozotocin-induced diabetic mouse model, we observed a myelin deficiency along with a disturbed composition of oligodendroglial lineage cells in diabetic optic nerve. We found that new myelin deposition, a continuous process that lasts throughout adulthood, was diminished during pathogenesis. Genetically dampening newly generated myelin by conditionally deleting olig2 in oligodendrocyte precursor cells within this short time window extensively delayed the signal transmission of the adult optic nerve. In addition, clemastine, an antimuscarinic compound that enhances myelination, significantly restored oligodendroglia, and promoted the functional recovery of the optic nerve in diabetic mice. Together, our results point to the role of new myelin deposition in optic neuropathy under diabetic insult and provide a promising therapeutic target for restoring visual function.
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Affiliation(s)
- Haoqian Wu
- Department of Ophthalmology, Daping Hospital, Army Medical Center, Army Medical University, Chongqing, China
| | - Xianjun Chen
- Department of Physiology, Research Center of Neuroscience, College of Basic Medical Science, Chongqing Medical University, Chongqing, China
| | - Bin Yu
- Department of Neurosurgery, 2nd Affiliated Hospital, Army Medical University, Chongqing, China
| | - Jieqiong Zhang
- Department of Ophthalmology, Daping Hospital, Army Medical Center, Army Medical University, Chongqing, China
| | - Xingmei Gu
- Department of Histology and Embryology, Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Army Medical University, Chongqing, China
| | - Wei Liu
- Department of Ophthalmology, Daping Hospital, Army Medical Center, Army Medical University, Chongqing, China
| | - Feng Mei
- Department of Histology and Embryology, Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Army Medical University, Chongqing, China
| | - Jian Ye
- Department of Ophthalmology, Daping Hospital, Army Medical Center, Army Medical University, Chongqing, China
| | - Lan Xiao
- Department of Neurosurgery, 2nd Affiliated Hospital, Army Medical University, Chongqing, China
- Department of Histology and Embryology, Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Army Medical University, Chongqing, China
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Li R, Li J, Wang Z. Quantitative assessment of the intraorbital segment of the optic nerve in patients with thyroid orbitopathy using diffusion tensor imaging. Acta Radiol 2023; 64:725-731. [PMID: 35291830 DOI: 10.1177/02841851221082419] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is difficult to detect optic nerve changes in patients with thyroid-associated ophthalmopathy (TAO) before the development of optic neuropathy. PURPOSE To detect changes in the intraorbital segment of the optic nerve in patients with TAO using diffusion tensor imaging (DTI) and determine any correlations with disease severity. MATERIAL AND METHODS A total of 74 participants (17 normal, 22 mild, and 35 moderate-severe TAO) were organized to be given 3-T DTI to measure fractional anisotropy (FA) and mean diffusivity (MD) for the orbital segments of their optic nerves. All underwent ophthalmological examinations for visual acuity, intraocular pressure, exophthalmos, and fundoscopy, and were assessed based on the Clinical Activity Score (CAS). Univariate analysis of variance and Pearson's correlation coefficients were carried out. RESULTS Patients with moderate-to-severe TAO had significantly lower FA values and higher MD values (P < 0.05). FA values were negatively correlated with CAS but had no obvious correlations with the degree of exophthalmos. MD values had no obvious correlations with CAS or the degree of exophthalmos. CONCLUSION DTI parameters of the intraorbital optic nerves were significantly altered in moderate-to-severe patients before onset of clinical optic nerve dysfunction and may, therefore, be used as an imaging biomarker for assessing the disease.
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Affiliation(s)
- Rui Li
- Beijing Friendship Hospital, 26455Capital Medical University, Beijing, PR China
| | - Jing Li
- Beijing Friendship Hospital, 26455Capital Medical University, Beijing, PR China
| | - Zhenchang Wang
- Beijing Friendship Hospital, 26455Capital Medical University, Beijing, PR China
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Kang L, Wan C. Application of advanced magnetic resonance imaging in glaucoma: a narrative review. Quant Imaging Med Surg 2022; 12:2106-2128. [PMID: 35284278 PMCID: PMC8899967 DOI: 10.21037/qims-21-790] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/26/2021] [Indexed: 04/02/2024]
Abstract
Glaucoma is a group of eye diseases characterized by progressive degeneration of the optic nerve head and retinal ganglion cells and corresponding visual field defects. In recent years, mounting evidence has shown that glaucoma-related damage may not be limited to the degeneration of retinal ganglion cells or the optic nerve head. The entire structure of the visual pathway may be degraded, and the degradation may even extend to some non-visual brain regions. We know that advanced morphological, functional, and metabolic magnetic resonance technologies provide a means to observe quantitatively and in real time the state of brain function. Advanced magnetic resonance imaging (MRI) techniques provide additional diagnostic markers for glaucoma, which are related to known potential histopathological changes. Many researchers in China and globally have conducted clinical and imaging studies on glaucoma. However, they are scattered, and we still need to systematically sort out the advanced MRI related to glaucoma. We reviewed literature published in any language and included all studies that were able to be translated into English from 1 January 1980 to 31 July 2021. Our literature search focused on emerging magnetic resonance neuroimaging techniques for the study of glaucoma. We then identified each functional area of the brain of glaucoma patients through the integration of anatomy, image, and function. The aim was to provide more information about the occurrence and development of glaucoma diseases. From the perspective of neuroimaging, our study provides a research basis to explain the possible mechanism of the occurrence and development of glaucoma. This knowledge gained from these techniques enables us to more clearly observe the damage glaucoma causes to the whole visual pathway. Our study provides new insights into glaucoma-induced changes to the brain. Our findings may enable the progress of these changes to be analyzed and inspire new neuroprotective therapeutic strategies for patients with glaucoma in the future.
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Affiliation(s)
- Longdan Kang
- Department of Ophthalmology, the First Hospital of China Medical University, Shenyang, China
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Ling M, Zhou J, Pang XQ, Liang J, Qin YF, Huang S, Liang GY, Li YF, Zeng ZS. White Matter Microstructural Abnormalities of the Visual Pathway in Type 2 Diabetes Mellitus: A Generalized Q-sampling Imaging Study. Acad Radiol 2022; 29 Suppl 3:S166-S174. [PMID: 34930656 DOI: 10.1016/j.acra.2021.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/16/2021] [Accepted: 10/21/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES Neurodegeneration is an early event in the pathogenesis of diabetic retinopathy (DR). We assessed the white matter microstructural integrity of the visual pathway in diabetes patients vs. healthy subjects, and investigated the advantages of generalized Q-sampling imaging (GQI) in the assessment of the visual pathway. MATERIALS AND METHODS T1-weighted, T2-weighted fluid-attenuated inversion recovery, and simultaneous multislice- diffusion sequences were acquired from 21 DR patients, 29 diabetes patients without DR (NDR group), and 28 age- and gender-matched healthy controls. Diffusion source images were reconstructed to GQI. Region of interest (ROI)-based analysis was utilized to evaluate microstructural alterations in the visual pathway. Multivariate linear regression analysis (forward stepwise method) was performed to investigate associations between clinical data and mean GQI parameters. RESULTS ROI-based analyses indicated that the GQI parameters generalized fractional anisotropy, quantitative anisotropy (QA), and normalized QA (NQA) were significantly lower in the NDR group than in the healthy controls, and even lower in the DR group than in the NDR group. Disease duration was significantly and negatively correlated with mean generalized fractional anisotropy and mean NQA. CONCLUSION GQI could sensitively and non-invasively evaluate the visual pathway in diabetes patients. The nerve fibers of the visual pathway were damaged before the onset of retinopathy, and this damage was aggravated after retinopathy onset, as a consequence of long exposure to hyperglycemia.
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