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Baumgartner T, Théaudin M, Loser V. Diffuse and acute pain syndrome in a 60-year-old woman. Pract Neurol 2024; 24:169-172. [PMID: 38253380 DOI: 10.1136/pn-2023-004024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Affiliation(s)
- Thomas Baumgartner
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Marie Théaudin
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Valentin Loser
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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2
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Hu Y, Chen HJ, Ma JH. Individualized intensive insulin therapy of diabetes: Not only the goal, but also the time. World J Diabetes 2024; 15:11-14. [PMID: 38313848 PMCID: PMC10835496 DOI: 10.4239/wjd.v15.i1.11] [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: 10/27/2023] [Revised: 12/03/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Intensive insulin therapy has been extensively used to control blood glucose levels because of its ability to reduce the risk of chronic complications of diabetes. According to current guidelines, intensive glycemic control requires individualized glucose goals rather than as low as possible. During intensive therapy, rapid blood glucose reduction can aggravate microvascular and macrovascular complications, and prolonged overuse of insulin can lead to treatment-induced neuropathy and retinopathy, hypoglycemia, obesity, lipodystrophy, and insulin antibody syndrome. Therefore, we need to develop individualized hypoglycemic plans for patients with diabetes, including the time required for blood glucose normalization and the duration of intensive insulin therapy, which deserves further study.
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Affiliation(s)
- Yun Hu
- Department of Endocrinology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - Hong-Jing Chen
- Department of Endocrinology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - Jian-Hua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing 210000, Jiangsu Province, China
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3
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Ma L, Zhao W, Huang S, Xu F, Wang Y, Deng D, Zhang T, Shu S, Chen X. IGF/IGF-1R signal pathway in pain: a promising therapeutic target. Int J Biol Sci 2023; 19:3472-3482. [PMID: 37497005 PMCID: PMC10367553 DOI: 10.7150/ijbs.84353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/20/2023] [Indexed: 07/28/2023] Open
Abstract
Pain, one of the most important problems in the field of medicine and public health, has great research significance. Opioids are still the main drugs to relieve pain now. However, its application is limited due to its obvious side effects. Therefore, it is urgent to develop new drugs to relieve pain. Multiple studies have found that IGF/IGF-1R pathway plays an important role in the occurrence and development of pain. The regulation of IGF/IGF-1R pathway has obvious effect on pain. This review summarized and discussed the therapeutic potential of IGF/IGF-1R signal pathway for pain. It also summarized that IGF/IGF-1R regulates pain by acting on neuronal excitability, neuroinflammation, glial cells, apoptosis, etc. However, its mechanisms of occurrence and development in pain still need further study in the future. In conclusion, although more deep researches are needed, these studies indicate that IGF/IGF-1R signal pathway is a promising therapeutic target for pain.
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Affiliation(s)
- Lulin Ma
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Wenjing Zhao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Shiqian Huang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Feng Xu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Yafeng Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Daling Deng
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Tianhao Zhang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Shaofang Shu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
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4
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Poonoosamy J, Lopes P, Huret P, Dardari R, Penfornis A, Thomas C, Dardari D. Impact of Intensive Glycemic Treatment on Diabetes Complications-A Systematic Review. Pharmaceutics 2023; 15:1791. [PMID: 37513978 PMCID: PMC10383300 DOI: 10.3390/pharmaceutics15071791] [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: 02/05/2023] [Revised: 04/28/2023] [Accepted: 06/12/2023] [Indexed: 07/30/2023] Open
Abstract
Diabetes complications can be related to the long duration of the disease or chronic hyperglycemia. The follow-up of diabetic patients is based on the control of chronic hyperglycemia, although this correction, if obtained rapidly in people living with severe chronic hyperglycemia, can paradoxically interfere with the disease or even induce complications. We reviewed the literature describing the impact of the rapid and intense treatment of hyperglycemia on diabetic complications. The literature review showed that worsening complications occurred significantly in diabetic microangiopathy with the onset of specific neuropathy induced by the correction of diabetes. The results for macroangiopathy were somewhat mixed with the intensive and rapid correction of chronic hyperglycemia having a neutral impact on stroke and myocardial infarction but a significant increase in cardiovascular mortality. The management of diabetes has now entered a new era with new therapeutic molecules, such as gliflozin for patients living with type 2 diabetes, or hybrid insulin delivery systems for patients with insulin-treated diabetes. Our manuscript provides evidence in support of these personalized and progressive algorithms for the control of chronic hyperglycemia.
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Affiliation(s)
| | - Philippe Lopes
- LBEPS, IRBA, Université Paris Saclay, 91025 Evry, France
| | | | - Randa Dardari
- Al Fourkan Diabetes Center, Al Fourkan, Aleppo, Syria
| | - Alfred Penfornis
- Diabetology Department, Centre Hopitalier Sud Francilien, 91100 Corbeil-Essonnes, France
- Paris-Sud Medical School, Paris-Saclay University, 91100 Corbeil-Essonnes, France
| | - Claire Thomas
- LBEPS, IRBA, Université Paris Saclay, 91025 Evry, France
| | - Dured Dardari
- LBEPS, IRBA, Université Paris Saclay, 91025 Evry, France
- Diabetology Department, Centre Hopitalier Sud Francilien, 91100 Corbeil-Essonnes, France
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5
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Breitinger U, Breitinger HG. Excitatory and inhibitory neuronal signaling in inflammatory and diabetic neuropathic pain. Mol Med 2023; 29:53. [PMID: 37069517 PMCID: PMC10111846 DOI: 10.1186/s10020-023-00647-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/27/2023] [Indexed: 04/19/2023] Open
Abstract
Pain, although unpleasant, is an essential warning mechanism against injury and damage of the organism. An intricate network of specialised sensors and transmission systems contributes to reception, transmission and central sensitization of pain. Here, we briefly introduce some of the main aspects of pain signal transmission, including nociceptors and nociceptive signals, mechanisms of inflammatory and neuropathic pain, and the situation of diabetes-associated neuropathic pain. The role of glia-astrocytes, microglia, satellite glia cells-and their specific channels, transporters and signaling pathways is described. A focus is on the contribution of inhibitory synaptic signaling to nociception and a possible role of glycine receptors in glucose-mediated analgesia and treatment-induced diabetic neuropathy. Inhibitory receptors such as GABAA- and glycine receptors are important contributors to nociceptive signaling; their contribution to altered pain sensation in diabetes may be of clinical relevance, and they could be promising therapeutic targets towards the development of novel analgesics.
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Affiliation(s)
- Ulrike Breitinger
- Department of Biochemistry, German University in Cairo, New Cairo, 11835, Egypt
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6
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Sun M, Zhang M, Yin H, Tu H, Wen Y, Wei X, Shen W, Huang R, Xiong W, Li G, Gao Y. Long non-coding RNA MSTRG.81401 short hairpin RNA relieves diabetic neuropathic pain and behaviors of depression by inhibiting P2X4 receptor expression in type 2 diabetic rats. Purinergic Signal 2023; 19:123-133. [PMID: 35022948 PMCID: PMC9984665 DOI: 10.1007/s11302-021-09828-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022] Open
Abstract
Patients with diabetic neuropathic pain (DNP) experience immense physical and mental suffering, which is comorbid with other mental disorders, including major depressive disorder (MDD). P2X4 receptor, one of the purinergic receptors, is a significant mediator of DNP and MDD. The present study aimed to identify the roles and mechanisms of MSTRG.81401, a long non-coding RNA (lncRNA), in alleviating DNP and MDD-like behaviors in type 2 diabetic rats. After administration with MSTRG.81401 short hairpin RNA (shRNA), the model + MSTRG.81401 shRNA group demonstrated increased mechanical withdrawal threshold, thermal withdrawal latency, open-field test, and sucrose preference test; however, immobility time on the forced swimming test decreased. MSTRG.81401 shRNA administration significantly decreased the expression of the P2X4 receptor, tumor necrosis factor-α, and interleukin-1β in the hippocampus and spinal cord in the model + MSTRG.81401 shRNA group. Simultaneously, MSTRG.81401 shRNA administration downregulated phosphorylation of ERK1/2 in the hippocampus and spinal cord. Thus, lncRNA MSTRG.81401 shRNA can alleviate DNP and MDD-like behaviors in type 2 diabetic rats and may downregulate the expression of P2X4 receptors in the hippocampus and spinal cord of rats.
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Affiliation(s)
- Mengyun Sun
- Department of Physiology, Basic Medical College, Nanchang University, 461 Bayi Road, Nanchang, Jiangxi, People's Republic of China
| | - Mingming Zhang
- Department of Physiology, Basic Medical College, Nanchang University, 461 Bayi Road, Nanchang, Jiangxi, People's Republic of China
| | - Haoming Yin
- Medical College of Grade 2017, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Hongcheng Tu
- Basic Medical College of Grade 2018, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yuqing Wen
- Department of Physiology, Basic Medical College, Nanchang University, 461 Bayi Road, Nanchang, Jiangxi, People's Republic of China
| | - Xingyu Wei
- Basic Medical College of Grade 2017, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Wenhao Shen
- Affiliated Stomatological Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Ruoyu Huang
- Affiliated Stomatological Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Wei Xiong
- Affiliated Stomatological Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Guodong Li
- Department of Physiology, Basic Medical College, Nanchang University, 461 Bayi Road, Nanchang, Jiangxi, People's Republic of China
| | - Yun Gao
- Department of Physiology, Basic Medical College, Nanchang University, 461 Bayi Road, Nanchang, Jiangxi, People's Republic of China.
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi, People's Republic of China.
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7
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Hori A, Hotta N, Fukazawa A, Estrada JA, Katanosaka K, Mizumura K, Sato J, Ishizawa R, Kim HK, Iwamoto GA, Vongpatanasin W, Mitchell JH, Smith SA, Mizuno M. Insulin potentiates the response to capsaicin in dorsal root ganglion neurons in vitro and muscle afferents ex vivo in normal healthy rodents. J Physiol 2022; 600:531-545. [PMID: 34967443 PMCID: PMC8810710 DOI: 10.1113/jp282740] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/23/2021] [Indexed: 02/03/2023] Open
Abstract
Systemic insulin administration evokes sympathoexcitatory actions, but the mechanisms underlying these observations are unknown. We reported that insulin sensitizes the response of thin-fibre primary afferents, as well as the dorsal root ganglion (DRG) that subserves them, to mechanical stimuli. However, little is known about the effects of insulin on primary neuronal responses to chemical stimuli. TRPV1, whose agonist is capsaicin (CAP), is widely expressed on chemically sensitive metaboreceptors and/or nociceptors. The aim of this investigation was to determine the effects of insulin on CAP-activated currents in small DRG neurons and CAP-induced action potentials in thin-fibre muscle afferents of normal healthy rodents. Additionally, we investigated whether insulin potentiates sympathetic nerve activity (SNA) responses to CAP. In whole-cell patch-clamp recordings from cultured mice DRG neurons in vitro, the fold change in CAP-activated current from pre- to post-application of insulin (n = 13) was significantly (P < 0.05) higher than with a vehicle control (n = 14). Similar results were observed in single-fibre recording experiments ex vivo as insulin potentiated CAP-induced action potentials compared to vehicle controls (n = 9 per group, P < 0.05). Furthermore, insulin receptor blockade with GSK1838705 significantly suppressed the insulin-induced augmentation in CAP-activated currents (n = 13) as well as the response magnitude of CAP-induced action potentials (n = 9). Likewise, the renal SNA response to CAP after intramuscular injection of insulin (n = 8) was significantly (P < 0.05) greater compared to vehicle (n = 9). The findings suggest that insulin potentiates TRPV1 responsiveness to CAP at the DRG and muscle tissue levels, possibly contributing to the augmentation in sympathoexcitation during activities such as physical exercise. KEY POINTS: Evidence suggests insulin centrally activates the sympathetic nervous system, and a chemical stimulus to tissues activates the sympathetic nervous system via thin fibre muscle afferents. Insulin is reported to modulate putative chemical-sensitive channels in the dorsal root ganglion neurons of these afferents. In the present study, it is demonstrated that insulin potentiates the responsiveness of thin fibre afferents to capsaicin at muscle tissue levels as well as at the level of dorsal root ganglion neurons. In addition, it is demonstrated that insulin augments the sympathetic nerve activity response to capsaicin in vivo. These data suggest that sympathoexcitation is peripherally mediated via insulin-induced chemical sensitization. The present study proposes a possible physiological role of insulin in the regulation of chemical sensitivity in somatosensory thin fibre muscle afferents.
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Affiliation(s)
- Amane Hori
- Graduate School of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan;,Japan Society for the Promotion of Science, Tokyo 102-8472, Japan
| | - Norio Hotta
- Graduate School of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan;,College of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan
| | - Ayumi Fukazawa
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Juan A. Estrada
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Kimiaki Katanosaka
- Graduate School of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan;,College of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan
| | - Kazue Mizumura
- Department of Physiology, Nihon University School of Dentistry, Tokyo 101-8310, Japan
| | - Jun Sato
- Graduate School of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan;,College of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan
| | - Rie Ishizawa
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Han-Kyul Kim
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Gary A. Iwamoto
- Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Wanpen Vongpatanasin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jere H. Mitchell
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Scott A. Smith
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Masaki Mizuno
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Baum P, Koj S, Klöting N, Blüher M, Classen J, Paeschke S, Gericke M, Toyka KV, Nowicki M, Kosacka J. Treatment-Induced Neuropathy in Diabetes (TIND)-Developing a Disease Model in Type 1 Diabetic Rats. Int J Mol Sci 2021; 22:ijms22041571. [PMID: 33557206 PMCID: PMC7913916 DOI: 10.3390/ijms22041571] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 02/06/2023] Open
Abstract
Treatment-induced neuropathy in diabetes (TIND) is defined by the occurrence of an acute neuropathy within 8 weeks of an abrupt decrease in glycated hemoglobin-A1c (HbA1c). The underlying pathogenic mechanisms are still incompletely understood with only one mouse model being explored to date. The aim of this study was to further explore the hypothesis that an abrupt insulin-induced fall in HbA1c may be the prime causal factor of developing TIND. BB/OKL (bio breeding/OKL, Ottawa Karlsburg Leipzig) diabetic rats were randomized in three groups, receiving insulin treatment by implanted subcutaneous osmotic insulin pumps for 3 months, as follows: Group one received 2 units per day; group two 1 unit per day: and group three 1 unit per day in the first month, followed by 2 units per day in the last two months. We serially examined blood glucose and HbA1c levels, motor- and sensory/mixed afferent conduction velocities (mNCV and csNCV) and peripheral nerve morphology, including intraepidermal nerve fiber density and numbers of Iba-1 (ionized calcium binding adaptor molecule 1) positive macrophages in the sciatic nerve. Only in BB/OKL rats of group three, with a rapid decrease in HbA1c of more than 2%, did we find a significant decrease in mNCV in sciatic nerves (81% of initial values) after three months of treatment as compared to those group three rats with a less marked decrease in HbA1c <2% (mNCV 106% of initial values, p ≤ 0.01). A similar trend was observed for sensory/mixed afferent nerve conduction velocities: csNCV were reduced in BB/OKL rats with a rapid decrease in HbA1c >2% (csNCV 90% of initial values), compared to those rats with a mild decrease <2% (csNCV 112% of initial values, p ≤ 0.01). Moreover, BB/OKL rats of group three with a decrease in HbA1c >2% showed significantly greater infiltration of macrophages by about 50% (p ≤ 0.01) and a decreased amount of calcitonin gene related peptide (CGRP) positive nerve fibers as compared to the animals with a milder decrease in HbA1c. We conclude that a mild acute neuropathy with inflammatory components was induced in BB/OKL rats as a consequence of an abrupt decrease in HbA1c caused by high-dose insulin treatment. This experimentally induced neuropathy shares some features with TIND in humans and may be further explored in studies into the pathogenesis and treatment of TIND.
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Affiliation(s)
- Petra Baum
- Department of Neurology, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany; (P.B.); (S.K.); (J.C.)
| | - Severin Koj
- Department of Neurology, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany; (P.B.); (S.K.); (J.C.)
| | - Nora Klöting
- Department of Medicine, University of Leipzig, Liebigstraße 21, D-04103 Leipzig, Germany; (N.K.); (M.B.)
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG), Helmholtz Zentrum München, University of Leipzig, Philipp-Rosenthal-Straße 27, D-04103 Leipzig, Germany
| | - Matthias Blüher
- Department of Medicine, University of Leipzig, Liebigstraße 21, D-04103 Leipzig, Germany; (N.K.); (M.B.)
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG), Helmholtz Zentrum München, University of Leipzig, Philipp-Rosenthal-Straße 27, D-04103 Leipzig, Germany
| | - Joseph Classen
- Department of Neurology, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany; (P.B.); (S.K.); (J.C.)
| | - Sabine Paeschke
- Institute of Anatomy, University of Leipzig, Liebigstraße 13, D-04103 Leipzig, Germany; (S.P.); (M.N.)
| | - Martin Gericke
- Institute of Anatomy and Cell Biology, University of Halle, Große Steinstraße 52, D-06108 Halle, Germany;
| | - Klaus V. Toyka
- Department of Neurology, University of Würzburg, Josef-Schneider-Straße 11, D-97080 Würzburg, Germany;
| | - Marcin Nowicki
- Institute of Anatomy, University of Leipzig, Liebigstraße 13, D-04103 Leipzig, Germany; (S.P.); (M.N.)
| | - Joanna Kosacka
- Department of Medicine, University of Leipzig, Liebigstraße 21, D-04103 Leipzig, Germany; (N.K.); (M.B.)
- Institute of Anatomy and Cell Biology, University of Halle, Große Steinstraße 52, D-06108 Halle, Germany;
- Correspondence: ; Tel.: +49-341-9713405
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9
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Gibbons CH. Treatment induced neuropathy of diabetes. Auton Neurosci 2020; 226:102668. [PMID: 32247944 DOI: 10.1016/j.autneu.2020.102668] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/31/2020] [Accepted: 03/22/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Treatment induced neuropathy of diabetes (TIND) is an iatrogenic painful sensory and autonomic neuropathy. Although the prevalence is not known, it is seen in up to 10% of tertiary cases referred for evaluation of diabetic neuropathy. EVIDENCE TIND is associated with a decrease in the glycosylated hemoglobin A1C in individuals with longstanding hyperglycemia. TIND is more common in individuals with type 1 diabetes, but can occur in anyone with diabetes through the use of insulin, oral hypoglycemic medications or diet control. There is an acute or subacute onset of neuropathy that is linked to the change in glucose control. Although the primary clinical manifestation is neuropathic pain there is a concurrent development of autonomic dysfunction, retinopathy and nephropathy. CONCLUSION TIND is more common than previously suspected. The number of cases reported over the past 10 years is much greater than historical literature predicted. Increased attention to target glucose control as a physician metric could suggest a possible explanation for the increased in TIND cases reported in recent years. At present, supportive care is the only recommended treatment. Future research is necessary to define the underlying mechanism, prevent development and to guide treatment recommendations.
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Affiliation(s)
- Christopher H Gibbons
- Beth Israel Deaconess Medical Center, 185 Pilgrim Rd, Palmer 111, Boston, MA 02215, United States of America.
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10
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Chandler E, Brown M, Wintergerst K, Doll E. Treatment-Induced Neuropathy of Diabetes (TIND) in Pediatrics: A Case Report and Review of the Literature. J Clin Endocrinol Metab 2020; 105:5587829. [PMID: 31613321 DOI: 10.1210/clinem/dgz067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/03/2019] [Indexed: 02/13/2023]
Abstract
CONTEXT Treatment-induced neuropathy of diabetes (TIND) is a rarely reported but important consideration in patients presenting with an acute onset of neuropathic symptoms following rapid correction of hyperglycemia in diabetes. Although it has been reported in children, the preponderance of literature focuses on adults with TIND. CASE DESCRIPTION We report an 18-year-old male with this condition and his clinical course. We then discuss the proposed pathophysiology of TIND and review the literature. We also provide a standard workup for the diagnosis of TIND. CONCLUSION In both pediatric and adult populations, TIND should be considered in diabetic patients who develop neuropathy acutely following rapid correction of hyperglycemia. Because the pathophysiology of TIND remains poorly understood, there is insufficient information regarding how to target susceptible individuals and prevent the development of TIND.
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Affiliation(s)
- Erika Chandler
- Department of Neurology, Division of Child Neurology, University of Louisville, Louisville, Kentucky
| | - Martin Brown
- Department of Neurology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Kupper Wintergerst
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Elizabeth Doll
- Department of Neurology, Division of Child Neurology, University of Louisville, Louisville, Kentucky
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Hotta N, Katanosaka K, Mizumura K, Iwamoto GA, Ishizawa R, Kim HK, Vongpatanasin W, Mitchell JH, Smith SA, Mizuno M. Insulin potentiates the response to mechanical stimuli in small dorsal root ganglion neurons and thin fibre muscle afferents in vitro. J Physiol 2019; 597:5049-5062. [PMID: 31468522 DOI: 10.1113/jp278527] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/27/2019] [Indexed: 01/23/2023] Open
Abstract
KEY POINTS Insulin is known to activate the sympathetic nervous system centrally. A mechanical stimulus to tissues activates the sympathetic nervous system via thin fibre afferents. Evidence suggests that insulin modulates putative mechanosensitive channels in the dorsal root ganglion neurons of these afferents. In the present study, we report the novel finding that insulin augments the mechanical responsiveness of thin fibre afferents not only at dorsal root ganglion, but also at muscle tissue levels. Our data suggest that sympathoexcitation is mediated via the insulin-induced mechanical sensitization peripherally. The present study proposes a novel physiological role of insulin in the regulation of mechanical sensitivity in somatosensory thin fibre afferents. ABSTRACT Insulin activates the sympathetic nervous system, although the mechanism underlying insulin-induced sympathoexcitation remains to be determined. A mechanical stimulus to tissues such as skin and/or skeletal muscle, no matter whether the stimulation is noxious or not, activates the sympathetic nervous system via thin fibre afferents. Evidence suggests that insulin modulates putative mechanosensitive channels in the dorsal root ganglion (DRG) neurons of these afferents. Accordingly, we investigated whether insulin augments whole-cell current responses to mechanical stimuli in small DRG neurons of normal healthy mice. We performed whole-cell patch clamp recordings using cultured DRG neurons and observed mechanically-activated (MA) currents induced by mechanical stimuli applied to the cell surface. Local application of vehicle solution did not change MA currents or mechanical threshold in cultured DRG neurons. Insulin (500 mU mL-1 ) significantly augmented the amplitude of MA currents (P < 0.05) and decreased the mechanical threshold (P < 0.05). Importantly, pretreatment with the insulin receptor antagonist, GSK1838705, significantly suppressed the insulin-induced potentiation of the mechanical response. We further examined the impact of insulin on thin fibre muscle afferent activity in response to mechanical stimuli in normal healthy rats in vitro. Using a muscle-nerve preparation, we recorded single group IV fibre activity to a ramp-shaped mechanical stimulation. Insulin significantly decreased mechanical threshold (P < 0.05), although it did not significantly increase the response magnitude to the mechanical stimulus. In conclusion, these data suggest that insulin augments the mechanical responsiveness of small DRG neurons and potentially sensitizes group IV afferents to mechanical stimuli at the muscle tissue level, possibly contributing to insulin-induced sympathoexcitation.
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Affiliation(s)
- Norio Hotta
- College of Life and Health Sciences, Chubu University, Kasugai, Japan.,Departments of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Kazue Mizumura
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Gary A Iwamoto
- Departments of Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rie Ishizawa
- Departments of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Han-Kyul Kim
- Departments of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Wanpen Vongpatanasin
- Departments of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jere H Mitchell
- Departments of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Scott A Smith
- Departments of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Departments of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Masaki Mizuno
- Departments of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Departments of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Yu T, Li L, Liu H, Li H, Liu Z, Li Z. KCNQ2/3/5 channels in dorsal root ganglion neurons can be therapeutic targets of neuropathic pain in diabetic rats. Mol Pain 2018; 14:1744806918793229. [PMID: 30027794 PMCID: PMC6088482 DOI: 10.1177/1744806918793229] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Diabetic neuropathic pain is poorly controlled by analgesics, and the precise molecular mechanisms underlying hyperalgesia remain unclear. The KCNQ2/3/5 channels expressed in dorsal root ganglion neurons are important in pain transmission. The expression and activity of KCNQ2/3/5 channels in dorsal root ganglion neurons in rats with diabetic neuropathic pain were investigated in this study. Methods The mRNA levels of KCNQ2/3/5 channels were analyzed by real-time polymerase chain reaction. The protein levels of KCNQ2/3/5 channels were evaluated by Western blot assay. KCNQ2/3/5 channel expression in situ in dorsal root ganglion neurons was detected by double fluorescent labeling technique. M current (IM) density and neuronal excitability were determined by whole-cell voltage and current clamp recordings. Mechanical allodynia and thermal hyperalgesia were assessed by von Frey filaments and plantar analgesia tester, respectively. Results The mRNA and protein levels of KCNQ2/3/5 channels significantly decreased, followed by the reduction of IM density and elevation of neuronal excitability of dorsal root ganglion neurons from diabetic rats. Activation of KCNQ channels with retigabine reduced the hyperexcitability and inhibition of KCNQ channels with XE991 enhanced the hyperexcitability. Administration of retigabine alleviated both mechanical allodynia and thermal hyperalgesia, while XE991 augmented both mechanical allodynia and thermal hyperalgesia in diabetic neuropathic pain in rats. Conclusion The findings elucidate the mechanisms by which downregulation of the expression and reduction of the activity of KCNQ2/3/5 channels in diabetic rat dorsal root ganglion neurons contribute to neuronal hyperexcitability, which results in hyperalgesia. These data provide intriguing evidence that activation of KCNQ2/3/5 channels might be the potential new targets for alleviating diabetic neuropathic pain symptoms.
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Affiliation(s)
- Ting Yu
- 1 Department of Anatomy, School of Basic Medical Sciences, Shandong University, Jinan, China.,2 Department of Physiology, Jining Medical University, Jining, China
| | - Lei Li
- 3 Department of Diagnosis, Jining Medical University, Jining, China
| | - Huaxiang Liu
- 4 Department of Rheumatology, Shandong University Qilu Hospital, Jinan, China
| | - Hao Li
- 5 Department of Orthopaedics, Shandong University Qilu Hospital, Jinan, China
| | - Zhen Liu
- 1 Department of Anatomy, School of Basic Medical Sciences, Shandong University, Jinan, China
| | - Zhenzhong Li
- 1 Department of Anatomy, School of Basic Medical Sciences, Shandong University, Jinan, China
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