The pathology of diabetic neuropathy and the effects of aldose reductase inhibitors

Diabetic complications and prospective immunotherapy

The incidence of Diabetes Mellitus is increasing globally. Individuals who have been burdened with diabetes for many years often develop complications as a result of hyperglycemia. More and more research is being conducted highlighting inflammation as an important factor in disease progression. In all kinds of diabetes, hyperglycemia leads to activation of alternative glucose metabolic pathways, resulting in problematic by-products including reactive oxygen species and advanced glycation end products. This review takes a look into the pathogenesis of three specific diabetic complications; retinopathy, nephropathy and neuropathy as well as their current treatment options. By considering recent research papers investigating the effects of immunotherapy on relevant conditions in animal models, multiple strategies are suggested for future treatment and prevention of diabetic complications with an emphasis on molecular targets associated with the inflammation.

Ultrastructural changes of human cardiac atrial nerve endings in diabetes mellitus

BACKGROUND

Autonomic neuropathy resulting from long-term diabetes mellitus may affect heart innervation. However, so far diabetes induced morphological changes of cardiac nerves are not well-known. In this study human cardiac atrial tissue from diabetic patients was analysed by electron microscopy for structural alterations as a result of diabetic neuropathy.

METHODS

In coronary bypass surgery, an edge of the right auricle was routinely resected for reason of extracorporal circulation. Thin cardiac tissue sections of 100 nm were studied by electron microscopy. Atrial tissue samples were collected from 5 patients with long-standing diabetes (for at least 8 years) and compared to atrial tissue samples from 5 patients without diabetes, equally undergoing coronary bypass surgery.

RESULTS

In all atria-free nerve endings with unmyelinized, axons were observed. Cross sections of 479 axons from diabetic patients were compared to 419 axons of nondiabetic patients. The number of altered axons was significantly higher in cardiac tissue of diabetic patients (32%) in comparison to normal subjects (17%). In diabetic patients, 20% of the intra-axonal mitochondria were condensed or hydropic, whereas in nondiabetic patients only 4% of the mitochondria were altered. Membrane fragments were present in 21% of the axons in atria of diabetic patients compared to 10% in nondiabetic subjects. Only in cardiac axons from diabetic patients there were lamellar bodies, dissolved axoplasma and junctions between neighbouring axons in a minor number. Few vacuoles were present in axons of both groups.

CONCLUSION

In myocardial atrial-free nerve fibre bundles of diabetic patients, the amount of degenerative changes was higher in comparison to atrial cardiac tissue from nondiabetic subjects. These morphological alterations may indicate manifestation of diabetic neuropathy and might contribute to the impairment of autonomic neural control affecting the heart in long-standing diabetes mellitus.

Effects of fructose on D-[6-3H]-glucose uptake and sorbitol metabolism of bovine retina in vitro

In order to study the influence of fructose on sorbitol formation, bovine retinal tissue was incubated with different concentrations of glucose and fructose, and supplemented with tracer amounts of D-[6-3H]-glucose. Combining high-performance liquid chromatography (HPLC) with radioactivity determinations allowed detection of sorbitol and fructose derived from glucose in the incubation medium. In addition, the total amount of sorbitol was measured with a sensitive bioluminescence method. In this way, it was possible to distinguish between sorbitol formation from glucose and fructose. High concentrations of glucose in the medium increased the formation of sorbitol and fructose from glucose. Addition of fructose to the incubation medium diminished the sorbitol and fructose formation from glucose although the total amount of sorbitol increased significantly. Incubating retinal tissue with an aldose reductase inhibitor decreased sorbitol formation from glucose but did not influence the formation of sorbitol from fructose. Thus, the present findings clearly demonstrate the important influence exerted by fructose on sorbitol formation. The possible significance of the present finding is discussed with respect to diabetes retinopathy and retinal osmoregulation.

Prevention of neuropathy in the pyloric sphincter of streptozotocin-diabetic rats by gangliosides

BACKGROUND

The effect of diabetes on the density of peptide-containing nerves in the pyloric sphincter of streptozotocin-induced diabetic rats and the possible preventive action of the ganglioside mixture AGF1 on the diabetes-induced changes were investigated.

METHODS

Immunohistochemical techniques were used to localize the general neuronal marker protein gene product 9.5 and the neuropeptides, calcitonin gene-related peptide, [met]-enkephalin, neuropeptide Y, substance P, and vasoactive intestinal polypeptide.

RESULTS

The density of neurones showing immunoreactivity to the above peptides in nerves supplying the thickened circular muscle layer of the pyloric sphincter was reduced extensively in diabetic rats. In the ganglioside-treated diabetic animals, this reduction was prevented; indeed, calcitonin gene-related peptide- and substance P-like immunoreactivity in the ganglioside-treated diabetic rats exceeded that seen in control animals. In the ganglioside-treated controls, there was no significant difference in the peptide immunoreactivity from that of untreated controls.

CONCLUSIONS

The results of the present study show that the ganglioside mixture AGF1 is effective in protecting the nerves of the pyloric sphincter from diabetes-induced changes.

Adrenergic innervation in the tibial and vagus nerves of rats with streptozotocin-induced diabetes

Adrenergic innervation of tibial and vagus nerves was studied after 1-16 weeks duration of streptozotocin (STZ)-induced diabetes in rats. Sucrose-phosphate glyoxylic acid (SPG) histochemistry and the formaldehyde-induced fluorescence (FIF) method were used to demonstrate adrenergic nerve fibers in the epi-perineurial and endoneurial compartments. Densities of innervation were quantitated with fluorescence microscopy. The density of periarteriolar adrenergic innervation in the epi-perineurium of the tibial and vagus nerves was increased 5 and 12 weeks after STZ injections as compared with control. At 16 weeks, mean densities of periarteriolar innervation in epi-perineurium had returned to or below control levels in both nerve types. In the endoneurium, however, the mean density of adrenergic nerve fibers decreased gradually at 5 weeks after induction of diabetes in both nerves, and was totally absent at 12 weeks. At 16 weeks no sign of recovering innervation in the endoneurium was seen. In conclusion, adrenergic innervation goes through similar pathological alterations both in tibial and vagus nerves shortly after the induction of streptozotocin diabetes. These changes may contribute to diabetic peripheral neuropathy by impairing the regulation of nerve blood flow.

Unilateral vocal cord palsy in a diabetic patient

Remittent isolated palsy of peripheral or of upper cranial nerves in patients with diabetes mellitus is well documented, but paralysis of a lower cranial nerve or an isolated branch of any cranial nerve has not been previously reported. In the case described, temporary paralysis of the left recurrent laryngeal nerve caused vocal cord palsy in a patient with insulin-dependent diabetes. The patient had hoarseness, which totally remitted within eight weeks, presumably owing to improved metabolic control.