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Sural nerve pathology in diabetic patients with minimal but progressive neuropathy

Sural nerve pathology in diabetic patients with minimal but progressive neuropathy
Sural nerve pathology in diabetic patients with minimal but progressive neuropathy
Aims/hypothesis: The early pathological features of human diabetic neuropathy are not clearly defined. Therefore we quantified nerve fibre and microvascular pathology in sural nerve biopsies from diabetic patients with minimal neuropathy.

Methods: Twelve diabetic patients underwent detailed assessment of neuropathy and fascicular sural nerve biopsy at baseline, with repeat assessment of neuropathy 8.7±0.6 years later.

Results: At baseline, neuropathic symptoms, neurological deficits, quantitative sensory testing, cardiac autonomic function and peripheral nerve electrophysiology showed minimal abnormality, which deteriorated at follow-up. Myelinated fibre density, fibre and axonal area, and g-ratio were normal but teased fibre studies showed paranodal abnormalities (p<0.001), segmental demyelination (p<0.01) and remyelination (p<0.01) without axonal degeneration. Unassociated Schwann cell profile density (p<0.04) and unmyelinated axon density (p<0.001) were increased and axon diameter was decreased (p<0.007). Endoneurial capillaries demonstrated basement membrane thickening (p<0.006), endothelial cell hyperplasia (p<0.004) and a reduction in luminal area (p<0.007).

Conclusions/interpretation: The early pathological features of human diabetic neuropathy include an abnormality of the myelinated fibre Schwann cell and unmyelinated fibre degeneration with regeneration. These changes are accompanied by a significant endoneurial microangiopathy.
demyelination, diabetes, microangiopathy, nerve fibres, neuropathy, schwann cell
0012-186X
578-585
Malik, R.A.
c56a96ae-3ef3-40ba-b86d-9007709d9959
Tesfaye, S.
e82f7151-68b9-4492-b472-b95f2eb64413
Newrick, P.G.
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Walker, D.
b94e6f46-ec02-4b5b-a726-67c0aafc9f94
Rajbhandari, S.M.
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Siddique, I.
bbd646aa-ae58-4462-851b-51d149aa192d
Sharma, A.K.
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Boulton, A.J.M.
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King, R.H.M.
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Thomas, P.K.
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Ward, J.D.
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Malik, R.A.
c56a96ae-3ef3-40ba-b86d-9007709d9959
Tesfaye, S.
e82f7151-68b9-4492-b472-b95f2eb64413
Newrick, P.G.
111655aa-3361-43d7-86d0-d24c93946b2b
Walker, D.
b94e6f46-ec02-4b5b-a726-67c0aafc9f94
Rajbhandari, S.M.
b0ebf93c-d7c1-4d03-a33f-343b5aece18c
Siddique, I.
bbd646aa-ae58-4462-851b-51d149aa192d
Sharma, A.K.
cc76926e-ecc6-4c90-b2fc-3788224c07c5
Boulton, A.J.M.
dbc9bc0c-b82c-4667-9bec-128c4a1a849c
King, R.H.M.
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Thomas, P.K.
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Ward, J.D.
09f8debb-291a-4dbd-b8ea-561186d654d0

Malik, R.A., Tesfaye, S., Newrick, P.G., Walker, D., Rajbhandari, S.M., Siddique, I., Sharma, A.K., Boulton, A.J.M., King, R.H.M., Thomas, P.K. and Ward, J.D. (2005) Sural nerve pathology in diabetic patients with minimal but progressive neuropathy. Diabetologia, 48 (3), 578-585. (doi:10.1007/s00125-004-1663-5). (PMID:15729579)

Record type: Article

Abstract

Aims/hypothesis: The early pathological features of human diabetic neuropathy are not clearly defined. Therefore we quantified nerve fibre and microvascular pathology in sural nerve biopsies from diabetic patients with minimal neuropathy.

Methods: Twelve diabetic patients underwent detailed assessment of neuropathy and fascicular sural nerve biopsy at baseline, with repeat assessment of neuropathy 8.7±0.6 years later.

Results: At baseline, neuropathic symptoms, neurological deficits, quantitative sensory testing, cardiac autonomic function and peripheral nerve electrophysiology showed minimal abnormality, which deteriorated at follow-up. Myelinated fibre density, fibre and axonal area, and g-ratio were normal but teased fibre studies showed paranodal abnormalities (p<0.001), segmental demyelination (p<0.01) and remyelination (p<0.01) without axonal degeneration. Unassociated Schwann cell profile density (p<0.04) and unmyelinated axon density (p<0.001) were increased and axon diameter was decreased (p<0.007). Endoneurial capillaries demonstrated basement membrane thickening (p<0.006), endothelial cell hyperplasia (p<0.004) and a reduction in luminal area (p<0.007).

Conclusions/interpretation: The early pathological features of human diabetic neuropathy include an abnormality of the myelinated fibre Schwann cell and unmyelinated fibre degeneration with regeneration. These changes are accompanied by a significant endoneurial microangiopathy.

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More information

Published date: 2005
Keywords: demyelination, diabetes, microangiopathy, nerve fibres, neuropathy, schwann cell
Organisations: Medical Education

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Local EPrints ID: 359154
URI: http://eprints.soton.ac.uk/id/eprint/359154
ISSN: 0012-186X
PURE UUID: 88efb2ce-9bf7-42bf-a0a2-166eb455b85d

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Date deposited: 23 Oct 2013 09:13
Last modified: 16 Jul 2019 21:19

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Contributors

Author: R.A. Malik
Author: S. Tesfaye
Author: P.G. Newrick
Author: D. Walker
Author: S.M. Rajbhandari
Author: I. Siddique
Author: A.K. Sharma
Author: A.J.M. Boulton
Author: R.H.M. King
Author: P.K. Thomas
Author: J.D. Ward

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