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Thakur K, Goyal M. Effectiveness of neuromuscular taping on balance, proprioception, pain, and nerve conduction parameters in patients with diabetic peripheral neuropathy: a two-group pretest-posttest randomized sham-controlled trial study protocol. J Diabetes Metab Disord 2023; 22:1793-1800. [PMID: 37975124 PMCID: PMC10638368 DOI: 10.1007/s40200-023-01275-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/30/2023] [Indexed: 11/19/2023]
Abstract
Background The management of diabetic peripheral neuropathy (DPN) comprises a multidimensional approach. Along with pharmacological treatment, physiotherapy has gained applaudable popularity in improving the symptoms of DPN. Neuromuscular taping (NMT) is effective in improving motor, sensory, and balance impairments in many neuromuscular and musculoskeletal conditions but no research has conducted to evaluate the effect of NMT on balance, proprioception, pain, and nerve conduction parameters in patients with DPN. Purpose To evaluate the effectiveness of NMT on balance, proprioception, pain, and nerve conduction parameters in patients with DPN. Methods 50 DPN patients aged 40-60 years, scored ≥ 2/13 on physical appearance and ≥ 1/10 on physical examination of Michigan Neuropathy Screening Instrument (MNSI), > 12 on Leeds Assessment of Neuropathic Symptom and Sign (LANSS) scale and < 45 on Berg Balance Scale (BBS) will be included. The experimental group (EG) will receive NMT at the tibialis anterior, tibialis posterior, and peroneus longus muscle and transverse arch of the foot and TENS at the tibial and peroneal nerves (80 Hz, 50 Amp, 0.2 ms square pulses, 2 to 3 times sensory threshold) and the control group (CG) will receive sham taping at the ankle joint and TENS with the same parameters as EG. Outcome measures will be taken at baseline, at 4 weeks, and at 8 weeks of intervention, respectively. Conclusion The results obtained upon completion of this study may provide a cost-effective non-invasive treatment option to improve the outcomes that will be measured in the present study in patients with DPN. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01275-5.
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Affiliation(s)
- Kanika Thakur
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana- Ambala, Haryana 133207 India
| | - Manu Goyal
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana- Ambala, Haryana 133207 India
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Lutchmansingh K, Venkatesh YS, Boppana LKT, Seemungal T, Rao A, Sandy S, Teelucksingh S. The Slipping Slipper Sign: A Poor Man's Test for Severe Diabetic Peripheral Neuropathy. J Neuromuscul Dis 2020; 7:175-181. [PMID: 31929118 DOI: 10.3233/jnd-190422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuropathic feet are at very high risk for infection and amputation. The slipping slipper sign (SSS) is elicited by a simple questionnaire test reported to detect the presence of severe diabetic peripheral neuropathy. This test can be administered by non-medical staff. In this study, subjects with and without the SSS were evaluated by nerve conduction studies (NCS) and ultrasound measurements of the right sural nerve diameters as well as with traditional scoring systems for peripheral and autonomic neuropathy. OBJECTIVE To demonstrate that the Slipping Slipper Sign can be used as an index of severe diabetic peripheral neuropathyMethod:This was a prospective cross sectional study in which 74 patients with diabetes (38 positive and 36 negative for SSS) underwent ultrasonography and NCS of the right sural nerve by an examiner blinded to SSS status. Findings were evaluated against demography, clinical history, anthropometry as well as traditional clinical and autonomic neuropathic scores. RESULTS Patients without the SSS [median (IQR) = 10.0 years (4.0-20.3)] had a significantly shorter duration of diabetes compared with those with the SSS [median (IQR) = 15.0 years (8.5-25.0)], p = 0.028. The frequencies of retinopathy (36.8% vs 2.8%, p < 0.05) and cerebrovascular accidents (18.4% vs 13.9 %, p < 0.05) were higher among those with SSS compared with those without. Differences in nerve conduction characteristics were markedly significant. The amplitude of the sural sensory nerve action potential (SNAP) was ([median (IQR)] 0 microvolts vs 4.0 microvolts (0.0-10.8) p < 0.002) between those with and without SSS, respectively whilst none of patients with SSS had a recordable SNAP vs 78% without a SSS. Similarly, maximal thickness of the right sural nerve at the ankle 3.0 mm (2.3-3.4) vs 3.5 mm (3.0-3.9), and leg 3.4 mm (2.7-3.8) vs 3.9 mm (3.3-4.2) was reduced, p < 0.01 in patients with the SSS compared with those with a negative SSS. CONCLUSION The SSS identifies feet with objective neurophysiological and imaging characteristics of severe neuropathy.
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Affiliation(s)
- Khama Lutchmansingh
- Department of Clinical Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - Y Swamy Venkatesh
- Department of Neurology, University of South Carolina School of Medicine, SC, USA
| | - Leela Krishna Teja Boppana
- Department of Clinical Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - Terence Seemungal
- Department of Clinical Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - Ambika Rao
- Department of Endocrinology, Diabetes and Metabolism, William Jennings Bryan Dorn VA Medical Center, SC, USA
| | - Sherry Sandy
- Department of Clinical Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - Surujpal Teelucksingh
- Department of Clinical Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago
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Dogiparthi SN, Muralidhar K, Seshadri KG, Rangarajan S. Cutaneous manifestations of diabetic peripheral neuropathy. Dermatoendocrinol 2018; 9:e1395537. [PMID: 29484103 PMCID: PMC5821163 DOI: 10.1080/19381980.2017.1395537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/17/2017] [Indexed: 12/25/2022]
Abstract
There is a rise in number of people diagnosed with Diabetes Mellitus. The incidence is rising in modern Indian society because of Industrial development and drastically changing lifestyles. Diabetic neuropathies are microvascular disorders that are usually associated with the duration of Diabetes. Among the various forms, the most common is Diabetic Peripheral Neuropathy. The disease if neglected leads to chronic ulcer formation leading to amputations frequently. Hence the aim of this study is to document the early cutaneous changes and create an early awareness in the importance of controlling Diabetes. The study consisted of 205 patients with Type 2 DM. Participant's neuropathy status was determined based on Neuropathy Disability Score and Diabetic Neuropathy Symptom Score. Among the Skin changes documented, the common changes seen were: Peripheral hair loss in 185 (90.2%), Xerosis in 168 (82%), Anhydrosis in 162 (79%), Plantar Fissures in 136 (66.3%), Plantar Ulcer in 80 (39%), common nail changes documented were Onychomycosis in 165 (80.5%) and Onychauxis in 53 (25.8%) patients in relation to the occupation and duration of Diabetes mellitus. In conclusion, it is important to control glycemic levels in the all stages of Diabetes and institute foot care measures to prevent the complications of neuropathy.
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Affiliation(s)
- S N Dogiparthi
- Department of Dermatology, Venereology and Leprosy, Department of Endocrinology, Diabetes and Metabolism, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamilnadu, India
| | - K Muralidhar
- Department of Dermatology, Venereology and Leprosy, Department of Endocrinology, Diabetes and Metabolism, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamilnadu, India
| | - K G Seshadri
- Department of Dermatology, Venereology and Leprosy, Department of Endocrinology, Diabetes and Metabolism, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamilnadu, India
| | - S Rangarajan
- Department of Dermatology, Venereology and Leprosy, Department of Endocrinology, Diabetes and Metabolism, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamilnadu, India
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Abstract
In recent years, berberine has increasingly become a topic of research as a treatment for diabetes due to its repair function, which recovers damaged pancreatic β cells. However, it is the complications of diabetes that seriously affect patients' life quality and longevity, among which diabetic neuropathy and the consequent acute pain are the most common. In this study, we established STZ-induced diabetic models to observe whether berberine, a main constitute of Coptis chinensis Franch which has shown good hypoglycemic effects, could relieve diabetes-induced pain and explored its possible mechanism in rats and mice. Behavior assays showed increasing mechanical allodynia and thermal hyperalgesia thresholds by the Von Frey test and tail flick test during the treatment of berberine. It was found that the administration of berberine (20, 60 mg/kg; 30, 90 mg/kg) suppressed the expression of PKCε and TRPV1 which could be activated by hyperglycemia-induced inflammatory reaction. Our results also presented its capability to reduce the over expression of TNF-[Formula: see text] in diabetic rats and mice. TNF-[Formula: see text] is an inflammatory cytokine, which is closely related to diabetic peripheral neuropathy (DPN). Consequently, we supposed that berberine exerts its therapeutic effects in part by suppressing the inflammatory process and blocking the PKC pathway to inhibit TRPV1 activation, which damages neurons and causes diabetic pain.
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Affiliation(s)
- Yan Zan
- 1 Jiangsu Key Laboratory of TCM Evaluation and Translational Research, Department of Pharmacology of Chinese Materia Medica, China Pharmaceutical University, Nanjing 210009, Jiangsu, P. R. China
| | - Cui-Xing Kuai
- 1 Jiangsu Key Laboratory of TCM Evaluation and Translational Research, Department of Pharmacology of Chinese Materia Medica, China Pharmaceutical University, Nanjing 210009, Jiangsu, P. R. China
| | - Zhi-Xia Qiu
- 1 Jiangsu Key Laboratory of TCM Evaluation and Translational Research, Department of Pharmacology of Chinese Materia Medica, China Pharmaceutical University, Nanjing 210009, Jiangsu, P. R. China
| | - Fang Huang
- 1 Jiangsu Key Laboratory of TCM Evaluation and Translational Research, Department of Pharmacology of Chinese Materia Medica, China Pharmaceutical University, Nanjing 210009, Jiangsu, P. R. China
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Pabbidi MR, Premkumar LS. Role of Transient Receptor Potential Channels Trpv1 and Trpm8 in Diabetic Peripheral Neuropathy. J Diabetes Treat 2017; 2017:029. [PMID: 30613832 PMCID: PMC6317870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE 1.1.Transient Receptor Potential (Vanilloid 1) TRPV1 and (Melastatin 8) TRPM8 are heat and cold sensing non-selective cation channels, respectively. We sought to correlate the modulation of TRPV1- and TRPM8-mediated membrane currents and altered thermal sensitivity in Diabetic Peripheral Neuropathy (DPN). METHOD 1.2.Streptozotocin (STZ)-induced diabetic mice were used and thermal (heat and cold) pain sensitivities were determined using hot plate and acetone drop test, respectively. Membrane currents were recorded using patch-clamp techniques. RESULTS 1.3.First, we tested thermal pain sensitivities to implicate a possible role of TRPV1 and TRPM8 in DPN. Paw withdrawal latency on a hot plate test was decreased, and acetone-induced cold sensitivity was enhanced in diabetic mice as compared to non-diabetic mice. Dorsal Root Ganglion (DRG) neurons dissociated from diabetic hyperalgesic mice exhibited an increase in TRPV1-mediated current and a decrease in TRPM8-mediated currents as compared to non-diabetic mice. Then, we determined the modulation of TRPV1- and TRPM8-mediated currents using HEK cells heterologously expressing TRPV1 by promoting PKC- and PKA-mediated phosphorylation. Both Phorbol 12,13-Dibutyrate (PDBu), a PKC activator and forskolin, a PKA activator upregulated TRPV1-mediated currents but downregulated TRPM8-mediated currents. In diabetic mice, intraplantar injection of capsaicin, a TRPV1 agonist-induced nocifensive behavior but the severity of this behavior was significantly lower when co-administered with menthol, a TRPM8 agonist. CONCLUSIONS 1.4.These findings suggest that diabetic thermal hyperalgesia mediated by up-regulation of TRPV1 function may be further aggravated by the downregulation of TRPM8 function. Targeting TRPV1 may be a useful approach to alleviate pain associated with DPN.
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Affiliation(s)
| | - Louis S Premkumar
- Department of Pharmacology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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DuBrava S, Mardekian J, Sadosky A, Bienen EJ, Parsons B, Hopps M, Markman J. Using Random Forest Models to Identify Correlates of a Diabetic Peripheral Neuropathy Diagnosis from Electronic Health Record Data. Pain Med 2017; 18:107-115. [PMID: 27252307 DOI: 10.1093/pm/pnw096] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective To identify variables correlated with a diagnosis of diabetic peripheral neuropathy (DPN) using random forest modeling applied to electronic health records. Design Retrospective analysis. Setting Humedica de-identified electronic health records database. Subjects Subjects ≥ 18 years old with type 2 diabetes from January 1, 2008-September 30, 2013 having continuous data for 1 year pre- and postindex with DPN (n = 35,050) and without DPN (n = 288,328) were identified. Methods Demographic, clinical, and health care resource utilization variables (e.g., inpatient and outpatient encounters, medications, and procedures) were input into a random forest model to identify the most important correlates of a DPN diagnosis. Random forest modeling is a computationally extensive, robust data mining technique that accommodates large sets of variables to identify associated factors using an ensemble of classifications trees. Accuracy of the model was evaluated using receiver operating characteristic curves (ROC). Results The final random forest model consisted of the following variables (importance) associated with a DPN diagnosis: Charlson Comorbidity Index score (100%), age (37.1%), number of pre-index procedures and services (29.7%), number of pre-index outpatient prescriptions (24.2%), number of pre-index outpatient visits (18.3%), number of pre-index laboratory visits (16.9%), number of pre-index outpatient office visits (12.1%), number of inpatient prescriptions (5.9%), and number of pain-related medication prescriptions (4.4%). ROC analysis confirmed model performance, with an area under the curve of 0.824 and accuracy of 89.6% (95% confidence interval 89.4%, 89.8%). Conclusions Random forest modeling can determine likelihood of a DPN diagnosis. Further validation of the random forest model may help facilitate earlier diagnosis and enhance management strategies.
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Affiliation(s)
| | | | | | | | | | | | - John Markman
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
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Kwai NCG, Arnold R, Poynten AM, Howells J, Kiernan MC, Lin CSY, Krishnan AV. In vivo evidence of reduced nodal and paranodal conductances in type 1 diabetes. Clin Neurophysiol 2015; 127:1700-1706. [PMID: 26725257 DOI: 10.1016/j.clinph.2015.11.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/13/2015] [Accepted: 11/29/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Diabetic neuropathy is a debilitating complication of diabetes. Animal models of type 1 diabetes (T1DM) suggest that functional and structural changes, specifically axo-glial dysjunction, may contribute to neuropathy development. The present study sought to examine and characterise early sensory axonal function in T1DM patients in the absence of clinical neuropathy. METHODS Thirty patients with T1DM (15M:15F) without neuropathy underwent median nerve sensory and motor axonal excitability studies to examine axonal function. A verified mathematical model of human motor and sensory axons was used to elucidate the underlying causes of observed alterations. RESULTS Compared to controls (NC), T1DM patients demonstrated significant axonal excitability abnormalities in sensory and motor axons. These included marked reductions in sensory and motor subexcitability during the recovery cycle (T1DM 7.9 ± 0.4:10.4 ± 0.6%, NC 10.4 ± 0.7:15.4 ± 1.2%, P<0.01) and during hyperpolarizing threshold electrotonus at 10-20 ms (T1DM -75.5 ± 0.8:-69.7 ± 0.8%, NC -78.4 ± 1:-72.7 ± 0.9%, P<0.01). Mathematical modelling demonstrated that these changes were due to reduced nodal Na(+) currents, nodal/paranodal K(+) conductances and Na(+)/K(+) pump dysfunction, consistent with axo-glial dysjunction as outlined in animal models of T1DM. CONCLUSIONS The study provided support for the occurrence of early changes in nodal and paranodal conductances in patients with T1DM. SIGNIFICANCE These data indicate that axonal excitability techniques may detect early changes in diabetic patients, providing a window of opportunity for prophylactic intervention in T1DM.
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Affiliation(s)
- Natalie C G Kwai
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - Ria Arnold
- Department of Pharmacology and Physiology, The University of New South Wales, Sydney, Australia
| | - Ann M Poynten
- Department of Endocrinology, Prince of Wales Hospital, Sydney, Australia
| | - James Howells
- Brain and Mind Centre, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
| | - Cindy S-Y Lin
- Department of Pharmacology and Physiology, The University of New South Wales, Sydney, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia.
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Yoo M, D'Silva LJ, Martin K, Sharma NK, Pasnoor M, LeMaster JW, Kluding PM. Pilot Study of Exercise Therapy on Painful Diabetic Peripheral Neuropathy. Pain Med 2015; 16:1482-9. [PMID: 25800666 DOI: 10.1111/pme.12743] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Painful diabetic peripheral neuropathy (DPN) is a common complication of diabetes. While the beneficial effect of exercise on diabetes is well established, its effect specifically on painful DPN has not been thoroughly explored. The objective of this pilot study was to examine the effect of aerobic exercise on pain in people with DPN. METHODS Fourteen sedentary individuals (mean age 57 ± 5.11 years) with painful DPN were enrolled in a 16-week, supervised aerobic exercise program. The Brief Pain Inventory-Diabetic Peripheral Neuropathy was used to assess pain intensity (worst, least, average, now) and pain interference with daily life (activity, mood, walk, normal work, relationship, sleep, enjoyment of life) pre intervention and postintervention. Body mass index (BMI), maximum oxygen uptake (VO2max ), hemoglobin A1c (HbA1c), and blood pressure were also measured preintervention and postintervention as secondary outcomes of interest. RESULTS Significant reductions in pain interference were observed with walking (4.93 ± 3.03 pre to 3.29 ± 2.89 post, P = 0.016), normal work (5.39 ± 3.32 pre to 3.79 ± 3.04 post, P = 0.032), relationship with others (3.96 ± 3.53 pre to 1.29 ± 1.27 post, P = 0.006), sleep (5.11 ± 3.04 pre to 3.5 ± 3.03 post, P = 0.02), and the overall pain interference (4.65 ± 2.70 pre to 2.97 ± 2.22 post, P = 0.013) following the intervention; however, there was no change in pain intensity. VO2max increased significantly postintervention (16.02 ± 3.84 ml/kg/min pre to 17.18 ± 4.19 ml/kg/min, P = 0.028), while BMI, HbA1c, and blood pressure remained unchanged. CONCLUSION These preliminary results suggest that perceived pain interference may be reduced following an aerobic exercise intervention among people with painful DPN, without a change in pain intensity. Further validation by a RCT is needed.
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Affiliation(s)
- Min Yoo
- Departments of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3051, Kansas City, Kansas, USA
| | - Linda J D'Silva
- Departments of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3051, Kansas City, Kansas, USA
| | - Katherine Martin
- Departments of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3051, Kansas City, Kansas, USA
| | - Neena K Sharma
- Departments of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3051, Kansas City, Kansas, USA
| | - Mamatha Pasnoor
- Departments of Neurology University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3051, Kansas City, Kansas, USA
| | - Joseph W LeMaster
- Family Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3051, Kansas City, Kansas, USA
| | - Patricia M Kluding
- Departments of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3051, Kansas City, Kansas, USA
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Cinci L, Corti F, Di Cesare Mannelli L, Micheli L, Zanardelli M, Ghelardini C. Oxidative, metabolic, and apoptotic responses of Schwann cells to high glucose levels. J Biochem Mol Toxicol 2015; 29:274-9. [PMID: 25683646 DOI: 10.1002/jbt.21695] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 11/10/2022]
Abstract
The specific response of murine Schwann cells IMS32 to acute and chronic hyperglycemia conditions was evaluated. The pathophysiological alterations were studied to deepening the role of Schwann cells in diabetes-related neurotoxicity and to assess a model to screen new protective molecules. IMS32 were incubated with 30 and 56 mM glucose for 48 h and 7 and 14 days, and markers of oxidative stress, apoptosis, and polyol pathway were evaluated. High glucose induced O(2) -production and lipid peroxidation at all time point whereas Caspase 3 activity was induced only after 14 days. Aldose reductase activity and expression were significantly increased after 48 h and 14 days, respectively. Our results describe the response of Schwann cells to high glucose conditions and suggest the use of IMS32 for the screening of protective molecules in diabetes-induced neuropathy.
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Affiliation(s)
- Lorenzo Cinci
- Department of Neuroscience, Psychology, Drug Research and Child health (NEUROFARBA), University of Florence, viale Pieraccini 6, 50139, Florence, Italy.
| | - Francesca Corti
- Department of Neuroscience, Psychology, Drug Research and Child health (NEUROFARBA), University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Lorenzo Di Cesare Mannelli
- Department of Neuroscience, Psychology, Drug Research and Child health (NEUROFARBA), University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Laura Micheli
- Department of Neuroscience, Psychology, Drug Research and Child health (NEUROFARBA), University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Matteo Zanardelli
- Department of Neuroscience, Psychology, Drug Research and Child health (NEUROFARBA), University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Carla Ghelardini
- Department of Neuroscience, Psychology, Drug Research and Child health (NEUROFARBA), University of Florence, viale Pieraccini 6, 50139, Florence, Italy
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Bramson C, Herrmann DN, Carey W, Keller D, Brown MT, West CR, Verburg KM, Dyck PJ. Exploring the role of tanezumab as a novel treatment for the relief of neuropathic pain. Pain Med 2015; 16:1163-76. [PMID: 25594611 DOI: 10.1111/pme.12677] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Evaluate efficacy and safety of tanezumab, a humanized monoclonal antibody against nerve growth factor, in neuropathic pain. DESIGN Two randomized controlled trials. SUBJECTS Patients with pain due to diabetic peripheral neuropathy (DPN) or postherpetic neuralgia (PHN). METHODS In the DPN study, patients received subcutaneous tanezumab 20 mg or placebo on Day 1 and Week 8. Evaluations included change from baseline in average DPN pain (primary endpoint), Patient's Global Assessment of DPN, and safety (including neuropathy assessments). Due to a partial clinical hold limiting enrollment and treatment duration, the prespecified landmark analysis was modified post hoc from Week 16 to Week 8. In the PHN study, patients received intravenous tanezumab 50 μg/kg, tanezumab 200 μg/kg, or placebo on Day 1. Evaluations included change from baseline in average daily pain (primary endpoint), Brief Pain Inventory-short form, Patient's Global Assessment of pain from PHN, and safety. RESULTS Mean DPN pain reduction from baseline to Week 8 was greater with tanezumab vs placebo (P = 0.009); differences in Patient's Global Assessment of DPN were not significant (P > 0.05). Neither tanezumab dose resulted in significant differences vs placebo in efficacy in PHN (P > 0.05), although tanezumab 200 μg/kg provided some benefit. Neuropathy assessments showed no meaningful changes. CONCLUSIONS Tanezumab provided effective pain reduction in DPN. In PHN, only the highest tanezumab dose reduced pain; treatment differences were not significant. No new safety concerns were observed despite preexisting neuropathy.
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Affiliation(s)
| | - David N Herrmann
- University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York
| | | | | | | | | | | | - Peter J Dyck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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