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. 2009 Jun;94(6):2157-63.
doi: 10.1210/jc.2008-2385. Epub 2009 Mar 10.

Microvascular reactivity and inflammatory cytokines in painful and painless peripheral diabetic neuropathy

John Doupis  1 , Thomas E Lyons, Szuhuei Wu, Charalambos Gnardellis, Thanh Dinh, Aristidis Veves
Affiliations

Microvascular reactivity and inflammatory cytokines in painful and painless peripheral diabetic neuropathy

John Doupis et al. J Clin Endocrinol Metab. 2009 Jun.

Abstract

Objective: We investigated the association between inflammation, microvascular reactivity, and the development of peripheral diabetic neuropathy.

Research design and methods: We studied three groups: 55 healthy control subjects, 80 nonneuropathic patients, and 77 neuropathic diabetic patients. We also subdivided the neuropathic patients into a subgroup of 31 subjects with painless neuropathy and 46 with painful neuropathy. We measured the foot skin endothelium-dependent and -independent vasodilation, the nerve axon reflex-related vasodilation (NARV), and inflammatory cytokines and biochemical markers of endothelial function.

Results: The endothelium-dependent and -independent vasodilation and NARV were lower in the neuropathic group (P < 0.05). NARV was further reduced in the subgroup of painless neuropathy when compared to painful neuropathy (P < 0.05). Compared to the other two groups, the neuropathic group also had higher serum levels of PDGF AA/BB (P < 0.05), RANTES (P < 0.01), leptin (P < 0.0001), osteoprotegerin (P < 0.01), G-CSF (P < 0.05), sE-Selectin (P < 0.01), sICAM (P < 0.0001), sVCAM (P < 0.001), CRP (P < 0.0001), TNFalpha (P < 0.05), and fibrinogen (P < 0.05). Patients with painful neuropathy had higher sICAM-1 (P < 0.05) and CRP levels (P < 0.01) when compared to painless neuropathy. No major changes in the above results were observed in 78 diabetic patients who were seen for a second visit 21 months after the first visit.

Conclusions: Peripheral diabetic neuropathy is associated with increased biochemical markers of inflammation and endothelial dysfunction. Painful neuropathy is associated with further increase in inflammation and markers of endothelial dysfunction and preservation of the nerve axon reflex.

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Figures

Figure 1
Figure 1
The sICAM serum levels were increased in patients with both painful and painless neuropathy when compared with the healthy controls and the nonneuropathic group [diabetes mellitus–no peripheral diabetic neuropathy (DM-No PDN)]. Furthermore, sICAM was increased in the patients with painful neuropathy when compared with patients with painless neuropathy.
Figure 2
Figure 2
The CRP serum levels were increased in patients with painful neuropathy when compared with the healthy controls, the nonneuropathic group [diabetes mellitus–no peripheral diabetic neuropathy (DM-No PDN)], and the patients with painless neuropathy. Furthermore, CRP was increased in the patients with painless neuropathy when compared with the healthy controls.
See this image and copyright information in PMC

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